Clinical Practice Guideline: Hoarseness (Dysphonia) (Update) Executive Summary.

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Stachler, Robert J; Francis, David O; Schwartz, Seth R; Damask, Cecelia C; Digoy, German P; Krouse, Helene J; McCoy, Scott J; Ouellette, Daniel R; Patel, Rita R; Reavis, Charles Charlie W; Smith, Libby J; Smith, Marshall; Strode, Steven W; Woo, Peak; Nnacheta, Lorraine C

2018-03-01

cause amenable to voice therapy. The guideline update group made recommendations for the following KASs: (1) Clinicians should identify dysphonia in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces quality of life (QOL). (2) Clinicians should assess the patient with dysphonia by history and physical examination for underlying causes of dysphonia and factors that modify management. (3) Clinicians should perform laryngoscopy, or refer to a clinician who can perform laryngoscopy, when dysphonia fails to resolve or improve within 4 weeks or irrespective of duration if a serious underlying cause is suspected. (4) Clinicians should perform diagnostic laryngoscopy, or refer to a clinician who can perform diagnostic laryngoscopy, before prescribing voice therapy and document/communicate the results to the speech-language pathologist (SLP). (5) Clinicians should advocate for surgery as a therapeutic option for patients with dysphonia with conditions amenable to surgical intervention, such as suspected malignancy, symptomatic benign vocal fold lesions that do not respond to conservative management, or glottic insufficiency. (6) Clinicians should offer, or refer to a clinician who can offer, botulinum toxin injections for the treatment of dysphonia caused by spasmodic dysphonia and other types of laryngeal dystonia. (7) Clinicians should inform patients with dysphonia about control/preventive measures. (8) Clinicians should document resolution, improvement or worsened symptoms of dysphonia, or change in QOL of patients with dysphonia after treatment or observation. The guideline update group made a strong recommendation against 1 action: (1) Clinicians should not routinely prescribe antibiotics to treat dysphonia. The guideline update group made recommendations against other actions: (1) Clinicians should not obtain computed tomography (CT) or magnetic resonance imaging (MRI) for patients with a primary voice complaint

Psychosis improved dysphonia

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Murphy, Ruth Ann; Hallahan, Brian

2013-01-01

We present the case of a 40-year-old single man with a diagnosis of Schizoaffective Disorder since 1989 and a comorbid diagnosis of functional (dissociative) dysphonia since 2011. Although receiving ongoing treatment from a Speech and Language Therapist, the patient's symptoms of dysphonia have remained prominent from the time of diagnosis in 2011 and have been particularly apparent during times of psychosocial and interpersonal stress. He had a dramatic and complete resolution of all dysphonic symptoms during an acute relapse of the psychosis in February 2013 and experienced a gradual re-emergence of dysphonic symptoms when his episode of psychosis resolved. This is the first case report to demonstrate such an association and we discuss potential mechanisms for the resolution of dysphonic symptoms during this psychotic relapse. PMID:24323380

[Incidence of dysphonia in teaching staff of schools].

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Bellia, S; Serafino, L; Luca, N; Farruggia, E; Bellia, M

2007-01-01

Some categories of workers (actors, teachers, singers) use a particular working tool: their voice. In order to assess the spread of dysphonia and its possible causes across a specific class of workers--the teachers of some schools in the city of Catania--we have set up a ad hoc questionnaire. A special database has been subsequently arranged, aimed at the statistical analysis of the responses obtained. The analysis of the responses shows that the phenomenon is more present in female than male teachers, 48% versus 30%. The dysphonia occurs mainly at the end of the working day, lasts throughout the school year and improves in summer, demonstrating the importance of teaching activity in its pathogenesis. One aspect especially stands out: dysphonia occurs exclusively in those individuals suffering from diseases with possible alterations of the voice, such as allergopathies, tireopathies and gastropathies. Therefore, work activity alone does not seem able to cause a chronic dysphonia, whereas the presence of diseases causing disability of vocal cords appears to play an important role.

Etiologies of Dysphonia in Patients Referred to ENT Clinics Based on videolaryngoscopy

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Keyvan Kiakojury

2014-07-01

Full Text Available Introduction: Laryngeal dysfunction may be divided into three categories; organic, neurologic and functional disorders. Dysphonia and hoarseness are the most common symptoms and, in some cases, the only signs of laryngeal dysfunction. In differential diagnosis of any type of chronic hoarseness, a neoplastic process must be considered and, thus continuous light video laryngoscopy can provide important information on the presence of neoplastic lesions in order to prevent disease progression via early detection and action.   Materials and Methods: This cross-sectional, descriptive-analytical study was carried out on 197 patients with voice disorders admitted to Ayatollah Rouhani Hospital for video laryngoscopy. Available sampling was used and the results achieved were analyzed using SPSS17 statistical software.   Results: A total of 197 patients (mean age, 40.72 ±15.17 years participated in this study, 56.9% of whom were male. From analysis of video laryngoscopy, organic dysphonia was found to be the most common cause of voice disorders, while functional and neurologic dysphonia were observed in 8.6% and 5.6% of patients, respectively. Vocal nodules and Reinke's edema were among the most common causes of organic dysphonia, with a frequency of 24.4% and 23.4%, respectively; while laryngeal carcinoma accounted for 2.5% of all diagnosed cases with organic causes.   Conclusion:  Since the presence of voice disorders for more than 3 weeks can be a sign of laryngeal dysfunction, early diagnosis using noninvasive methods such as video laryngoscopy and appropriate medical measures can help prevent the disease progression and eliminate the need for actions such as laryngectomy.

Consideration of genetic contributions to the risk for spasmodic dysphonia.

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Sharma, Nutan; Franco, Ramon A

2011-09-01

Spasmodic dysphonia, a form of the neurologic condition known as dystonia, results from involuntary spasms of the larynx, producing interruptions of speech and changes in voice quality. The pathogenesis of spasmodic dysphonia is not well understood. However, several genetic mutations have been identified that cause different forms of dystonia. In some individuals, these genetic mutations result in spasmodic dysphonia, either with no other signs of dystonia or as part of a broader dystonia phenotype. Thus, research in the growing field of dystonia genetics may help to inform our understanding of the pathogenesis of spasmodic dysphonia.

Spasmodic dysphonia: description of the disease and associated neurologic disorders

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Coelho, Marina Serrato

2010-06-01

Full Text Available Introduction: Spasmodic dysphonia (SD is a problem that affects speech and vocalization, one of the most devastating disorders of oral communication. It is characterized by vocal quality tensaestrangulada, harshly and / or interspersed with abrupt vocal attack and a great tension in the vocal tract. The etiology of spasmodic dysphonia is unclear. Some authors point to psychogenic causes, neurological or even unknown. Objective: To assess the prevalence of muscular dystonias and other neurological symptoms in patients with ED. Method: A retrospective study of 10 cases with diagnosis of ED for symptoms and neurological disorders associated. Results: There was a significant predominance of the disease in females (9:1. The average age of onset of symptoms was 32 years, ranging between 14 and 60 years. The mean disease duration was 10 years. Among the patients, 87.5% had a diagnosis of disorders of movement made by a neurologist, including orofacial dystonias (50%, essential tremor (50% and spastic paraparesis (12%. Conclusion: The presence of movement disorders followed almost all cases of spasmodic dysphonia. More studies are needed to clarify the pathophysiological basis of disease.

Dysphonia in very preterm children: a review of the evidence.

