Effect of voice therapy on vocal fold polyp treatment.

PURPOSE: To investigate the role of voice therapy (VT) and factors that may affect the response to VT in the treatment of vocal fold polyps, especially as a complement to phonosurgery. METHODS: Retrospective review of patients with vocal fold polyp undergoing surgery and/or VT in a tertiary medical center. The demographic data, phoniatric history, videolaryngostroboscopic findings, polyp characteristics, VHI-10 and GRB scores, and voice analysis data were recorded before and after the treatment. The patients were grouped as those who had undergone endolaryngeal microsurgery only (Group S), those who had first received VT then undergone surgery due to inadequate VT outcome (Group VTpS), and those who had only undergone VT with a follow-up plan (Group VT). RESULTS: Data were reviewed from 211 (108 M, 103 F) patients with a mean age of 41.3 ± 11 years. The improvement in all voice-related variables observed in the S and VTpS groups was significantly greater compared to the VT group despite the degree of improvement achieved in this group. At the end of the treatment period, improvements in G-R-B, VHI-10 and stroboscopy scores were significantly greater in the VTpS group than in the S and VT groups. CONCLUSION: Voice therapy can improve voice quality to some extent during the treatment of vocal fold polyps. However, VT alone is unsatisfactory compared to surgery alone. Pre-surgical VT can enhance the ultimate success of treatment. A young age, small polyps, and short duration of dysphonia may increase the possibility of benefiting from VT.

Electromyography-Guided Botulinum Toxin Injection Into the Cricothyroid Muscles in Bilateral Vocal Fold Abductor Paralysis.

OBJECTIVES: Bilateral vocal fold abductor paralysis (BVFAP) both deteriorates quality of life and may cause life-threatening respiratory problems. The aim of this study was to reduce respiratory symptoms in BVFAP patients using cricothyroid (CT) botulinum toxin (BTX) injection. METHODS: Before and 2 weeks and 4 months after bilateral BTX injection into the CT muscles under electromyography; alterations in respiratory, acoustic, aerodynamic and quality of life parameters were evaluated in BVFAP patients with respiratory distress. For the respiratory evaluation modified Borg scale and spirometry, for the voice and aerodynamic evaluations Voice Handicap Index-30 (VHI-30), GRBAS, acoustic analysis (sound pressure level, F0, jitter%, shimmer%, noise-to-harmonic ratio) and maximum phonation time and for the quality of life assessment Short Form-36 (SF-36) form were used. RESULTS: All patients were female with a mean age of 47±8.1 years. There was a mean time of 11.8±5.5 (minimum 2, maximum 23) months between BVFAP development and BTX injection. In all cases, other than one case with unknown aetiology, the cause of vocal fold paralysis was prior thyroid surgery. In total 18.6±3.1 units of BTX were applied to the CTs. In the preinjection period, and the 2nd week and 4th month after injection, the Borg dyspnea scale was 7.3/5.3/5.0, FIV1 (forced inspiratory volume in one second) was 1.7/1.7/1.8 L, peak expiratory flow (PEF) was 1.4/1.7/2.1 L/sec, maximum phonation time was 7.0/6.4/6.2 seconds and VHI-30 was 63.2/52.2/61.7 respectively. There was no significant alteration in acoustic analysis parameters. Many of the patients reported transient dysphagia within the first week. There were insignificant increases in SF-36 sub-scale values. CONCLUSION: After BTX injection, improvements in the mean Borg score, PEF and FIV1 values and SF-36 sub-scale scores showed the restricted success of this approach. This modality may be kept in mind as a transient treatment option for patients refused persistent tracheotomy or ablative airway surgeries.

Investigation of intra-esophageal air kinetics and esophageal sphincters in patients with total laryngectomy during esophageal speech.

The purpose of this study was to evaluate the air kinetics of well- and poor-speaking patients and their upper (UES) and lower (LES) esophageal sphincter pressures . The esophageal speech capability of 23 total laryngectomy patients was assessed with the Wepman scale. LES and UES points and pressures were measured, and air kinetics were compared. All patients were male, with an average age of 58 years. Both the LES and UES pressures were not statistically different between good-speaking and poor-speaking patients (p > 0.05). The ability to speak was estimated only by looking at tracings. Good speakers are able to retain air successfully and on a long-term basis between the upper and lower esophageal sphincters. During short and/or rapid speech, these patients are able to rapidly suck and then expel the air from their upper esophagus. During long speeches, after sucking the air into their distal esophagus, they used the air in the upper part of the esophagus during the speech, only later seeming to fill the lower esophagus with the air as a possible reserve in the stomach. It has been shown that the basic requirement for speaking is the capacity to suck and store the air within the esophagus. For successful speech, the air should be stored inside the esophagus. MII technology contributes to our understanding of speech kinetics and occupies an important place in patient training as a biofeedback technique.

