Vocal Outcome After Cordectomy by Transoral CO2 Laser Microsurgery in Patients With Laryngeal Intraepithelial Neoplasia and Non-neoplastic Lesions.

OBJECTIVES: This study investigates vocal outcome after cordectomy by transoral CO2 laser microsurgery (TLM-cordectomy) in patients with laryngeal intra-epithelial neoplasia (LIN) or non-neoplastic lesions (NNL), for improved individual patient advice and potential adjustment of national treatment strategy by which patients suspected to have glottic LIN or T1a cancer are offered TLM-cordectomy, without prior biopsy. STUDY DESIGN: Prospective, longitudinal, quasi-experimental time series. METHODS: Consecutively included patients (n = 155) with LIN (n = 84) or NNL (n = 71) who underwent voice assessments before and after TLM-cordectomy. The multi-dimensional voice assessment protocol comprised voice and speech range profiles, aerodynamics, acoustic analysis, self-evaluated voice handicap, and perceptual auditory voice ratings. RESULTS: Median follow-up time was 195 (range 50-1121) days for patients with LIN and 193 (range 69-1294) days for patients with NNL. Statistically significant changes, LIN: in voice handicap index (VHI) and breathiness after TLM-cordectomy. Statistically significant changes, NNL: voice range profile (voice range area, intensity range, and frequency range) and VHI after TLM-cordectomy. All group-wise changes were to less disordered voices. Previous smokers had the largest decreases in VHI and breathiness. Patients with baseline VHI scores >65 had smaller increases in VHI, however 13-19% of the patients had increases in VHI above the clinically relevant threshold after TLM-cordectomy. CONCLUSION: Overall, TLM-cordectomy in patients with LIN and NNL improved vocal outcome and our study thus supports the current Danish treatment strategy and improves the basis for proper patient advice. Multi-dimensional voice assessment is suggested preoperatively and six-nine months postoperatively, with focus on individual vocal differences and voice demands.

The Voice-Related Quality of Life (V-RQOL) Instrument: Cross-Cultural Translation and Test of Validity and Reliability of the Danish Version.

OBJECTIVES: To translate the voice-related quality of life (V-RQOL) questionnaire into Danish and to test the validity and reliability of this Danish version of the V-RQOL instrument. METHODS: The translation process was done using forward and backward translation followed by pretesting interviews, performed on 21 participants. The final Danish version was then tested for validity and reliability on 80 cases with voice disorders and 21 controls without voice disorders. RESULTS: The Danish version proved to be valid and reliable. Validity was confirmed by convergent and discriminant validity, known-groups validity, clinical validity (Spearman correlation coefficient 0.64), confirmatory factor analysis, and Rasch analysis. The instrument showed no ceiling effects, but all items and the Social-Emotional domain showed substantial floor effects. The item-total correlations were all high (0.58-0.82) and none of the interitem correlations were low. Reliability was confirmed with regard to internal reliability (Cronbach's alpha 0.92) and test-retest reliability (interclass correlation coefficient 0.89). CONCLUSION: Our study shows that the Danish translation of the V-RQOL questionnaire is a valid and reliable instrument suitable for the assessment of the dysphonic patient. The high floor effects, however, indicate that minor differences in voice problems between patients may not be captured in the lower end of the scale with regard to the individual item and the Social-Emotional domain.

Auditory-Perceptual Evaluation of Dysphonia: A Comparison Between Narrow and Broad Terminology Systems.

OBJECTIVE: In auditory-perceptual voice analysis, a multiparameter approach and a more reductionist approach may be compared with narrow and broad phonetic transcription and used interchangeably, depending on the purpose. The aim of this study was to investigate the perspectives of a translation of the terminology used in the multiparameter Danish Dysphonia Assessment (DDA) approach into the five-parameter GRBAS system. METHODS: Voice samples illustrating type and grade of the voice qualities included in DDA were rated by five speech language pathologists using the GRBAS system with the aim of estimating inter- and intrarater reliability. The same samples were then rated using the DDA terminology. RESULTS: Both inter- and intrarater reliability were found to be very high for the GRBAS parameters grade, rough, and breathy, but somewhat lower for asthenic and strained. Further, strong and clear associations were found between the DDA and GRBAS rating for grade, rough, breathy, and strained, whereas the relation between DDA ratings and asthenic was weaker and less clear. CONCLUSION: The data strongly support that the DDA system can be translated into the GRBAS system for auditory-perceptual voice analysis. The consensus discussion prior to the listening test is believed to have contributed to the high degree of inter- and intrarater reliability. We suggest for future use of the GRBAS system that rater reliability for asthenic and strained can increase, if these parameters are defined as behavioral terms and antagonists, reflecting muscular hypo- and hyperfunction.

VoiceRelease.

VoiceRelease is a progressively structured treatment system that aims to release the voice through muscle tension reduction by manual therapy, thereby facilitating healthy voice production. The VoiceRelease treatment should closely interact with functional voice training and should therefore be carried out by the speech-language therapist (SLT). The aim of this paper is not to present the treatment in detail, but to describe the benefits of using the techniques in the voice clinic and to argue that laryngeal manual therapy complements the skills of the SLT and that it in a natural and integrated way applies to the treatment of voice problems. In order to comply with the present skills of the SLT, VoiceRelease is progressively structured in four levels.