-
Scandinavian Journal of Pain Apr 2010Introduction Trismus, or limited mouth opening, is a well-known complication of head and neck cancer and its treatment. It may be caused by tumour infiltration into the...
Introduction Trismus, or limited mouth opening, is a well-known complication of head and neck cancer and its treatment. It may be caused by tumour infiltration into the masticatory muscles or by treatment like surgery and radiotherapy. A limited mouth opening may have a negative effect on nutrition, phonation, dental hygiene and treatment, and quality of life. The severity of this complication depends on the location of the tumour, the type of reconstruction, the total radiation dose, fractionation, and treatment techniques. If there is no intervention, these changes may be progressive and persist for life. There are no specific treatments for trismus. Current strategies emphasize prevention and, in instances of existing trismus, collaboration between health care professionals to establish pain control, prevent the progression of trismus, and restore function. The prevalence of trismus in head and neck cancer patients ranges from 5% to 38%. Despite numerous studies, reliable data on the aetiology of trismus and appropriate treatment for it are scarce. Case report We describe a patient with squamous cell carcinoma of the oropharynx who developed trismus after surgery and radiotherapy. A multidisciplinary treatment strategy including analgesics, regional blocks, hyperbaric oxygenation therapy, external dynamic bite opener and physiotherapy, increased the mouth opening from 5 mm to 22 mm, however, the patient still suffered from xerostomia and had problems with intake of solid food. Material and methods A systematic literature search (starting January 1., 1980, and ending June 1., 2009) was performed to identify evidence-based interventions for the treatment of trismus in head and neck cancer patients. A total of 244 articles were identified from the databases. Of these, eight were excluded because of the absence of an English abstract and 214 were excluded because they were of marginal relevance to the inclusion criteria. The remaining 22 articles were evaluated independently by two experts using the Scottish Inter-collegiate Guidelines Network criteria for quality and evidence. Results There were few studies of good methodological quality on this topic. Two systematic reviews and two RCTs were identified. The other reports involved cohorts, case series, and expert opinions. Discussion Evidence in the form of clinical studies on therapeutic interventions is scarce. Numerous pharmacological treatment modalities have been described, but few are supported by the results of comparative trials involving control groups. Few studies have documented therapeutic effects for longer than a year. Better evidence was found for non-pharmacological methods, especially for physical therapy with passive and active stretching exercises, an important first-line strategy. The interincisal distance criterion for trismus varies between authors from 15 to 40 mm, which renders comparison between studies difficult. The absence of a standardized assessment protocol may also have contributed to variation between studies. An interincisal distance of 35 mm has been proposed as a definition of trismus. Explicit and precise treatment algorithms could not be established based on the available literature. However, a coordinated multidisciplinary approach in order to estimate and understand patient dysfunction is recommended; a systematic treatment plan should result in good symptom control and patient care. Prevention of trismus is more desirable than treatment for trismus.
PubMed: 29913945
DOI: 10.1016/j.sjpain.2010.01.006 -
The Cochrane Database of Systematic... Oct 2021Inability to communicate in a manner that can be understood causes extreme distress for people requiring an artificial airway and has implications for care quality and... (Review)
Review
BACKGROUND
Inability to communicate in a manner that can be understood causes extreme distress for people requiring an artificial airway and has implications for care quality and patient safety. Options for aided communication include non-vocal, speech-generating, and voice-enabling aids.
OBJECTIVES
To assess effectiveness of communication aids for people requiring an artificial airway (endotracheal or tracheostomy tube), defined as the proportion of people able to: use a non-vocal communication aid to communicate at least one symptom, need, or preference; or use a voice-enabling communication aid to phonate to produce at least one intelligible word. To assess time to communication/phonation; perceptions of communication; communication quality/success; quality of life; psychological distress; length of stay and costs; and adverse events.
SEARCH METHODS
We searched the Cochrane Library (Wiley version), MEDLINE (OvidSP), Embase (OvidSP), three other databases, and grey literature from inception to 30 July 2020.
SELECTION CRITERIA
We included randomised controlled trials (RCTs), quasi-RCTs, cluster-RCTs, controlled non-randomised parallel group, and before-after studies evaluating communication aids used in adults with an artificial airway.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures recommended by Cochrane. Two review authors independently performed data extraction and assessment of risk of bias.