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Reynolds, Victoria; Meldrum, Suzanne; Simmer, Karen; Vijayasekaran, Shyan; French, Noel

2014-01-01

Intubation is a known risk factor for dysphonia yet is essential in the perinatal care of many very preterm infants. Children born preterm, who are frequently resuscitated with endotracheal intubation, may be at risk of dysphonia at school age and beyond. To identify and describe the evidence pertaining to long-term voice outcomes and risk factors for developing dysphonia in preterm children. In addition to case studies and series, three larger-scale studies have reported on dysphonia and voice outcomes in preterm children. Studies reporting treatment outcomes were not available. Factors associated with poor voice outcomes included female gender, birth weight Dysphonia is a newly reported, long-term complication of preterm birth, yet the number of relevant studies remains limited. Further research is required to confirm the risk factors for developing dysphonia, which will inform future voice treatment studies.

The epidemiology of dysphonia in the aging population.

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Marino, Jeffrey P; Johns, Michael M

2014-12-01

The expanding elderly population continues to exert profound effects on the United States healthcare delivery system. This review summarizes the epidemiology of dysphonia in the aging population as well as its impact on quality of life and the emerging challenges of managing elderly patients with voice disorders. Although often underreported, dysphonia is present in as many as one in three elderly patients. The differential diagnosis for dysphonia in an aging patient is broad, and multifactorial causes are common. In the elderly, dysphonia exerts significant adverse effects on quality of life and often occurs against a background of multiple chronic medical conditions, polypharmacy, hearing loss, dysphagia, and neurologic disease. Recent data have demonstrated that elderly patients respond well to both surgical and nonsurgical treatments for voice disorders. Elderly patients and medical providers, as well as families and caregivers, must be educated about the prevalence of dysphonia in the aging population, its psychosocial impact, and available treatment options. Optimizing the care of voice disorders is essential to maximizing quality of life in aging patients.

[Functional dysphonia and vocal cord nodules in teachers in Navarra, Spain].

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Palomino Moreno, María Prado; Hoyo Rodríguez, Asier; García López, Vega; Losantos Martínez, Juan Tomás

2013-01-01

To describe teachers treated for dysphonia and vocal cord nodules by the public health system in Navarra (Spain), to describe associated factors and to identify the proportion of these cases registered as occupational diseases. Cases of dysphonia occurring in persons between the age of 18 and 65 years, registered between May 2010 and June 2011, and treated in a specific unit (Speech Unit) of Otorhinolaryngology Services were identified. Information on occupation, sex and clinical diagnosis was collected. For teachers, additional information was obtained on smoking habits, teaching level and prior training in speech disorders and their prevention. Cases declared as occupational diseases were identified from the official Register of Occupational Diseases of Navarra. 135 teachers (18% of all dysphonia patients in the sample) were treated for dysphonia in the Speech Unit (87% women). Being female was 3-fold higher among teachers than other occupations (crude prevalence odds ratio = 3.5; 95% confidence interval, 95%CI, 2.1-5.9). Female teachers were also 6.5 years (95%CI, 1.7-11.4) younger than male teachers. No association was found between smoking and risk of vocal cord nodules or dysphonia. Only 20% of teachers treated had received training on speech disorders and their prevention. Nine out of 83 cases of vocal cord nodules diagnosed in professional voice users were officially declared as occupational diseases; in all cases, these were teachers. Dysphonia in teachers is a frequent reason for visiting a specialty clinic. Among these professionals, women showed a higher risk of suffering from vocal cord nodules. Most cases of vocal cord nodules in our sample were not reported as occupational diseases. Copyright belongs to the Societat Catalana de Seguretat i Medicina del Treball.

Vocal therapy of hyperkinetic dysphonia

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Mumović Gordana

2014-01-01

Full Text Available Introduction. Hyperkinetic (hyperfunctional dysphonia is a common pathology. The disorder is often found in vocal professionals faced with high vocal requirements. Objective. The objective of this study was to evaluate the effects of vocal therapy on voice condition characterized by hyperkinetic dysphonia with prenodular lesions and soft nodules. Methods. The study included 100 adult patients and 27 children aged 4-16 years with prenodular lesions and soft nodules. A subjective acoustic analysis using the GIRBAS scale was performed prior to and after vocal therapy. Twenty adult patients and 10 children underwent objective acoustic analysis including several acoustic parameters. Pathological vocal qualities (hoarse, harsh and breathy voice were also obtained by computer analysis. Results. The subjective acoustic analysis revealed a significant (p<0.01 reduction in all dysphonia parameters after vocal treatment in adults and children. After treatment, all levels of dysphonia were lowered in 85% (85/100 of adult patients and 29% (29/100 had a normal voice. Before vocal therapy 9 children had severe, 13 had moderate and 8 slight dysphonia. After vocal therapy only 1 child had severe dysphonia, 7 had moderate, 10 had slight levels of dysphonia and 9 were without voice disorder. The objective acoustic analysis in adults revealed a significant improvement (p≤0.025 in all dysphonia parameters except SD F0 and jitter %. In children, the acoustic parameters SD F0, jitter % and NNE (normal noise energy were significantly improved (p=0.003-0.03. Pathological voice qualities were also improved in adults and children (p<0.05. Conclusion. Vocal therapy effectively improves the voice in hyperkinetic dysphonia with prenodular lesions and soft nodules in both adults and children, affecting diverse acoustic parameters.

Vocal therapy of hyperkinetic dysphonia.

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Mumović, Gordana; Veselinović, Mila; Arbutina, Tanja; Škrbić, Renata

2014-01-01

Hyperkinetic (hyperfunctional) dysphonia is a common pathology. The disorder is often found in vocal professionals faced with high vocal requirements. The objective of this study was to evaluate the effects of vocal therapy on voice condition characterized by hyperkinetic dysphonia with prenodular lesions and soft nodules. The study included 100 adult patients and 27 children aged 4-16 years with prenodular lesions and soft nodules. A subjective acoustic analysis using the GIRBAS scale was performed prior to and after vocal therapy. Twenty adult patients and 10 children underwent objective acoustic analysis including several acoustic parameters. Pathological vocal qualities (hoarse, harsh and breathy voice) were also obtained by computer analysis. The subjective acoustic analysis revealed a significant (pvocal treatment in adults and children. After treatment, all levels of dysphonia were lowered in 85% (85/100) of adult patients and 29% (29/100) had a normal voice. Before vocal therapy 9 children had severe, 13 had moderate and 8 slight dysphonia. After vocal therapy only 1 child had severe dysphonia, 7 had moderate, 10 had slight levels of dysphonia and 9 were without voice disorder. The objective acoustic analysis in adults revealed a significant improvement (p≤0.025) in all dysphonia parameters except SD FO and jitter %. In children, the acoustic parameters SD FO, jitter % and NNE (normal noise energy) were significantly improved (p=0.003-0.03). Pathological voice qualities were also improved in adults and children (pVocal therapy effectively improves the voice in hyperkinetic dysphonia with prenodular lesions and soft nodules in both adults and children, affectinq diverse acoustic parameters.

[Acoustic characteristics of adductor spasmodic dysphonia].

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Yang, Yang; Wang, Li-Ping

2008-06-01

To explore the acoustic characteristics of adductor spasmodic dysphonia. The acoustic characteristics, including acoustic signal of recorded voice, three-dimensional sonogram patterns and subjective assessment of voice, between 10 patients (7 women, 3 men) with adductor spasmodic dysphonia and 10 healthy volunteers (5 women, 5 men), were compared. The main clinical manifestation of adductor spasmodic dysphonia included the disorders of sound quality, rhyme and fluency. It demonstrated the tension dysphonia when reading, acoustic jitter, momentary fluctuation of frequency and volume, voice squeezing, interruption, voice prolongation, and losing normal chime. Among 10 patients, there were 1 mild dysphonia (abnormal syllable number dysphonia (abnormal syllable number 25%-49%), 1 severe dysphonia (abnormal syllable number 50%-74%) and 2 extremely severe dysphonia (abnormal syllable number > or = 75%). The average reading time in 10 patients was 49 s, with reading time extension and aphasia area interruption in acoustic signals, whereas the average reading time in health control group was 30 s, without voice interruption. The aphasia ratio averaged 42%. The respective symptom syllable in different patients demonstrated in the three-dimensional sonogram. There were voice onset time prolongation, irregular, interrupted and even absent vowel formants. The consonant of symptom syllables displayed absence or prolongation of friction murmur in the block-friction murmur occasionally. The acoustic characteristics of adductor spasmodic dysphonia is the disorders of sound quality, rhyme and fluency. The three-dimensional sonogram of the symptom syllables show distinctive changes of proportional vowels or consonant phonemes.

