“Cold-Steel” Phonosurgery of Reinke Edema Evaluated by the Multidimensional Voice Program

Publication date: Available online 5 June 2017
Source:Journal of Voice
Author(s): Ylva Margareta Schyberg, Kristian Hveysel Bork, Martin Kryspin Sørensen, Niels Rasmussen
Objectives“Cold-steel” phonosurgery (PS) of Reinke edema is challenging, as the delicate structures of the vocal folds are difficult to preserve. This study aimed to evaluate the results of PS using the Multidimensional Voice Program (MDVP) .Materials and MethodsFrom 2003 to 2007, 76 consecutive patients with Reinke edema were treated with PS for the first time. Reliable MDVP data were available in 37 female patients with both pre- and postoperative values in 14 patients. Voice quality and outcome after PS were evaluated by jitter, shimmer, soft phonation index, and fundamental frequency (f0) using MDVP, videostroboscopy, and a five-step voice outcome score.ResultsIn the 14 patients, the mean f0 increased from 172 to 222 (P = 0.01), and jitter decreased from 2.03 to 1.17 (P = 0.04) 3 months postoperatively. Vocal fold grading based on videostroboscopy correlated significantly with jitter (P = 0.01). Patients with high preoperative values of jitter, shimmer, or soft phonation index had larger reductions than those with normal values. All had a postoperative reduction of the edemas. The mean voice outcome score increased postoperatively. None of the 37 patients reported complications, but seven patients were reoperated. Preoperatively, 95% of the 37 patients were smokers and only 9 (24%) changed smoking habits. Pre- or postoperative voice therapy was used in 23 (62%) patients.Conclusionsf0 and jitter by MDVP adequately reflected the postoperative voice improvement and reduction of the edema. Removal of large amounts of edematous tissue, many years of vocal abuse, and unchanged smoking habits may prevent optimal results.



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Acoustic Analysis of Voice and Electroglottography in Patients With Laryngopharyngeal Reflux

Publication date: Available online 5 June 2017
Source:Journal of Voice
Author(s): Daphne Anahit Morales Ramírez, Víctor Manuel Valadez Jiménez, Xochiquetzal Hernández López, Pablo Antonio Ysunza
BackgroundLaryngopharyngeal reflux (LPR) refers to the flow of gastric acid content into the laryngopharynx. It has been reported that 10% of the patients consulting an otolaryngologist present with this condition. Signs of LPR can be identified during flexible or rigid laryngoscopy. The Voice Handicap Index (VHI) is a reliable tool for detecting the impact of voice disorders, and acoustic assessment of voice including acoustic analysis of voice (AAV) and electroglottography (EGG) provide objective data of voice production and voice disorders.ObjectiveThis study aimed to describe changes in AAV, EGG, and VHI in patients who present with LPR compared with a matched control group of healthy subjects.Materials and MethodsSeventeen patients with LPR were studied. A group of healthy subjects matched by age and gender without any history of voice disorder, LPR, or gastroesophageal reflux disease was assembled. Both groups of patients were studied by VHI, flexible laryngoscopy, AAV, and EGG.ResultsAll patients with LPR demonstrated abnormal VHI values. Shimmer, jitter, open quotient, and irregularity were significantly increased in the patients with LPR. Nonsignificant correlations were found between VHI scores and abnormal acoustic parameters in patients with LPR.ConclusionsAlthough abnormal acoustic parameters of patients with LPR were not predictive of the overall VHI score, the abnormal acoustic parameters of patients with LPR suggest a decrease in adequate laryngeal control during phonation.