MAIN RESULTS
We included 11 studies (1931 participants) conducted in intensive care units (ICUs). Eight evaluated non-vocal communication aids and three voice-enabling aids. Usual care was the comparator for all. For six studies, this comprised no aid; usual care in the remaining five studies comprised use of various communication aids. Overall, our confidence in results regarding effectiveness of communication interventions was very low due to imprecision, measurement heterogeneity, inconsistency in results, and most studies at high or unclear risk of bias across multiple domains. No non-vocal aid studies reported our primary outcome. We are uncertain of the effects of early use of a voice-enabling aid compared to routine use on ability to phonate at least one intelligible word (risk ratio (RR) 3.03, 95% confidence interval (CI) 0.18 to 50.08; 2 studies; very low-certainty evidence). Compared to usual care without aids, we are uncertain about effects of a non-vocal aid (communication board) on patient satisfaction (standardised mean difference (SMD) 2.92, 95% CI 1.52 to 4.33; 4 studies; very low-certainty evidence). No studies of non-vocal aids reported quality of life. Low-certainty evidence from two studies suggests early use of a voice-enabling aid may have no effect on quality of life (MD 2.27, 95% CI -7.21 to 11.75). Conceptual differences in measures of psychological distress precluded data pooling; however, intervention arm participants reported less distress suggesting there might be benefit, but our certainty in the evidence is very low. Low-certainty evidence suggest voice-enabling aids have little or no effect on ICU length of stay; we were unable to determine effects of non-vocal aids. Three studies reported different adverse events (physical restraint use, bleeding following tracheostomy, and respiratory parameters indicating respiratory decompensation). Adverse event rates were similar between arms in all three studies. However, uncertainty remains as to any harm associated with communication aids.
AUTHORS' CONCLUSIONS
Due to a lack of high-quality studies, imprecision, inconsistency of results, and measurement heterogeneity, the evidence provides insufficient information to guide practice as to which communication aid is more appropriate and when to use them. Understanding effectiveness of communication aids would benefit from development of a core outcome measurement set.
Topics: Adult; Bias; Communication; Humans; Intensive Care Units; Quality of Life; Ventilators, Mechanical
PubMed: 34637143
DOI: 10.1002/14651858.CD013379.pub2 -
Scientific Reports Aug 2018A therapeutic decision in the treatment of Tis/T1a glottic carcinoma with radiotherapy (RT) or transoral laser surgery (TOS) is still an open issue. Oncologic outcome... (Comparative Study)
Comparative Study Meta-Analysis
A therapeutic decision in the treatment of Tis/T1a glottic carcinoma with radiotherapy (RT) or transoral laser surgery (TOS) is still an open issue. Oncologic outcome and voice quality may support the choice for the latter To conduct a systematic review and meta-analysis to compare oncologic and functional outcomes of TOS and RT as treatment options for Tis/T1a glottic cancer. Literature research on online databases was carried out. Potentially eligible articles were reviewed. Relevant articles were selected and evaluated. There was statistical significance favoring patients initially treated with TOS when it comes to overall survival, disease-specific survival and larynx preservation. No difference in local control was found. TMF, Jitter and Shimmmer measurements presented statistically significant results in favor of RT. Self-assessment of voice quality (VHI) and f0 showed no statistically significant differences. Maximum Phonation Time (MPT) had a better response to RT. There is a trend in favor of RT. Tis/T1a glottic cancer patients submitted to TOS had significant overall and disease specific survival and had fewer risks of having a total laryngectomy, when compared to the radiotherapy group. The self-assessment of voice quality and f0 did not show any difference; however, Jitter, Shimmer and MPT measurements favored radiotherapy.
