Role and Effectiveness of Postoperative Voice Therapy in Laryngeal Microsurgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Voice therapy is performed following laryngeal microsurgery to help the recovery of the operation site and assist in optimal voice output. The aim of this study was to evaluate the effect of postoperative voice therapy and to obtain objective evidence about the necessity of voice therapy. SUBJECTS AND METHOD: The voice of 109 patients who underwent laryngeal microsurgery for vocal fold lesions and received voice therapy was analyzed. Voice analysis was performed preoperatively, postoperatively, and after the first voice therapy. GRBAS scale was used for auditory perceptual evaluation and acoustic analysis was performed for objective evaluation. RESULTS: Overall, significant improvement was observed postoperatively in both auditory perceptual evaluation and acoustic parameters, and significantly better voice was obtained after the first postoperative voice therapy. The degree of postoperative voice improvement varied on the type of vocal fold lesions, but voice quality was improved in all diseases after first postoperative voice therapy. The number of voice therapy decreased significantly as the voice quality improved after the operation or the first voice therapy. Four or more voice therapy were needed when the cepstral/spectral index of dysphonia (CSID) value was 5.88 or higher. CONCLUSION: Voice therapy following laryngeal microsurgery was effective in better voice output. The CSID value after the first postoperative voice therapy was predictive of finding patients who need long-term voice therapy. These results suggest that the first postoperative voice therapy will be helpful in finding the adequate vocalization method and providing objective evidence for selecting patients who would require continuous voice therapy.

Analysis of Acoustic Parameters to Objectively Reflect the Change of Voice Quality before and after Surgery in Benign Vocal Fold Mucosal Disorders / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to compare between preoperative and postoperative voices by subjective auditory perceptual evaluation and objective acoustic analysis. The study also analyzed the acoustic parameters that best reflected the auditory perceptual characteristics in laryngeal microsurgery. SUBJECTS AND METHOD: The records of 49 patients who had been diagnosed as benign vocal fold mucosal diseases and had undergone laryngeal microsurgery were retrospectively analyzed. Preoperative and postoperative voices were assessed by auditory perceptual evaluation using the GRBAS Scale and acoustic analysis using Multi-Dimensional Voice Program (MDVP) and Analysis of Dysphonia in Speech and Voice (ADSV). Correlation between auditory perceptual characteristics and acoustic parameters was analyzed. RESULTS: Auditory perceptual evaluation showed that the patients' voices were improved after the operation. Several acoustic parameters of MDVP related to short-term and long-term variability showed significant improvement. Also, there were significant differences in several cepstral/spectral parameters of ADSV after operation. In the correlation analysis, the overall grade (G) of the GRBAS Scale showed highest correlation with the cepstral spectral index of dysphonia (CSID) (r=-0.700). The roughness (R) of GRBAS Scale was correlated with the smoothed amplitude perturbation quotient of long-term variability of MDVP (r=0.468), breathiness (B) with cepstral peak prominence (r=-0.703) and strain (S) with CSID (r=0.650) (p<0.01). CONCLUSION: Our results showed that the acoustic parameters were related to the long-term variability of MDVP, and the parameters of cepstrum/spectrum were useful for the objective assessment of voice quality in patients who received laryngeal microsurgery. These parameters were also useful for the quantification of voice quality and abnormality of phonation.

Effect of Laryngopharyngeal Neuromuscular Electrical Stimulation on Dysphonia Accompanied by Dysphagia in Post-stroke and Traumatic Brain Injury Patients: A Pilot Study

OBJECTIVE: To investigate the effect of laryngopharyngeal neuromuscular electrical stimulation (NMES) on dysphonia in patients with dysphagia caused by stroke or traumatic brain injury (TBI). METHODS: Eighteen patients participated in this study. The subjects were divided into NMES (n=12) and conventional swallowing training only (CST, n=6) groups. The NMES group received NMES combined with CST for 2 weeks, followed by CST without NMES for the next 2 weeks. The CST group received only CST for 4 weeks. All of the patients were evaluated before and at 2 and 4 weeks into the study. The outcome measurements included perceptual, acoustic and aerodynamic analyses. The correlation between dysphonia and swallowing function was also investigated. RESULTS: There were significant differences in the GRBAS (grade, roughness, breathiness, asthenia and strain scale) total score and sound pressure level (SPL) between the two groups over time. The NMES relative to the CST group showed significant improvements in total GRBAS score and SPL at 2 weeks, though no inter-group differences were evident at 4 weeks. The improvement of the total GRBAS scores at 2 weeks was positively correlated with the improved pharyngeal phase scores on the functional dysphagia scale at 2 weeks. CONCLUSION: The results demonstrate that laryngopharyngeal NMES in post-stroke or TBI patients with dysphonia can have promising effects on phonation. Therefore, laryngopharyngeal NMES may be considered as an additional treatment option for dysphonia accompanied by dysphagia after stroke or TBI.

Treating Apraxia of Speech (AOS) using the Motor Learning Guided (MLG) Approach: A case report

The treatments of AOS have been debated since the late 1960s. Despite a considerable amount of study of intervention approaches to AOS, the effectiveness and efficacy of the treatment of AOS is still unclear. This study investigates the effect of motor learning guided (MLG) approach on individuals with AOS. Two individuals with AOS whose severity ranged from mild to moderate participated in this study. Two sets (each 20 utterance) of stimuli were created (based on high functionality) by the participants and their primary care-givers. Subjects were instructed to produce the target word three times with 4-second pause between each attempt. After 3 attempts, the experimenter provided knowledge of results (KR). Each target word was randomly selected from the written stimulus cards. The results showed that the mean scores of all the subjects increased during the sessions and this effect was transferred to the untrained target words.