Etiopathological Study of 100 Patients of Hoarseness of Voice: In a Rural Based Hospital

Hoarseness of voice is one of the commonest symptoms in otolaryngological practice and it indicates diseases ranging from totally benign condition to the most malignant condition. This is a study to know the etiology, predisposing factor, and clinical profile of patients having hoarseness of voice. The study was carried out in the department of ENT, Mahatma Gandhi Institute of Medical Sciences, Sewagram. Patients coming to our OPD were selected. All the patients then underwent detailed history and routine investigations. Stroboscopic evaluation was done to reach to a diagnosis. A total of 100 patients having hoarseness of voice with male to female ratio 1.50:1 were analysed. Age group varied from 12 to 82 years. Largest group comprised of labourer (33 %) followed by house wives (30 %) and vocal paralysis was found in 33 % of the cases. Upper respiratory tract infection (24 %) and smoking (33 %) were found to be the common predisposing factors. Functional disorders were found in 14 % of the cases.     

Evaluation of some of the vocal dynamic function tests in laryngeal diseases and voice disorders

A preliminary study of vocal dynamic function tests in 38 patients having various laryngeal diseases and voice disorders was conducted using stroboscopy, pulmonary function tests and maximum phonation time. The parameters studied were pitch, vital capacity (VC), forced expiratory volume in one second (FEV₁, maximum mid-expiratory flow rate (MMFR) peak expiratory flow rate (PEFR), maximum phonation time (MPT) and phonation quotient (PQ). This study revealed that the determination of the PEFR, MMFR and MPT were useful tests in objective evaluation of laryngeal diseases and voice disorders.     

Risk factors for voice quality after radiotherapy for early glottic cancer

Background and purpose

In the majority of patients irradiated for early glottic cancer an abnormal voice was reported. The purpose of the study was to determine the factors influencing voice quality after radiotherapy for T1 glottic cancer.

Methods

The voices of 75 male patients irradiated for T1 glottic carcinoma were assessed subjectively and objectively by acoustic analyses and aerodynamic measurements. The laryngeal function and morphology were evaluated by videolaryngostroboscopy. The data on smoking habits, the associated diseases influencing voice quality, the extent of the tumor, the type of biopsy, and the irradiation technique were collected from the medical records. The data on the factors influencing voice quality were compared for patients with a normal/near-normal voice and those with a hoarse voice.

Results

Voice quality was at least slightly abnormal in 94.7% and 81.3% of patients, when assessed perceptively and objectively, respectively. Smoking after the completed treatment, more severe morphologic alterations of the vocal folds, dryness of the throat, incomplete closure of the vocal folds and functional voice disorders expressed as supraglottic activity adversely influenced the voice quality. A good correlation between the perceptive voice assessment and the acoustic analyses was established.

Conclusions

After the successful irradiation for T1 glottic carcinoma, the great majority of the patients have at least a slightly hoarse voice. A better voice outcome could be achieved if radiotherapy was followed by the patient’s cessation of smoking and the appropriate voice therapy.     

Predictive value of Electroglottography in voice disorders

A prospective study of 62 consecutive cases of voice disorders in which an attempt has been made to define the predicictive value of electrography in voice disorders. The overall predictability is 69.3% with a high sensitivity for mass lesions and mobality disorders of vocal cord.     

Outcome analysis of benign vocal cord lesions by videostroboscopy, acoustic analysis and voice handicap index

Benign vocal cord lesions affect vibratory vocal fold function resulting in significant dysphonia. A prospective study of 30 patients with benign vocal fold lesions was undertaken at our centre to compare the pre and post operative voice using videostroboscopy, voice analysis and voice handicap index. The vibratory pattern of the cord improved as evidenced by the stroboscopic parameters-symmetry, mucosal wave and glottic closure (p<0.05). Voice analysis showed a trend towards normalcy but the values obtained did not attain statistical significance. Voice handicap index showed a reduction in the total and the subscales scores. Videostroboscopy along with acoustic analysis and voice handicap index are useful tools in the objective and subjective assessment of the effectiveness of treatment in patients with benign vocal cord lesions. Their routine use in a voice clinic is recommended.     