Lower cervical levels: Increased risk of early dysphonia following anterior cervical spine surgery.

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Zeng, Ji-Huan; Li, Xiao-Dan; Deng, Liang; Xiao, Qiang

2016-10-01

The present study aimed to re-evaluate the incidence of early dysphonia after anterior cervical spine surgery (ACSS) and to determine the related risk factors. Patients underwent ACSS between January 2011 and December 2013 at two sites were identified retrospectively from hospital's patient databases. A total of 233 cases were included in this study. Dysphonia developed 1 month postoperatively was recorded. Follow-up was conducted in all positive-response patients. Those reporting severe or persistent voice symptoms were referred to otolaryngologists for further assessments and (or) treatments. Pre and intraoperative factors were collected to determine their relationships with dysphonia one month postoperatively. 45 patients developed dysphonia at one month, including 23 males and 22 females, yielding to an incidence of 19.3%. 34 cases resolved themselves in 3 months, leaving the remaining 11 patients considered to be severe or persistent cases. However, 10 of them recovered spontaneously in the next 9 months, while the last case received vocal cord medialization and returned to almost normal speech function at 18 months. In univariate analysis, only approaching level involving C6-C7 or (and) C7-T1 was significantly associated with postoperative dysphonia (Pdysphonia following ACSS was relatively high and approaching at lower cervical levels was an independent predictive factor. Copyright © 2016 Elsevier B.V. All rights reserved.

Spasmodic dysphonia: a seven-year audit of dose titration and demographics in the Indian population.

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Nerurkar, N K; Banu, T P

2014-07-01

This study aimed to evaluate the demographics of spasmodic dysphonia in the Indian population and to analyse the optimum dose titration of botulinum toxin type A in this group. A comparative analysis with international studies was also performed. The study involved a retrospective analysis and audit of botulinum toxin type A dose titration in spasmodic dysphonia patients who visited our voice clinic between January 2005 and January 2012. The average total therapeutic dose required for patients with adductor spasmodic dysphonia was 4.2 U per patient per vocal fold (total 8.4 U per patient), and for patients with abductor spasmodic dysphonia, it was 4.6 U per patient. Our audit revealed that 80 per cent of the spasmodic dysphonia patients were male, which contrasts dramatically with international studies, wherein around 80 per cent of spasmodic dysphonia patients were female. Our study also revealed a higher dose titration of botulinum toxin for the Indian spasmodic dysphonia population in both adductor and abductor spasmodic dysphonia cases.

Dysphonia and vocal fold telangiectasia in hereditary hemorrhagic telangiectasia.

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Chang, Joseph; Yung, Katherine C

2014-11-01

This case report is the first documentation of dysphonia and vocal fold telangiectasia as a complication of hereditary hemorrhagic telangiectasia (HHT). Case report of a 40-year-old man with HHT presenting with 2 years of worsening hoarseness. Hoarseness corresponded with a period of anticoagulation. Endoscopy revealed vocal fold scarring, vocal fold telangiectasias, and plica ventricular is suggestive of previous submucosal vocal fold hemorrhage and subsequent counterproductive compensation with ventricular phonation. Hereditary hemorrhagic telangiectasia may present as dysphonia with vocal fold telangiectasias and place patients at risk of vocal fold hemorrhage. © The Author(s) 2014.

Dysphonia in preterm children: assessing incidence and response to treatment.

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Reynolds, Victoria; Meldrum, Suzanne; Simmer, Karen; Vijayasekaran, Shyan; French, Noel P

2014-03-01

Mild dysphonia in childhood is surprisingly common, yet moderate to severe dysphonia is rare. The latter has been associated with complex medical conditions and congenital abnormalities. Intubation injury has also been documented as a cause of childhood dysphonia. Children born very preterm may be intubated as part of the intensive care administered in the perinatal and neonatal periods, yet there are few studies investigating dysphonia in this population. This study will be the first to: use an objective acoustic voice assessment in a paediatric study, document the incidence of dysphonia in very preterm children at school age, and conduct a controlled trial of behavioural voice therapy in this population. This study will consist of three phases: assessment of voice quality and its impact on quality of life in up to 200 children born at less than 32 weeks' gestation: assessment of the nature and extent of laryngeal pathology in children with moderate to severe dysphonia; and a non-blinded, randomised controlled trial of behavioural voice therapy in children with moderate to severe dysphonia. This study will be the first to use clinical assessment to examine the voice quality of very preterm children, and to use fibre optic endoscopic evaluation of laryngeal function to determine the nature and extent of any laryngeal pathology in such children. Those participants with significant voice difficulties will be randomised to receive treatment immediately or after the eight week assessment. This study is registered on the Australian New Zealand Clinical Trials Registry (ACTRN12613001015730/ACTRN12613001012763). Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

Comprehensive Management of Psychogenic Dysphonia: A Case Illustration

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Sudhir, Paulomi M.; Chandra, Prabha S.; Shivashankar, N.; Yamini, B. K.

2009-01-01

Psychogenic dysphonia refers to the loss of voice, in the absence of apparent structural or neurological pathology. It is a disorder seen more often in women and is usually associated with significant life events and emotional difficulties that may lead to conflict over speaking. Therapeutic interventions in voice disorders recommend the adoption…

[Clinical-psychological components in the consideration of functional dysphonia--a review].

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Kiese-Himmel, C

2015-03-01

The etiopathogenesis of functional dysphonia is complex; it is not sufficient to look solely at vocal behavior aspects. The predisposing basis for functional dysphonia can lie in the constitution of an individual, his/her professional speaking and speech behavior and/or may be personality-based. (Prolonged) psychosocial stress, vocal overstressing, unfavorable speaking habits, infection of the upper respiratory tract, inflammatory processes in the larynx, emotional life events and COSO events are considered as possible triggers. The interaction of predisposed and causal factors is unknown. Stress, overall fatigue, anxiety, depression and/or certain personality traits (which complicate or hamper coping) are considered as perpetuating factors. In any case, overlaps between voice symptoms and reactive psychic as well as social problems have to be kept in mind (e. g. the burden of suffering, depressive processing, speaking anxiety, socially withdrawal). Because the association of multiple psychosocial factors with functional dysphonia is not distinct--such are always existent in organ medically unexplained symptoms--functional dysphonia has to be diagnostically differentiated. For the purpose of the article, a psycho-diagnostic path following the ICD-10 chapter V along general lines is presented. Until now, it is unknown which psychosocial factors discriminate a psychogenic dysphonia from muscle tension dysphonia. © Georg Thieme Verlag KG Stuttgart · New York.

Phenotype- and genotype-specific structural alterations in spasmodic dysphonia.

