Voice Improvement in Patients with Functional Dysphonia Treated with the Proprioceptive-Elastic (PROEL) Method.

The objective of the study was to analyze the outcome of the proprioceptive-elastic (PROEL) voice therapy method in patients with functional dysphonia (FD). Fifty-two patients with FD were involved in the study; they were composed of three subgroups of patients with (1) FD without glottal insufficiency (n = 28), (2) FD and glottal insufficiency (n = 9), and (3) FD, glottal insufficiency, and vocal nodules (n = 15). A multidimensional assessment protocol including videolaryngostroboscopy; maximum phonation time; perceptual evaluation of dysphonia with the Grade, Instability, Roughness, Breathiness, Asthenia, and Strain (GIRBAS) scale; and 10-item version of the Voice Handicap Index was conducted before and after 15 sessions of voice therapy. All voice therapy sessions were conducted by the same speech-language pathologist. The comparison between voice assessment before and after voice therapy with the PROEL method in patients with FD, in all the three subgroups, revealed a statistically significant improvement in periodicity and the mucosal wave in the laryngostroboscopy, maximum phonation time, GIRBAS scale scores, and VHI-10. Voice of patients with FD improved after treatment with the PROEL method. Further studies are needed to analyze the efficacy of the PROEL method with randomized double-blind clinical trials using different methods for voice therapy. At present, the PROEL method represents an alternative tool for the speech pathologist to improve voice in patients with FD.

Cross-Cultural Adaptation and Validation of the Italian Version of the Voice Symptom Scale (I-VoiSS).

OBJECTIVES: To evaluate the reliability and validity of the Italian Voice Symptom Scale (I-VoiSS). STUDY DESIGN: Cross-sectional, nonrandomized, prospective study with controls. METHODS: The study consisted of five phases: item generation, reliability analysis, normative data generation, validity and responsiveness analysis. A group of 113 dysphonic patients was enrolled for the internal consistency analysis. Seventy-three of them completed the I-VoiSS twice, 2 weeks apart, for test-retest reliability analysis. A group of 150 vocally healthy participants completed the I-VoiSS for normative data generation. I-VoiSS scores obtained by dysphonic and vocally healthy participants were compared for validity analysis. I-VoiSS scores were correlated with those of the Italian version of the Voice Handicap Index (I-VHI) in 49 dysphonic patients for criterion validity analysis. I-VoiSS scores obtained in a group of 37 nonsmoker dysphonic patients before and after surgical treatment for vocal fold polyps were compared for responsiveness analysis. Finally, the cutoff value of the I-VoiSS was calculated. RESULTS: All the enrolled participants managed to complete the I-VoiSS autonomously. Internal consistency and test-retest were satisfactory (α = 0.92 and r = 0.91). A significant difference in the I-VoiSS scores between the dysphonic and vocally healthy participants was found (p = 0.001). Positive significant correlations were found between I-VoiSS and I-VHI scores (r = 0.85). I-VoiSS scores obtained in the pretreatment condition were significantly higher than those obtained after surgery (p = 0.001). The cutoff value of I-VoiSS was 15.5. CONCLUSION: I-VoiSS is reliable, valid, responsive to changes, and recommended for clinical practice and outcome research.

Vocal symptoms in telemarketers: a random and controlled field trial.

The present study was carried out to evaluate the effectiveness of a specific program regarding the occurrence of vocal attrition symptoms in telemarketers. A total of 71 subjects participated in this study: 28 completed the Vocal Symptoms questionnaire to test its reliability, and 43 were randomly assigned to two groups: an 8-week vocal training group (n = 14) and a no-training control group (n = 29), to evaluate the effectiveness of the training program with this tool. The voice training group also filled in the posttraining questionnaire 'Benefits Obtained with Voice Training' (BVT). The vocal training program was not considered effective with regard to the occurrence of vocal symptoms. However, due to a probable increase in symptoms in untrained telemarketers, it can work as a protective factor. According to BVT answers, the vocal training contributed to an improvement in vocal use as a communication tool for telemarketers.

Projection structure of the monomeric porin OmpG at 6 A resolution.

The Escherichia coli porin OmpG, which acts as an efficient unspecific channel for mono-, di- and trisaccharides, has been purified and crystallized in two dimensions. Projection maps of two different crystal forms of OmpG at 6 A resolution show that the protein has a beta-barrel structure characteristic for outer membrane proteins, and that it does not form trimers, unlike most other porins such as OmpF and OmpC, but appears in monomeric form. The size of the barrel is approximately 2.5 nm, indicating that OmpG may consist of 14 beta-strands. The projection map suggests that the channel is restricted by internal loops.

The use of buccal mucosa graft at posterior cricoid splitting for subglottic stenosis repair.