Soft phonation index — a sensitive parameter?

Objective

The diagnosis of voice disorders is based on perceptual and acoustic paradigms. Modern acoustic analysis systems are relatively inexpensive and user friendly. One aspect of laryngeal function that is of great interest is the extent of vocal fold closure. Soft phonation index (SPI) is the parameter in Multi Dimensional Voice Program, which reflects the approximation of vocal folds. High values of SPI are stated to correlate with incomplete vocal fold adduction and are a better indicator of breathiness than EGG. This study aims to determine the sensitivity of this acoustic parameter of SPI, as a reflective indicator of incomplete vocal fold adduction in male patients diagnosed with unilateral vocal nodules.

Methodology

60 participants were included in the study; 30 with normal vocal fold functioning in the control group and 30 with unilateral vocal nodules in the experimental group. The phonation sample of vowel /a/ was recorded into CSL 4150 of Kay Elemetrics, in a sound treated room. The readings of SPI on the MDVP analysis was extracted and subjected to statistical analysis using independent samples ‘t-test’ using SPSS Version 11.

Results

The results of the study reveal that there was a statistically significant difference between the means of the SPI values between the control and the experimental groups.

Discussion

It can be understood that SPI is a sensitive parameter to detect abnormalities in vocal fold approximation in the considered population of individuals with vocal nodules. This is in coherence with a study done on patients with vocal fold palsy and cordectomy, wherein SPI was found to be a good indicator of breathiness. The SPI mean obtained for participants in the control group was higher than the Western normative mean specified in MDVP, which highlights the importance of establishing normative values for Indian population.

Conclusion

It can be concluded that SPI was sensitive to detect changes affecting vocal fold closure in unilateral vocal nodules. But this conclusion has to be generalized with caution keeping in mind that only one population with vocal pathology was studied. The factors of vocal fold physiology and mechanical properties of vocal tract, which may contribute to individual variations in SPI values, have to be considered for further research.     

Pre and Post Operative Voice Analysis After Medialization Thyroplasty in Cases of Unilateral Vocal Fold Paralysis

The present study was undertaken to assess the efficacy of medialization thyroplasty on outcome of voice quality in vocal cord paralysis by analyzing the voice. A total 19 patients with vocal cord paralysis of different etiologies were included in the study. Preoperative voice analysis was done by voice recordings, GRBAS score, maximum phonation time (MPT) and acoustic analysis using Dr Speech software (University version 4.0) using habitual fundamental frequency (F0), jitter %, shimmer % and normalized noise energy (NNE) as parameters. 18 patients underwent type 1 or medialization thyroplasty alone and 1 patient had undergone medialization thyroplasty along with arytenoids adduction. Post operative voice analysis was done using same parameters. There was post operative improvement of voice in 16 patients whereas 3 patients showed no significant improvement. Mean preoperative MPT was 4.8947 s and post operative was 13 s. Mean preoperative GRBAS score was 76.1579 and post operative was 30. On acoustic analysis, mean preoperative habitual fundamental frequency (F0), jitter %, shimmer % and NNE was 278.16 Hz, 1.7, 6.81 and 1.81 dB respectively whereas post operative mean was 132.37 Hz, 0.41, 1.65 and 123.38 dB respectively. Thyroplasty offers good voice outcome in patients of uncompensated vocal cord paralysis. Improvement can be documented in terms of perceptual evaluation of voice and acoustic analysis as well as maximum phonation time in addition to voice recording.     

Predisposing factors and aetiology of Hoarseness of voice

A study comprising 110 patients with hoarseness of voice was carried out between Jan 1998 and September 1999 to find out the predisposing factors and aetiology oj the condition Septic foci in nose and throat and vocal abuse were the common predisposing factors observed in 41 8% and 40 9% cases respectively Chronic non specific laryngitis was the commonest aetiology of hoarseness of voice seen in 43 6% of cases     

Consequences of voice impairment in daily life for patients following radiotherapy for early glottic cancer: voice quality, vocal function, and vocal performance

Purpose: To assess consequences of voice impairment in daily life for patients following radiotherapy for early glottic cancer, by means of a multidimensional analysis protocol including voice quality, vocal function, and vocal performance measures.

