Voice-Related Quality of Life Outcomes from Pneumatic Artificial Laryngeal and Esophageal Speakers.

The self-reporting voice-related quality of life (V-RQOL) instrument has been viewed as a modular index of quality of life for speakers using tracheoesophageal, esophageal (ES), or electrolaryngeal speech. However, V-RQOL has never been studied with pneumatic artificial laryngeal (PA) individuals. This study attempted to quantify the self-assessed voice-related performance of PA and ES speakers in Taiwan via the V-RQOL questionnaire, and further to compare the results for PA and ES speakers. METHODS: V-RQOL was assessed in 79 PA and 25 ES speakers undergoing total laryngectomy without using tracheoesophageal puncture. Data were collected from members of Taiwan's Association of Laryngectomees. RESULTS: There was no significant difference between PA and ES participants in social-emotional, physical functioning and total scores, suggesting both may consider their quality of life comparable with each other. In ES participants, there was a significant effect of time after total laryngectomy in physical functioning and total scores. CONCLUSIONS: PA speakers did not exhibit more dissatisfaction or disability than ES speakers on 10 statements in the V-RQOL, but after total laryngectomy the ES have been shown to improve over time. Information on the experience of PA and ES speakers could be used by clinicians to inform patients of potential outcomes, and help them select suitable rehabilitation techniques.

The Mandarin Voice Handicap Index for Laryngectomees With Pneumatic Artificial Laryngeal and Esophageal Speech.

Purpose The Voice Handicap Index (VHI) questionnaire assesses the impact of total laryngectomy on voice-related quality of life. This study evaluates the Mandarin VHI, including its internal consistency, test-retest reliability, content validity, and differences in scores for Mandarin alaryngeal patients with pneumatic artificial laryngeal (PA) and esophageal (ES) speech. Method Translation and validation of the VHI questionnaire was performed through the forward-backward translation technique. This study used a sample of 78 PA and 23 ES participants from Taiwan who completed the Mandarin VHI. Forty-two of the alaryngeal participants completed the Mandarin VHI twice over a period of 7-63 days. Results The measurement of the internal consistency of the Mandarin VHI showed a high Cronbach's alpha coefficient for the total score (.975) and the functional (.930), physical (.939), and emotional (.938) subscales. Based on the results of the intraclass correlation coefficients, good test-retest reliability for the total and domain scores was found (intraclass correlation coefficient = .827-.863). Conclusion The Mandarin VHI was validated as an instrument with proper internal consistency and reliability, which supports the Mandarin VHI as a valid instrument for the self-evaluation of handicaps related to voice problems in PA and ES speakers.

Laryngeal electromyography-guided hyaluronic acid vocal fold injection for unilateral vocal fold paralysis: a prospective long-term follow-up outcome report.

IMPORTANCE: Unilateral vocal fold paralysis (UVFP) is a common voice disorder that may cause glottal closure insufficiency with hoarseness of voice. Laryngeal electromyography (LEMG)-guided hyaluronic acid vocal fold (VF) injection has been proposed as a treatment option to improve glottal closure with a satisfactory short-term effect. To our knowledge, this study reports the first long-term follow-up result of this treatment modality. OBJECTIVE: To present the long-term treatment results of LEMG-guided hyaluronic acid VF injection for UVFP. DESIGN, SETTING, AND PARTICIPANTS: Prospective study of the treatment results of 74 patients who received LEMG-guided hyaluronic acid VF injection for UVFP at a tertiary referral medical center from March 2010 to February 2013. INTERVENTIONS: In the office-based procedure, 1.0 mL of hyaluronic acid was injected via a 26-gauge monopolar injectable needle electrode into paralyzed thyroarytenoid muscles by LEMG guidance. MAIN OUTCOMES AND MEASURES: Various glottal closure evaluations such as normalized glottal gap area, maximal phonation time, phonation quotient, mean airflow rate, perceptual GRBAS (grade, roughness, breathiness, asthenia, strain) scale, and Voice Handicap Index were compared before and after injection using the nonparametric Wilcoxon signed rank test within 1 month, at 6 months, and at the last follow-up examination. RESULTS: Sixty patients had been followed up for at least 6 months. Forty-four patients received only 1 injection, and 16 patients received repeated injections (2 injections for 13 patients and 3 for 3 patients). All the glottal closure parameters improved significantly (P < .001) within 1 month, at 6 months, and at the last follow-up examination, with a mean (SD) of 17.4 (8.9) months. At the last follow-up examination, the mean (SD) normalized glottal gap area was significantly reduced from 7.9 (5.7) to 0.6 (1.6). Mean (SD) maximal phonation time was significantly prolonged from 4.6 (3.8) seconds to 12.1 (7.4) seconds. Mean (SD) phonation quotient was significantly reduced from 647 (508) mL/s to 277 (212) mL/s. Mean (SD) airflow rate was significantly reduced from 445 (338) mL/s to 175 (145) mL/s. When all the GRBAS scale parameters improved, the mean (SD) Voice Handicap Index score was significantly reduced from 76 (22) to 38 (30) (all P < .001). CONCLUSIONS AND RELEVANCE: Of the 74 patients in this study, 44 (60%) who received a single injection and 16 (22%) who received repeated injections did not require another treatment after long-term follow-up. Laryngeal electromyography-guided hyaluronic acid VF injection is an option for treating UVFP with satisfactory results.

