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Journal of Voice : Official Journal of... Jan 2015Previous studies of geriatric dysphonia prevalence have been limited to ambulatory outpatient and senior communities. Our goal was to identify prevalence of dysphonia in...
OBJECTIVE
Previous studies of geriatric dysphonia prevalence have been limited to ambulatory outpatient and senior communities. Our goal was to identify prevalence of dysphonia in nursing home residents and assisted living residents and search for correlations between indices of dysphonia and indices of frailty.
STUDY DESIGN
Prospective epidemiological survey.
METHODS
Residents of a vertically integrated senior care organization who were 65 or older and able to understand and complete the questionnaire were recruited to complete the voice handicap index 10 (VHI-10) to assess for dysphonia (VHI-10 > 10 = dysphonia) and Vulnerable Elders Survey 13 (VES-13), a validated instrument to assess for frailty (VES > 3 = frailty).
RESULTS
A total of 119 residents were surveyed. Thirty-three percent of nursing home residents, and 25% of assisted living residents reported dysphonia with 29% of all respondents reporting dysphonia. The mean VHI-10 was 7.4, the median was 5, and the interquartile range was 2-12.5. There was a significant relationship between VHI-10 and VES-13 score (P = 0.029). There were no statistically significant relationships between frailty, age, or type of living and dysphonia or VHI-10.
CONCLUSION
There is a high prevalence of voice dysfunction in assisted living and nursing home residents. The correlation between VHI-10 and VES-13 suggests that voice declines as frailty increases.
Topics: Aged; Aged, 80 and over; Dysphonia; Frail Elderly; Homes for the Aged; Humans; Nursing Homes; Prevalence; Wisconsin
PubMed: 25499517
DOI: 10.1016/j.jvoice.2014.06.006 -
The Laryngoscope May 2020Voice patients with voice disorders have a high prevalence of distress and mental health (MH) comorbidities, but it is unknown to what extent distress precedes or... (Comparative Study)
Comparative Study
OBJECTIVES
Voice patients with voice disorders have a high prevalence of distress and mental health (MH) comorbidities, but it is unknown to what extent distress precedes or follows voice disorder diagnoses. Objectives were to compare 1) proportions of voice patients with MH diagnoses who received MH diagnoses first versus voice-related diagnoses first, 2) voice-related diagnoses and care utilization, and 3) time to specialty evaluation in each group.
METHODS
Patients with voice and MH diagnoses were identified using International Classification of Diseases, Ninth and Tenth Revisions codes in a large health system data repository from January 2005 through July 2017. Sociodemographics, comorbidities, MH- and voice-related diagnoses, and voice-related care utilization were analyzed using descriptive statistics and multivariable regression modeling.
RESULTS
Among the 11,419 patients with both voice and MH diagnoses, 63% (n = 7,251) received MH diagnoses prior to voice diagnoses, compared with 37% with a voice diagnosis first (P < 0.0001). The latter group received more specific voice-related diagnoses (e.g., laryngeal cancer [odds ratio (OR) 4.27], benign laryngeal neoplasm [OR 1.60]), and were more likely to ever see an otolaryngologist than those receiving MH diagnoses first (P < 0.0001).
CONCLUSION
Most patients with voice and MH diagnoses received a MH diagnosis first. Patients who receive MH diagnoses first appeared to have different voice-related healthcare compared to those who received voice diagnoses first.
LEVEL OF EVIDENCE
NA Laryngoscope, 130:1243-1248, 2020.
Topics: Adult; Aged; Dysphonia; Female; Humans; Male; Mental Disorders; Middle Aged; Patient Acceptance of Health Care; Retrospective Studies
PubMed: 32034963
DOI: 10.1002/lary.28203 -
Journal of Clinical Neuroscience :... Jun 2019Voice and swallowing impairments are common in movement disorders, but their effect on patients' quality of life is not well known. This study was conducted to determine...