Methods and Materials: A total of 60 men treated with radiotherapy (66 Gy/33 fractions, 60 Gy/30fractions, 60 Gy/25fractions) for early T1 glottic cancer and 20 matched control speakers filled in questionnaires on vocal performance. Furthermore, perceptual analyses of voice quality and stroboscopic measures of vocal function were performed. There was a longitudinal group of 10 patients from whom data were collected before, as well as 6 months and 2 years after, radiation. Furthermore, data were collected on 5 separate groups of 10 patients each: before, 6 months after, 2 years after, 3–7 years after, and 7–10 years after radiation.

Results: High correlations were found between self-ratings of vocal performance and several voice measures. Patients before radiotherapy experienced poor voice characteristics that improved 6 months to 10 years after treatment, and became comparable to vocal performance of control speakers in 50% of the patients. Following radiotherapy, deviant voice characteristics and consequences in daily life occurred significantly more often for patients in whom initial diagnosis consisted of stripping the vocal cord instead of biopsies and for patients who continued smoking after treatment.

Conclusion: Voice characteristics of patients diagnosed with early glottic cancer improved after radiotherapy, and became normal in half of our patients. Stripping the vocal cord for initial diagnosis and continued smoking after treatment decreased deviant voice characteristics.     

Cordoplasty: A New Technique for Managing Bilateral Vocal Cord Paralysis and Its Comparison with Posterior Cordotomy and External Procedure in a Large Study Group

To compare the functional results between posterior cordotomy, cordoplasty and external procedure in managing bilateral vocal cord paralysis in one of the largest published study group. Retrospective and comparative study. 54 patients with bilateral vocal cord paralysis who underwent posterior cordotomy (Group-I), cordoplasty (Group-II) and external procedure (Group-III) from 2001 to 2013 were compared for functional outcomes. Successful decannulation was achieved more in Group-I and II than in Group-III. Voice outcome was better in Group-II patients compared to other groups. Outcomes of cordoplasty was better than posterior cordotomy and external procedures, with acceptable airway and good quality of voice. Posterior cordotomy is preferred in patients without tracheostomy and in pediatric patients. In patients with tracheostomy or who accept temporary tracheostomy, a cordoplasty is preferred for favorable voice. External procedure is preferred for patients not fit for general anesthesia.     

Role of radiation in the management of early vocal cord carcinoma

From 1952-1978, 177 patients with epidermoid carcinoma confined to the true vocal cords with normal mobility (T1NO) were treated with radiation alone. Five- and 10-year adjusted actuarial survival rates for all patients were 97 and 95%, respectively. The tumor recurred in the larynx and/or neck in 16% of patients with T1a (one cord involved) and 23% of the patients with T1b (both vocal cords involved) disease. Radiation failures were surgically salvaged in 89% of patients with T1a disease without anterior commissure involvement, in 60% of those with T1a disease with anterior commissure involvement and in 57% of those with T1b disease. Tumor was ultimately controlled in 97% of the patients with T1a and 90% of the patients with T1b disease. Voice was preserved in 93% of the patients with T1a disease and 77% of patients with T1b disease. Of 121 patients evaluated for voice quality, 77% had good and 22% had fair voice, while only one patient had poor quality of voice. Patients with fair or poor quality voice usually had had salvage hemilaryngectomy. We recommend radiation for all patients with early vocal cord carcinoma.     

全喉切除一期发音重建术

目的：总结对晚期喉癌患者施行全喉切除术后,一期完成发音重建术的方法、要点及效果。方法：对11例晚期喉癌患者施全喉切除,同时切除双侧咽缩肌、进行气管-食管造瘘,一期完成发音重建术,结果：11例患者术后均能正常进食,经安放硅胶发音钮后,均成功发音,随访三个月,其中9例言语自如,音量及音质均佳。2例话音连续性差、音量较低。结论：在全喉切除术中切断咽缩肌同时进行食管-气管造瘘可提高发音重建术的成功率。     

Medialization laryngoplasty-A study of 15 cases

Type I thyroplasty has become a primary surgical choise for voice restoration in patients with glottal incompetence due to vocal cord palsy. In this study 15 such cases of different etiologies were taken up for medializatioin laryngoplasty and their preoperative und post operative. voice assessment were done. We found that there was significant improvement in loudness: hoarseness and breathiness. Postoperative maximum phonation time also increased to normal limits. There were no major complications of the surgery.     