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Menstrual Cycle, Vocal Performance, and Laryngeal Vascular Appearance: An Observational Study on 17 Subjects

Publication date: Available online 5 June 2017
Source:Journal of Voice
Author(s): Hagit Shoffel-Havakuk, Narin N. Carmel-Neiderman, Doron Halperin, Yael Shapira Galitz, Dan Levin, Yaara Haimovich, Oded Cohen, Jean Abitbol, Yonatan Lahav
ObjectiveTo assess the anatomical and functional features of the vocal folds during different phases of the female menstrual cycle.MethodsAn observational study of 17 healthy fertile female volunteers not using hormonal contraception was carried out. Each volunteer underwent two examinations: first, during the early days of the menstrual cycle when progesterone levels are low (p-depletion), and second, during premenstruation when progesterone levels are high (p-peak). The workup included blood hormone levels, Voice Handicap Index, acoustic analysis, rigid telescopy, stroboscopy, and narrow band imaging. The videos were evaluated by blinded observers.ResultsThe participants' mean age was 31.7 ± 5.6 (range 23–43). Progesterone levels were 13- to 45-fold higher in p-peak relative to p-depletion. No significant differences were detected in Voice Handicap Index scores, stroboscopic reports, or acoustic analysis between p-peak and p-depletion examinations. Analyzing the rigid telescopy and narrow band imaging videos, the observers tended to estimate the different laryngeal subsites more vascularized during the p-peak examination. Moreover, this tendency was significantly correlated with blood progesterone levels during the p-depletion examinations; the lower the blood progesterone levels were during p-depletion, the higher the probability for the observers to estimate the p-peak examinations more vascularized (P value = 0.024).ConclusionsAlterations in laryngeal vascular characteristics are evident throughout the menstrual cycle and may suggest increased congestion during premenstrual days. Variations in progesterone levels during the menstrual cycle correlate with laryngeal vascular changes. Hormone-related alterations in vocal folds' vascularity may have a role in the variability of vocal performance in certain women.



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Noncomprehension Signaling in Males and Females With Fragile X Syndrome

Purpose

This study used a prospective longitudinal design to evaluate the trajectory and predictors of noncomprehension signaling in male and female youth with fragile X syndrome (FXS).

Method

A direction-following task in which some of the directions were inadequate was administered. Participants were 52 youth (36 boys, 16 girls) with FXS. Upon study entry, participants ranged from 10 to 16 years. The average number of annual assessments per participant was 3.65 (range = 1–4), providing 198 data points for analysis.

Results

Participants with FXS were less likely to signal noncomprehension than younger, typically developing, cognitively matched children. The average rate of change in noncomprehension signaling was not significantly different from 0 for either boys or girls, suggesting a plateau. Both FMRP and nonverbal IQ were significant independent predictors of noncomprehension signaling for boys. Variability in noncomprehension signaling among girls was not explained by any of the predictors, but trends similar to those observed for boys were observed.

Conclusions

Noncomprehension signaling appears to be an area of weakness for individuals with FXS. Because the failure to signal noncomprehension can have negative, cumulative effects on comprehension, the results suggest a need for interventions targeting the requisite cognitive skills.

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Sensitivity of the Speech Intelligibility Index to the Assumed Dynamic Range

Purpose

This study aims to evaluate the sensitivity of the speech intelligibility index (SII) to the assumed speech dynamic range (DR) in different languages and with different types of stimuli.

Method

Intelligibility prediction uses the absolute transfer function (ATF) to map the SII value to the predicted intelligibility for a given stimuli. To evaluate the sensitivity of the predicted intelligibility to the assumed DR, ATF-transformed SII scores for English (words), Korean (sentences), and Mandarin (sentences) were derived for DRs ranging from 10 dB to 60 dB.

Results

Increasing the assumed DR caused steeper ATFs for all languages. However, high correlation coefficients between predicted and measured intelligibility scores were observed for DRs from 20 dB to 60 dB for ATFs in English, Korean, and Mandarin.

Conclusions

Results of the present study indicate that the intelligibility computed from the SII is not sensitive to the assumed DR. The 30-dB DR commonly used in computing the SII is thus a reasonable assumption that produces accurate predictions for different languages and different types of stimuli.

