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The Medical Clinics of North America Sep 2021Hoarseness is a common problem, typically of transient nature. When hoarseness does not resolve, or when it is associated with concerning symptoms, it is important to... (Review)
Review
Hoarseness is a common problem, typically of transient nature. When hoarseness does not resolve, or when it is associated with concerning symptoms, it is important to consider a wide differential and refer to an otolaryngologist. This article discusses the physiology of the voice and possible causes of dysphonia, and explores when it warrants further work-up by ENT. A discussion of diagnostic techniques and the myriad of tools to treat hoarseness follows. Additionally, the role of reflux in dysphonia is examined with a critical eye to aid in accurate assessment of the patient's complaint.
Topics: Diagnosis, Differential; Dysphonia; Hoarseness; Humans; Laryngoscopy; Primary Health Care
PubMed: 34391543
DOI: 10.1016/j.mcna.2021.05.012 -
Pediatric Clinics of North America Apr 2022Pediatric voice disorders are increasing being noted as a barrier to success in school and socialization. Significant advances over the past decade in evaluation,... (Review)
Review
Pediatric voice disorders are increasing being noted as a barrier to success in school and socialization. Significant advances over the past decade in evaluation, diagnosis, and management of pediatric voice disorders have improved both short-term and long-term outcomes. Practitioners should have a thorough understanding of anatomy and physiology, accurately work up a pediatric voice disorder, and efficiently treat voice disorders. Comprehensive voice evaluation in children is essential to properly assessing pediatric dysphonia. Diagnosis and treatment are best managed by a multidisciplinary team. Accurate diagnosis allows for effective treatment, which includes voice therapy, medical therapy, and surgical intervention as needed.
Topics: Child; Dysphonia; Hoarseness; Humans; Treatment Outcome
PubMed: 35337543
DOI: 10.1016/j.pcl.2022.01.003 -
Otolaryngologic Clinics of North America Aug 2019Sulcus vocalis, defined as a type of groove along the free edge of the vocal fold, disrupts the normal, pliable vocal fold cover, causing alterations in the intrinsic... (Review)
Review
Sulcus vocalis, defined as a type of groove along the free edge of the vocal fold, disrupts the normal, pliable vocal fold cover, causing alterations in the intrinsic mucosal wave. The primary symptom is breathy, effortful dysphonia. Diagnosis may be challenging, and this classically has led to difficulties with identification and management. Treatment options, although often promising, have been notoriously unreliable. Current understanding, considerations for management, and future treatment options are explored.
Topics: Diagnosis, Differential; Dysphonia; Glottis; Humans; Laryngeal Mucosa; Otorhinolaryngologic Surgical Procedures; Plastic Surgery Procedures; Secondary Prevention; Stroboscopy; Vocal Cords
PubMed: 31088694
DOI: 10.1016/j.otc.2019.03.016 -
Ugeskrift For Laeger May 2023Laryngeal dystonia (LD) is a rare neurological disorder emerging in middle-aged persons as a chronic and disabling voice disorder. It is a focal dystonia affecting... (Review)
Review
Laryngeal dystonia (LD) is a rare neurological disorder emerging in middle-aged persons as a chronic and disabling voice disorder. It is a focal dystonia affecting intrinsic laryngeal muscle control only during speech, resulting in voice breaks, effortful phonation, and strangled voice. Due to lack of awareness and lack of well-defined diagnostic criteria, it can be difficult for patients to be diagnosed and treated. This review, the first Danish publication on the subject of LD, presents the latest terminology, a brief history, treatment options and the psychosocial consequences of LD.
Topics: Middle Aged; Humans; Dystonia; Dysphonia; Laryngeal Muscles; Electromyography
PubMed: 37264860
DOI: No ID Found -
Vestnik Otorinolaringologii 2020Drug-induced dysphonia is a non-life-threatening adverse drug reaction, however, this complication can significantly worsen the quality of life of patients, especially...
