Carotid Body Paraganglioma Extending to the Middle Ear Cavity.

No abstract available

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How Do Voice Perceptual Changes Predict Acoustic Parameters in Persian Voice Patients?

Publication date: Available online 21 October 2017
Source:Journal of Voice
Author(s): Shamim Hosseinifar, Farhad Torabinezhad, Leila Ghelichi, Masoud Roudbari, Erin Pearson Silverman, Maryam Faham
IntroductionPerceptual and acoustic analyses are essential tools that help voice therapists comprehensively assess voice quality. While perceptual evaluations are subjective and are influenced by external and culturally driven factors, acoustic analysis is an objective and reliable means of evaluating voice. The goals of this study were (1) to determine which acoustic parameters were predicted by perceptual voice quality and (2) to assess the effect of a short period of training on the reliability of perceptual voice analyses for Persian speakers.MethodThis was a cross-sectional study. Subjects were 20 patients with various voice disorders. Voice samples were obtained during text reading and /a/ prolongation. Fifteen expert voice clinicians completed perceptual evaluations on voice samples using the Grade, Roughness, Breathiness, Asthenia, and Strain scale. We repeated this process after a short period of perceptual voice evaluation training. Acoustic analysis was completed using the Praat program. We used the intraclass correlation coefficient (ICC) for reliability measurement of the perceptual evaluation results and ordinal regression procedures to analyze all data. Significance level was set at P < 0.05.ResultsBoth intrarater and interrater reliability increased after training, for all five parameters. The ICC for grade increased to 0.95 after training. Grade and roughness significantly predicted fundamental frequency (F0) (P = 0.021 and P = 0.030, respectively) and harmonic-to-noise ratio (HNR) (P = 0.019 and P = 0.016, respectively). Breathiness significantly predicted shimmer (P = 0.013).ConclusionTraining had a positive effect and increased the reliability of perceptual voice evaluation. For Persian listeners, changes in F0, increases in HNR, and shimmer were perceptually associated with poor voice quality.



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Vocal Changes Following Thyroid Surgery: Prospective Study of Objective and Subjective Parameters

Publication date: Available online 19 October 2017
Source:Journal of Voice
Author(s): Beatriz Delgado-Vargas, Azucena Lloris Romero-Salazar, Ignacio Cobeta
ObjectiveVocal changes are frequent following a surgical procedure to the thyroid gland. Even though they are a recognized morbidity, their bases are yet to be defined as well as their effect on vocal parameters. This study investigates the objective and subjective changes that occur after the surgery.Study designThis study is a prospective analysis of consecutive cases.SettingThis study was conducted in a single-center tertiary care facility.Subjects and methodsPatients programmed for any thyroid procedure in Hospital Universitario Ramón y Cajal were enrolled consecutively to perform the vocal analysis before and after the surgery from April 2014 to April 2016. Patients were divided according to the vocal fold motility, and their vocal and aerodynamic parameters were obtained by means of electroglottography and phonatory aerodynamic system. Patients filled in the 10-item Voice Handicap Index (VHI-10) questionnaire. Statistical analysis was performed comparing vocal and aerodynamic parameters and quality of life before and after the surgery.Results218 patients met inclusion criteria and completed the protocol. A total of 86.6% of the sample showed no vocal motility impairment, whereas the rest of the patients showed a paresis or a paralysis. Maximum phonatory time and VHI-10 questionnaire showed a statistically significant difference (P < 0.05) between groups. No differences were assessed regarding other vocal parameters.ConclusionsEfforts are still needed to understand the groundings and magnitude of the vocal changes after a thyroid surgery.