Topics: Glottis; Humans; Laryngeal Neoplasms; Laser Therapy; Mouth; Radiotherapy; Treatment Outcome; Voice Quality
PubMed: 30093659
DOI: 10.1038/s41598-018-30218-x -
American Journal of Otolaryngology 2024In early glottic squamous cell carcinoma, similar results have been described in terms of disease control between transoral laser microsurgery (TLM) and radiation... (Meta-Analysis)
Meta-Analysis Comparative Study Review
PURPOSE
In early glottic squamous cell carcinoma, similar results have been described in terms of disease control between transoral laser microsurgery (TLM) and radiation therapy (RT). During the past two decades, several studies compared subjective vocal outcomes of exclusive RT with those of TLM, showing a trend towards improving results for TLM over time. However, the objective differences in terms of spectro-acoustic voice parameters between exclusive RT and TLM have been less frequently investigated. The aim of this systematic review with meta-analysis was to evaluate voice quality after TLM and RT treatment for early glottic carcinoma, based on acoustic analysis parameters including jitter, shimmer, noise to harmonic ratio, fundamental frequency and maximum phonation time.
MATERIAL AND METHODS
A search of the English published literature was conducted on the Pubmed, Scopus and Cochrane databases following PRISMA guidelines.
RESULTS
A total of 441 titles were retrieved from the search. After full-text screening and application of inclusion/exclusion criteria, 12 articles were included. We found no significant differences between TLM and RT treatment in the considered acoustic analysis parameters, except for Shimmer, with more favorable values reported in the RT group.
CONCLUSIONS
Considering the spread of the disease and expecting an improvement in long-term survival over time, well-designed and multicentric studies involving larger populations with a long-term follow up are mandatory to better assess objective voice outcomes in terms of spectro-acoustic voice parameters.
Topics: Humans; Laryngeal Neoplasms; Microsurgery; Glottis; Laser Therapy; Voice Quality; Neoplasm Staging; Treatment Outcome; Carcinoma, Squamous Cell; Speech Acoustics; Male
PubMed: 38579506
DOI: 10.1016/j.amjoto.2024.104272 -
Brazilian Journal of Otorhinolaryngology 2020There are no official diagnostic protocols for singing voice assessment. In this publication, on the basis of a literature review, standards for the singing voice... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
There are no official diagnostic protocols for singing voice assessment. In this publication, on the basis of a literature review, standards for the singing voice handicap index exclusively dedicated to voice disorders in singing have been given.
OBJECTIVE
The study aims to determine the normative values for the singing voice handicap index.
METHODS
The study is a systematic review and a meta-analysis. A systematic literature search was performed using PubMed to access relevant databases and to locate outcome studies. The "inclusion" criteria were as follows: English language, original papers and human studies retrospective and prospective papers, cross-sectional and case-control studies.
RESULTS
Eight articles were included for the final analysis. The normative value for the singing voice handicap index was 20.35 with a confidential range of 10.6-30.1 for a group of 729 healthy subjects whose voices were judged as normal, with an age range of 16-64 years.
CONCLUSION
The mean normative value of the singing voice handicap index was 20.35 with the confidence levels between 10.6 and 30.1.
Topics: Adolescent; Adult; Cross-Sectional Studies; Humans; Middle Aged; Prospective Studies; Retrospective Studies; Singing; Voice; Voice Disorders; Voice Quality; Young Adult
PubMed: 30846419
DOI: 10.1016/j.bjorl.2018.12.004 -
Journal of Clinical Medicine May 2023Vocal fold polyps (VFP) are a common cause of voice disorders and laryngeal discomfort. They are usually treated by behavioral voice therapy (VT) or phonosurgery, or a...
BACKGROUND
Vocal fold polyps (VFP) are a common cause of voice disorders and laryngeal discomfort. They are usually treated by behavioral voice therapy (VT) or phonosurgery, or a combination (CT) of both. However, the superiority of either of these treatments has not been clearly established.
METHODS
Three databases were searched from inception to October 2022 and a manual search was performed. All clinical trials of VFP treatment were included that reported at least auditory-perceptual judgment, aerodynamics, acoustics, and the patient-perceived handicap.
RESULTS
We identified 31 eligible studies (VT: n = 47-194; phonosurgery: n = 404-1039; CT: n = 237-350). All treatment approaches were highly effective, with large effect sizes ( > 0.8) and significant improvements in almost all voice parameters (-values < 0.05). Phonosurgery reduced roughness and NHR, and the emotional and functional subscales of the VHI-30 were the most compared to behavioral voice therapy and combined treatment (-values < 0.001). Combined treatment improved hoarseness, jitter, shimmer, MPT, and the physical subscale of the VHI-30 more than phonosurgery and behavioral voice therapy (-values < 0.001).
