Endoscopic and Phoniatric Evaluation in Singing Students

Publication date: Available online 11 December 2017
Source:Journal of Voice
Author(s): Andrea Nacci, Giovanna Baracca, Salvatore Osvaldo Romeo, Maria Denise Cavaliere, Maria Rosaria Barillari, Stefano Berrettini, Francesco Ursino, Bruno Fattori
ObjectivesIn To analyze laryngostroboscopic findings and ENT/phoniatric examination results in a group of singing students and in a control group of non-singing subjects to emphasize the importance of ENT/phoniatric examination and of laryngostroboscopy before taking up singing.Methods56 singing students and 60 healthy euphonic non-singer volunteers were recruited. In each subject a perceptual assessment and a self-assessment (VHI) of the voice were performed. The singing students filled out the Singing-VHI. All subjects underwent flexible fiberoptic endoscopy and laryngostroboscopy. All subjects were evaluated through the Reflux Symptom Index (RSI) and the Reflux Finding Score (RFS).ResultsAt laryngostroboscopy, 60.7% of students presented pathological findings, versus 20% of controls (P < 0.0001). Incomplete glottic closure (35.7% vs. 13.3%), supraglottic hypertonus (16.1% vs. 5%), organic lesions (bilateral nodules, cysts, sulcus vergeture) (17.9% vs. 3.3%), posterior erythema (16.1% vs. 5%) and laryngeal edema (14.3% vs 3.3%) were more frequent in the students. The most common symptoms in singers were phonasthenia (37.5 % vs 6.7%; P =  0.0001) and mucus sensation (17.9% vs. 5%, P = 0.03). S-VHI showed higher values in students with pathological laryngostroboscopy (P < 0.0001). Finally, average RSI and RFS were higher in students.ConclusionsDue to the high percentage of organic and functional voice disorders in singing students, it would be desirable that every subject who is going to start singing underwent an ENT/phoniatric investigation with videostrobolaryngoscopy to ascertain vocal folds healthy condition.



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Bamboo Nodes on a Series of 15 Patients: Vocal Fold Lesion as a Sign of Autoimmune Disease and Microphonotrauma

Publication date: Available online 11 December 2017
Source:Journal of Voice
Author(s): Natalie Oker, Aude Julien-Laferrière, Philippe Herman, Gérard Chevaillier
ObjectivesBamboo nodes are band-like submucosal deposits of the middle third of the vocal fold. They are often related to connective tissue disorders, but can also precede them. The aim of this study was to report our experience with conservative treatment of those rare lesions.MethodsThis is a retrospective series of 15 patients consulting for hoarseness and presenting bamboo nodes from 2010 to 2016.ResultsAll patients were women of mean age of 38 years with a moderate or high degree of daily vocal effort. Nine patients (60%) presented with known autoimmune disease at the phoniatric appointment. The other patients (40%) benefited from a systematic biological research for autoimmune disease, which retrieved two poorly symptomatic connective tissue disorders.Patients were clinically improved by speech therapy (53%) or by an optimization or introduction of immunosuppressive treatment (46%). A spontaneous improvement was observed for three patients after voice rest (one after retirement, one after professional change, and last one after resuming professional singing). In our series, no phonosurgery was performed.The vocal profile at last appointment found a moderate Voice Handicap Index at 35.3/120, a low maximum time of phonation at 13.6 seconds, and a high jitter at 1.4, sign of instability of the vibrator.ConclusionThis series emphasizes the importance of diagnosing bamboo nodes in middle-aged female presenting an autoimmune disease. Vice versa for each patient with bamboo nodes, a systematic autoimmune check-up has to be realized to detect a biological asymptomatic autoimmune disease.