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Bianchi, Serena; Battistella, Giovanni; Huddleston, Hailey; Scharf, Rebecca; Fleysher, Lazar; Rumbach, Anna F; Frucht, Steven J; Blitzer, Andrew; Ozelius, Laurie J; Simonyan, Kristina

2017-04-01

Spasmodic dysphonia is a focal dystonia characterized by involuntary spasms in the laryngeal muscles that occur selectively during speaking. Although hereditary trends have been reported in up to 16% of patients, the causative etiology of spasmodic dysphonia is unclear, and the influences of various phenotypes and genotypes on disorder pathophysiology are poorly understood. In this study, we examined structural alterations in cortical gray matter and white matter integrity in relationship to different phenotypes and putative genotypes of spasmodic dysphonia to elucidate the structural component of its complex pathophysiology. Eighty-nine patients with spasmodic dysphonia underwent high-resolution magnetic resonance imaging and diffusion-weighted imaging to examine cortical thickness and white matter fractional anisotropy in adductor versus abductor forms (distinct phenotypes) and in sporadic versus familial cases (distinct genotypes). Phenotype-specific abnormalities were localized in the left sensorimotor cortex and angular gyrus and the white matter bundle of the right superior corona radiata. Genotype-specific alterations were found in the left superior temporal gyrus, supplementary motor area, and the arcuate portion of the left superior longitudinal fasciculus. Our findings suggest that phenotypic differences in spasmodic dysphonia arise at the level of the primary and associative areas of motor control, whereas genotype-related pathophysiological mechanisms may be associated with dysfunction of regions regulating phonological and sensory processing. Identification of structural alterations specific to disorder phenotype and putative genotype provides an important step toward future delineation of imaging markers and potential targets for novel therapeutic interventions for spasmodic dysphonia. © 2017 International Parkinson and Movement Disorder Society. © 2017 International Parkinson and Movement Disorder Society.

Dysphonia and dysphagia after anterior cervical decompression.

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Tervonen, Hanna; Niemelä, Mika; Lauri, Eija-Riitta; Back, Leif; Juvas, Anja; Räsänen, Pirjo; Roine, Risto P; Sintonen, Harri; Salmi, Tapani; Vilkman, S Erkki; Aaltonen, Leena-Maija

2007-08-01

In this paper, the authors investigate the effects of anterior cervical decompression (ACD) on swallowing and vocal function. The study comprised 114 patients who underwent ACD. The early group (50 patients) was examined immediately pre- and postoperatively, and the late group (64 patients) was examined at only 3 to 9 months postoperatively. Fifty age- and sex-matched patients from the Department of Otorhinolaryngology-Head and Neck Surgery who had not been intubated in the previous 5 years were used as a control group. All patients in the early and control groups were examined by a laryngologist; patients in the late group were examined by a laryngologist and a neurosurgeon. Videolaryngostroboscopy was performed in all members of the patient and control groups, and the function of the ninth through 12th cranial nerves were clinically evaluated. Data were collected concerning swallowing, voice quality, surgery results, and health-related quality of life. Patients with persistent dysphonia were referred for phoniatric evaluation and laryngeal electromyography (EMG). Those with persistent dysphagia underwent transoral endoscopic evaluation of swallowing function and videofluorography. Sixty percent of patients in the early group reported dysphonia and 69% reported dysphagia at the immediate postoperative visit. Unilateral vocal fold paresis occurred in 12%. The prevalence of both dysphonia and dysphagia decreased in both groups 3 to 9 months postoperatively. All six patients with vocal fold paresis in the early group recovered, and in the late group there were two cases of vocal fold paresis. The results of laryngeal EMG were abnormal in 14 of 16 patients with persistent dysphonia. Neither intraoperative factors nor age or sex had any effect on the occurrence of dysphonia, dysphagia, or vocal fold paresis. Most patients were satisfied with the surgical outcome. Dysphonia, dysphagia, and vocal fold paresis are common but usually transient complications of ACD

Comparing health locus of control in patients with Spasmodic Dysphonia, Functional Dysphonia and Nonlaryngeal Dystonia.

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Haselden, Karen; Powell, Theresa; Drinnan, Mike; Carding, Paul

2009-11-01

Locus of Control (LoC) refers to an individuals' perception of whether they are in control of life events. Health Locus of Control refers to whether someone feels they have influence over their health. Health Locus of Control has not been studied in any depth in voice-disordered patients. The objective of this study was to examine Health Locus of Control in three patient groups: (1) Spasmodic Dysphonia, (2) Functional Dysphonia and (3) a nondysphonic group with Nonlaryngeal Dystonia. LoC was measured and compared in a total of 57 patients using the Multidimensional Health Locus of Control Scales (diagnostic specific) Form C. Internal, Chance, and Powerful others LoC were measured and comparisons were made using one-way analysis of variance. Contrary to expectations Internal LoC was found to be significantly higher in the Functional Dysphonia group when compared to the other two groups. There was no significant difference between the groups in Chance or Powerful others LoC. The two organic groups, Spasmodic Dysphonia and Nonlaryngeal Dystonia, were more alike in Internal Health Locus of Control than the Functional Dysphonia group. The diagnostic nature of the groups was reflected in their LoC scores rather than their voice loss. These results contribute to the debate about the etiology of Spasmodic Dysphonia and will be of interest to those involved in the psychology of voice and those managing voice-disordered patients.

The prevalence of laryngeal pathology in a treatment-seeking population with dysphonia.

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Van Houtte, Evelyne; Van Lierde, Kristiane; D'Haeseleer, Evelien; Claeys, Sofie

2010-02-01

This article describes the prevalence of laryngeal pathology in a treatment-seeking population with dysphonia in the Flemish part of Belgium. Retrospective investigation. During a period of 5 years (2004-2008), data were collected from 882 patients who consulted with dysphonia at the ear, nose, and throat department of the University Hospital in Ghent (Belgium). Laryngeal pathology was diagnosed using videostroboscopy. Ages ranged from 4 years to 90 years. Functional voice disorders were most frequently diagnosed (30%), followed by vocal fold nodule (15%), and pharyngolaryngeal reflux (9%). The role of age, gender, and occupation was investigated. Pathologies were significantly more common in females than in males, representing 63.8% and 36.2% of the population, respectively. Professional voice users accounted for 41% of the workforce population, with teachers as main subgroup. In professional voice users, functional dysphonia occurred in 41%, vocal fold nodules in 15%, and pharyngolaryngeal reflux in 11%. Our data were compared with data from other countries. Functional voice disorders were overall the most common cause of voice disorders (except in childhood), followed by vocal fold nodules and pharyngolaryngeal reflux. Professional voice users accounted for almost one half of the active population, with functional voice disorders as the main cause of dysphonia.

Selective lateral laser thyroarytenoid myotomy for adductor spasmodic dysphonia.

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Hussain, A; Shakeel, M

2010-08-01

Selective lateral laser thyroarytenoid myotomy is a conceptually sound, simple, minimally invasive, repeatable and predictable new surgical procedure for treating adductor spasmodic dysphonia. This paper aims to introduce and describe the surgical technique, and to present a clinical case series and its outcomes. A prospective, clinical case series treated with selective lateral laser thyroarytenoid myotomy, with follow up of 2.5 years. Pre- and post-operative data were collected prospectively for patients undergoing selective lateral laser thyroarytenoid myotomy. These data included patient demographics, previous interventions for adductor spasmodic dysphonia, technical aspects of surgery and clinical outcome. Outcome data included clinical assessment, voice handicap index, need for further intervention, and patient satisfaction assessed by subjective improvement (detailed subjectively by the patients themselves and objectively using the Glasgow benefit inventory). Four patients (two men and two women; mean age 65 years; age range 41-80 years) were included. The mean duration of adductor spasmodic dysphonia was 11 years. All patients had previously been treated with botulinum toxin A. All patients reported improvement in voice quality, fluency, sustainability and elimination of voice breaks over 2.5 years' follow up. Clinical assessment revealed no alteration in mucosal wave, and complete relief of hyperadduction was observed on phonation. No patients required supplementary botulinum toxin treatment during follow up. Selective lateral laser thyroarytenoid myotomy seems to represent a curative procedure for adductor spasmodic dysphonia, a chronic, debilitating condition. This procedure is conceptually simple, minimally invasive and repeatable. It also seems to offer a safe and lasting alternative to botulinum toxin therapy.