CONCLUSIONS
All three treatment approaches were effective in eliminating vocal fold polyps or their negative sequelae, with phonosurgery and combined treatment providing the greatest improvement. These results may inform future treatment decisions for patients with vocal fold polyps.
PubMed: 37240557
DOI: 10.3390/jcm12103451 -
European Journal of Pain (London,... Jan 2020Singing can have a range of health benefits; this paper reviews the evidence of the effects of group singing for chronic pain in people with long-term health conditions.
BACKGROUND AND OBJECTIVES
Singing can have a range of health benefits; this paper reviews the evidence of the effects of group singing for chronic pain in people with long-term health conditions.
DATABASE AND DATA TREATMENT
We searched for published peer-reviewed singing studies reporting pain measures (intensity, interference and depression) using major electronic databases (last search date 31 July 2018). After screening 123 full texts, 13 studies met the inclusion criteria: five randomized controlled trials (RCTs), seven non-RCTs and one qualitative study. Included studies were appraised using Downs and Black and the Critical Appraisals Skills Programme quality assessments.
RESULTS
Included studies reported differences in the type of singing intervention, long-term condition and pain measures. Due to the high heterogeneity, we conducted a narrative review. Singing interventions were found to reduce pain intensity in most studies, but there was more equivocal support for reducing pain interference and depression. Additionally, qualitative data synthesis identified three key linked and complementary themes: physical, psychological and social benefits.
CONCLUSION
Group singing appears to have the potential to reduce pain intensity, pain interference and depression; however, we conclude that there is only partial support for singing on some pain outcomes based on the limited available evidence of varied quality. Given the positive findings of qualitative studies, this review recommends that practitioners are encouraged to continue this work. More studies of better quality are needed. Future studies should adopt more robust methodology and report their singing intervention in details. Group singing may be an effective and safe approach for reducing persistent pain and depression in people with long-term health conditions.
SIGNIFICANCE
This systematic review assesses research evidence for the effectiveness of group singing on chronic pain in people with long-term health conditions. Narrative syntheses revealed that there is partial support for singing effects on some pain outcomes based on the limited available evidence of varied quality. Qualitative data provided additional support of physical, psychological and social benefits. The review highlights implications for practice and future studies.
Topics: Chronic Pain; Humans; Qualitative Research; Singing
PubMed: 31549451
DOI: 10.1002/ejp.1485 -
OncoTargets and Therapy 2017The voice quality assessment of laser surgery (LS) in comparison with radiotherapy (RT) remains uncertain in T1a glottic carcinoma treatment. This systematic review and...
BACKGROUND AND OBJECTIVES
The voice quality assessment of laser surgery (LS) in comparison with radiotherapy (RT) remains uncertain in T1a glottic carcinoma treatment. This systematic review and meta-analysis were conducted to compare the voice quality of the two treatments.
METHODS
Searches were conducted in PubMed, EMBASE, and Cochrane with the following index words: glotti*, layn*, vocal cord, vocal, surgery, cordectomy, laser, radiation, irradiation, radiotherapy, cancer, and carcinoma for relative studies that compared the voice quality between LS and RT. Random-effect models were used, and heterogeneity was assessed.
RESULTS
A total of 14 studies were included in the analysis, consisting of 1 randomized controlled trial, 1 prospective study, and 12 retrospective studies. RT has increased the maximum phonation time (MPT; mean difference [MD] =-1.89, 95% confidence interval [CI] =-3.66 to -0.11, =0.04) and decreased the fundamental frequency (MD =14.06, 95% CI =10.30-17.83, <0.00001) in comparison with LS. No statistical difference was observed between the two groups in terms of Voice Handicap Index, Jitter, Shimmer, and airflow rate.
CONCLUSION
RT may be a better choice for T1a glottic carcinoma treatment compared with LS because patients undergoing RT may have the advantage of increased MPT and decreased fundamental frequency. However, more multicenter, randomized, controlled trials are urgently needed to verify these differences.