Acoustic voice analysis in different phonetic contexts after larynx radiotherapy for T1 vocal cord carcinoma

Introduction Radiotherapy for early vocal cord carcinoma affects quality of voice. Nevertheless, most patients refer to having a high satisfaction level with their voice. The few acoustic studies on quality of voice have been performed only in prolonged vowel production, which is not a usual speech situation. The present study has been done with the aim of establishing which phonetic situations reflect a greater alteration in voice production related to irradiation. Material and methods Eighteen male patients irradiated for Tis-T1 vocal cord carcinoma and a control group of 31 non-irradiated subjects were included in a study of acoustic voice analysis. This analysis was performed one year after radiotherapy. Patients and control group voices were tape recorded in extended vowel production, oral reading of a standard paragraph, spontaneous speech and in a song. Acoustic analysis was performed by a Kay Elemetric’s Computerized Speech Lab (model CSL #4300). Fundamental frequency, jitter, shimmer and harmonics-to-noise ratio were obtained in both groups. Statistical test: Lin concordance coefficient and Pearson’s correlation coefficient, Student’s t-test and ROC curves. Results Concordance and correlation studies did not allow selection of any subgroup in acoustic parameters and different acoustic situations. Acoustic parameters had higher median values in irradiated patients. Student’s t-test showed significant differences for fundamental frequency in sustained vowel production and spontaneous speech; for jitter there was statistical significance in all the acoustic situations and for shimmer in oral reading and song. Jitter showed a cut-off of 2.02% with a sensitivity of 89% and specificity of 97% in classifying irradiated and non-irradiated groups. The ROC curve for jitter correctly classified 94% of subjects into irradiated or non-irradiated groups. Conclusions The present study showed that jitter obtained from spontaneous speech was the most relevant parameter in discriminating voice in irradiated patients by acoustic analysis. Jitter in spontaneous speech is in need of more analysis in bigger series and in more advanced stages of larynx cancer as its relevance has been demonstrated.     

Effects of vocal fatigue on voice parameters of Indian Teachers

Vocal fatigue is a frequently reported voicec symptom among professional voice users. Indian School teachers teach lontinuously for many hours in advene acoustical environments and are highly susceptible to vocal fatigue. The present study is the first to examine acoustic voice measures in teacher, reporting naturally induced vocal fatigue. 40 female primary school teachers (mean age =36 yearn) with varying severity of vocal fatigue participated in this studr. Voice measures of minimum and maximum fundametal frequency were obtained before and after one and a half hours of continuous teaching at the workplace. Maximum fundamental frequent was an important acoustic parameter in determining presence of weal fatigue. Most cummin perceptual sympioms include throat dryneis, discomfort and loss of voit e. The rule of vocal hygiene and warm-up in reducing vocal fatigue are considered.     

Voice quality assessment after laryngeal cancer radiotherapeutic treatment at initial stages

Introduction The voice quality resulting from the radiotherapeutic treatment is a relevant factor to take into consideration at the time of evaluating the results. In this study the results of an objective assessment in relation to the vocal function and the patients' voice self-evaluation are presented. Materials and methods 18 glottic tumour patients, at initial stage, treated with radiotherapy, were studied. There were made an objective analysis on the voice and a study on the perceived quality both by the examiners and the patients. Results p Normal voices were observed in the 11%, slight dysphonias in 44.4%, moderate dysphonias in 27.8% and severe dysphonias in 16.7% of the cases. Spectrographically, the 18 samples were classified as Grade I one case (5.5%), Grade II 7 (38.8%), Grade III 5 (27.7%) and Grade IV 5 (27.7%). The questionnaire Voice Handicap Index Which was completed by the patients themselves, gave out results values very close to normality. Conclusions The patients voice acoustic analysis of the series shows the damage thereof after the radiotherapeutic treatment is minimum as well as the handicap feeling of the T1 laryngeal carcinoma patients treated with radiotherapy.     

