Vocal Problems in Sports and Fitness Instructors: A Study of Prevalence, Risk Factors, and Need for Prevention in France

Publication date: Available online 12 August 2016
Source:Journal of Voice
Author(s): Lionel Fontan, Marie Fraval, Anne Michon, Sébastien Déjean, Muriel Welby-Gieusse
ObjectivesSports and fitness instructors (SFIs) are known for being a high-risk population for voice difficulties (VD). However, past studies have encountered various methodological difficulties in determining prevalence and risk factors for VD in SFIs, such as limited population, gender and selection biases, or poor statistical power, because VD were studied as a binary variable. The present research work addresses these issues and aims at studying the prevalence of vocal problems and risk factors in French SFIs, a population in which no such study was conducted yet. Another objective is to survey the French SFIs' habits and expectations regarding vocal prevention and care.Study designThis is a cross-sectional study.MethodsThree hundred and twenty SFIs answered a questionnaire, whether in an online (n = 267) or a paper (n = 53) version. The questionnaire consisted of 31 items addressing self-reported vocal difficulties, supposed risk factors, and personal health-care history, followed by the Voice Handicap Index assessment.ResultsPrevalence of self-reported vocal difficulties is 55%. The Voice Handicap Index is significantly associated with gender, age, and variables related to work environment (noise and music) and habits (shouting, frequency of classes), as well as with daily sleeping time. Results also indicate that a minority of the SFIs (37%) received information on vocal difficulties, whereas a majority (80%) declares being interested in participating in prevention programs.ConclusionsThis work confirms that SFIs are a high-risk population for VD, underlines the need for specific information programs in France, and provides relevant data for driving such preventive actions.



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Pre- and Poststimulation Study on the Phonatory Aerodynamic System on Participants with Dysphonia

Publication date: Available online 12 August 2016
Source:Journal of Voice
Author(s): Natalie Schaeffer
PurposeThe purpose of this preliminary investigation was to examine the sensitivity of the Phonatory Aerodynamic System (PAS) in an exploratory investigation that looked at the effects of stimulation training (pre and post stimulation) on 20 participants with vocal complaints. The following parameters were tested: subglottal pressure, sound pressure level, airflow, and fundamental frequency.MethodsA total of 20 participants with vocal complaints performed the Voicing Efficiency protocol on the (PAS). The participants spoke into a mask and repeated the utterance /papapa/ five times on a single breath for three sets (pausing between sets). Measurements of the parameters were recorded on the PAS. Subsequently, the participants were given stimulation training involving the coordination of respiration and phonation and purposely engaging the abdominal muscles upon phonation. They repeated the same PAS task, using the training. Their parameters after training were compared to normal values to determine improvements post stimulation results.ResultsThe participants showed improvement in a number of parameters post stimulation, especially subglottal pressure and fundamental frequency (i.e., closer to normal values in comparison with pre-stimulation results) and on the graphic readouts; the respiratory waveforms showed greater consistency and evenness on certain parameters compared with those in the pre-training graphs. Perceptually, the participants' voices revealed reduced noise and strain.ConclusionPost stimulation, a number of parameters improved towards normal values; the respiratory graphic waveforms were more consistent and even, and perceptually improved vocal quality was noted by judges and participants.



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Content Validity of Temporal Bone Models Printed Via Inexpensive Methods and Materials

Hypothesis: Computed tomographic (CT) scans of the 3-D printed temporal bone models will be within 15% accuracy of the CT scans of the cadaveric temporal bones. Background: Previous studies have evaluated the face validity of 3-D-printed temporal bone models designed to train otolaryngology residents. The purpose of the study was to determine the content validity of temporal bone models printed using inexpensive printers and materials. Methods: Four cadaveric temporal bones were randomly selected and clinical temporal bone CT scans were obtained. Models were generated using previously described methods in acrylonitrile butadiene styrene (ABS) plastic using the Makerbot Replicator 2× and Hyrel printers. Models were radiographically scanned using the same protocol as the cadaveric bones. Four images from each cadaveric CT series and four corresponding images from the model CT series were selected, and voxel values were normalized to black or white. Scan slices were compared using PixelDiff software. Gross anatomic structures were evaluated in the model scans by four board certified otolaryngologists on a 4-point scale. Results: Mean pixel difference between the cadaver and model scans was 14.25 ± 2.30% at the four selected CT slices. Mean cortical bone width difference and mean external auditory canal width difference were 0.58 ± 0.66 mm and 0.55 ± 0.46 mm, respectively. Expert raters felt the mastoid air cells were well represented (2.5 ± 0.5), while middle ear and otic capsule structures were not accurately rendered (all averaged