PubMed: 28496338
DOI: 10.2147/OTT.S137210 -
Journal of Clinical Sleep Medicine :... Sep 2020To systematically survey the scientific literature concerning the effect of playing a wind instrument or singing on sleep, snoring, and/or obstructive sleep apnea. (Meta-Analysis)
Meta-Analysis
STUDY OBJECTIVES
To systematically survey the scientific literature concerning the effect of playing a wind instrument or singing on sleep, snoring, and/or obstructive sleep apnea.
METHODS
The PubMed, EMBASE, and Cochrane databases were searched up to December 2019. Observational studies and (Randomized) Controlled Clinical Trials that assessed sleep, snoring, or obstructive sleep apnea as clinical outcome or via a questionnaire were included. For the individual studies, the potential risk of bias was scored. Data between oral musicians and control participants were extracted. Descriptive analysis and meta-analysis were performed.
RESULTS
Six eligible studies (5 cross-sectional, 1 randomized controlled trial) were retrieved, with an estimated potential bias ranking from low to high. The sample sizes ranged from 25 to 1,105 participants. Descriptive analysis indicated that players of a double-reed instrument have a lower risk of obstructive sleep apnea and that singers snore less compared with control participants. Playing a didgeridoo showed a positive effect on apnea-hypopnea index, daytime sleepiness, and partner's rating for sleep disturbance. The descriptive analysis could not be substantiated in the meta-analysis. The magnitude of the effect was zero to small, and the generalizability was limited because of long (professional) rehearsal time or small sample size.
CONCLUSIONS
Playing a wind instrument and singing may have a small but positive effect on sleep disorders. Considering the practicality and investment of (rehearsal) time, didgeridoo and singing are the most promising interventions to reduce obstructive sleep apnea and snoring, respectively. However, the results of this review are based on few studies and the synthesis of the evidence is graded to have low certainty.
Topics: Cross-Sectional Studies; Humans; Singing; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Snoring
PubMed: 32536365
DOI: 10.5664/jcsm.8628 -
PloS One 2020It is widely believed that 'creaky voice' ('creak', 'vocal fry', 'glottal fry') is increasingly prevalent among some English speakers, particularly among young American...
BACKGROUND/AIM
It is widely believed that 'creaky voice' ('creak', 'vocal fry', 'glottal fry') is increasingly prevalent among some English speakers, particularly among young American women. Motivated by the widespread and cross-disciplinary interest in the phenomenon, this paper offers a systematic review of peer-reviewed research (up to January 2019) on the prevalence of creaky voice in varieties of English. The review aimed to understand whose and what speech has been studied, how creaky voice prevalence has been measured, and what the findings collectively reveal.
METHOD
Literature was located by searching four electronic databases (ProQuest, PubMed, SCOPUS, Web of Science) and the proceedings of two recurrent conferences ('ICPhS' and 'SST'). Studies were included if they reported the prevalence of creaky voice in naturalistic samples of English spoken by vocally-healthy speakers. Reference lists of included studies were cross-checked.
RESULTS
Only ten studies meeting inclusion criteria were identified. All studies sampled a small number of speakers and/or short durations of speech. Nine were recent studies of American-English speakers, and many of these sampled young, female, college students. Across the ten studies, creaky voice was detected using three types of methods, and prevalence was calculated using five different formulae. The findings show that prevalence varies across groups, individuals, and contexts. However, the precise nature of this variability remains unclear due to the scarcity and methodological heterogeneity of the research.
CONCLUSIONS
This paper illustrated the application of systematic literature review methods in sociophonetic research-a field in which such methods are not common. The review found that creaky voice prevalence in English is not well understood, and that widespread claims of its recent increase among young American women have not been empirically confirmed. A number of specific limitations in the existing research are highlighted, which may serve as a guide for future research design.
Topics: Age Factors; Humans; Language; Phonation; Sex Factors; Speech; Speech Acoustics; Speech Perception; Speech Production Measurement; Time Factors; Voice; Voice Quality
PubMed: 32160255
DOI: 10.1371/journal.pone.0229960