Voice and swallowing impairments are common in movement disorders, but their effect on patients' quality of life is not well known. This study was conducted to determine the onset and prevalence of patient-reported dysphonia and dysphagia symptoms in Parkinson's disease (PD), dystonia, Atypical Parkinsonian Syndromes (APS), and Essential Tremor (ET). Patients referred to a movement disorders clinic in a tertiary care academic medical center completed validated voice and swallowing specific Quality of Life (QOL) questionnaires: Voice Handicap Index-10 (VHI-10) and Eating Assessment Tool-10 (EAT-10). Patient demographics and clinical data were also collected. Two hundred and sixty-eight patients (males = 150, females = 118) completed the questionnaires (n was PD = 103, APS = 30, ET = 56, dystonia = 32, other = 47). Prevalence of patient-reported dysphagia symptoms was significantly higher in APS (63%) than PD (26%), ET (25%), and dystonia (31%). Prevalence of patient-reported dysphonia symptoms was significantly lower in ET (14%) compared to PD (34%) and APS (43%). Disease duration was shorter in PD and APS compared to ET and dystonia (p < 0.05) before reporting clinically significant dysphonia and dysphagia symptoms indicating an earlier onset of these symptoms. There were significant positive correlations between VHI-10 and EAT-10 scores and disease severity, as indicated by Unified Parkinson's Disease motor scores (p < 0.0001) and modified Fahn-Tolosa-Marin Tremor Rating sub-scores (p = 0.0013). Patient-reported dysphonia and dysphagia symptoms were present in one fourth of patients with PD, ET, dystonia, and almost two thirds in APS. Patient-reported QOL measures, such as VHI-10 and EAT-10, can help screen movement disorder patients for dysphonia and dysphagia symptoms.
Topics: Academic Medical Centers; Aged; Deglutition Disorders; Dysphonia; Female; Humans; Male; Middle Aged; Movement Disorders; Prevalence; Quality of Life; Surveys and Questionnaires
PubMed: 30948311
DOI: 10.1016/j.jocn.2019.03.043 -
Movement Disorders : Official Journal... Apr 2017Spasmodic dysphonia is a focal dystonia characterized by involuntary spasms in the laryngeal muscles that occur selectively during speaking. Although hereditary trends...
BACKGROUND
Spasmodic dysphonia is a focal dystonia characterized by involuntary spasms in the laryngeal muscles that occur selectively during speaking. Although hereditary trends have been reported in up to 16% of patients, the causative etiology of spasmodic dysphonia is unclear, and the influences of various phenotypes and genotypes on disorder pathophysiology are poorly understood. In this study, we examined structural alterations in cortical gray matter and white matter integrity in relationship to different phenotypes and putative genotypes of spasmodic dysphonia to elucidate the structural component of its complex pathophysiology.
METHODS
Eighty-nine patients with spasmodic dysphonia underwent high-resolution magnetic resonance imaging and diffusion-weighted imaging to examine cortical thickness and white matter fractional anisotropy in adductor versus abductor forms (distinct phenotypes) and in sporadic versus familial cases (distinct genotypes).
RESULTS
Phenotype-specific abnormalities were localized in the left sensorimotor cortex and angular gyrus and the white matter bundle of the right superior corona radiata. Genotype-specific alterations were found in the left superior temporal gyrus, supplementary motor area, and the arcuate portion of the left superior longitudinal fasciculus.
CONCLUSIONS
Our findings suggest that phenotypic differences in spasmodic dysphonia arise at the level of the primary and associative areas of motor control, whereas genotype-related pathophysiological mechanisms may be associated with dysfunction of regions regulating phonological and sensory processing. Identification of structural alterations specific to disorder phenotype and putative genotype provides an important step toward future delineation of imaging markers and potential targets for novel therapeutic interventions for spasmodic dysphonia. © 2017 International Parkinson and Movement Disorder Society.
Topics: Adult; Aged; Anisotropy; Apoptosis Regulatory Proteins; Brain Mapping; Cerebral Cortex; DNA-Binding Proteins; Diffusion Tensor Imaging; Dysphonia; Female; GTP-Binding Protein alpha Subunits; Genotype; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Middle Aged; Molecular Chaperones; Nuclear Proteins; Phenotype; Severity of Illness Index; Tomography Scanners, X-Ray Computed; Tubulin
PubMed: 28186656
DOI: 10.1002/mds.26920 -
Medicina (Kaunas, Lithuania) Sep 2023Transcutaneous electrical nerve stimulation (TENS), a pain-alleviating and muscle-relaxing treatment used in physio-therapeutic clinical practice, has recently appeared... (Review)
Review
Transcutaneous electrical nerve stimulation (TENS), a pain-alleviating and muscle-relaxing treatment used in physio-therapeutic clinical practice, has recently appeared to be just as effective in dysphonia. This review aimed at clarifying whether TENS can be an effective practice in dysphonia therapy and/or management on its own or combined with other types of interventions and, hence, whether its practice can be a useful, more widespread establishment to speech and language therapy intervention methods. A search was conducted on the PubMed database using specific terms based on the PICO search strategy. Eventually, four randomized controlled studies and four clinical trials were included. The methodological quality of the included studies was evaluated using the physiotherapy evidence-based database (PEDro) assessment tool, and this indicated high-quality research with an average score of 8.43. The studies utilized various TENS devices, predominantly the Dualpex 961 device (frequency of 10 Hz, phase of 200 ms). The assessment methods varied, including auditory perception, vocal therapy, electrostimulation, audio and video perceptual assessments, and laryngeal evaluations. The clinical outcomes of TENS showed a reduction in musculoskeletal pain in various areas, while the acoustic analysis results were significant in only one study. TENS was compared to manual laryngeal therapy (LMT), placebo TENS, and vocal therapy in different studies with mixed results. This review supports the idea that a multidimensional approach, incorporating various therapeutic modalities (TENS, LMT, speech therapy, and vocal training) can yield positive outcomes for patients with voice disorders. Further research is needed to explore the specific mechanisms of action and optimal treatment protocols for TENS in voice therapy.