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The Effects of Exposure to Environmental Cigarette Smoke on the Vocal Folds of Rats

Publication date: Available online 18 October 2017
Source:Journal of Voice
Author(s): Mahmut Babalık, İlhan Topaloğlu, Ziya Saltürk, Güler Berkiten, Yavuz Atar, Belgin Tutar, Şenol Baş
ObjectiveThis study aimed to investigate histopathologically and immunohistochemically the effects of environmental smoke on the vocal folds.MethodsThis study examined 20 healthy Wistar albino rats, which were divided into four groups of five rats. Group 1 was exposed to smoke for 45 days and group 2 for 90 days. Groups 3 and 4 were the respective control groups. The rats in groups 1 and 3 were sacrificed on day 45 and those in groups 2 and 4 on day 90.The larynx specimens were stained with hematoxylin and eosin, and the inflammation, hyperplasia, and metaplasia were evaluated. Ki-67 staining was used for the immunohistochemical analysis.ResultsThere was no significant difference in mononuclear cell infiltration between the experimental and control groups (group 1 vs. group 3 P = 0.20, group 2 and 4 P = 0.41) (Table 3), but there was a significant difference between the two experimental groups (P = 0.007). Mild and moderate hyperplasia was seen in groups 1 and 2, respectively.ConclusionEnvironmental exposure to cigarette smoke has destructive effects on the vocal folds of rats.



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The Fortuitous Discovery of the Olin EILOBI Breathing Techniques: A Case Study

Publication date: Available online 16 October 2017
Source:Journal of Voice
Author(s): Sarah Graham, Emily Deardorff, Kristina Johnston, J. Tod Olin
Exercise-induced laryngeal obstruction (EILO) is the term for the condition previously named vocal cord dysfunction and paradoxical vocal fold motion. It is defined by glottic or supraglottic obstruction during periods of intense exercise. Not all patients respond to conventional therapy with speech-language pathology, behavioral health interventions, and treatment of contributing conditions. In this edition of Journal of Voice, the authors describe a novel series of respiratory retraining techniques, now called Olin EILOBI (EILO biphasic inspiratory) breathing techniques, specifically designed for athletes with EILO. This case presentation describes the discovery of one of these techniques during a session of therapeutic laryngoscopy during exercise. The patient was an adolescent with EILO who demonstrated a positive response to therapy with a variant of these techniques over a few days, having previously struggled with symptoms despite multiple sessions of conventional respiratory retraining over the course of months.



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The Olin EILOBI Breathing Techniques: Description and Initial Case Series of Novel Respiratory Retraining Strategies for Athletes with Exercise-Induced Laryngeal Obstruction

Publication date: Available online 16 October 2017
Source:Journal of Voice
Author(s): Kristina L. Johnston, Hannah Bradford, Heather Hodges, Camille M. Moore, Emily Nauman, J. Tod Olin
IntroductionExercise-induced laryngeal obstruction (EILO), the condition previously known as paradoxical vocal fold motion and vocal cord dysfunction, is characterized by inappropriate glottic or supraglottic obstruction during high-intensity exercise, causing exertional dyspnea, frequently with stridor. EILO is definitively diagnosed through upper-airway visualization during a characteristic episode. Although respiratory retraining is a primary therapy for EILO, many patients report symptom persistence despite adequate performance of traditional techniques. This report describes three novel breathing techniques for EILO, the Olin EILOBI (EILO biphasic inspiratory) breathing techniques. We include a teaching process and case series with patient-reported assessments.Materials and MethodsFollowing descriptions of the techniques and teaching process, we present data from a questionnaire offered to all patients who learned at least one of the techniques between September 2015 and March 2017. Subjects evaluated (1) expectation setting, (2) teaching processes, (3) their ability to implement the techniques during high-intensity exercise, and (4) perceived clinical effectiveness.ResultsNinety-five percent of eligible patients participated, a primarily young, female, and Caucasian sample. Over 50% of subjects competed at the high school varsity level. Sixty-two percent of subjects perceived reasonable expectations, and 82% positively evaluated the teaching process. Seventy-nine percent were able to employ their technique in the high-intensity activity of choice, and 66% perceived clinical effectiveness with the techniques.ConclusionsThe Olin EILOBI breathing techniques are novel respiratory retraining techniques for use in high-intensity exercise. Case series subjects reported reasonable expectations, a helpful teaching process, the ability to use these techniques during high-intensity exercise, and perceived clinical effectiveness.