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Using Pupillometry to Investigate Sentence Comprehension in Children With and Without Specific Language Impairment

Purpose

In this study pupillometry was used to investigate the allocation of attentional resources associated with sentence comprehension in children with and without specific language impairment (SLI).

Method

Eighteen children with SLI (age: M = 6.4 years) and 18 typically developing (TD) children (age: M = 6.3 years) participated in the study. A sentence comprehension task was presented that comprised items designated as easy or hard. Easy sentences contained 4 or 5 words, and hard sentences contained 6 or 7 words.

Results

For the TD group, pupil size was significantly larger when comprehending hard sentences compared with easy sentences. There was no effect of sentence difficulty on pupil size in the SLI group. Comparisons between groups revealed pupil sizes for the SLI group were significantly larger than those for the TD group for easy sentences. There were no group differences for the hard sentences.

Conclusion

In TD children, pupillometry was sensitive to the attentional demands associated with sentence comprehension. Between-subjects comparisons indicated that the TD group allocated less attention than did the children with SLI for the easy sentences but not for the hard sentences. This study provides evidence of attentional differences between children with SLI and TD children under conditions of low processing demands.

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Speech Motor Sequence Learning: Acquisition and Retention in Parkinson Disease and Normal Aging

Purpose

The aim of the current investigation was to examine speech motor sequence learning in neurologically healthy younger adults, neurologically healthy older adults, and individuals with Parkinson disease (PD) over a 2-day period.

Method

A sequential nonword repetition task was used to examine learning over 2 days. Participants practiced a sequence of 6 monosyllabic nonwords that was retested following nighttime sleep. The speed and accuracy of the nonword sequence were measured, and learning was inferred by examining performance within and between sessions.

Results

Though all groups exhibited comparable improvements of the nonword sequence performance during the initial session, between-session retention of the nonword sequence differed between groups. Younger adult controls exhibited offline gains, characterized by an increase in the speed and accuracy of nonword sequence performance across sessions, whereas older adults exhibited stable between-session performance. Individuals with PD exhibited offline losses, marked by an increase in sequence duration between sessions.

Conclusions

The current results demonstrate that both PD and normal aging affect retention of speech motor learning. Furthermore, these data suggest that basal ganglia dysfunction associated with PD may affect the later stages of speech motor learning. Findings from the current investigation are discussed in relation to studies examining consolidation of nonspeech motor learning.

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Predictors of Language Gains Among School-Age Children with Language Impairment in the Public Schools

Purpose

This study aimed to identify child-level characteristics that predict gains in language skills for children with language impairment who were receiving therapy within the public schools. The therapy provided represented business-as-usual speech/language treatment provided by speech-language pathologists in the public schools.

Method

The sample included 272 kindergartners and first-graders with language impairment who participated in a larger study titled “Speech-Therapy Experiences in the Public Schools.” Multilevel regression analyses were applied to examine the extent to which select child-level characteristics, including age, nonverbal cognition, memory, phonological awareness, vocabulary, behavior problems, and self-regulation, predicted children's language gains over an academic year. Pratt indices were computed to establish the relative importance of the predictors of interest.

Results

Phonological awareness and vocabulary skill related to greater gains in language skills, and together they accounted for nearly 70% of the explained variance, or 10% of total variance at child level. Externalizing behavior, nonverbal cognition, and age were also potentially important predictors of language gains.

Conclusions

This study significantly advances our understanding of the characteristics of children that may contribute to their language gains while receiving therapy in the public schools. Researchers can explore how these characteristics may serve to moderate treatment outcomes, whereas clinicians can assess how these characteristics may factor into understanding treatment responses.

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Noncomprehension Signaling in Males and Females With Fragile X Syndrome

Purpose

This study used a prospective longitudinal design to evaluate the trajectory and predictors of noncomprehension signaling in male and female youth with fragile X syndrome (FXS).