Topics: Humans; Transcutaneous Electric Nerve Stimulation; Dysphonia; Musculoskeletal Pain; Treatment Outcome
PubMed: 37893455
DOI: 10.3390/medicina59101737 -
Journal of Speech, Language, and... May 2023The purpose of this study was to determine whether patient voice-related diagnosis, severity of dysphonia, and rater's experience influence the relationship between...
PURPOSE
The purpose of this study was to determine whether patient voice-related diagnosis, severity of dysphonia, and rater's experience influence the relationship between laryngeal oscillation ratings made from videostroboscopic and high-speed videoendoscopic (HSV) exams.
METHOD
Stroboscopy and HSV exams from 15 patients with adductor spasmodic dysphonia (ADSD) and 15 with benign vocal fold lesions were rated for laryngeal oscillation and closure by 10 licensed speech-language pathologists (SLPs). Raters were divided into low- (< 5 years) and high-experience (> 5 years) groups. Ratings of vocal fold amplitude, mucosal wave, periodicity, phase symmetry, nonvibrating portion of the vocal fold, and glottal closure were examined using an online form adapted from the Voice Vibratory Assessment of Laryngeal Imaging (VALI).
RESULTS
Stroboscopy and HSV ratings were more strongly positively correlated for patients with benign vocal fold lesions ( between .43 and .75) than for those with ADSD ( between .40 and .68). Differences between stroboscopy and HSV exams were significantly greater for ratings of amplitude, mucosal wave, and periodicity in patients with ADSD than for patients with benign vocal fold lesions. Raters with < 5 years of experience showed significantly greater differences between stroboscopy and HSV ratings of amplitude and nonvibrating portion of the vocal fold for patients with ADSD only. Significantly greater differences between ratings of periodicity and phase symmetry were observed in patients with more severe dysphonia.
CONCLUSIONS
Differences in laryngeal ratings made between HSV and stroboscopy exams may be influenced by patient diagnosis, severity of dysphonia, and rater experience. Future study is warranted to determine how the differences observed influence clinical diagnosis and outcomes.
Topics: Humans; Dysphonia; Video Recording; Larynx; Vocal Cords; Laryngoscopy
PubMed: 37040690
DOI: 10.1044/2023_JSLHR-22-00649 -
Toxins Jul 2022Spasmodic dysphonia (SD) is a rare neurological disorder that impairs phonatory function by triggering involuntary and intermittent contractions of the intrinsic... (Review)
Review
Spasmodic dysphonia (SD) is a rare neurological disorder that impairs phonatory function by triggering involuntary and intermittent contractions of the intrinsic laryngeal muscles. SD is classified into three types: adductor SD (AdSD), abductor SD (AbSD), and mixed SD. Of these, AdSD accounts for 90-95% of disease; younger females are predominantly affected. Botulinum toxin injection into the laryngeal muscles is safe, minimally invasive, and very effective. Here, we review the history of clinical research for SD conducted in Japan. The first use of botulinum toxin injection therapy to treat SD in Japan was by Kobayashi et al. in 1989. The group developed an objective mora (syllable) method to evaluate SD severity. Recently, we conducted a placebo-controlled, randomized, double-blinded clinical trial of botulinum toxin therapy for AdSD and an open-label trial for AbSD to obtain the approval of such therapy by the Japanese medical insurance system. The mora method revealed significant voice improvement and the evidence was of high quality. Additionally, a clinical trial of type 2 thyroplasty using titanium bridges confirmed the efficacy and safety of such therapy. These studies broadened the SD treatment options and have significantly benefited patients.