Drug-induced dysphonia is a non-life-threatening adverse drug reaction, however, this complication can significantly worsen the quality of life of patients, especially those in voice-speaking professions. The aim of the work was to search for information about the prevalence, etiology, pathogenesis, and features of treatment and prevention of drug-induced dysphonia. In the case of some drugs, the true prevalence may be higher than described in the literature, due to the fact that dysphonia is in most cases mild, reversible and, in comparison with other undesirable drug reactions, rarely attracts the attention of both the patient and practitioners.
Topics: Dysphonia; Hoarseness; Humans; Pharmaceutical Preparations; Quality of Life; Voice Quality
PubMed: 33474922
DOI: 10.17116/otorino20208506171 -
Advances in Oto-rhino-laryngology 2020Spasmodic dysphonia (SD) is a rare focal laryngeal dystonia. It is characterized by task-specific voice dysfluency resulting from selective intrinsic laryngeal... (Review)
Review
Spasmodic dysphonia (SD) is a rare focal laryngeal dystonia. It is characterized by task-specific voice dysfluency resulting from selective intrinsic laryngeal musculature hyperfunction. Symptoms may be attenuated by a sensory trick. Although SD can be seen at times in generalized dystonia syndromes, it is typically a sporadic phenomenon. Involvement of the laryngeal adductor muscles is more common than abductor muscles. The standard treatment of this disorder is with botulinum toxin injection, usually electromyography-guided, which must be repeated periodically as the toxin wears off. A number of non-reversible surgical procedures have also been described to mitigate the symptoms. Other treatment modalities are under investigation, including implantable electrical stimulation devices and deep brain stimulation.
Topics: Botulinum Toxins, Type A; Dysphonia; Electric Stimulation Therapy; Electromyography; Humans; Laryngeal Muscles; Neuromuscular Agents; Spasm
PubMed: 33166970
DOI: 10.1159/000456693 -
Brain and Nerve = Shinkei Kenkyu No... Jan 2023Spasmodic dysphonia (SD) is a chronic voice disorder characterized by excessive or inappropriate contraction of laryngeal muscles during speech. SD manifests as...
Spasmodic dysphonia (SD) is a chronic voice disorder characterized by excessive or inappropriate contraction of laryngeal muscles during speech. SD manifests as excessive glottic closure (adductor type) or sudden opening of the vocal folds (abductor type). Strained or strangled voice is the main symptom of adductor type SD, while abductor type SD presents with a breathy or absent voice. Adductor type SD accounts for 97% of all SD cases and 70% display abnormal contractions of extra laryngeal muscles. SD is currently understood to be a focal dystonia of inner laryngeal muscle during speech. Injection of botulinum toxin into laryngeal muscles is the primary treatment for SD, similar to other dystonia diseases. As the effects of botulinum toxin last for around three months, patients need repeated injections. There are two kind of surgical procedures which aim to achieve permanent emission, namely type 2 thyroplasty (TP2) and bilateral thyroarytenoid muscle myectomy (TAM). Both of these are effective and over 50% of patients can become symptom-free. However, in some cases, patient voices can become breathy and pitch ranges are reduced. For abductor type SD, there are no effective treatments apart from botulinum toxin injections into posterior cricoarytenoid muscles which open the vocal folds.
Topics: Humans; Dysphonia; Laryngeal Muscles; Botulinum Toxins; Treatment Outcome; Speech
PubMed: 36574969
DOI: 10.11477/mf.1416202274 -
HNO Jan 2022Prolonged ulcerative laryngitis is a rare, benign inflammatory alteration of the larynx that persists for months. The laryngoscopic findings suggest a malignant... (Review)
Review
BACKGROUND
Prolonged ulcerative laryngitis is a rare, benign inflammatory alteration of the larynx that persists for months. The laryngoscopic findings suggest a malignant process and can therefore be a challenge for the treating ear, nose and throat (ENT) physician.
OBJECTIVES
Presentation of the current database to provide an overview of the etiology, progress and treatment for everyday clinical practice.
METHODS
Three case studies from the Department of Phoniatrics and Speech Pathology of the ENT Department, University Hospital Zurich, Switzerland, are presented. Analysis and discussion of the current literature base and of case reports in the English literature.
