Long-term Results of 18 Fat Injections in Unilateral Vocal Fold Paralysis.

OBJECTIVE: The purposes of this study were to assess the long-term efficacy of medialization laryngoplasty via injection of autologous fat in patients with unilateral laryngeal paralysis, and to discuss the results based on the volume of fat injected and the size of the initial glottic gap. STUDY DESIGN: This was a retrospective study with clinical reevaluation of 18 patients treated for unilateral laryngeal paralysis at Liège University Hospital between April 1, 2011, and December 1, 2014. METHOD: The voice examination included subjective scales (GRBAS and the Voice Handicap Index), a report on acoustic and aerodynamic voice parameters, and laryngostroboscopic assessment of glottic closure and mucosal wave (T0: preoperative; T1: immediate postoperative; T2: >1 year). RESULTS: The median follow-up duration was 19 months. We observed a significant improvement in maximum phonation time; mean flow rate; jitter; the Voice Handicap Index; the G, R, B, and A subscales of the GRBAS-I; and glottic closure at T1. These parameters remained stable over time, without any significant difference except for shimmer and glottic closure between T1 and T2. Regardless of the volume of fat injected and the magnitude of the initial glottic gap, we did not see any significant difference from one assessment time to another. CONCLUSION: Medialization laryngoplasty by means of the injection of autologous fat is a safe, effective surgical technique for patients with unilateral laryngeal paralysis regardless of the size of the initial glottic gap. The results are maintained longer than 1 year, and no evidence of significant resorption of the fat was found in our study over a period of 12-58 months. The volume of fat injected does not seem to affect the functional results.

[Reliability and Validity of the "Voice Handicap Index (VHI) Adapted to the Singing Voice"]. / Reliabilität und Validität des "Voice Handicap Index (VHI) adaptiert an die Gesangsstimme".

BACKGROUND: The Voice Handicap Index (i. e., VHI) is one of the most reliable standardized self-evaluation assessments in diagnosis of voice disorders. That tool is the most used in daily clinic. In 2007, the VHI was adapted to the singing population, called 'VHI adapté aux chanteurs'. The aim of our study was to investigate the reliability and validity of the German version of the VHI adapted to the singing voice. MATERIALS AND METHODS: 113 German singers (41 males and 72 females) with diverse singing styles and profession were included in the study. They were divided into 2 groups: a test-group (n=20) with self-perceived vocal complaints and a control-group (n=93) without vocal complaints. Statistical analysis to measure the reliability and validity was conducted with the Cronbach's alpha (i. e., Cron. α), independent t-test and receiver operating characteristics as well likelihood ratio, respectively. RESULTS: Reliability was confirmed by acceptable Cron. α (0.713-0.850) for each of the sub-scales and total score. The validity between the 2 groups showed high significant differences for each of the sub-scales and total score by which the test-group indicated higher scores than the control-group. Only the construct validity revealed no clear results. CONCLUSION: The VHI adapted to the singing voice is suited as reliable and valid standardized evaluation tool, but the diagnostic accuracy has to be investigated again because of too high inaccuracy in the interpretation of the outcome of the present data.

Subjective evaluation of the long-term efficacy of speech therapy on dysfunctional dysphonia.

The objective of the study was to measure the subjective long-term effects of vocal therapy (more than 6 months) in 29 patients suffering from dysfunctional dysphonia. Four subjective measurements were used: one visual analog scale ranging from 0 (not efficient at all) to 100 (very efficient); one question "Is the speech therapy still efficient?," answered by yes or no; the GRB parameters of the GRBAS scale (evaluated by the patient); and the VHI-10. The results show that 76% of the patients consider that the vocal therapy they received is still efficient. On the vocal quality (G), roughness (R), and breathiness (B) parameters, we observe a high degree of satisfaction on the G parameter (median=77). The scores on the R and B parameters are lower (median R=12, S=5). Roughness is significantly correlated to the Grade (Spearman coefficient r=0.516, P=0.004), whereas breathiness is not (P=0.251, NS). The comparison of the results on the VHI-10 pre and post treatment shows a significant decrease in the grade of perceived handicap (medians 15 vs 11, P=0.017). The correlations between the judgment of the treatment's efficacy and the vocal quality is significant (r=0.623, P<0.001) as well as the correlation between the VHI-10 and the length of the treatment (r=0.416, P=0.035). The conclusion can be made that speech therapy plays an important role in long-term treatment of dysfunctional dysphonias.

[Voice handicap index adapted to the singing voice]. / Adaptation du voice handicap index à la voix chantée.