Objective and Subjective Evaluation of Larynx in Smokers and Nonsmokers: A Comparative Study

The deleterious effects of smoking on laryngeal mucosa are indisputable. Smoking not only causes histologic (microscopic) alterations in the vocal fold epithelium but also affect the acoustic property of voice. The goal of this study was to determine the effects of smoking on the laryngeal structures and phonatory physiology via videostroboscopy, acoustic voice analysis and electroglottography. Cross-sectional and observational study was carried out in Department of ENT, Pt. J. N. M. Medical College, Raipur, in 100 male volunteers (50 smokers and 50 nonsmokers) between the ages of 18 and 60 years with no voice complaints. All subjects were analyzed for detailed history and underwent videostroboscopic, acoustic voice analysis and electroglottographic examination. Videostroboscopic examination results showed significant relationships between smoking and abnormal vocal fold edge, abnormal texture, edema, erythema, abnormal mucosal cover, abnormal phase symmetry and abnormal pliability/stiffness. Voice analysis showed that smoking has a clear effect on some acoustic voice and electroglottographic parameters. The parameters most commonly affected by smoking are fundamental frequency (F0), jitter, shimmer, F0 tremor, normalized noise energy, signal noise ratio, maximum phonation time (MPT), s/z ratio, opening rate and closing rate. The results indicate that smoking has a significant effect on laryngeal structures and phonatory physiology.     

Microlaryngoscopic study of 100 cases of Hoarseness of voice

100 patients with hoarseness of voice were studied with the help of microlaryngoscopy along with other conventional methods. The peak incidence of the laryngeal diseases was in the age group between 21 to 30 years (28%). The incidence in males (56%), was more than females (44%). Maximum incidence was found among house-wives (29%). 72% patients had a history of vocal abuse. Commonest disease was vocal nodule (30%). The ratio of unilateral and bilateral affection was near about 5 : 4. Hoarseness of voice due to vocal nodules, Reinke’s oedema, vocal polyps or fibroangioma was cured in 88%–100% of the cases by microlaryngeal surgery.     

Acoustic analysis after radiotherapy in T1 vocal cord carcinoma: a new approach to the analysis of voice quality

PURPOSE: The study of acoustic voice parameters (fundamental frequency, jitter, shimmer, and harmonics-to-noise ratio) in extended vowel production, oral reading of a standard paragraph, spontaneous speech and a song in irradiated patients for Tis-T1 vocal cord carcinoma. METHODS AND MATERIALS: Eighteen male patients irradiated for Tis-T1 vocal cord carcinoma and a control group of 31 nonirradiated subjects of the same age were included in a study of acoustic voice analysis. The control group had been rigorously selected for voice quality and the irradiated group had previous history of smoking in two-thirds of the cases and a vocal cord biopsy. Radiotherapy patients were treated with a 6MV Linac receiving a total dose of 66 Gy, 2 Gy/day, with median treatment areas of 28 cm(2). Acoustic voice analysis was performed 1 year after radiotherapy, the voice of patients in extended vowel production, oral reading of a standard paragraph, spontaneous speech, and in a song was tape registered and analyzed by a Kay Elemetric's Computerized Speech Lab (model CSL# 4300). Fundamental frequency, jitter, shimmer, and harmonics-to-noise ratio were obtained in each case. Mann Whitney analysis was used for statistical tests. RESULTS: The irradiated group presented higher values of fundamental frequency, jitter, shimmer, and harmonics-to-noise ratio. Mann-Whitney analysis showed significant differences for fundamental frequency and jitter in vowel production, oral reading, spontaneous speech, and song. Shimmer only showed differences in vowel production and harmonics-to-noise ratio in oral reading and song. CONCLUSIONS: In our study only fundamental frequency and jitter showed significant increased values to the control group in all the acoustic situations. Sustained vowel production showed the worst values of the acoustic parameters in comparison with the other acoustic situations. This study seems to suggest that more work should be done in this field.