Method

A direction-following task in which some of the directions were inadequate was administered. Participants were 52 youth (36 boys, 16 girls) with FXS. Upon study entry, participants ranged from 10 to 16 years. The average number of annual assessments per participant was 3.65 (range = 1–4), providing 198 data points for analysis.

Results

Participants with FXS were less likely to signal noncomprehension than younger, typically developing, cognitively matched children. The average rate of change in noncomprehension signaling was not significantly different from 0 for either boys or girls, suggesting a plateau. Both FMRP and nonverbal IQ were significant independent predictors of noncomprehension signaling for boys. Variability in noncomprehension signaling among girls was not explained by any of the predictors, but trends similar to those observed for boys were observed.

Conclusions

Noncomprehension signaling appears to be an area of weakness for individuals with FXS. Because the failure to signal noncomprehension can have negative, cumulative effects on comprehension, the results suggest a need for interventions targeting the requisite cognitive skills.

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Sensitivity of the Speech Intelligibility Index to the Assumed Dynamic Range

Purpose

This study aims to evaluate the sensitivity of the speech intelligibility index (SII) to the assumed speech dynamic range (DR) in different languages and with different types of stimuli.

Method

Intelligibility prediction uses the absolute transfer function (ATF) to map the SII value to the predicted intelligibility for a given stimuli. To evaluate the sensitivity of the predicted intelligibility to the assumed DR, ATF-transformed SII scores for English (words), Korean (sentences), and Mandarin (sentences) were derived for DRs ranging from 10 dB to 60 dB.

Results

Increasing the assumed DR caused steeper ATFs for all languages. However, high correlation coefficients between predicted and measured intelligibility scores were observed for DRs from 20 dB to 60 dB for ATFs in English, Korean, and Mandarin.

Conclusions

Results of the present study indicate that the intelligibility computed from the SII is not sensitive to the assumed DR. The 30-dB DR commonly used in computing the SII is thus a reasonable assumption that produces accurate predictions for different languages and different types of stimuli.

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Using Pupillometry to Investigate Sentence Comprehension in Children With and Without Specific Language Impairment

Purpose

In this study pupillometry was used to investigate the allocation of attentional resources associated with sentence comprehension in children with and without specific language impairment (SLI).

Method

Eighteen children with SLI (age: M = 6.4 years) and 18 typically developing (TD) children (age: M = 6.3 years) participated in the study. A sentence comprehension task was presented that comprised items designated as easy or hard. Easy sentences contained 4 or 5 words, and hard sentences contained 6 or 7 words.

Results

For the TD group, pupil size was significantly larger when comprehending hard sentences compared with easy sentences. There was no effect of sentence difficulty on pupil size in the SLI group. Comparisons between groups revealed pupil sizes for the SLI group were significantly larger than those for the TD group for easy sentences. There were no group differences for the hard sentences.

Conclusion

In TD children, pupillometry was sensitive to the attentional demands associated with sentence comprehension. Between-subjects comparisons indicated that the TD group allocated less attention than did the children with SLI for the easy sentences but not for the hard sentences. This study provides evidence of attentional differences between children with SLI and TD children under conditions of low processing demands.

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Speech Motor Sequence Learning: Acquisition and Retention in Parkinson Disease and Normal Aging

Purpose

The aim of the current investigation was to examine speech motor sequence learning in neurologically healthy younger adults, neurologically healthy older adults, and individuals with Parkinson disease (PD) over a 2-day period.

Method

A sequential nonword repetition task was used to examine learning over 2 days. Participants practiced a sequence of 6 monosyllabic nonwords that was retested following nighttime sleep. The speed and accuracy of the nonword sequence were measured, and learning was inferred by examining performance within and between sessions.

Results

Though all groups exhibited comparable improvements of the nonword sequence performance during the initial session, between-session retention of the nonword sequence differed between groups. Younger adult controls exhibited offline gains, characterized by an increase in the speed and accuracy of nonword sequence performance across sessions, whereas older adults exhibited stable between-session performance. Individuals with PD exhibited offline losses, marked by an increase in sequence duration between sessions.