BACKGROUND: Since 1955, when Réthi established the posterior cricoid split augmentation (PCSA) method, several authors have published supporting reports of the validity and proven efficacy of its basic principles. A 27-year prospective, retrospective study. OBJECTIVES: To report on experience in performing the PCSA method for subglottic and/or posterior-glottic stenosis repair using buccal mucosa interposition grafting at posterior cricoid split and stenting for 8 weeks, and to assess the impact on vocal function. METHODS: From 1972 on, 60 patients (45 adults, 15 children, aged 8 mo to 72 y) with subglottic and/or posterior-glottic stenosis were operated on using a modified PCSA method. The surgical technique consisted of posterior cricoid splitting, including or not the interarytenoid muscle; wide lateral retraction of the posterior cricoid halves; buccal mucosa interposition grafting and stenting for 8 weeks. The factors evaluated included the subglottic remodeling rate, donor and recipient sites morbidity, time to decannulation, rate of graft take, and phonatory function tests. RESULTS: The modified PCSA procedure resulted in a decannulation rate of 90%, 18 (30%) of which had further procedure to achieve decannulation, and 6 adult patients (10%) were considered failures because of restenosis. The rate of take of the mucosa graft was 100% in both children and adults, with complete epithelialization of the grafted area, the mucosa not becoming dry and crusty. No interarytenoid muscle division resulted in near-normal to normal glottic voicing. Interarytenoid muscle division determined supraglottic voicing with inspiratory noise and pneumophonic incoordination, breathy and hoarse voice, low fundamental frequency, limited dynamic range, and shortened phonation time. CONCLUSION: The PCSA procedure with buccal mucosa graft is reliable, safe, and highly successful with respect to the graft incorporation and subglottic remodeling. The division or not of the interarytenoid muscle is the most important factor influencing the postoperative vocal function.

Behavioral management of pediatric dysphonia.

Children's voice disorders may be functional or organic in cause and a thorough evaluation by the otolaryngologist and speech-language pathologist is necessary to obtain the proper diagnosis, to understand the underlying etiologic factors, and to prepare a plan of treatment that is appropriate for the child. Because voice disorders may be present with developmental communication problems, treatment must include all factors that affect growth and development of the child.

Effect of voice rehabilitation on oral communication of Parkinson's disease patients.

Voice and speech disorders are common in Parkinson's disease patients and may lead to social isolation. We employed routine clinical voice therapy measures to evaluate the effect of voice rehabilitation. Twenty patients with a stable drug regimen participated in this study. The patients were assessed before and after a program of voice rehabilitation consisting of 13 group therapy sessions during 1 month, with emphasis on the increase in laryngeal sphincteric activity. Voice rehabilitation produced an increase in maximal phonation times, decrease in the values of s/z ratio and air flow, increase in vocal intensity, decrease in the complaints of weak and strained-strangled voice and monotonous and unintelligible speech and elimination of complaints of swallowing alterations. These data indicate a greater glottic efficiency after voice rehabilitation reflecting a more functional oral communication.

Treatment of sulcus vocalis: auditory perceptual and acoustical analysis of the slicing mucosa surgical technique.

Sulcus vocalis is a furrow in the mucosa of the vocal folds that causes glottic insufficiency, irregular vibrations, and a distinctive dysphonia of variable severity. Treatment of sulcus vocalis needs to achieve anatomical and functional improvements that satisfy the behavior of the larynx and vocal quality. We suggest a combined approach, which includes vocal fold mucosal surgery through a technique called slicing mucosa, followed by intensive vocal rehabilitation. The aim of the surgery is to detach the mucosa of the sulcus and to interrupt the longitudinal fibrotic tension lines. The results of this procedure in 10 patients were analyzed through visual, auditory, and acoustical methods, and the data lead us to conclude that the treatment proposed offered a good anatomical result, a better vibratory pattern, and an improvement in overall vocal quality.

Recurrent laryngeal nerve section for spastic dysphonia: 5- to 14-year preliminary results in the first 300 patients.

This presentation compares the preoperative voice recordings and the latest follow-up voice recordings, made 5 to 14 years postoperatively, of the first 300 patients with various degrees of spastic dysphonia whom we treated with recurrent laryngeal nerve (RLN) sections from 1975 to 1982. Voice therapy was usually given afterward and in some patients, when necessary, "fine tuning" surgery was performed later. The 243 patients who could be located were asked to answer a questionnaire regarding their voice production and communication abilities, and to make a voice recording. The preoperative and long-term postoperative voice recordings were analyzed by means of perceptual voice evaluation and acoustic analysis of the voice spectra. Fifteen percent developed recurrence of mild to moderate spasticity 6 to 24 months after the RLN section. This was curable with laser vocal cord thinning via direct laryngoscopy. Eighty-two percent of patients had little or no voice spasticity 5 to 14 years after their RLN section. The experimental alternative of injecting botulin directly into the vocal cord to temporarily paralyze it is discussed.