[How to render an expert opinion on dysphonia].

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Nawka, T; Rosanowski, F; Gross, M

2014-09-01

In Germany, parameters for medicolegal evaluation of dysphonia have to be revised against the background of communication disorders getting more important in a modern communication society. In this work, up-to-date diagnostic tools are reviewed and evaluated for medicolegal purposes. Parametrization is -performed according to the International Classification of Functioning, Disability and Health ICF. Following this schema, -dysphonia is graded as follows: 1) No dysphonia (no problem, percentile 0-4) impairment of the whole person 0%, 2) Slight, strain-induced dysphonia (slight problem, percentile 5-24) -impairment of the whole person 0-10%, 3) Moderate dysphonia (moderate problem, percentile 25-49) impairment of the whole person 20-30%, 4) Severe dysphonia (severe problem, percentile 50-95) impairment of the whole person 40-50%, 5) Complete loss of voice (extreme problem, percentile 96-100%) impairment of the whole person 50%. © Georg Thieme Verlag KG Stuttgart · New York.

Research Priorities in Spasmodic Dysphonia

Science.gov (United States)

Ludlow, Christy L.; Adler, Charles H.; Berke, Gerald S.; Bielamowicz, Steven A.; Blitzer, Andrew; Bressman, Susan B.; Hallett, Mark; Jinnah, H. A.; Juergens, Uwe; Martin, Sandra B.; Perlmutter, Joel S.; Sapienza, Christine; Singleton, Andrew; Tanner, Caroline M.; Woodson, Gayle E.

2009-01-01

OBJECTIVE To identify research priorities for increasing understanding of the pathogenesis, diagnosis and improved treatment of spasmodic dysphonia. STUDY DESIGN AND SETTING A multidisciplinary working group was formed including both scientists and clinicians from multiple disciplines, otolaryngology, neurology, speech pathology, genetics and neuroscience, to review currently available information on spasmodic dysphonia and to identify research priorities. RESULTS Operational definitions for spasmodic dysphonia at different levels of certainty were recommended for diagnosis and recommendations made for a multi-center multidisciplinary validation study. CONCLUSIONS The highest priority is to characterize the disorder and identify risk factors that may contribute to its onset. Future research should compare and contrast spasmodic dysphonia with other forms of focal dystonia. Development of animal models is recommended to explore hypotheses related to pathogenesis. Improved understanding of the pathophysiology of SD should provide the basis for developing new treatment options and exploratory clinical trials. SIGNIFICANCE This document should foster future research to improve the care of patients with this chronic debilitating voice and speech disorder by otolaryngology, neurology, and speech pathology. PMID:18922334

Voice symptoms and vocal deviation self-assessment in different types of dysphonia.

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Moreti, Felipe; Zambon, Fabiana; Behlau, Mara

2014-01-01

To identify the relationship among the type of dysphonia, vocal deviation self-assessed and the presence of voice symptoms in adults. One hundred sixty-four subjects of both genders (58 males and 106 females, mean age 42.89 years) diagnosis of dysphonia, divided into three groups according to the type of dysphonia: 87 individuals with functional dysphonia, 35 individuals with organofunctional dysphonia and 42 individuals with organic dysphonia, answered the Brazilian validated version of Voice Symptom Scale (VoiSS) (Escala de Sintomas Vocais - ESV), that consists of 30 questions with four scores: Impairment, Emotional, Physical and Total, and self-assessed their voices as excellent, very good, good, fair or poor. According to the dysphonia type, there were differences in ESV Impairment, Emotional and Total mean scores, which was not found in the Physical score. The Impairment, Emotional and Total mean scores were higher in organic dysphonia, followed by organofunctional dysphonia and finally functional dysphonia. When the vocal self-assessment is poor, the higher are the deviations in the Impairment, Emotional and Total ESV scores. Individuals with organic dysphonia reported higher perception of voice symptoms, followed by subjects with organofunctional dysphonia and finally individuals with functional dysphonia. In general, individuals with dysphonia presented physical voice symptoms, regardless of the type of the dysphonia. Finally, there are direct correlations between Impairment, Emotional and Total ESV scores and the vocal self-assessment.

Spasmodic Dysphonia

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... in Children Hoarseness Taking Care of Your Voice Teachers: Take Care of Your Voice News Sargent research ... crack the riddle of spasmodic dysphonia Wall Street Journal ( 10/31/2016 ) More News Have a question? ...

Is perceived dysphonia related to perceived healthiness?

Science.gov (United States)

Maryn, Youri; Debo, Kim

2015-10-01

Literature has shown that voice-disordered persons are at higher risk for negative attitudes on several personality and physical appearance traits than vocally normal persons. This study investigated general perceptions of health in subjects with various degrees of dysphonia. Recordings from 100 normophonic and dysphonic subjects were auditorily rated on dysphonia severity by five experienced clinicians and on degree of healthiness/unhealthiness by seven unexperienced listeners. Results revealed strong correlation between auditory ratings of dysphonia severity and unhealthiness severity. Dysphonic subjects are rated significantly unhealthier than normophonic subjects, and the receiver-operating characteristics curve showed that even slight dysphonia induces negative attributions of unhealthiness. This study provides additional evidence for the negative attitudes with which dysphonic speakers are confronted, especially in terms of health.

Spasmodic Dysphonia: A Review. Part 1: Pathogenic Factors.

Science.gov (United States)

Hintze, Justin M; Ludlow, Christy L; Bansberg, Stephen F; Adler, Charles H; Lott, David G

2017-10-01

Objective The purpose of this review is to describe the recent advances in identifying possible factors involved in the pathogenesis of spasmodic dysphonia. Spasmodic dysphonia is a task-specific focal laryngeal dystonia characterized by irregular and uncontrolled voice breaks. Pathogenesis of the disorder is poorly understood. Data Sources PubMed, Google Scholar, and Cochrane Library. Review Methods The data sources were searched using the following search terms: ( spasmodic dysphonia or laryngeal dystonia) and ( etiology, aetiology, diagnosis, pathogenesis, or pathophysiology). Conclusions Several potential etiological factors have been proposed by epidemiological, genetic, and neuropathological studies. Spasmodic dysphonia is a rare disorder primarily affecting females beginning in their 40s. Vocal tremor co-occurs in 30% to 60%. Large cohort studies identified risk factors such as a family history of neurological disorders including dystonia and tremor, recent viral illness, and heavy voice use. As none are rare events, a complex interactive process may contribute to pathogenesis in a small proportion of those at risk. Consequences to pathogenesis are neurological processes found in spasmodic dysphonia: loss of cortical inhibition, sensory processing disturbances, and neuroanatomical and physiological differences in the laryngeal motor control system. Implications for Practice Diagnosis of spasmodic dysphonia usually includes speech and laryngoscopic assessment. However, as diagnosis is sometimes problematic, measurement of neurophysiological abnormalities may contribute useful adjuncts for the diagnosis of spasmodic dysphonia in the future.

Vocal therapy of hyperkinetic dysphonia

OpenAIRE

Mumović Gordana; Veselinović Mila; Arbutina Tanja; Škrbić Renata

2014-01-01

Introduction. Hyperkinetic (hyperfunctional) dysphonia is a common pathology. The disorder is often found in vocal professionals faced with high vocal requirements. Objective. The objective of this study was to evaluate the effects of vocal therapy on voice condition characterized by hyperkinetic dysphonia with prenodular lesions and soft nodules. Methods. The study included 100 adult patients and 27 children aged 4-16 years with prenodular lesions and soft...