Topics: Botulinum Toxins; Botulinum Toxins, Type A; Dysphonia; Female; Humans; Injections; Japan; Laryngeal Muscles; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 35878189
DOI: 10.3390/toxins14070451 -
BMJ Case Reports Dec 2013We present the case of a 40-year-old single man with a diagnosis of Schizoaffective Disorder since 1989 and a comorbid diagnosis of functional (dissociative) dysphonia...
We present the case of a 40-year-old single man with a diagnosis of Schizoaffective Disorder since 1989 and a comorbid diagnosis of functional (dissociative) dysphonia since 2011. Although receiving ongoing treatment from a Speech and Language Therapist, the patient's symptoms of dysphonia have remained prominent from the time of diagnosis in 2011 and have been particularly apparent during times of psychosocial and interpersonal stress. He had a dramatic and complete resolution of all dysphonic symptoms during an acute relapse of the psychosis in February 2013 and experienced a gradual re-emergence of dysphonic symptoms when his episode of psychosis resolved. This is the first case report to demonstrate such an association and we discuss potential mechanisms for the resolution of dysphonic symptoms during this psychotic relapse.
Topics: Acute Disease; Adult; Anti-Anxiety Agents; Antipsychotic Agents; Clonazepam; Diagnosis, Differential; Dysphonia; Humans; Male; Psychotic Disorders; Recurrence; Remission, Spontaneous; Risperidone; Treatment Outcome
PubMed: 24323380
DOI: 10.1136/bcr-2013-201531 -
BMJ Case Reports Jun 2021Forestier's disease is an idiopathic noninflammatory condition associated with enthesopathy leading to hyperostosis of the vertebrae and peripheral skeletal system. The...
Forestier's disease is an idiopathic noninflammatory condition associated with enthesopathy leading to hyperostosis of the vertebrae and peripheral skeletal system. The disease tends to affect elderly individuals and remains asymptomatic in most of the cases. Uncommonly, the patient may present with upper aerodigestive symptomatology, usually dysphagia. In elderly individuals, the disease may closely mimic upper aerodigestive tract malignancy, which should be actively excluded. In our patient, the hypopharyngeal soft tissue distortions created by the bony hypertrophy shifted the clinicoradiological suspicion towards malignant pathology. The current case presents the diagnostic dilemma associated with the disease and the need to keep the possibility of severe cervical bony hypertrophy as a cause of upper aerodigestive symptoms in mind.
Topics: Aged; Cervical Vertebrae; Deglutition Disorders; Dysphonia; Hoarseness; Humans; Hyperostosis, Diffuse Idiopathic Skeletal; Spine
PubMed: 34083199
DOI: 10.1136/bcr-2021-243060 -
Auris, Nasus, Larynx Apr 2021Spasmodic dysphonia (SD) is a rare disease and its epidemiological status is unclear. This review aimed to explore the current prevalence and clinical features of SD in... (Comparative Study)
Comparative Study Review
OBJECTIVES
Spasmodic dysphonia (SD) is a rare disease and its epidemiological status is unclear. This review aimed to explore the current prevalence and clinical features of SD in Japan.
METHODS
We reviewed Japanese surveys of SD and compared them to surveys reported from other countries. We focused on SD prevalence, clinical features (SD type, sex and age), and treatment modalities.
RESULTS
The SD prevalence in Japan was 3.5-7.0/100,000, similar to that in Rochester (NY, USA) and Iceland. Adductor SD predominated (90-95%) and females were four-fold more likely to be affected than males. Mean age at onset was approximately 30 years in Japan. Several years elapsed from onset to diagnosis. The most frequent treatment was botulinum toxin injection, and surgical intervention, particularly type 2 thyroplasty is becoming more popular.
CONCLUSIONS
Our review demonstrated some differences of clinical features of SD in Japan compared with other countries, such as a greater female predominance and younger age of onset. Many physicians and patients may be unfamiliar with the clinical features of SD leading to delayed of diagnosis. Therefore, we proposed diagnostic criteria to facilitate early diagnosis and an appropriate choice of treatment modalities.
Topics: Adolescent; Adult; Age of Onset; Aged; Aged, 80 and over; Child; Dysphonia; Europe; Female; Humans; Japan; Laryngoplasty; Male; Middle Aged; New York; Prevalence; Sex Distribution; Surveys and Questionnaires; Young Adult
PubMed: 32861505
DOI: 10.1016/j.anl.2020.08.013