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Asymmetrical Hearing Loss in Cases of Industrial Noise Exposure: A Systematic Review of the Literature

Objective: Asymmetrical hearing thresholds are common in people claiming compensation for noise-induced hearing loss (NIHL). When present and otherwise unexplained, there is some controversy as to whether such asymmetry can be attributed to occupational noise exposure. In this review, our main objectives were to collate the overall prevalence of this finding in subjects with NIHL, and further, to provide a balanced argument regarding causality. Data Sources: MEDLINE, CINAHL, EMBASE, Cochrane, Google Scholar. No date or language restrictions. Study Selection and Data Extraction: A systematic review of the literature was performed and data on noise exposure, pure tone audiometry, and lateralized hearing outcomes were reviewed. Newcastle-Ottawa (N-O) criteria were employed to assess quality of studies where applicable. Data Synthesis: N/A Conclusion: Six studies met the inclusion criteria giving a total of 4,735 individual cases with NIHL. Asymmetrical hearing loss accounted for between 2.4% and 22.6% of NIHL cases (L-R difference >15 dB for any frequency 0.5–8 kHz). However, the overwhelming majority of subjects in this review have symmetrical hearing loss when adjusted for other significant variables, e.g., age, sex, and binaural hearing deterioration. Subjects considered for noise exposure remuneration were men (94.3% SE ± 2.7), aged 52.9 years (inter-quartile range, 46.1–58.4), and from a broad range of industrial backgrounds. Future research will be needed to establish the influence of other factors such as smoking status, exposure to chemical agents, specific drugs, or genetic predisposition.

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Facial Nerve Disorders and Diseases: Diagnosis and Management: Orlando Guntinas-Lichius and Barry M. Schaitkin; Stuttgart: Thieme, 2015.

No abstract available

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The Impact of Electrode Array Length on Hearing Preservation in Cochlear Implantation

Objective: The aim of the study was to determine the degree of hearing preservation (HP) and its relation to electrode array length after cochlear implantation using different thin flexible electrode arrays (TFEA). Study Design: Retrospective analysis. Intervention: One hundred twenty adult patients with preoperative residual hearing received a cochlear implant with a TFEA: 46 received a TFEA20, 34 a TFEA24, and 40 a TFEA28 mm. Main Outcome Measures: Pure-tone audiometry (125–1500 Hz) was performed preoperatively, at initial fitting, and at 3, 6, and 12 months postoperatively. Median hearing loss (HL) was determined for each of the three array groups. The pre- to postoperative pure-tone average difference was scaled into three groups (≤15 dB, >15 to ≤30 dB, >30 dB) for array group. Results: At initial fitting, median HL of 17.5 dB (TFEA20), 20 dB (TFEA24), and 24 dB (TFEA28) was observed. At 12 months, medial HL of 15 dB (TFEA20), 19.4 dB (TFEA24), and 32.5 dB (TFEA28) was observed. At initial fitting, a HL of ≤15 dB was achieved in 45.6% TFEA20 subjects, 29.4% TFEA24 subjects, and 15.0% TFEA28 subjects; compared with 48.8% TFEA20 subjects, 50.0% TFEA24 subjects, and 15.8% TFEA28 subjects at 12 months. Conclusion: HP is possible in the majority of subjects who are implanted with a TFEA20, 24, or 28. Using shorter arrays led to greater HP and lower median HL.