Voice symptoms and vocal deviation self-assessment in different types of dysphonia

OpenAIRE

Moreti,Felipe; Zambon,Fabiana; Behlau,Mara

2014-01-01

PURPOSE: To identify the relationship among the type of dysphonia, vocal deviation self-assessed and the presence of voice symptoms in adults.METHODS: One hundred sixty-four subjects of both genders (58 males and 106 females, mean age 42.89 years) diagnosis of dysphonia, divided into three groups according to the type of dysphonia: 87 individuals with functional dysphonia, 35 individuals with organofunctional dysphonia and 42 individuals with organic dysphonia, answered the Brazilian validate...

Cortical Silent Period Reveals Differences Between Adductor Spasmodic Dysphonia and Muscle Tension Dysphonia.

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Samargia, Sharyl; Schmidt, Rebekah; Kimberley, Teresa Jacobson

2016-03-01

The pathophysiology of adductor spasmodic dysphonia (AdSD), like other focal dystonias, is largely unknown. The purposes of this study were to determine (a) cortical excitability differences between AdSD, muscle tension dysphonia (MTD), and healthy controls; (b) distribution of potential differences in cranial or skeletal muscle; and (c) if cortical excitability measures assist in the differential diagnosis of AdSD and MTD. Ten participants with adductor spasmodic dysphonia, 8 with muscle tension dysphonia, and 10 healthy controls received single and paired pulse transcranial magnetic stimulation (TMS) to the primary motor cortex contralateral to tested muscles, first dorsal interosseus (FDI), and masseter. We tested the hypothesis that cortical excitability measures in AdSD would be significantly different from those in MTD and healthy controls. In addition, we hypothesized that there would be a correlation between cortical excitability measures and clinical voice severity in AdSD. Cortical silent period duration in masseter and FDI was significantly shorter in AdSD than MTD and healthy controls. Other measures failed to demonstrate differences. There are differences in cortical excitability between AdSD, MTD, and healthy controls. These differences in the cortical measure of both the FDI and masseter muscles in AdSD suggest widespread dysfunction of the GABAB mechanism may be a pathophysiologic feature of AdSD, similar to other forms of focal dystonia. Further exploration of the use of TMS to assist in the differential diagnosis of AdSD and MTD is warranted. © The Author(s) 2015.

Association between asthma and dysphonia: A population-based study.

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Park, Bumjung; Choi, Hyo Geun

2016-09-01

We investigated whether asthma predisposes patients to organic laryngeal lesions or increases dysphonia in those without organic laryngeal lesions. We performed a cross-sectional study with data from the Korea National Health and Nutrition Examination Survey; 19,330 subjects from 2008 through 2011 were included. The associations of asthma with organic laryngeal lesions and dysphonia were analyzed using a simple/multiple logistic regression analysis with complex sampling while adjusting for confounding factors (age, sex, smoking status, stress level, and body mass index) that could contribute to dysphonia. Compared with non-asthma participants, the asthma patients tended to be older and female and to have higher stress levels. These factors were associated with dysphonia (Age, AOR = 1.20, 95% CI = 1.14 = 1.23, P dysphonia. Compared with non-asthma participants, asthma patients who had not taken asthma medication recently showed a higher AOR (1.62; 95% CI = 1.0-2.42) for dysphonia, and asthma patients who had taken asthma medication recently showed the highest adjusted odds ratio for dysphonia (AOR = 1.97; 95% confidence interval, CI = 1.28-3.02, P = 0.001). On multiple logistic regression analysis, vocal nodules, laryngeal polyps, and laryngitis were not associated with asthma (all P > 0.05). Asthma patients are predisposed to subjective dysphonia due to demographic and clinical characteristics (older age, female, and higher stress level) as well as to asthma itself. However, asthma was not associated with organic laryngeal lesions in this study.

Sonographic detection of basal ganglia abnormalities in spasmodic dysphonia.

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Walter, U; Blitzer, A; Benecke, R; Grossmann, A; Dressler, D

2014-02-01

Abnormalities of the lenticular nucleus (LN) on transcranial sonography (TCS) are a characteristic finding in idiopathic segmental and generalized dystonia. Our intention was to study whether TCS detects basal ganglia abnormalities also in spasmodic dysphonia, an extremely focal form of dystonia. Transcranial sonography of basal ganglia, substantia nigra and ventricles was performed in 14 patients with spasmodic dysphonia (10 women, four men; disease duration 16.5 ± 6.1 years) and 14 age- and sex-matched healthy controls in an investigator-blinded setting. Lenticular nucleus hyperechogenicity was found in 12 spasmodic dysphonia patients but only in one healthy individual (Fisher's exact test, P spasmodic dysphonia severity (Spearman test, r = 0.82, P spasmodic dysphonia to that of more widespread forms of dystonia. © 2013 The Author(s) European Journal of Neurology © 2013 EFNS.

Behavioral Dysphonia and Depression in Elementary School Teachers.

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Marques da Rocha, Luise; Behlau, Mara; Dias de Mattos Souza, Luciano

2015-11-01

To verify the relationship between behavioral dysphonia and current depressive episodes in municipal elementary school teachers. We hypothesize that teachers with behavioral dysphonia will be more susceptible to psychiatric disorders. Cross-sectional study, quantitative, conducted across municipal schools in both rural and urban regions of Pelotas. Five-hundred seventy-five teachers from urban and rural areas of the same Brazilian state were included. The full version of the Voice Handicap Index validated into Brazilian Portuguese was used to determine the presence of behavioral dysphonia. A profile of vocal behaviors was also used to quantify the number of phonotraumatic events. In addition, the Mini-International Neuropsychiatric Interview was used to determine current episodes of depression. Data were analyzed via correlative studies using chi-square and Poisson regression analyses. Across all teachers, the prevalence of dysphonia was 33.9% and 55% reported that they had already taken a leave because of their voice. Those teachers with a current depressive episode had a higher rate of dysphonia compared with those without depression (prevalence ratio [PR] 1.66; P Teachers who presented with a risk of serious vocal problems had a prevalence ratio of 2.58, indicating a greater proportion of dysphonia, whereas teachers classified as champions of abuse were five times more likely compared with those teachers with behaved or candidates for voice problems. There is an association between behavioral dysphonia and current depressive episodes in elementary school teachers. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Vocal dose in teachers: correlation with dysphonia.

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Gama, Ana Cristina Côrtes; Santos, Juliana Nunes; Pedra, Elisângela de Fátima Pereira; Rabelo, Alessandra Terra Vasconcelos; Magalhães, Max de Castro; Casas, Estevam Barbosa de Las

2016-04-01

Teachers are professionals with high prevalence of dysphonia, whose main risk factors are the large work hours in classrooms with the presence of background noise. The purpose of the study was to calculate the phonation time and the cycle dose of teachers with dysphonia and teachers without voice disorders during the class. There were two groups analyzed: five teachers with functional dysphonia were the first group and five teachers without voice disorders were the second group. For the data was used the VoxLog® dosimeter and the parameters were: intensity; fundamental frequency; phonation time and cycle dose. The statistical analysis used ANOVA, Student's T-test, and Kruskal-Wallis test. Dysphonic teachers showed major values of phonation time and cycle dose compared with teachers without voice disorders. The dysphonia is related to extended period of speech time and greater exposure of the tissue of the vocal fold to phonotrauma.