Conclusions

The current results demonstrate that both PD and normal aging affect retention of speech motor learning. Furthermore, these data suggest that basal ganglia dysfunction associated with PD may affect the later stages of speech motor learning. Findings from the current investigation are discussed in relation to studies examining consolidation of nonspeech motor learning.

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Predictors of Language Gains Among School-Age Children with Language Impairment in the Public Schools

Purpose

This study aimed to identify child-level characteristics that predict gains in language skills for children with language impairment who were receiving therapy within the public schools. The therapy provided represented business-as-usual speech/language treatment provided by speech-language pathologists in the public schools.

Method

The sample included 272 kindergartners and first-graders with language impairment who participated in a larger study titled “Speech-Therapy Experiences in the Public Schools.” Multilevel regression analyses were applied to examine the extent to which select child-level characteristics, including age, nonverbal cognition, memory, phonological awareness, vocabulary, behavior problems, and self-regulation, predicted children's language gains over an academic year. Pratt indices were computed to establish the relative importance of the predictors of interest.

Results

Phonological awareness and vocabulary skill related to greater gains in language skills, and together they accounted for nearly 70% of the explained variance, or 10% of total variance at child level. Externalizing behavior, nonverbal cognition, and age were also potentially important predictors of language gains.

Conclusions

This study significantly advances our understanding of the characteristics of children that may contribute to their language gains while receiving therapy in the public schools. Researchers can explore how these characteristics may serve to moderate treatment outcomes, whereas clinicians can assess how these characteristics may factor into understanding treatment responses.

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Noncomprehension Signaling in Males and Females With Fragile X Syndrome

Purpose

This study used a prospective longitudinal design to evaluate the trajectory and predictors of noncomprehension signaling in male and female youth with fragile X syndrome (FXS).

Method

A direction-following task in which some of the directions were inadequate was administered. Participants were 52 youth (36 boys, 16 girls) with FXS. Upon study entry, participants ranged from 10 to 16 years. The average number of annual assessments per participant was 3.65 (range = 1–4), providing 198 data points for analysis.

Results

Participants with FXS were less likely to signal noncomprehension than younger, typically developing, cognitively matched children. The average rate of change in noncomprehension signaling was not significantly different from 0 for either boys or girls, suggesting a plateau. Both FMRP and nonverbal IQ were significant independent predictors of noncomprehension signaling for boys. Variability in noncomprehension signaling among girls was not explained by any of the predictors, but trends similar to those observed for boys were observed.

Conclusions

Noncomprehension signaling appears to be an area of weakness for individuals with FXS. Because the failure to signal noncomprehension can have negative, cumulative effects on comprehension, the results suggest a need for interventions targeting the requisite cognitive skills.

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Sensitivity of the Speech Intelligibility Index to the Assumed Dynamic Range

Purpose

This study aims to evaluate the sensitivity of the speech intelligibility index (SII) to the assumed speech dynamic range (DR) in different languages and with different types of stimuli.

Method

Intelligibility prediction uses the absolute transfer function (ATF) to map the SII value to the predicted intelligibility for a given stimuli. To evaluate the sensitivity of the predicted intelligibility to the assumed DR, ATF-transformed SII scores for English (words), Korean (sentences), and Mandarin (sentences) were derived for DRs ranging from 10 dB to 60 dB.

Results

Increasing the assumed DR caused steeper ATFs for all languages. However, high correlation coefficients between predicted and measured intelligibility scores were observed for DRs from 20 dB to 60 dB for ATFs in English, Korean, and Mandarin.

Conclusions

Results of the present study indicate that the intelligibility computed from the SII is not sensitive to the assumed DR. The 30-dB DR commonly used in computing the SII is thus a reasonable assumption that produces accurate predictions for different languages and different types of stimuli.