LittlEARS(®) early speech production questionnaire validation in hearing Turkish infants.

AIM: The LEESPQ validated on hearing, German infants is a standardized tool examining preverbal speech development. This study aims to validate the LEESPQ on hearing, Turkish infants. MATERIALS AND METHODS: This is a prospective, cross-sectional validation study using the LEESPQ in Turkish. The LEESPQ was filled in once for each hearing infant. Data for ≥10 infants was collected at 19 test intervals, ≥ 0-1, ≥ 1-2……, ≥18-19 months. Psychometric validation was performed through confirmatory factor analysis, item response analysis, item analysis, and analysis of reliability and validity. RESULTS: The LEESPQ was found to be gender independent, have high predictive accuracy and almost exclusively assess speech production ability. A very high correlation between total score and chronological age means score can be interpreted as child's speech production developmental age. Expected and minimum scores were defined for each monthly interval. CONCLUSION: The LEESPQ (Turkish) has clinical value to confirm typical speech production development and detect potential problems.

Aneurysmal bone cysts of the spine.

PURPOSE: Aneurysmal bone cyst is a benign, relatively uncommon lesion, representing 1.4 % of primary bone tumors. The vertebral column is involved in 3-30 % of cases. This report describes clinical characteristics and treatment results of 18 patients with aneurysmal bone cyst of the spine. METHODS: Between 1991 and 2008, 18 patients with aneurysmal bone cyst of the spine were surgically treated in our department. The clinical records, radiographs, histologic sections, and operative reports were analyzed. RESULTS: There were 11 male and 7 female patients; mean age was 22.1 years (range 7-46 years). Localizations were cervical (3), cervicothoracic (2), thoracic (3), lumbar (4), and sacrum (6). Tumor was localized on the left side in 11 cases, on the right side in 2 and at midline in 5 patients. The two most common clinical features were axial pain (14 patients) and radicular pain (8 patients). Neurological signs were paraparesis in 3, monoparesis in 6. Mean duration of symptoms was 9 months (range 3 months-3 years). All patients underwent surgery: total removal was performed in 13 patients and subtotal resection in 5. Posterior (11), anterolateral (1), or combined anterior-posterior (6) approaches were used. Mean follow-up duration was 112.3 months (range 4-21 years). We detected four recurrences in subtotal excision group (4/5), and one recurrence in total excision group (1/13). CONCLUSION: Treatment options for aneurysmal bone cysts are simple curettage with or without bone grafting, complete excision, embolization, radiation therapy, or a combination of these modalities. Radical surgical excision should be the goal of surgery to decrease the recurrence rate. Recurrence rate is significantly lower in case of total excision.

Impact of laryngeal findings on acoustic parameters of patients with laryngopharyngeal reflux.

OBJECTIVES: To identify the effects of laryngopharyngeal reflux (LPR)-related laryngeal findings on objective voice parameters. METHODS: Two hundred and thirty patients clinically diagnosed as having LPR and 48 healthy controls were included. The reflux finding score was determined for each subject via videolaryngoscopy. The acoustic parameters evaluated were jitter, shimmer, noise-to-harmonic ratio and Voice Turbulence Index (VTI). RESULTS: Shimmer and VTI showed statistically significant differences between the LPR and control groups among males (p < 0.05). For females, all of the 4 acoustic voice parameters were significantly different between the two groups (p < 0.05). Erythema/hyperemia was found to affect the highest number of voice parameters. VTI was found to be affected by the highest number of laryngeal findings. CONCLUSION: Objective voice changes were documented in LPR patients, with VTI being the most affected parameter, and therefore it should be considered in the acoustic analysis of patients with LPR in addition to the conventional parameters. With hyperemia in the first rank, ventricular obliteration, pseudosulcus and vocal fold edema are found to have an impact on voice, suggesting that these should be concentrated on in the diagnosis and follow-up of LPR patients with voice disorders.

[Reliability and validity of the Turkish version of the Voice Handicap Index]. / Ses Handikap Endeksi (Voice Handicap Index) Türkçe versiyonunun güvenilirligi ve geçerliligi.