Visual assessment of voice disorders in patients with occupational dysphonia

Directory of Open Access Journals (Sweden)

Bożena Kosztyła-Hojna

2014-11-01

Full Text Available [b]introduction[/b]. In a group of persons using the voice occupationally, the frequent symptoms are hoarseness, voice fatigability and aphonia. Pathological changes in the larynx may have organic or functional character which require different methods of treatment and rehabilitation. Visualization of vibrations of the vocal folds is an essential condition for an appropriate assessment of the causes of dysphonia. [b]objective[/b]. The purpose of the study is assessment of the usefulness of a high-speed imaging (HSI system in the diagnosis of functional and organic dysphonia of occupational character, compared with digital kymography (DKG and digital stroboscopy (DS with a high resolution module. [b]material and methods[/b]. The study group consisted of 64 patients with voice quality disorders with features of occupational dysphonia. The control group consisted of 15 patients with euphonic voice. Analysis of the voice quality parameters during phonation of the ‘e’ vowel was performed using HSI, DKG and stroboscopy of high resolution, by means of a digital HS camera (HRES Endocam, Richard Wolf GmbH, Knittlingen, Germany. Vocal folds vibrations were registered at the rate of 4,000 frames per second. [b]results[/b]. HSI is the most reliable diagnostic tool giving the possibility of an analysis of the true vibrations of the vocal folds. It also enables an observation of the aperiodicity of vibrations of the vocal folds, while DS with high resolution allows diagnosis of the periodicity of the vibrations. [b]conclusions[/b]. HSI is particularly useful in the diagnosis of neurologically-based pathology of the voice (paralytic dysphonia and organic dysphonia. The quickest method of diagnosing the phonatory paresis of the glottis is DKG. The advantage of both HSI and DKG is the non-invasiveness of examinations; however, their limitations are time-consuming and the high cost of equipment.

Co-Prevalence of Tremor with Spasmodic Dysphonia: A Case-Control Study

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White, Laura; Klein, Adam; Hapner, Edie; Delgaudio, John; Hanfelt, John; Jinnah, H. A.; Johns, Michael

2011-01-01

OBJECTIVES/HYPOTHESIS The aim of this study was to define the co-prevalence of tremor with spasmodic dysphonia (SD). STUDY DESIGN A single institution prospective, case-control study was performed from May 2010 to July 2010. METHODS Consecutive patients with SD (cases) and other voice disorders (controls) were enrolled prospectively. Each participant underwent a voice evaluation and an evaluation for tremor. RESULTS 146 voice disorder controls and 128 patients with SD were enrolled. 26% of patients with SD had vocal tremor, 21% had non-vocal tremor. Patients with SD were 2.8 times more likely to have co-prevalent tremor than the control group (OR = 2.81; 95% CI, 1.55 to 5.08) and only 35% of patients with SD had been seen by a neurologist for the evaluation of dystonia and tremor. CONCLUSIONS Tremor is highly prevalent in patients with SD. It is important for each patient diagnosed with SD to undergo an evaluation for tremor, this is especially important in patients diagnosed with vocal tremor. Level of evidence 3b. PMID:21792965

Whispering dysphonia (DYT4 dystonia) is caused by a mutation in the TUBB4 gene

NARCIS (Netherlands)

Lohmann, Katja; Wilcox, Robert A.; Winkler, Susen; Ramirez, Alfredo; Rakovic, Aleksandar; Park, Jin-Sung; Arns, Björn; Lohnau, Thora; Groen, Justus; Kasten, Meike; Brüggemann, Norbert; Hagenah, Johann; Schmidt, Alexander; Kaiser, Frank J.; Kumar, Kishore R.; Zschiedrich, Katja; Alvarez-Fischer, Daniel; Altenmüller, Eckart; Ferbert, Andreas; Lang, Anthony E.; Münchau, Alexander; Kostic, Vladimir; Simonyan, Kristina; Agzarian, Marc; Ozelius, Laurie J.; Langeveld, Antonius P. M.; Sue, Carolyn M.; Tijssen, Marina A. J.; Klein, Christine

2013-01-01

OBJECTIVE: A study was undertaken to identify the gene underlying DYT4 dystonia, a dominantly inherited form of spasmodic dysphonia combined with other focal or generalized dystonia and a characteristic facies and body habitus, in an Australian family. METHODS: Genome-wide linkage analysis was

Whispering dysphonia (DYT4 dystonia) is caused by a mutation in the TUBB4 gene

NARCIS (Netherlands)

Lohmann, Katja; Wilcox, Robert A.; Winkler, Susen; Ramirez, Alfredo; Rakovic, Aleksandar; Park, Jin-Sung; Arns, Bjoern; Lohnau, Thora; Kasten, Meike; Brueggemann, Norbert; Hagenah, Johann; Schmidt, Alexander; Kaiser, Frank J.; Kumar, Kishore R.; Zschiedrich, Katja; Alvarez-Fischer, Daniel; Altenmueller, Eckart; Ferbert, Andreas; Lang, Anthony E.; Muenchau, Alexander; Kostic, Vladimir; Simonyan, Kristina; Agzarian, Marc; Ozelius, Laurie J.; Langeveld, Antonius P. M.; Sue, Carolyn M.; Tijssen, Marina A. J.; Klein, Christine; Groen, Justus

Objective A study was undertaken to identify the gene underlying DYT4 dystonia, a dominantly inherited form of spasmodic dysphonia combined with other focal or generalized dystonia and a characteristic facies and body habitus, in an Australian family. Methods Genome-wide linkage analysis was carried

Parkinson's disease detection based on dysphonia measurements

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Lahmiri, Salim

2017-04-01

Assessing dysphonic symptoms is a noninvasive and effective approach to detect Parkinson's disease (PD) in patients. The main purpose of this study is to investigate the effect of different dysphonia measurements on PD detection by support vector machine (SVM). Seven categories of dysphonia measurements are considered. Experimental results from ten-fold cross-validation technique demonstrate that vocal fundamental frequency statistics yield the highest accuracy of 88 % ± 0.04. When all dysphonia measurements are employed, the SVM classifier achieves 94 % ± 0.03 accuracy. A refinement of the original patterns space by removing dysphonia measurements with similar variation across healthy and PD subjects allows achieving 97.03 % ± 0.03 accuracy. The latter performance is larger than what is reported in the literature on the same dataset with ten-fold cross-validation technique. Finally, it was found that measures of ratio of noise to tonal components in the voice are the most suitable dysphonic symptoms to detect PD subjects as they achieve 99.64 % ± 0.01 specificity. This finding is highly promising for understanding PD symptoms.

Pediatrician approach to dysphonia.

Science.gov (United States)

Sajisevi, Mirabelle; Cohen, Seth; Raynor, Eileen

2014-08-01

The prevalence of voice disorders reaches up to 23.4% in the pediatric population and has a negative impact on quality of life. The objective of this study is to examine how pediatricians assess and manage patients with voice disorders and barriers they face when evaluating patients with dysphonia. The study was designed as a cross-sectional survey. Pediatricians who are members of the North Carolina Pediatric Society or Duke University affiliated physicians were selected to participate in the study. They were emailed a description of the study with a link to a questionnaire regarding comfort level in recognizing an abnormal voice, how often they assess for dysphonia, barriers to evaluation of voice problems, reasons for referral, and common treatments employed. A total of 1125 physicians were sent a questionnaire and 72 replied for a response rate of 6.4%. Of those who responded, only 16.7% routinely assess patients for voice problems. The most common reasons for not assessing patients for dysphonia include patients not complaining of voice problems or parents not concerned, and being unsure of the best method or available treatment options. Referrals were most commonly made when speech could not be understood or when the voice problem coincided with other neurological symptoms. Allergy and reflux medications were often trialed prior to referral. The majority of responders felt that voice problems impacted quality of life and 84.7% were interested in more information regarding pediatric voice problems. Pediatricians encounter barriers in the assessment of voice problems in their patients. There is evidence from our study that they have interest in learning more about dysphonia. Otolaryngologists must continue to provide outreach to pediatricians to enhance the screening and management of patients with voice disorders. Copyright © 2014. Published by Elsevier Ireland Ltd.

Occupational and individual risk factors for dysphonia in teachers.