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Introduction to the Pharmaceutical Interventions for Hearing Loss Clinical Research Guidance Papers

No abstract available

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Electrode Location and Angular Insertion Depth Are Predictors of Audiologic Outcomes in Cochlear Implantation

Objectives: 1) Investigate the impact of electrode type and surgical approach on scalar electrode location; and 2) examine the relation between electrode location and postoperative audiologic performance. Setting: Tertiary academic hospital. Patients: Two hundred twenty post-lingually deafened adults undergoing cochlear implant (CI). Main Outcome Measures: Primary outcome measures of interest were scalar electrode location and postoperative audiologic performance. Results: In 68% of implants, electrodes were observed to be located solely in the scala tympani (ST). Multivariate analysis demonstrated perimodiolar (PM) and mid-scala (MS) electrodes were 22.4 (95% CI: 6.3–80.0, p 

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Influence of Posterior Fossa Volume on Clinical Outcomes After Vestibular Schwannoma Resection

Objectives: To determine the influence of posterior fossa dimensions on surgical outcomes after vestibular schwannoma management. Study Design: Retrospective chart review. Setting: Tertiary care academic medical center. Patients: Patients with sporadic vestibular schwannomas who underwent surgical resection via retrosigmoid or translabyrinthine techniques. Interventions: Diagnostic. Main Outcome Measures: One and two-way analysis of variance (ANOVAs) of the cohort based on volumetric and clinical outcome groupings. Results: A total of 95 patients were identified. A one-way ANOVA looking at the entire cohort of patients showed that outcomes like surgical time (p 

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The Effect of Round Window Sealants on Delayed Hearing Loss in a Guinea Pig Model of Cochlear Implantation

Aim: To determine whether the type of material used to seal the cochlea after round window cochlear implantation influences delayed hearing loss. Background: Cochlear implants are now prescribed to patients with residual, low-frequency hearing. This hearing—which provides perceptual benefits for the implanted ear—is frequently lost for unknown reasons weeks to months after surgery in a proportion of patients. A post-surgical change in cochlear mechanics, related to the material used to seal the cochlea after round window implantation, may contribute to this loss. Methods: An electrode array was implanted in guinea pigs via the round window, which was then sealed with muscle, periosteum, or fibrin glue. Auditory brainstem responses (ABRs) to pure tones (2, 8, 16, 24, and 32 kHz) were recorded before surgery and 1, 4, and 12 weeks after surgery, with subjects then euthanized and their cochleae harvested for histological analysis. Results: Muscle and periosteum, but not fibrin glue, exhibited delayed threshold rises at 2 kHz. Twelve weeks after implantation, 2 kHz threshold shifts differed significantly between muscle (mean, 27.1 dB) and fibrin glue (9.3 dB), but not between these groups and periosteum (19.3 dB). Muscle was sometimes associated with much greater tissue reactions than the other sealants. Most cochleae had injuries to the basilar membrane and/or osseous spiral lamina, regardless of sealant. Hair cell counts did not differ significantly among sealants. Conclusion: Delayed, low-frequency hearing loss was observed when cochleae were sealed with muscle or periosteum, but not when cochleae were sealed with fibrin glue.

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Conductive Hearing Loss in Association With Urate Deposits in the Middle Ear

No abstract available

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Electrode Location and Audiologic Performance After Cochlear Implantation: A Comparative Study Between Nucleus CI422 and CI512 Electrode Arrays

