Middle and inner ear malformations in two siblings exposed to valproic acid during pregnancy: a case report.

Valproic acid (VPA) is a known teratogenic drug. Exposure to VPA during the pregnancy can lead to a distinct facial appearance, a cluster of major and minor anomalies and developmental delay. In this case report, two siblings with fetal valproate syndrome and a mild conductive hearing loss were investigated. Radiologic evaluation showed middle and inner ear malformations in both children. Audiologic, vestibular and motor examination was performed. This is the first case report to describe middle and inner ear malformations in children exposed to VPA.

An examination of surface EMG for the assessment of muscle tension dysphonia.

OBJECTIVES: Muscle tension dysphonia (MTD) is the pathological condition in which an excessive tension of the (para)laryngeal musculature leads to a disturbed voice. Surface electromyography (sEMG) was used to investigate differences in extralaryngeal muscles' tension in patients with MTD compared with normal speakers. sEMG was examined as a diagnostic tool to differentiate between patients with MTD and controls. METHODS: Eighteen patients with MTD and 44 normal speakers were included in the study. All subjects were evaluated with videostroboscopy, voice assessment protocol, and sEMG. sEMG was performed on three locations of the anterior neck. Measurements were taken during silence, phonation tasks, and while reading, with comparisons made between both study groups. RESULTS: Patients with MTD did not express higher levels of sEMG during rest, phonation, or reading compared with normal speakers. There were no significant differences in sEMG values between males and females in both study groups. CONCLUSION: sEMG was not able to detect an increase in muscle tension in patients with MTD. The results of this study do not support the use of sEMG as a diagnostic tool for distinguishing patients with and without MTD. Clinical examination with laryngeal palpation, videostroboscopy, and dysphonia severity index remain the key investigations.

Voice disorders in teachers: occupational risk factors and psycho-emotional factors.

BACKGROUND: Teaching is a high-risk occupation for developing voice disorders. The purpose of this study was to investigate previously described vocal risk factors as well as to identify new risk factors related to both the personal life of the teacher (fluid intake, voice-demanding activities, family history of voice disorders, and children at home) and to environmental factors (temperature changes, chalk use, presence of curtains, carpet, or air-conditioning, acoustics in the classroom, and noise in and outside the classroom). METHODS: The study group comprised 994 teachers (response rate 46.6%). All participants completed a questionnaire. Chi-square tests and logistic regression analyses were performed. RESULTS: A total of 51.2% (509/994) of the teachers presented with voice disorders. Women reported more voice disorders compared to men (56.4% versus 40.4%, P < 0.001). Vocal risk factors were a family history of voice disorders (P = 0.005), temperature changes in the classroom (P = 0.017), the number of pupils per classroom (P = 0.001), and noise level inside the classroom (P = 0.001). Teachers with voice disorders presented a higher level of psychological distress (P < 0.001) compared to teachers without voice problems. CONCLUSION: Voice disorders are frequent among teachers, especially in female teachers. The results of this study emphasize that multiple factors are involved in the development of voice disorders.

UES pressure during phonation using high-resolution manometry and 24-h dual-probe pH-metry in patients with muscle tension dysphonia.

Muscle tension dysphonia (MTD) is the pathological condition in which excessive tension of the (para)laryngeal musculature leads to a disturbed voice. This study was developed to investigate if differences in pressure in the upper esophageal sphincter (UES) were present in patients with MTD in comparison with normal speakers. Concurrently, all patients were screened for gastroesophageal reflux disease (GERD) as an associated cause or aggravating factor in MTD. The study's design was a prospective case-control study. Fourteen patients with MTD (mean age = 40.2 years, range = 22-62 years) and 14 adult controls (mean age = 33.9 years, range = 23-58 years) were studied. A water-perfusion assembly with 22 sensors was positioned to record pressures during phonation. The mean values of the phonation pressures at the UES were measured. All patients underwent a dual-probe 24-h ambulatory pH impedance in order to measure the pH and the height of the refluxes from the lower esophageal sphincter to the hypopharynx. There were no significant differences in the UES pressures of patients with MTD compared to those of normal speakers during phonation tasks and reading. Two patients were identified with GERD. In these patients the refluxate reached the UES but this did not influence the UES pressures. We conclude that this study was not able to detect differences in phonation-induced UES pressures between patients with MTD and normal speakers using a standard water-perfusion high-resolution manometry assembly. Future investigation should be focused on developing probes with closely spaced sensors in the hypopharynx and the esophagus in order to investigate if differences in UES pressures in these study populations are present.

Pathophysiology and treatment of muscle tension dysphonia: a review of the current knowledge.