Laryngeal electromyography and prognosis of unilateral vocal fold paralysis--a long-term prospective study.

OBJECTIVES/HYPOTHESIS: To confirm the value of using laryngeal electromyography (LEMG) to predict the long-term prognosis of unilateral vocal fold paralysis (UVFP), and elucidate the adequate timing of LEMG. STUDY DESIGN: Prospective cohort prognosis study. METHODS: The LEMG data of 84 patients with UVFP were prospectively collected, and 81 patients received follow-up at least 6 months after symptom onset. If the paralyzed vocal fold had <20% recruitment reduction during phonation compared to the normal vocal fold signals, and absence of fibrillation when the patient was silent, the prognosis was considered to be good (negative finding). Otherwise, the prognosis was considered to be poor (positive finding). The association between UVFP outcome and LEMG prognostic rules and the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of LEMG were calculated. RESULTS: The mean duration of LEMG after symptom onset was 3.7 months, and follow-up after symptoms onset was 18.4 months. Sixty-six of 71 patients with a positive finding had persistent UVFP; four of 10 patients with a negative finding recovered vocal fold motion. LEMG results were significantly associated with the outcome of UVFP (P = .007). The overall accuracy, sensitivity, specificity, PPV, and NPV of LEMG were 86.4%, 91.7%, 44.4%, 93.0%, and 40.0%, respectively. When LEMG was done more than 2 months after symptom onset, the PPV was 97.9%. CONCLUSIONS: LEMG has a high PPV in predicting the long-term outcome of UVFP patients with poor prognosis. Permanent laryngeal framework surgery is feasible if patients have positive findings at least 2 months after symptom onset.

Laryngeal electromyography-guided hyaluronic acid vocal fold injection for unilateral vocal fold paralysis--preliminary results.

OBJECTIVES: The purpose of this study is to investigate the feasibility of using an injectable needle electrode to guide hyaluronic acid (HA) vocal fold injection (VFI) during laryngeal electromyography (LEMG) for unilateral vocal fold paralysis (UVFP). STUDY DESIGN: Prospective study. METHODS: From March to June 2010, 20 UVFP patients received LEMG examination at our clinic. Before completion of LEMG, 1.0 cc of HA (Restylane Perlane(®); Q-Med, Uppsala, Sweden) was injected via a 26-gauge monopolar injectable needle electrode into paralyzed thyroarytenoid muscle. After injection, 20 patients completed 3-months follow-up and 16 patients completed 6-months follow-up. The data before, 1 week, 3 months, and 6 months after injection, including the normalized glottal gap area (NGGA) from videostroboscopy, maximal phonation time (MPT), mean airflow rate (MAFR), phonation quotient (PQ), perceptual evaluation of voice (grade, roughness, breathiness, asthenia, strain [GRBAS] scale), Voice Handicap Index (VHI), and self-grading of choking (grade 1-7), were analyzed by the Wilcoxon signed rank test. RESULTS: All of the patients completed the procedure without complications. After injection, mean NGGA was significantly reduced from 8.28 units to 0.52 units (1 week), 1.79 units (3 months), and 1.36 units (6 months). The mean MPT was prolonged from 5.66 seconds to 11.73, 11.25, and 11.93 seconds, respectively. VHI was reduced from 76.05 to 38.10, 37.40 and 35.00, respectively. Other analyzed data (PQ, MAFR, GRBAS scale, and choking severity) also showed statistically significant improvement. CONCLUSION: LEMG-guided HA VFI provides UVFP patients with neuromuscular function evaluation and treatment in one step. This clinical technique is feasible, and the short-term results are satisfactory.