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Transcanal Transpromontorial Acoustic Neuroma Surgery: Results and Facial Nerve Outcomes

Background: Recently, the transcanal approach for the removal of acoustic neuromas has been introduced. Facial nerve (FN) preservation is one of the main challenges of this kind of surgery. Objective: To describe our experience in the surgical treatment of acoustic neuromas, focusing on the functional results of FN preservation after a transcanal approach. Methods: A retrospective chart review was carried out on clinical data and videos from operations on 49 patients who underwent surgery with a totally transcanal exclusive endoscopic approach for Koos stage I–II lesions, or an enlarged transcanal transpromontorial approach for Koos stage II–III tumors, between March 2012 and February 2017. Patients and tumor characteristics, clinical manifestations, radiologic features, audiological results, FN outcomes (according to the House–Brackmann [HB] grading system) and complications were evaluated. Tumors were classified according to the Koos grading system. Results: The age of the patients (34 females and 15 males) ranged from 27 to 77 years (mean age: 54.9 yr). Preoperative diagnosis was “vestibular schwannoma” in all patients. At the last follow-up (range 1–60 mo, mean 13.9 mo), 42 of 49 showed grade I HB FN function, 5 of 49 grade II HB, and 2 of 49 grade III HB. Overall, in 95.9%, FN function was preserved (grade I–II HB) with stable results at follow-up; in 4.1% of cases, FN function was reduced, but not worse than grade III. Conclusion: The transcanal approach represents a feasible, minimally invasive, and conservative technique for the management of acoustic neuromas of the internal auditory canal. Address correspondence and reprint requests to Cristoforo Fabbris, M.D., Otolaryngology Department, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy; E-mail: cristoforo.fabbris@student.unife.it Author contributions: Conception and design: D.M., L.P. Acquisition of data: D.M., C.F., S.D.R., B.M., D.V. Analysis and interpretation of data: D.S., D.M. Drafting the article: D.S., D.M., C.F. Critically revising the article: D.M. Reviewed submitted version of manuscript: C.F. Approved the final version of the manuscript on behalf of all authors: C.F. Administrative/technical/material support: C.F., S.D.R., D.S., D.M. Study supervision: D.M. The authors disclose no conflicts of interest. Copyright © 2017 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

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Assessment of Masses of the External Ear With Diffusion-Weighted MR Imaging

Purpose: To assess masses of the external ear with diffusion-weighted MR imaging. Material and Methods: Retrospective analysis of 43 consecutive patients with soft tissue mass of the external ear. They underwent single shot diffusion-weighted MR imaging of the ear. The apparent diffusion coefficient (ADC) value of the mass of the external ear was calculated. The final diagnosis was performed by biopsy. The ADC value correlated with the biopsy results. Results: The mean ADC value of malignancy (=27) of external ear (0.95 ± 0.19 × 10−3 mm2/s) was significantly lower (p = 0.001) than that of benign (n = 16) lesions (1.49 ± 0.08 × 10−3 mm2/s). The cutoff ADC used for differentiation of malignancy from benign lesions was 1.18 × 10−3 mm2/s with an area under the curve of 0.959, an accuracy of 93%, a sensitivity of 92%, and specificity of 93%. There was a significant difference in the ADC of well and moderately differentiated malignancy versus poorly and undifferentiated squamous cell carcinoma (p = 0.001), and stages I and II versus stages III and IV (p = 0.04) of squamous cell carcinoma. Conclusion: ADC value is a non-invasive promising imaging parameter that can be used for differentiation of malignancy of the external ear from benign lesions, and grading and staging of squamous cell carcinoma of the external ear. Address correspondence and reprint requests to Ahmed Abdel Khalek Abdel Razek, M.D., Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura 13551, Egypt; E-mail: arazek@mans.edu.eg The author discloses no conflicts of interest. Copyright © 2017 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

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What Is the Safety and Efficacy of Chemical Venous Thromboembolism Prophylaxis Following Vestibular Schwannoma Surgery?