OBJECTIVES: We investigated the reliability and validity of the Turkish version of the Voice Handicap Index (VHI), and developed a short VHI form that would be more practical. PATIENTS AND METHODS: The original VHI was translated to Turkish by 10 otolaryngologists, then it was translated back to English by a linguist, and the final text was prepared by the evaluation committee composed of three members. The translated version was administered to a group of 220 subjects twice with 7-14 days intervals. Based on the responses, statistical analyses were performed to assess its reliability and validity. RESULTS: Internal consistency reliability was found to be highly significant (Cronbach's alpha=0.97). Test-retest correlation coefficient was 0.93 for the total score. Factor analysis yielded three factors explaining 64.8% of the total variance. The corrected item-total correlation coefficients ranged from 0.50 to 0.80. The 10 most robust VHI items, namely, E7, E9, P10, F11, F12, E15, F16, P18, P20 and E29, were selected using the corrected item-total correlation coefficients, and a shortened form of the Turkish VHI was developed. CONCLUSION: As some items are thought to be contentious in the Turkish VHI, the short form of the Turkish VHI is more suitable for use in clinics.

CT and MRI findings in X-linked progressive deafness.

Congenital X-linked mixed deafness is a rare anomaly that has typical features and can be diagnosed on the basis of progressive mixed hearing loss and the typical imaging findings. Recognition of these findings may alter the course of treatment and perilymph gushing can be avoided. A 10-year-old male patient presented with a history of progressive hearing loss. Computed tomography of the temporal bones showed bulbous dilatation of the fundi of the internal auditory canals (IAC) and the absence of the bony plates separating the basal turn of the cochleas and IAC. Magnetic resonance imaging demonstrated obliteration of the labyrinthine spaces at the right side.

A multivariate analysis of objective voice changes after thyroidectomy without laryngeal nerve injury.

OBJECTIVE: To evaluate the impact of thyroidectomy and the possible effects of factors such as patient sex, operation type, and surgeon experience on objective voice parameters of patients undergoing thyroidectomy without laryngeal nerve injury. DESIGN: Prospective study. SETTING: University hospital. PATIENTS: Thirty-six patients undergoing primary thyroidectomy because of thyroid disease. MAIN OUTCOME MEASURES: The effect of thyroidectomy on voice was examined by recording the voices of the patients before and 1 week after thyroidectomy. The Multi-Dimensional Voice Program was used for capturing and analyzing the voice samples. RESULTS: On postoperative examination of objective voice changes, thyroidectomy had no multivariate effect on the combination of voice parameters. Patient sex, type of surgery, and surgeon experience had no effect on the combination of voice parameters before and after thyroidectomy. Regardless of within-patient factors (type of surgery, patient sex, and surgeon experience), 4 acoustic parameters (highest fundamental frequency, standard deviation of average fundamental frequency, phonatory average fundamental frequency range in semitones, and degree of subharmonics) significantly decreased after thyroidectomy (P < .05). Although they tended to be worse, none of the acoustic parameters showed significant changes in male patients. However, significant changes in some of the acoustic parameters of female patients were observed. Highest fundamental frequency, standard deviation of average fundamental frequency, phonatory average fundamental frequency range in semitones, absolute jitter, relative average perturbation, pitch perturbation quotient, shimmer in decibels, percentage of shimmer, amplitude perturbation quotient, noise to harmonic ratio, and degree of subharmonics values were all lower in female patients after thyroidectomy (P < .05). CONCLUSIONS: Voice changes may occur after thyroidectomy without any evident laryngeal injury, and deterioration and amelioration of acoustic parameters can be observed to occur differently among male and female patients. Preoperative and postoperative objective voice analyses may be helpful in documenting voice changes.

The effect of stimulus duration on perception of Turkish vowels in normal-hearing and hearing-impaired children.

The objective of the study was to examine the effects of stimulus duration on vowel perception in normal-hearing and hearing-impaired children. For this purpose, 80 semisynthetic vowel stimuli consisting of eight different Turkish vowels with ten different durations were presented to 14 normal-hearing and 15 hearing impaired children, and they were asked to identify the vowel they heard. Thirteen normal-hearing adults served as speaker subjects to get normative data on mean durations of the Turkish vowels. While there was no significant effect of duration on perception in normal-hearing children, perception errors for very short and very long vowels were observed in hearing-impaired children. The most frequent responses as a function of duration showed four different patterns: (1) three vowels were perceived correctly in all durations; (2) two were perceived correctly in middle and longer durations; (3) two were perceived correctly in middle duration; and (4) only one was perceived correctly in short duration. It was concluded that the effects of stimulus duration on vowel perception were determined by natural duration of the vowel in a given language, and unnaturally short and long vowels were misperceived by hearing impaired subjects.

Bipolar electrodissection tonsillectomy in children.