OBJECTIVE: Muscle tension dysphonia (MTD) is a clinical and diagnostic term describing a spectrum of disturbed vocal fold behavior caused by increased tension of the (para)laryngeal musculature. Recent knowledge introduced MTD as a bridge between functional and organic disorders. This review addresses the causal and contributing factors of MTD and evaluates the different treatment options. METHODS: We searched MEDLINE (Pubmed, 1950-2009) and CENTRAL (The Cochrane Library, Issue 2, 2009). Studies were included if they reviewed the classification of functional dysphonia or the pathophysiology of MTD. Etiology and pathophysiology of MTD and circumlaryngeal manual therapy (CMT) were obligatory based on reviews and prospective cohort studies because randomized controlled trials (RCTs) are nonexisting. Concerning the treatment options of voice therapy and vocal hygiene, selection was based on RCTs and systematic reviews. RESULTS: Etiological factors can be categorized into three new subgroups: (1) psychological and/or personality factors, (2) vocal misuse and abuse, and (3) compensation for underlying disease. The effective treatment options for MTD are (1) indirect therapy: vocal hygiene and patient education; (2) direct therapy: voice therapy and CMT; (3) medical treatment; and (4) surgery for secondary organic lesions. CONCLUSIONS: MTD is the pathological condition in which an excessive tension of the (para)laryngeal musculature, caused by a diverse number of etiological factors, leads to a disturbed voice. Etiological factors range from psychological/personality disorders and vocal misuse/abuse to compensatory vocal habits in case of laryngopharyngeal reflux, upper airway infections, and organic lesions. MTD needs to be approached in a multidisciplinary setting where close cooperation between a laryngologist and a speech language pathologist is possible.

The impact of voice disorders among teachers: vocal complaints, treatment-seeking behavior, knowledge of vocal care, and voice-related absenteeism.

OBJECTIVES: Teachers are at increased risk for developing voice disorders. Occupational risk factors have been extensively examined; however, little attention has been paid to the consequences of the vocal complaints. The objective of this study was to investigate the knowledge that teachers have about vocal care, treatment-seeking behavior, and voice-related absenteeism. METHODS: The study group comprised 994 teachers and 290 controls whose jobs did not involve vocal effort. All participants completed a questionnaire inquiring about vocal complaints, treatment-seeking behavior, voice-related absenteeism, and knowledge about vocal care. Comparisons were made between teachers with and without vocal complaints and with the control group. RESULTS: Teachers reported significantly more voice problems than the control population (51.2% vs. 27.4%) (χ2=50.45, df=1, P<0.001). Female teachers reported significantly higher levels of voice disorders than their male colleagues (38% vs 13.2%, χ2=22.34, df=1, P<0.001). Teachers (25.4%) sought medical care and eventually 20.6% had missed at least 1 day of work because of voice problems. Female teachers were significantly more likely to seek medical help (χ2=7.24, df=1, P=0.007) and to stay at home (χ2=7.10, df=1, P=0.008) in comparison with their male colleagues. Only 13.5% of all teachers received information during their education. CONCLUSIONS: Voice disorders have an impact on teachers' personal and professional life and imply a major financial burden for society. A substantial number of teachers needed medical help and was obligated to stay at home because of voice problems. This study strongly recommends the implementation of vocal education during the training of teacher students to prepare the vocal professional user.

The prevalence of laryngeal pathology in a treatment-seeking population with dysphonia.

OBJECTIVES/HYPOTHESIS: This article describes the prevalence of laryngeal pathology in a treatment-seeking population with dysphonia in the Flemish part of Belgium. STUDY DESIGN: Retrospective investigation. METHODS: During a period of 5 years (2004-2008), data were collected from 882 patients who consulted with dysphonia at the ear, nose, and throat department of the University Hospital in Ghent (Belgium). Laryngeal pathology was diagnosed using videostroboscopy. Ages ranged from 4 years to 90 years. RESULTS: Functional voice disorders were most frequently diagnosed (30%), followed by vocal fold nodule (15%), and pharyngolaryngeal reflux (9%). The role of age, gender, and occupation was investigated. Pathologies were significantly more common in females than in males, representing 63.8% and 36.2% of the population, respectively. Professional voice users accounted for 41% of the workforce population, with teachers as main subgroup. In professional voice users, functional dysphonia occurred in 41%, vocal fold nodules in 15%, and pharyngolaryngeal reflux in 11%. Our data were compared with data from other countries. CONCLUSIONS: Functional voice disorders were overall the most common cause of voice disorders (except in childhood), followed by vocal fold nodules and pharyngolaryngeal reflux. Professional voice users accounted for almost one half of the active population, with functional voice disorders as the main cause of dysphonia.