Objective: The benefit of routine chemical prophylaxis use for venous thromboembolism (VTE) prevention in skull base surgery is controversial. Chemical prophylaxis can prevent undue morbidity and mortality, however there are risks for hemorrhagic complications. Study Design: Retrospective case-control. Methods: A retrospective chart review of patients who underwent surgery for vestibular schwannoma from 2011 to 2016 was performed. Patients were divided by receipt of chemical VTE prophylaxis. Number of VTEs and hemorrhagic complications (intracranial hemorrhage, abdominal hematoma, and postauricular hematoma) were recorded. Results: One hundred twenty-six patients were identified, 55 received chemical prophylaxis, and 71 did not. All the patients received mechanical prophylaxis. Two patients developed a deep vein thrombosis (DVT) and one patient developed a pulmonary embolism (PE). All patients who developed a DVT or PE received chemical prophylaxis. There was no difference in DVT (p = 0.1886) or PE (p = 0.4365) between those who received chemical prophylaxis and those who did not. Five patients developed a hemorrhagic complication, two intracranial hemorrhage, three abdominal hematoma, and zero postauricular hematoma. All five patients with a complication received chemical prophylaxis (p = 0.00142). The relative risk of a hemorrhagic complication was 14.14 (95% CI = 0.7987–250.4307; p = 0.0778). Conclusion: There was a significant difference between the number of hemorrhagic complications but not between numbers of DVT or PE. Mechanical and chemical prophylaxis may lower the risk of VTE but in our series, hemorrhagic complications were observed. These measures should be used selectively in conjunction with early ambulation. Address correspondence and reprint requests to Geoffrey C. Casazza, M.D., Division of Otolaryngology—Head and Neck Surgery, University of Utah, 50 N. Medical Drive, SOM 3C-120, Salt Lake City, UT 84132; E-mail: geoffrey.casazza@hsc.utah.edu The authors disclose no conflicts of interest. Copyright © 2017 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

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Potential Risk Factors Affecting Repeated Canalith Repositioning Procedures in Benign Paroxysmal Positional Vertigo

Objective: To define the risk factors and adverse effects associated with repeated canalith repositioning procedures (CRPs). Study Design: A case series featuring chart review. Setting: An academic university hospital. Patients: We retrospectively reviewed 1900 patients (average age, 54.9 years; range, 11–88 years) diagnosed with benign paroxysmal positional vertigo (BPPV). All underwent repeated CRPs. We recorded clinical features including age, gender, BPPV cause (idiopathic or secondary), symptom duration, the canal involved, the number of sessions of CRP, recurrence, follow-up duration, and complications. We compared these factors using Pearson's chi-squared test and multiple linear regression analysis with dummy variables. Interventions: BPPV was diagnosed based on the results of the head roll and Dix-Hallpike tests. Results: The overall BPPV resolution rate for patients treated with repeated CRPs was 96.4%. The risk factors for the need for multiple CRPs in BPPV were the duration of vertigo before treatment (β = 0.326, p 50 years. Address correspondence and reprint requests to Seong Jun Choi, MD, PhD, Department of Otolaryngology—Head and Neck Surgery, Soonchunhyang University College of Medicine, 31 Soonchunhyang 6gil, Cheonan, Chungcheongnam-do 31151, Republic of Korea; E-mail: akas9238@hanmail.net J.Y. and J.B.L. contributed equally to this study. This work was supported by the basic Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science, and Technology grant (NRF-2015R1C1A1A01054868), and was supported by the Soonchunhyang University Research Fund. The authors disclose no conflicts of interest. Copyright © 2017 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

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What Is the Sensitive Period to Initiate Auditory Stimulation for the Second Ear in Sequential Cochlear Implantation?