The purpose of this study was to compare bipolar electrodissection tonsillectomy with traditional cold dissection tonsillectomy in the pediatric population. Forty children with recurrent tonsillitis and/or obstructive symptoms were included in the study. The study population was randomly divided into two groups, and the two techniques were compared with regard to operative time, intraoperative and postoperative bleeding and postoperative pain. There were 23 children in the bipolar electrodissection tonsillectomy group (mean age, 8.1 years; range, 5-12 years), and 17 children in the cold dissection tonsillectomy group (mean age, 6.7 years; range, 5-12 years). The average operative times were 15.2+/-8.5 min for bipolar electrodissection tonsillectomy and 29.06+/-13.5 min for cold dissection tonsillectomy (P < 0.05). The blood loss in bipolar electrodissection tonsillectomy and cold dissection tonsillectomy was 5.0+/-4.2 ml and 32.1+/-11.3 ml, respectively (P < 0.05). Postoperative hemorrhage was not observed. Bipolar electrodissection tonsillectomy was less painful the first 30 min postoperatively (P < 0.05). Bipolar electrodissection tonsillectomy in children is a useful technique, with results comparable to traditional cold dissection tonsillectomy.

Laryngeal findings and voice quality in Sjögren's syndrome.

OBJECTIVE: The effect of Sjögren syndrome (SS) on perceptual ratings of the laryngeal findings using the Reflux Finding Score (RFS) and the Reflux Symptom Index (RSI) and the objective voice quality using Jitter (JITT), Pitch Period Perturbation Quotient (PPQ), Shimmer (Shim), Amplitude Perturbation Quotient (APQ) and Noise-to-Harmonic Ratio (NHR) was examined. METHODS: Seventy-seven patients with SS and seventy-seven healthy individuals for the control group were studied. The Reflux Symptom Index (RSI); nine-item outcomes instrument for assessment of symptoms in patients and the Reflux Finding Score (RFS), eight-item laryngoscopic-based scale for evaluation of laryngeal findings in patients were realised. The Multi Dimensional Voice Program (MDVP) was used for capturing and analysis of the voice samples. For comparison of all parameters of patients and control group subjects, the independent sample t-test was used. RESULTS: The difference of RSI and RFS between patients with SS and control subjects was statistically significant. The difference of voice quality parameters between patients with SS and control subjects expect NHR were statistically significant. CONCLUSION: There is a significant association between SS and a variety of laryngeal pathologies. The SS patients with reflux symptoms and voice problems must be examined by an ENT specialist and local laryngeal manifestations of SS can be treated symptomatically.

Hearing results after primary cartilage tympanoplasty with island technique.

OBJECTIVE: Because of its rigid quality, cartilage is the grafting material of choice in advanced pathologies, such as adhesive processes or recurrent perforations. However, the use of such a rigid material in tympanic membrane reconstruction causes controversies as to the audiologic aspect. The purpose of this study was to assess overall and frequency-specific hearing results after primary cartilage tympanoplasty with island technique in comparison to the hearing results after primary tympanoplasty with temporalis muscle fascia. STUDY DESIGN AND SETTING: This study was a retrospective review of selected cases between 1999 and 2002. Primary cases with intact ossicular chain, normal middle ear mucosa, and subtotal perforation of the tympanic membrane were included in the study. Fifteen patients were in the cartilage group, whereas 10 patients were in the fascia group. Preoperative and postoperative air-bone gaps at the frequencies of 0.5, 1, 2, and 4 kHz were compared. RESULTS: Both groups were statistically similar on the aspect of the severity of middle ear pathology and the preoperative hearing levels. Mean postoperative gains in air-bone gap were 11.9 dB for the cartilage group and 11.5 dB for the fascia group. There were no statistically significant differences in the postoperative frequency-specific gains in air-bone gap between the 2 groups. CONCLUSIONS: Although cartilage is the ideal grafting material in problem cases, its comparable acoustic properties, especially in the form of cartilage island, to those of fascia will allow a more liberal application in less severe cases, in which functional outcome is more essential.

The effects of vowels on voice perturbation measures.

This study examines voice perturbation parameters of the sustained [a] in English and of the eight vowels in Turkish to discover whether any difference exists between these languages, and whether a correlation exists between voice perturbation parameters and articulatory and acoustic properties of the Turkish vowels. Eight Turkish vowels uttered by 26 healthy nonsmoker volunteer males who are native Turkish speakers were compared with a voice database that includes samples of normal and disordered voices belonging to American English speakers. Fundamental frequencies, the first and second formants, and perturbation parameters, such as jitter percent, pitch perturbation quotient, shimmer percent, and amplitude perturbation quotient of the sustained vowels, were measured. Also, the first and second formants of the sustained [a] in English were measured, and other parameters have been obtained from the database. When the voice perturbation parameters in Turkish and English were compared, statistically significant differences were not found. However, when Turkish vowels compared with each other, statistically significant differences were found among perturbation values. Categorical comparisons of the Turkish vowels like high-low, rounded-unrounded, and front-back revealed significant differences in perturbation values. In correlation analysis, a weak linear inverse relation between jitter percent and the first formant (r=-0.260, p<0.05) was found.