Objectives: 1) Compare rates of scala tympani (ST) insertion between Nucleus CI422 Slim Straight electrodes and Nucleus CI512 Contour Advance electrodes; 2) examine audiometric performance with both electrode arrays, while controlling for electrode location. Setting: Tertiary academic hospital. Patients: Fifty-six post-lingually deafened adults undergoing cochlear implant (CI). Main Outcome Measures: Primary outcome measures of interest were scalar electrode location and postoperative audiologic performance. Results: Fifty-six implants in 49 patients were included; 20 were implanted with Nucleus CI422 Slim Straight electrodes, and 36 were implanted with Nucleus CI512 Contour Advance electrodes. Overall, 62.5% (35 of 56) of implants had all electrodes located within the ST. Significantly, higher rates of ST insertion (90%) were observed for Nucleus CI422 Slim Straight electrodes when compared with Nucleus CI512 Contour Advance electrodes (47.2%) (p = 0.002). In regards to audiologic performance, consonant-nucleus-consonant (CNC) scores were significantly higher for Nucleus CI422 Slim Straight electrodes (55.4%) compared with Nucleus CI512 Contour Advance electrodes (36.5%) (p = 0.005). In addition, AzBio scores were better for Nucleus CI422 Slim Straight electrodes (71.2%) when compared with Nucleus CI512 Contour Advance electrodes (46.7%) (p = 0.004). Controlling for ST insertion, higher AzBio scores were again observed for Nucleus CI422 Slim Straight electrodes (p = 0.02). Conclusions: The results of this study demonstrate that the Nucleus CI422 Slim Straight electrode is more likely to reside entirely within the ST when compared with the Nucleus CI512 Contour Advance electrode. Furthermore, AzBio scores were superior for patients with Nucleus CI422 Slim Straight electrodes in all patients, as well as those with only ST insertions.

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Serial Monitoring of Otoacoustic Emissions in Clinical Trials

The purpose of this report is to provide guidance on the use of otoacoustic emissions (OAEs) as a clinical trial outcome measure for pharmaceutical interventions developed to prevent acquired hearing loss secondary to cochlear insult. OAEs are a rapid, noninvasive measure that can be used to monitor cochlear outer hair cell function. Serial monitoring of OAEs is most clearly established for use in hearing conservation and ototoxicity monitoring programs in which they exhibit more frequent and earlier changes compared with pure-tone audiometry. They also show promise in recent human trials of otoprotectants. Questions remain, however, concerning the most appropriate OAE protocols to use and what constitutes a “significant” OAE response change. Measurement system capabilities are expanding and test efficacy will vary across locations and patient populations. Yet, standardizing minimal measurement criteria and reporting of results is needed including documentation of test-retest variability so that useful comparisons can be made across trials. It is also clear that protocols must be theoretically sound based on known patterns of damage, generate valid results in most individuals tested, be accurate, repeatable, and involve minimal time. Based on the potential value added, OAEs should be included in clinical trials when measurement conditions and time permit.

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Taste Disturbance Due to Cochlear Implant Stimulation

Objective: To characterize stimulation of taste fibers in the facial nerve following cochlear implantation. Patient: A 34-year old presented with reversible dysgeusia following activation of a cochlear implant. Intervention: Reprogramming targeted to specific offending electrodes reduced symptom intensity. Computed tomography demonstrated dehiscence of the bone separating the labyrinthine segment of the facial nerve and the basal turn of the cochlea in proximity to the electrode array. Results: Dysgeusia was attributed to stimulation of taste fibers in the facial nerve by electrodes 13 to 16 of the cochlear implant array located in the superior-most portion of the basal turn. Conclusions: Dysgeusia following cochlear implant activation has not previously been reported. This likely results from stimulation of taste fibers through dehiscence of the bone separating the labyrinthine segment of the Fallopian canal and the basal turn of the cochlea. While in some cases of apparent dehiscence there may be thin bone present, recognition of this potential anatomic feature may influence the choice of which ear and which electrode design to implant.

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Temporal Lobe Gliosarcoma After Gamma Knife Radiosurgery for Vestibular Schwannoma

Objective: Secondary tumorigenesis after exposure to ionizing radiation is a well-described phenomenon. The probability of developing a malignancy after stereotactic radiosurgery (SRS) is theoretically less than conventional external beam radiation therapy; however, the exact risk remains unknown. Such information is important for patient counseling when considering treatment of benign conditions such as vestibular schwannoma (VS). The objective of the current report is to describe a case of a temporal lobe gliosarcoma developing 3 years after radiosurgical treatment of a sporadic VS. Setting: Tertiary academic referral center. Patient: A 54-year-old man was diagnosed with a left-sided 1.6 cm cerebellopontine angle mass, consistent with VS. After reviewing treatment options, the patient proceeded with radiosurgery, and a tumor volume of 2.4 cm3 was treated with a marginal dose of 12.5 Gy prescribed to the 50% isodose line. Results: Serial magnetic resonance imaging (MRI) revealed good treatment response, demonstrated by central necrosis and tumor shrinkage. However, 3 years after treatment, the patient presented to the emergency department for a month long history of progressive word finding difficulties. Imaging revealed a 5 cm temporal lobe mass consistent with a high-grade glial neoplasm. He subsequently underwent stereotactic resection and final pathology confirmed World Health Organization Grade IV gliosarcoma. Conclusion: De novo malignancy after radiosurgery for VS is rare. We present only the second case of a gliosarcoma arising within the low-dose radiation field of the radiosurgery treatment plan. Some of the challenges of establishing causality between radiation treatment and secondary tumor development are discussed. The reporting of malignancy after radiation therapy, and even microsurgery, warrants continued vigilance.