Objectives: Bilateral cochlear implants (CI) are the standard treatment for bilaterally deaf children, but it is unclear how much the second CI can be delayed in sequential bilateral CI. We investigated the performances of sequential CI to answer this question. Study Design: Retrospective case series review. Setting: Tertiary referral center. Methods: We studied a cohort of congenitally deaf children (n = 73) who underwent sequential CI without any inner ear anomaly or combined disabilities. Hearing threshold levels and speech perception were evaluated by aided pure tone audiometry and Asan-Samsung Korean word recognition test. The scores were analyzed by the ages at surgery and compared among the different age groups. Results: When the second CI was performed before 3.5 years (the optimal period for the first CI), the second CI scores (96.9%) were comparable to the first CI scores. Although the first CI scores were more than or equal to 80% when the first CI was implanted before the age of 7 years, the second CI scores were more than or equal to 80% when the second CI was implanted before the age of 12 to 13 years. The hearing threshold levels were not different regardless of the ages and between the first and second CIs. Conclusion: Our cohort demonstrated that the second CI showed comparable results to the first CI when implanted before 3.5 years, suggesting that optimal periods for the first CI and the second CI are same. However, the sensitive period (12–13 yr) for the second CI with good scores (≥80%) was much longer than that (7 yr) of the first CI, suggesting that the first CI prolongs the sensitive period for the second CI. The second CI should be implanted early, but considered even at a later age. Address correspondence and reprint requests to Hong Ju Park, M.D., Ph.D., Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, South Korea; E-mail: dzness@amc.seoul.kr Sponsorships: None. Funding Source: None. The authors disclose no conflicts of interest. Copyright © 2017 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

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Is the Role of External Feedback in Auditory Skill Learning Age Dependent?

Purpose

The purpose of this study is to investigate the role of external feedback in auditory perceptual learning of school-age children as compared with that of adults.

Method

Forty-eight children (7–9 years of age) and 64 adults (20–35 years of age) conducted a training session using an auditory frequency discrimination (difference limen for frequency) task, with external feedback (EF) provided for half of them.

Results

Data supported the following findings: (a) Children learned the difference limen for frequency task only when EF was provided. (b) The ability of the children to benefit from EF was associated with better cognitive skills. (c) Adults showed significant learning whether EF was provided or not. (d) In children, within-session learning following training was dependent on the provision of feedback, whereas between-sessions learning occurred irrespective of feedback.

Conclusions

EF was found beneficial for auditory skill learning of 7–9-year-old children but not for young adults. The data support the supervised Hebbian model for auditory skill learning, suggesting combined bottom-up internal neural feedback controlled by top-down monitoring. In the case of immature executive functions, EF enhanced auditory skill learning. This study has implications for the design of training protocols in the auditory modality for different age groups, as well as for special populations.

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Effects of Aging on Interference During Pronoun Resolution

Purpose

The purpose of this study is to investigate the effects of healthy aging on the ability to suppress grammatically illicit antecedents during pronoun resolution.

Method

In 2 reading-based acceptability–judgment experiments, younger and older speakers of German read sentences containing an object pronoun and 2 potential antecedent noun phrases, only 1 of which was a grammatically licit antecedent. Using a gender-mismatch paradigm, we compared to what extent younger and older speakers were sensitive to feature (mis)matches between the pronoun and either of the 2 antecedents. All participants were fluent readers of German and had finished at least secondary education.

Results

Experiment 1 used a self-paced reading paradigm. Older speakers showed greater sensitivity than younger ones to mismatching licit antecedents, but no group showed any evidence of interference from an intervening competitor antecedent. In Experiment 2, we increased the processing demand by using paced word-by-word stimulus presentation and longer sentences. Here, older participants showed reduced sensitivity, in comparison with younger people, to mismatching licit antecedents. Unlike our younger participants, they showed signs of distraction by the presence of a linearly closer but grammatically inappropriate antecedent when no appropriate antecedent was available.

Conclusion

Together, our results show that older (but not younger) speakers' ability to compute intrasentential referential dependencies is vulnerable to increased task demands. We briefly discuss a potential role for executive functions, such as interference control.

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Collinearity and Sample Coverage Issues in the Objective Measurement of Vocal Quality: The Case of Roughness and Breathiness

Purpose

The aim of the study was to address the reported inconsistencies in the relationship between objective acoustic measures and perceptual ratings of vocal quality.

Method

This tutorial moves away from the more widely examined problems related to obtaining the perceptual ratings and the acoustic measures and centers in less scrutinized issues regarding the procedure to establish the correspondence. Expressions for the most common measure of association between perceptual and acoustic measures (Pearson's r) are derived using a multiple linear regression model. The particular case where the multiple linear regression involves only roughness and breathiness is discussed to illustrate the issues.