OBJECTIVE: The present study is the outcome of 5 former studies aiming at adapting the V.H.I. to singers. We propose in this last version a V.H.I. valid for all types of singers, dysodic or not. MATERIAL AND METHODS: The reliability, validity and internal coherence were evaluated on a population of 192 classical singers and 27 non singers. RESULTS: The comparison of the mean scores at the test and the retest shows that the results at the retest are significantly inferior in both the functional scale (p= 0.013) and the global score (p= 0.006). The test/re-test stability is good (ICC: Functional scale (F): 0.869, Emotional scale (E): 0.846, Physical scale (P): 0.85, Global score (G): 0.878/ Spearman's rho F: 0.855, E: 0.834, P: 0.858, G: 0.886). The internal coherence of each sub scale is good (Cronbach's alpha: > 0.80). The correlation between the 3 subscales is quite high (FvsE: 0,613 /EvsP: 0,737/ FvsP: 0,693) which means that each scale measures a specific dimension but that they are still homogeneous. The test/re-test difference between the singers and the controls are not significant but the control group has a greater variability in their answers (Levene test: F: p<0.001; P: p= 0.009; G: p= 0.02). Three variables increase the results: being a solist (F: p= 0.046; E: p= 0.002; P: p= 0.056; G: p= 0.006), being an amateur (F: p< 0.001; E: p= 0.019; P: p< 0.001; G: p= 0.001), having a vocal complaint (F, E, P et G: p< 0.001). CONCLUSION: This version of the V.H.I. is reliable, valid and adapted to the population of classical singers.

[A proposal to adapt the voice handicap index to the singing voice]. / Proposition d'adaptation du Voice Handicap Index à la voix chantée.

OBJECTIVES: The voice handicap index by Jacobson et al doesn't render the difficulties experienced by singers. The aim of this study is to adapt the V.H.I. to the singing voice and evaluate it's reliability and coherence. In order to obtain this first scale, we went through three stages. MATERIAL ET METHOD: The first consisted in the modification of the existing items and the creation of new ones. The second was to measure the stability by a test - retest and the coherence of the adapted and the new items. This was done on groups of dysodic singers and professional voice users. The third stage consisted in evaluating the reliability and the coherence of 31 items on a homogeneous population of 132 classical singers with and without vocal impairment. The subjects were divided in three groups. The first group was composed of 95 normophonic singers, the second included 37 dysphonic singers and the third group was the control group, composed of 20 non singers without vocal complaints. RESULTS: The statistical results show a good stability of the test - retest (ICC=0.949; Rho: 0.912; Bland et Altman [-010.19, +13.23]). The internal coherence of each sub scale (Cronbach's alpha) is good (>0.70). The correlations between the three sub scales are moderate between the functional and the emotional sub scale: 0.58; between the emotional and the physical: 0.64; and between the functional and the physical: 0.78). Each sub scale is measuring a specific dimension; still they are homogeneous between one another. Four variables have a significative influence on the results: the pathology (p<0.001), being a professional singer (p<0.001), the repetition (p=0.003), being a chorister (p=0.002). CONCLUSION: The VH.I adapted to the singers, appears to be reliable, valid and adapted to the population of dysodic classical singers.

Comparison between the GIRBAS Scale and the Acoustic and Aerodynamic Measures Provided by EVA for the Assessment of Dysphonia following Unilateral Vocal Fold Paralysis.

The aim of this study is to establish relevant objective parameters for evaluating dysphonia following unilateral vocal fold paralysis. To do so, the study compares objective and perceptual voice measures. The objective measures were obtained using a voice analysis software (Evaluation Vocale Assistée), whereas the perceptual measures were established with the GIRBAS Scale (grade, instability, roughness, breathiness, asthenia, and strain). All measurements were performed on 40 voice samples: 28 dysphonic subjects with unilateral laryngeal paralysis, and 12 control subjects. The intra- and inter-judge agreements were fairly good, at least for control subjects. The six GIRBAS measures obtained from the pathological voices were higher than those from the control voices (p < 0.001) and the correlation between both groups was good. Grade, breathiness and asthenia correlated with the objective parameters that express the aperiodicity of the phonatory signal (p < 0.01), namely, the coefficient of variability of the fundamental frequency, the coefficient of variability of intensity, and jitter. Our findings suggest that the perceptual reality of laryngeal paralysis-induced dysphonia depends more on grade, breathiness and asthenia than it does on roughness or instability.

A study of vibrato: assessment by panel of judges compared to spectral voice analysis.

Experts in voice singing and voice training were asked to judge the vibrato of 30 singers (4 samples per singer: a sung [a] held without vibrato; a sung a[ held with vibrato; a self-selected passage and an imposed passage. In the first part, they ticked the type of oscillations (vibrato, straight tone, tremolo, quivering...). In the second part, they appraised various criteria. Intra-judge and inter-judge consistencies were determined. The subjective parameters were thereafter correlated with the measurements of six parameters of the MDVP (MultiDimentional Voice Program). The measurements were carried out on each task. Intra-judge consistency was good for only one judge (67-87% consistency). Since judge 2 and 3 were hardly reproducible (45-73%; 28-57%) measurement of the inter-judge consistency was pointless. The results of judge 1 were correlated with the Fundamental Tremor Frequency Index, the jitter and the shimmer.

High-resolution frequency analysis as applied to the singing voice.

We have applied high-resolution vocal frequent analysis to a population of singing voices. Two important elements have become apparent: (1) Confirmation that the singing formant originates in the resonators. This is observed especially on a low fundamental, and it is acquired through technical skill and experience. (2) Observation of the vibrato, which, isolated from the clinical study, regarding only its graphic presentation, could have been interpreted as 'abnormal'.