The comparison of an empiric proton pump inhibitor trial vs 24-hour double-probe Ph monitoring in laryngopharyngeal reflux.

Laryngopharyngeal reflux (LPR), which is defined as the backflow of gastric contents into the upper aerodigestive tract, is a relatively common disorder. However, its diagnosis still poses many problems. Twenty-four-hour double-probe pH monitoring is currently the diagnostic test of choice, but it has many disadvantages. Thus, an empiric trial of antireflux therapy has been suggested as an alternative method for diagnosis. The purpose of this article is to evaluate the validity of this alternative method in the management of LPR. The study group consisted of 36 patients with symptoms and physical findings suggesting LPR. The control subjects were 23 healthy adults. Twenty-four-hour double-probe pH monitoring was performed both in the study group and the control group, and the results were compared. In addition, the symptoms and physical findings in the study group was scored by the modified reflux symptom index (MRSI) and reflux finding score (RFS) at four intervals: before the start of therapy and at the second, fourth and sixth months of the therapy. The results of the 24-hour double-probe pH monitoring showed no significant difference between the study and the control groups (p>0.05). In the study group, the MRSI before the therapy was 13.6+/-4.4. This index improved significantly to 4.3+/-1.9 at the second month; to 1.5+/-0.6 at the fourth month, and to 0.5+/-0.2 at the sixth month of the therapy (p<0.05). The RFS before the start of the therapy was 14.8+/-3.8; and it improved significantly to 7.7+/-3.8 at the second month; to 4.5+/-2.3 at the fourth month, and to 1.4+/-0.9 at the sixth month of the therapy (p<0.05). The significant improvement in the MRSI and the RFS during the course of proton pump inhibitor therapy relates the patients' symptoms and physical findings to LPR. This implies the validity of the method, not only in the treatment of LPR, but in the diagnosis of this disorder, as well. Unfortunately, 24-hour double-probe pH monitoring has failed to differentiate LPR patients from healthy individuals.

Jugular bulb diverticula: clinical and radiologic aspects.

OBJECTIVE: This study was performed to determine the clinical presentation of jugular diverticulum and its relevance with the extension of the lesion. STUDY DESIGN: The records and high-resolution CT scans of 1474 patients, with otologic symptoms or related clinical findings, were evaluated retrospectively. In 17 cases in which CT scans revealed the presence of jugular diverticulum, sensorineural symptoms were evaluated with respect to a reference line, perpendicular to the basal turn of the cochlea and tangent to the vestibule in axial CT scan images. RESULTS: When the extension of jugular diverticulum was posterior to the reference line, sensorineural symptoms with vertigo were dominant in most patients (72.7%) in this group. On the other hand, for the patients with anterior-extending jugular diverticulum, sensorineural symptoms without vertigo were detected in 50% of patients, whereas 33.3% had sensorineural symptoms with vertigo. CONCLUSION: This study revealed a relationship between the extension of jugular diverticulum and clinical symptoms. However, this relationship lacks statistical evidence because of the limited number of patients.

[Laser posterior cordectomy in bilateral vocal cord paralysis]. / Iki tarafli vokal kord paralizisinde lazer posterior kordektomi.

OBJECTIVES: We evaluated the functional results of laser posterior cordectomy with respect to respiration, phonation, and deglutition. PATIENTS AND METHODS: Unilateral laser posterior cordectomy was performed in nine patients (7 women, 2 men; mean age 56 years; range 46 to 61 years) with bilateral vocal cord paralysis. Postoperatively, respiration, deglutition, and phonation were evaluated with the use of an exercise tolerance scale, the Pearson scale, and wavelet analysis, respectively. The mean follow-up period was 14.2 months. RESULTS: Respiration was satisfactory in eight patients. Of these, four patients had excellent, and four patients had good exercise tolerance. The procedure resulted in success without tracheotomy in four patients. No deglutition or aspiration problems developed. Of eight patients with satisfactory respiration, voice quality remained unchanged in six patients, whereas an improved voice quality was noted in two patients who received postoperative phoniatric rehabilitation. CONCLUSION: Laser posterior cordectomy for the treatment of bilateral vocal cord paralysis resolves respiration problems, it restores phonation and deglutition functions, as well.