RESULTS
The etiology and predisposing factors for this disease are unclear. Previous respiratory infection with cough and dysphonia seems to be the most common cause. Biopsies should be avoided.
CONCLUSIONS
The typical laryngoscopic findings show corresponding circumscribed lancet-shaped ulcerations in the middle third of the vocal fold. The course of the disease appears to be self-limiting and without permanent structural consequences. Therefore, good patient education and close laryngoscopic follow-up should be performed.
Topics: Dysphonia; Hoarseness; Humans; Laryngitis; Laryngoscopy; Vocal Cords
PubMed: 34170335
DOI: 10.1007/s00106-021-01079-0 -
Clinical Pediatrics Oct 2023The reported prevalence of voice disorders in the pediatric population varies widely between studies, ranging from 3.9% to 23%. Despite this, not all children with...
The reported prevalence of voice disorders in the pediatric population varies widely between studies, ranging from 3.9% to 23%. Despite this, not all children with dysphonia are referred to a voice specialist for further evaluation. The objective of this study is to examine the relationship between dysphonia history, voice assessment, and laryngeal findings to help guide referrals of dysphonic children. A retrospective review was conducted of pediatric patients at a tertiary voice clinic between January 2014 and December 2017. Data including dates of presentation, demographics, co-morbidities, presenting symptoms, laryngeal exam findings, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores, and Pediatric Voice Handicap Index (pVHI) scores were collected and analyzed. Of 475 patients initially identified, 459 met inclusion criteria and were reviewed. In all, 272 (59.3%) were male and 187 (40.7%) were female. Mean age at first presentation was 8.6 years old (range: 2-18). Males were more likely to present at a younger age than females. CAPE-V data were available for 439 patients, and pVHI data were available for 109 patients. The mean CAPE-V Overall Severity score was 38.2. The mean total pVHI score was 25.4. Males had higher CAPE-V Overall Severity (40.0 vs. 35.4), Roughness (32.2 vs. 27.6), and Strain scores (37.2 vs. 32.4) than females. Patient pVHI scores did not differ by gender. In all, 283 patients self-reported a length of symptoms prior to evaluation. Children with a longer duration of symptoms prior to evaluation had higher CAPE-V Overall Severity scores. Diagnoses of vocal fold movement impairment and benign vocal fold lesions that were not nodules were associated with higher average CAPE-V Overall Severity scores. Overall, 310 patients (67.5%) were recommended intervention for their dysphonia. These patients had higher CAPE-V Overall Severity scores than those who were solely recommended observation (42.8 vs. 28.0). Males were more likely than females to present with dysphonia and presented with more severe perceptual dysphonia scores on average. The length of symptoms and certain diagnoses correlated with higher CAPE-V Scores. Referrals to a pediatric voice clinic should be considered in patients with a dysphonia history lasting greater than 3 months and in patients with more severe symptoms.
Topics: Child; Humans; Male; Female; Child, Preschool; Adolescent; Dysphonia; Voice Quality; Retrospective Studies; Self Report; Severity of Illness Index
PubMed: 36856137
DOI: 10.1177/00099228231157957 -
Cleveland Clinic Journal of Medicine Aug 2023The terms hoarseness and dysphonia are used interchangeably, and both describe a type of altered vocal quality affecting one-third of patients. While hoarseness may be... (Review)
Review
The terms hoarseness and dysphonia are used interchangeably, and both describe a type of altered vocal quality affecting one-third of patients. While hoarseness may be secondary to benign conditions such as reflux or viral laryngitis, it may suggest benign or malignant vocal-fold pathology. It is important for caregivers to know how to evaluate, treat, and when to refer patients for direct visualization via laryngoscopy. In this article, we review basic laryngeal anatomy and function, symptoms of vocal-fold pathology, and current guidelines from the American Academy of Otolaryngology-Head and Neck Surgery on the diagnosis and treatment of dysphonia, including patient referral.
Topics: Humans; United States; Hoarseness; Dysphonia; Laryngitis; Gastroesophageal Reflux; Laryngoscopy
PubMed: 37527869
DOI: 10.3949/ccjm.90a.23010