Results

Most problems reported regarding inconsistent findings in the relationship between given acoustic measures and particular perceptual ratings could be linked to sample properties not directly related to the actual relationship. The influential sample properties are the collinearity between the regressors in the multiple linear regression and their relative variances. Recommendations on how to rule out this possible cause of inconsistency are given, varying in scope from data collection, reporting, manipulation, and results interpretation.

Conclusions

The problems described can be extended to more general cases than the exemplified roughness and breathiness sample's coverage. Ruling out this possible cause of inconsistency would increase the validity of the results reported.

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Is the Role of External Feedback in Auditory Skill Learning Age Dependent?

Purpose

The purpose of this study is to investigate the role of external feedback in auditory perceptual learning of school-age children as compared with that of adults.

Method

Forty-eight children (7–9 years of age) and 64 adults (20–35 years of age) conducted a training session using an auditory frequency discrimination (difference limen for frequency) task, with external feedback (EF) provided for half of them.

Results

Data supported the following findings: (a) Children learned the difference limen for frequency task only when EF was provided. (b) The ability of the children to benefit from EF was associated with better cognitive skills. (c) Adults showed significant learning whether EF was provided or not. (d) In children, within-session learning following training was dependent on the provision of feedback, whereas between-sessions learning occurred irrespective of feedback.

Conclusions

EF was found beneficial for auditory skill learning of 7–9-year-old children but not for young adults. The data support the supervised Hebbian model for auditory skill learning, suggesting combined bottom-up internal neural feedback controlled by top-down monitoring. In the case of immature executive functions, EF enhanced auditory skill learning. This study has implications for the design of training protocols in the auditory modality for different age groups, as well as for special populations.

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Effects of Aging on Interference During Pronoun Resolution

Purpose

The purpose of this study is to investigate the effects of healthy aging on the ability to suppress grammatically illicit antecedents during pronoun resolution.

Method

In 2 reading-based acceptability–judgment experiments, younger and older speakers of German read sentences containing an object pronoun and 2 potential antecedent noun phrases, only 1 of which was a grammatically licit antecedent. Using a gender-mismatch paradigm, we compared to what extent younger and older speakers were sensitive to feature (mis)matches between the pronoun and either of the 2 antecedents. All participants were fluent readers of German and had finished at least secondary education.

Results

Experiment 1 used a self-paced reading paradigm. Older speakers showed greater sensitivity than younger ones to mismatching licit antecedents, but no group showed any evidence of interference from an intervening competitor antecedent. In Experiment 2, we increased the processing demand by using paced word-by-word stimulus presentation and longer sentences. Here, older participants showed reduced sensitivity, in comparison with younger people, to mismatching licit antecedents. Unlike our younger participants, they showed signs of distraction by the presence of a linearly closer but grammatically inappropriate antecedent when no appropriate antecedent was available.

Conclusion

Together, our results show that older (but not younger) speakers' ability to compute intrasentential referential dependencies is vulnerable to increased task demands. We briefly discuss a potential role for executive functions, such as interference control.

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Collinearity and Sample Coverage Issues in the Objective Measurement of Vocal Quality: The Case of Roughness and Breathiness

Purpose

The aim of the study was to address the reported inconsistencies in the relationship between objective acoustic measures and perceptual ratings of vocal quality.

Method

This tutorial moves away from the more widely examined problems related to obtaining the perceptual ratings and the acoustic measures and centers in less scrutinized issues regarding the procedure to establish the correspondence. Expressions for the most common measure of association between perceptual and acoustic measures (Pearson's r) are derived using a multiple linear regression model. The particular case where the multiple linear regression involves only roughness and breathiness is discussed to illustrate the issues.

Results

Most problems reported regarding inconsistent findings in the relationship between given acoustic measures and particular perceptual ratings could be linked to sample properties not directly related to the actual relationship. The influential sample properties are the collinearity between the regressors in the multiple linear regression and their relative variances. Recommendations on how to rule out this possible cause of inconsistency are given, varying in scope from data collection, reporting, manipulation, and results interpretation.

