Acoustic and Aerodynamic Comparisons of Voice Qualities Produced After Voice Training.

Characteristics of true vocal fold vibration such as the proportion of closed phase of vibration to open phase, longitudinal tension, and the amount of medial compression are used to define four conditions during Estill Voice Training. However, it is unknown whether trainees achieve these phonatory differences after training. Acoustic and aerodynamic measures were used to determine differences in Slack, Thick, Thin, and Stiff conditions. Twenty-four female speech-language pathology graduate students received training perceiving and producing these four conditions and volunteered to participate 3-5 months later. After a 20-minute refresher training, participants were recorded using the Phonatory Aerodynamic System with electroglottography and Computerized Speech Lab. Four Estill Voice Training experts independently categorized the voice quality productions. Aerodynamic and acoustic measures of productions classified by at least three of four experts as having the intended quality determined if measures differentiated among voice qualities and supported the hypothesized physiological concepts used in training at Bonferroni corrected P ≤ 0.0063. Results showed that Slack had low fundamental frequency (fo), low sound pressure level (SPL), and high vibratory instability; Thick had high subglottal pressure (Psg), high SPL, and high vibratory stability; Stiff had high airflow while Thin had lower Psg than Thick. Seven measures differentiated the four qualities with 88.1% accuracy while only Psg, airflow, and jitter were required to differentiate Thick, Stiff, and Thin with 88.7% accuracy. As acoustic and aerodynamic measures differentiated among voice qualities and supported the theoretical physiological characteristics used in training, they could be used to track accuracy during training.

Predicting Patient Needs for Interdisciplinary Services in a Voice and Swallowing Center.

In a subspecialty interdisciplinary voice and swallowing clinic, patient referrals come from a wide variety of disciplines for various reasons, which can make scheduling their initial evaluations challenging. Depending on the nature of complaints and symptoms, patients may best be evaluated either by a single provider (a laryngologist) or by an interdisciplinary team that includes a speech-language pathologist. If not scheduled appropriately, the provider and the patient may lose valuable time, resources, and money. This was a retrospective chart review of 76 patients who received an interdisciplinary evaluation in our Voice and Swallowing Center's first 7 months of operation. Two factors were examined for their predictive values: the most common reasons for referral and the disciplines that commonly refer to the clinic. The goal was to probe for any variables known at the time of referral that could inform us whether an interdisciplinary evaluation would be beneficial or not. This information informs resource planning for space, equipment, scheduling, and staffing. The results showed that the most common reasons for a referral to the Voice and Swallowing Center were dysphonia (34.8%), dyspnea/paradoxical vocal fold motion ("PVFM," 20.2%), and dysphagia (18%). Statistical analysis of the results indicated that certain reasons for referral were more likely to require an interdisciplinary evaluation than others: dysphonia, irritable larynx syndrome/chronic cough, and PVFM. Referrals most commonly came from providers with a background discipline of primary care (26%) and otolaryngology (22%). The discipline of a referring provider alone was not a strong enough indicator to reliably predict the type of evaluation needed. Examining the available data on referral patterns, as this study has done, has the potential to inform providers how to better anticipate their patients' needs and also improve clinic operations.

Comorbid Dysphagia and Dyspnea in Muscle Tension Dysphonia: A Global Laryngeal Musculoskeletal Problem.

OBJECTIVE: To characterize the associated symptoms of dysphagia and dyspnea among patients presenting with muscle tension dysphonia (MTD). STUDY DESIGN: Retrospective chart review performed over a 14-month period from October 2014 to December 2015. SETTING: Voice and swallowing center of a tertiary academic medical center. SUBJECTS AND METHODS: Thirty-eight patients with MTD were included for analysis. Clinical data were collected and analyzed, including perceptual voice evaluation and patient-reported outcomes measures. RESULTS: Among patients with a diagnosis of MTD, the incidence of reported dysphagia during clinical history and examination was 44.7%. Among patients with MTD, 60.5% had an EAT-10 (10-item Eating Assessment Tool) score ≥3 (ie, abnormal). Patients who reported dysphagia and/or had abnormal EAT-10 score (≥3) had significantly greater voice impairment than that of patients without dysphagia (P = .02). Patients who reported dysphagia also had significantly higher Clinical COPD Questionnaire scores than those of patients who reported only dysphonia (P = .002). CONCLUSIONS: Patients presenting for dysphonia who are diagnosed with MTD have a high rate of comorbid dysphagia. Patients who reported dysphagia had significantly higher self-reported voice impairment and greater severity of breathing dysfunction as measured by the Clinical COPD Questionnaire. The coincidence of these symptoms in this patient cohort may suggest an underlying pathophysiology that has yet to be elucidated. Further prospective studies are needed to clarify the underlying cause of dysphagia and breathing dysfunction in the setting of MTD and to investigate diagnostic and therapeutic paradigms.