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Moving Beyond GDP: Cost Effectiveness of Cochlear Implantation and Deaf Education in Latin America

Hypothesis: Cochlear implantation (CI) and deaf education are cost effective management strategies of childhood profound sensorineural hearing loss in Latin America. Background: CI has been widely established as cost effective in North America and Europe and is considered standard of care in those regions, yet cost effectiveness in other economic environments has not been explored. With 80% of the global hearing loss burden existing in low- and middle-income countries, developing cost effective management strategies in these settings is essential. This analysis represents the continuation of a global assessment of CI and deaf education cost effectiveness. Methods: Brazil, Colombia, Ecuador, Guatemala, Paraguay, Trinidad and Tobago, and Venezuela participated in the study. A Disability Adjusted Life Years model was applied with 3% discounting and 10-year length of analysis. Experts from each country supplied cost estimates from known costs and published data. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost effectiveness was determined using the World Health Organization standard of cost effectiveness ratio/gross domestic product per capita (CER/GDP)

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Vestibular Schwannomas: Do Linear and Volumetric Parameters on MRI Correlate With Hearing Loss?

Purpose: To determine if two-dimensional and volumetric imaging parameters in vestibular schwannomas (VS) correlate with hearing loss at presentation. Study Design: Retrospective. Methods: Forty-one cases of pathologically confirmed sporadic VS were analyzed. Maximal tumor dimensions in anteroposterior (AP), coronal (ML), and craniocaudal (CC) dimensions were obtained along with tumor-fundus distance and internal auditory canal (IAC) porus diameters. Volumetric analysis was done on 37 cases. Tumors volumes were calculated through both 3-D volumetric and ABC/2 [AP × ML × CC/2] methodology. With the 3-D method, total tumor volume (TTV), and cerebellopontine angle (CPA) tumor volume were separately calculated and IAC volumes obtained by subtracting CPA tumor volumes from TTV. Pure tone average (PTA) and speech discrimination scores (SDS) were correlated with tumor dimensions. Results: Non-volumetric analysis was performed on 41 tumors. The AP and ML dimensions correlated with both PTA and SDS (p 

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National Utilization and Forecasting of Ototopical Antibiotics: Medicaid Data Versus “Dr. Google”

Objectives: To forecast national Medicaid prescription volumes for common ototopical antibiotics, and correlate prescription volumes with internet user search interest using Google Trends (GT). Study Design: National United States Medicaid prescription and GT user search database analysis. Methods: Quarterly national Medicaid summary drug utilization data and weekly GT search engine data for ciprofloxacin-dexamethasone (CD), ofloxacin (OF), and Cortisporin (CS) ototopicals were obtained from January 2008 to July 2014. Time series analysis was used to assess prescription seasonality, Holt–Winter's method for forecasting quarterly prescription volumes, and Pearson correlations to compare GT and Medicaid data. Results: Medicaid prescription volumes demonstrated sinusoidal seasonality for OF (r2 = 0.91), CS (r2 = 0.71), and CD (r2 = 0.62) with annual peaks in July, August, and September. In 2017, OF was forecasted to be the most widely prescribed ototopical, followed by CD. CS was the least prescribed, and volumes were forecasted to decrease 9.0% by 2017 from 2014. GT user search interest demonstrated analogous sinusoidal seasonality and significant correlations with Medicaid data prescriptions for CD (r = 0.38, p = 0.046), OF (r = 0.74, p 