Conclusions

The problems described can be extended to more general cases than the exemplified roughness and breathiness sample's coverage. Ruling out this possible cause of inconsistency would increase the validity of the results reported.

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Is the Role of External Feedback in Auditory Skill Learning Age Dependent?

Purpose

The purpose of this study is to investigate the role of external feedback in auditory perceptual learning of school-age children as compared with that of adults.

Method

Forty-eight children (7–9 years of age) and 64 adults (20–35 years of age) conducted a training session using an auditory frequency discrimination (difference limen for frequency) task, with external feedback (EF) provided for half of them.

Results

Data supported the following findings: (a) Children learned the difference limen for frequency task only when EF was provided. (b) The ability of the children to benefit from EF was associated with better cognitive skills. (c) Adults showed significant learning whether EF was provided or not. (d) In children, within-session learning following training was dependent on the provision of feedback, whereas between-sessions learning occurred irrespective of feedback.

Conclusions

EF was found beneficial for auditory skill learning of 7–9-year-old children but not for young adults. The data support the supervised Hebbian model for auditory skill learning, suggesting combined bottom-up internal neural feedback controlled by top-down monitoring. In the case of immature executive functions, EF enhanced auditory skill learning. This study has implications for the design of training protocols in the auditory modality for different age groups, as well as for special populations.

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Effects of Aging on Interference During Pronoun Resolution

Purpose

The purpose of this study is to investigate the effects of healthy aging on the ability to suppress grammatically illicit antecedents during pronoun resolution.

Method

In 2 reading-based acceptability–judgment experiments, younger and older speakers of German read sentences containing an object pronoun and 2 potential antecedent noun phrases, only 1 of which was a grammatically licit antecedent. Using a gender-mismatch paradigm, we compared to what extent younger and older speakers were sensitive to feature (mis)matches between the pronoun and either of the 2 antecedents. All participants were fluent readers of German and had finished at least secondary education.

Results

Experiment 1 used a self-paced reading paradigm. Older speakers showed greater sensitivity than younger ones to mismatching licit antecedents, but no group showed any evidence of interference from an intervening competitor antecedent. In Experiment 2, we increased the processing demand by using paced word-by-word stimulus presentation and longer sentences. Here, older participants showed reduced sensitivity, in comparison with younger people, to mismatching licit antecedents. Unlike our younger participants, they showed signs of distraction by the presence of a linearly closer but grammatically inappropriate antecedent when no appropriate antecedent was available.

Conclusion

Together, our results show that older (but not younger) speakers' ability to compute intrasentential referential dependencies is vulnerable to increased task demands. We briefly discuss a potential role for executive functions, such as interference control.

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Collinearity and Sample Coverage Issues in the Objective Measurement of Vocal Quality: The Case of Roughness and Breathiness

Purpose

The aim of the study was to address the reported inconsistencies in the relationship between objective acoustic measures and perceptual ratings of vocal quality.

Method

This tutorial moves away from the more widely examined problems related to obtaining the perceptual ratings and the acoustic measures and centers in less scrutinized issues regarding the procedure to establish the correspondence. Expressions for the most common measure of association between perceptual and acoustic measures (Pearson's r) are derived using a multiple linear regression model. The particular case where the multiple linear regression involves only roughness and breathiness is discussed to illustrate the issues.

Results

Most problems reported regarding inconsistent findings in the relationship between given acoustic measures and particular perceptual ratings could be linked to sample properties not directly related to the actual relationship. The influential sample properties are the collinearity between the regressors in the multiple linear regression and their relative variances. Recommendations on how to rule out this possible cause of inconsistency are given, varying in scope from data collection, reporting, manipulation, and results interpretation.

Conclusions

The problems described can be extended to more general cases than the exemplified roughness and breathiness sample's coverage. Ruling out this possible cause of inconsistency would increase the validity of the results reported.

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