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Using Pupillometry to Investigate Sentence Comprehension in Children With and Without Specific Language Impairment

Purpose

In this study pupillometry was used to investigate the allocation of attentional resources associated with sentence comprehension in children with and without specific language impairment (SLI).

Method

Eighteen children with SLI (age: M = 6.4 years) and 18 typically developing (TD) children (age: M = 6.3 years) participated in the study. A sentence comprehension task was presented that comprised items designated as easy or hard. Easy sentences contained 4 or 5 words, and hard sentences contained 6 or 7 words.

Results

For the TD group, pupil size was significantly larger when comprehending hard sentences compared with easy sentences. There was no effect of sentence difficulty on pupil size in the SLI group. Comparisons between groups revealed pupil sizes for the SLI group were significantly larger than those for the TD group for easy sentences. There were no group differences for the hard sentences.

Conclusion

In TD children, pupillometry was sensitive to the attentional demands associated with sentence comprehension. Between-subjects comparisons indicated that the TD group allocated less attention than did the children with SLI for the easy sentences but not for the hard sentences. This study provides evidence of attentional differences between children with SLI and TD children under conditions of low processing demands.

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Speech Motor Sequence Learning: Acquisition and Retention in Parkinson Disease and Normal Aging

Purpose

The aim of the current investigation was to examine speech motor sequence learning in neurologically healthy younger adults, neurologically healthy older adults, and individuals with Parkinson disease (PD) over a 2-day period.

Method

A sequential nonword repetition task was used to examine learning over 2 days. Participants practiced a sequence of 6 monosyllabic nonwords that was retested following nighttime sleep. The speed and accuracy of the nonword sequence were measured, and learning was inferred by examining performance within and between sessions.

Results

Though all groups exhibited comparable improvements of the nonword sequence performance during the initial session, between-session retention of the nonword sequence differed between groups. Younger adult controls exhibited offline gains, characterized by an increase in the speed and accuracy of nonword sequence performance across sessions, whereas older adults exhibited stable between-session performance. Individuals with PD exhibited offline losses, marked by an increase in sequence duration between sessions.

Conclusions

The current results demonstrate that both PD and normal aging affect retention of speech motor learning. Furthermore, these data suggest that basal ganglia dysfunction associated with PD may affect the later stages of speech motor learning. Findings from the current investigation are discussed in relation to studies examining consolidation of nonspeech motor learning.

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Predictors of Language Gains Among School-Age Children with Language Impairment in the Public Schools

Purpose

This study aimed to identify child-level characteristics that predict gains in language skills for children with language impairment who were receiving therapy within the public schools. The therapy provided represented business-as-usual speech/language treatment provided by speech-language pathologists in the public schools.

Method

The sample included 272 kindergartners and first-graders with language impairment who participated in a larger study titled “Speech-Therapy Experiences in the Public Schools.” Multilevel regression analyses were applied to examine the extent to which select child-level characteristics, including age, nonverbal cognition, memory, phonological awareness, vocabulary, behavior problems, and self-regulation, predicted children's language gains over an academic year. Pratt indices were computed to establish the relative importance of the predictors of interest.

Results

Phonological awareness and vocabulary skill related to greater gains in language skills, and together they accounted for nearly 70% of the explained variance, or 10% of total variance at child level. Externalizing behavior, nonverbal cognition, and age were also potentially important predictors of language gains.

Conclusions

This study significantly advances our understanding of the characteristics of children that may contribute to their language gains while receiving therapy in the public schools. Researchers can explore how these characteristics may serve to moderate treatment outcomes, whereas clinicians can assess how these characteristics may factor into understanding treatment responses.

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Falls Risk Reduction and Robotics

Understanding and reducing falls in the elderly is an important cornerstone in vestibular and balance rehabilitation, and there may be a new tool on the horizon that could change the way our patients achieve this, namely, exoskeleton technology. Previously, the use of exoskeletons assistance has been limited. Initial prototypes were cumbersome and designed for those with significant motor-control impairment, which left most of the control to the device itself. 

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