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Parsonage–Turner Syndrome: A Case of Idiopathic Upper Extremity Paresis Following Middle Cranial Fossa Resection of a Vestibular Schwannoma

Objective: In this patient report, Parsonage–Turner syndrome (acute brachial neuropathy) developed in our patient 1 day after resection of a vestibular schwannoma by a middle cranial fossa approach. Aiming to increase awareness of this rare disorder among neurotologists, we describe differential diagnoses, work-up, and management strategies. Patient: A 67-year-old man treated for vestibular schwannoma at a single tertiary referral center. Intervention: Surgery for vestibular schwannoma, electromyography for confirmation of diagnosis, and physical therapy. Main Outcome and Results: After ruling out postoperative complications by intracranial imaging and physical examination, electromyography was confirmatory of the suspected diagnosis, Parsonage–Turner syndrome; steroids were not indicated. With physical therapy as treatment, our patient is experiencing gradual recovery of all neurologic deficits, including gross motor function. Conclusion: As a rare condition reported only sporadically in the orthopedic and neurology literature, our patient with Parsonage–Turner syndrome represents (to our knowledge) the first within neurotology literature. This rare, idiopathic disease process is usually self-limiting, and may mimic cerebral-vascular accident or injury from surgical positioning. Its presentation is one of limited motor and sensory neuropathies of the brachial plexus distribution.

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Acoustic Transmission Characteristics of a Eustachian Tube Volitionally Opened in Two Living Subjects

Objective: To assess the acoustic transmission characteristics of the Eustachian tube (ET) in living subjects in verified patent and closed ET states to facilitate the detection and quantification of ET function using acoustic measures such as sonotubometry. Patients: The two subjects in this study had no history of ear disease nor previous ear surgery and were capable of volitionally opening and closing their ET. Interventions: Tympanometry and otologic examinations were used to confirm ET patent and closed states by observing tympanic membrane movement with respiration and by acoustic immitance measurements during forced respiration. A series of 500-ms long chirps containing frequencies from 100 Hz to 10 kHz were introduced into the nasal cavity during both ET states and recorded by microphones in both the contralateral naris and external auditory canal. Main Outcome Measures: Acoustic energy transmission through the ET across the 0.1 to 10 kHz frequency range in the closed state versus the patent state. Results: An increase in acoustic energy transmission occurs across the frequencies of 1 to 4 kHz between the closed and patent ET states, particularly in frequencies below 2.5 kHz. Conclusions: Results support sonotubometry as a potential diagnostic tool for ET dysfunction. Acoustic differences between the ET states manifest as a general increase in transmitted signal amplitude. Characterizing the acoustic properties in the verified patent and closed ET states allows investigators to more reliably interpret sonotubometric tests of ET function.

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Bilateral Petrous Apex Cephaloceles and Skull Base Attenuation in Setting of Idiopathic Intracranial Hypertension

No abstract available

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The Role of Bacteriologic Studies in Predicting Recurrent Mastoiditis in 456 Patients

Objectives: To evaluate the effect of microbiologic growth on the recurrence rate of mastoiditis. Materials and Methods: A historical prospective study on all cases of children with acute mastoiditis (AM) admitted between 2000 and 2015, was performed. The following data were collected in the recurrent AM (rAM) group: age, sex, and medical history, antibiotic therapy before hospitalization, clinical presentation at admission including symptoms and signs, blood test results, computed tomography (CT) imaging, microbiological findings, treatment, complications, outcome, and follow-up duration. Results: Four hundred fifty six consecutive hospitalizations because of mastoiditis were identified; 22 patients were found to have rAM. The median age at first episode in the rAM group was 1 year (range, 1–11 years), and the median period from one episode to the next was 2 months. There were 15 men and 7 women. The right ear was involved in 11 cases in the first and in the second episode. The rate of Pseudomonas aeruginosa growth in the rAM group was significantly higher compared with the AM group (40.9 and 8.9%, respectively) (p = 0.001) as was found in anerobic growth (15 vs. no growth) (p 

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