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Acoustic Analysis of Normal Voice Patterns in Pakistani Adults

Publication date: Available online 21 October 2017
Source:Journal of Voice
Author(s): Saira Ambreen, Nazia Bashir, Sharmeen Aslam Tarar, Rukhsana Kausar
This study was designed to find out normative acoustic measures of adults in Pakistan. Age and gender differences in these parameters were also studied. The study variables include fundamental frequency, absolute jitter, relative jitter, relative average perturbation, 5-point period perturbation quotient perturbation quotient, jitter average absolute difference between consecutive periods, divided by the average period, shimmer local, shimmer decibel, three-point amplitude perturbation quotient, five-point amplitude perturbation quotient, average absolute difference of consecutive differences between the consecutive periods' amplitudes, and harmonics-to-noise ratio. Participants (N = 71; men = 34; women = 37) were recruited through two-stage sampling; convenience and purposive sampling. Participants were selected from students, staff, and faculty of the University of the Punjab, caretakers of the clients coming for clinical services, and researchers' friends, family, and acquaintances. Gender groups were further divided into three subgroups based on the age bands of 21–30, 31–40, and 41–50 years. After screening for health issues, the voice samples were recorded in a sound-proof acoustic laboratory by using a stand-held microphone and Praat software. Praat was also used for voice analyses. Means and standard deviations were conducted for the participants. Age and gender differences were investigated by using the two-way analysis of variance. Normative values were also measured for men and women between the age bracket of 21 and 50 years. Age differences were not significant for any variable. Gender differences were significant in fundamental frequency, absolute jitter, relative jitter, jitter period perturbation quotient, shimmer five-point amplitude perturbation quotient, and harmonics-to-noise ratio. The interaction between age and gender was significant in all the jitter measures. The interaction showed an increase in all these measures between the ages of 31 and 40 years and a decrease between the ages of 41 and 50 years in women, whereas men showed a reverse effect both in the age ranges of 31–40 and 41–50 years.



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Clinical investigation of the Nucleus Slim Modiolar Electrode

Aims: The Nucleus CI532 cochlear implant incorporates a new precurved electrode array, i.e., the Slim Modiolar electrode (SME), which is designed to bring electrode contacts close to the medial wall of the cochlea while avoiding trauma due to scalar dislocation or contact with the lateral wall during insertion. The primary aim of this prospective study was to determine the final position of the electrode array in clinical cases as evaluated using flat-panel volume computed tomography. Methods: Forty-five adult candidates for unilateral cochlear implantation were recruited from 8 centers. Eleven surgeons attended a temporal bone workshop and received further training with a transparent plastic cochlear model just prior to the first surgery. Feedback on the surgical approach and use of the SME was collected via a questionnaire for each case. Computed tomography of the temporal bone was performed postoperatively using flat-panel digital volume tomography or cone beam systems. The primary measure was the final scalar position of the SME (completely in scala tympani or not). Secondly, medial-lateral position and insertion depth were evaluated. Results: Forty-four subjects received a CI532. The SME was located completely in scala tympani for all subjects. Pure round window (44% of the cases), extended round window (22%), and inferior and/or anterior cochleostomy (34%) approaches were successful across surgeons and cases. The SME was generally positioned close to the modiolus. Overinsertion of the array past the first marker tended to push the basal contacts towards the lateral wall and served only to increase the insertion depth of the first electrode contact without increasing the insertion depth of the most apical electrode. Complications were limited to tip fold-overs encountered in 2 subjects; both were attributed to surgical error, with both reimplanted successfully. Conclusions: The new Nucleus CI532 cochlear implant with SME achieved the design goal of producing little or no trauma as indicated by consistent scala tympani placement. Surgeons should be carefully trained to use the new deployment method such that tip fold-overs and over insertion may be avoided.
Audiol Neurotol 2017;22:169-179

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