Science.gov (United States)

Assunção, A Á; Bassi, I B; de Medeiros, A M; Rodrigues, C de Souza; Gama, A C C

2012-10-01

In recent decades several groups of researchers have been interested in describing and understanding vocal morbidity in teachers in order to explain the large number of teachers diagnosed with dysphonia and account for the absenteeism attributed to vocal disability. To determine the proportion of teachers who reported a diagnosis of dysphonia and measure associations between individual and contextual factors and the event of interest. Teachers were recruited from the city of Belo Horizonte and invited to complete a web-based institutional intranet questionnaire. In total, 649 teachers responded; 32% (CI 28.5-35.5) reported that they had received a physician diagnosis of dysphonia. This prevalence was significantly higher among female teachers (prevalence ratio (PR) 2.33; CI 1.41-3.85), and groups who reported limited technical resources and equipment (PR 1.56; CI 1.14-2.15), a diagnosis of gastritis (PR 1.59; CI 1.28-1.98), not being summoned for an annual physician examination (PR 0.47; CI 0.32-0.68), or absenteeism (PR 1.39; CI 1.06-1.81). The high prevalence of dysphonia in teachers was not associated with any individual variables, except for sex and comorbidity (diagnosis of gastritis). Limited technical resources and equipment were associated with dysphonia and suggests policy change is important in preventing dysphonia.

The role of voice therapy in the treatment of dyspnea and dysphonia in a patient with a vagal nerve stimulation device.

Science.gov (United States)

Gillespie, Amanda I; Helou, Leah B; Ingle, John W; Baldwin, Maria; Rosen, Clark A

2014-01-01

Vagal nerve stimulators (VNS) are implanted to treat medically refractory epilepsy and depression. The VNS stimulates the vagus nerve in the left neck. Laryngeal side effects are common and include dysphagia, dysphonia, and dyspnea. The current case study represents a patient with severe dyspnea and dysphonia, persisting even with VNS deactivation. The case demonstrates the use of voice and respiratory retraining therapy for the treatment of VNS-induced dysphonia and dyspnea. It also highlights the importance of a multidisciplinary approach, including laryngology, neurology, and speech-language pathology, in the treatment of these challenging patients. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Validation of the Cepstral Spectral Index of Dysphonia (CSID) as a Screening Tool for Voice Disorders: Development of Clinical Cutoff Scores.

Science.gov (United States)

Awan, Shaheen N; Roy, Nelson; Zhang, Dong; Cohen, Seth M

2016-03-01

The purposes of this study were to (1) evaluate the performance of the Cepstral Spectral Index of Dysphonia (CSID--a multivariate estimate of dysphonia severity) as a potential screening tool for voice disorder identification and (2) identify potential clinical cutoff scores to classify voice-disordered cases versus controls. Subjects were 332 men and women (116 men, 216 women) comprised of subjects who presented to a physician with a voice-related complaint and a group of non-voice-related control subjects. Voice-disordered cases versus controls were initially defined via three reference standards: (1) auditory-perceptual judgment (dysphonia +/-); (2) Voice Handicap Index (VHI) score (VHI +/-); and (3) laryngoscopic description (laryngoscopic +/-). Speech samples were analyzed using the Analysis of Dysphonia in Speech and Voice program. Cepstral and spectral measures were combined into a CSID multivariate formula which estimated dysphonia severity for Rainbow Passage samples (i.e., the CSIDR). The ability of the CSIDR to accurately classify cases versus controls in relation to each reference standard was evaluated via a combination of logistic regression and receiver operating characteristic (ROC) analyses. The ability of the CSIDR to discriminate between cases and controls was represented by the "area under the ROC curve" (AUC). ROC classification of dysphonia-positive cases versus controls resulted in a strong AUC = 0.85. A CSIDR cutoff of ≈24 achieved the best balance between sensitivity and specificity, whereas a more liberal cutoff score of ≈19 resulted in higher sensitivity while maintaining respectable specificity which may be preferred for screening purposes. Weaker but adequate AUCs = 0.75 and 0.73 were observed for the classification of VHI-positive and laryngoscopic-positive cases versus controls, respectively. Logistic regression analyses indicated that subject age may be a significant covariate in the discrimination of dysphonia-positive and VHI

Managing dysphonia in paediatric patients with complex airway conditions.

Science.gov (United States)

Ojha, S; Setlur, J; Bunting, G; Hartnick, C J

2015-08-01

To suggest a phonosurgical management strategy that can be used for children who have previously undergone laryngotracheal reconstruction. This cases series describes three children who presented with complex, multi-level airway stenosis and marked dysphonia. Phonosurgical intervention involved endoscopic and open approaches, and was combined with voice therapy. A phonosurgical reconstruction management algorithm is suggested for evaluating and treating these complex conditions. Pre-operative assessment is critical, and should involve voice analysis and glottal anatomy assessment using office laryngoscopy and stroboscopy. The risks must be weighed up against the benefit of vocal improvement. Surgical intervention should involve combined endoscopic and open approaches. Voice restoration after paediatric airway reconstruction is a complex challenge. Surgical intervention should be conducted in a step-by-step manner to reduce the risk of worsening dysphonia and airway compromise. The risks and benefits must be carefully explored and discussed.

Long term results of childhood dysphonia treatment.

Science.gov (United States)

Mackiewicz-Nartowicz, Hanna; Sinkiewicz, Anna; Bielecka, Arleta; Owczarzak, Hanna; Mackiewicz-Milewska, Magdalena; Winiarski, Piotr

2014-05-01

The aim of this study was to assess the long term results of treatment and rehabilitation of childhood dysphonia. This study included a group of adolescents (n=29) aged from 15 to 20 who were treated due to pediatric hyperfunctional dysphonia and soft vocal fold nodules during their pre-mutational period (i.e. between 5 and 12 years of age). The pre-mutational therapy was comprised of proper breathing pattern training, voice exercises and psychological counseling. Laryngostroboscopic examination and perceptual analysis of voice were performed in each patient before treatment and one to four years after mutation was complete. The laryngostroboscopic findings, i.e. symmetry, amplitude, mucosal wave and vocal fold closure, were graded with NAPZ scale, and the GRBAS scale was used for the perceptual voice analysis. Complete regression of the childhood dysphonia was observed in all male patients (n=14). Voice disorders regressed completely also in 8 out of 15 girls, but symptoms of dysphonia documented on perceptual scale persisted in the remaining seven patients. Complex voice therapy implemented in adolescence should be considered as either the treatment or preventive measure of persistent voice strain, especially in girls. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Brainstem pathology in spasmodic dysphonia

Science.gov (United States)

Simonyan, Kristina; Ludlow, Christy L.; Vortmeyer, Alexander O.

2009-01-01

Spasmodic dysphonia (SD) is a primary focal dystonia of unknown pathophysiology, characterized by involuntary spasms in the laryngeal muscles during speech production. We examined two rare cases of postmortem brainstem tissue from SD patients compared to four controls. In SD patients, small clusters of inflammation were found in the reticular formation surrounding solitary tract, spinal trigeminal and ambigual nuclei, inferior olive and pyramids. Mild neuronal degeneration and depigmentation were observed in the substantia nigra and locus coeruleus. No abnormal protein accumulations and no demyelination or axonal degeneration were found. These neuropathological findings may provide insights into the pathophysiology of SD. PMID:19795469

Adductor spasmodic dysphonia and botulinum toxin treatment : The effect on well-being

NARCIS (Netherlands)

Langeveld, TPM; Luteijn, F; van Rossum, M; Drost, HA; De Jong, RJB

2001-01-01

Adductor spasmodic dysphonia (AdSD) is a controversial and enigmatic voice disorder. It is generally accepted that it has a neurologic, although undetermined, cause, and it is accompanied by much psychological and physical distress. In this prospective study, standardized psychometric tests were

Refractory Dysphonia Due to Isolated Cricothyroid Muscle Dystonia.

Science.gov (United States)

Kraft, Shannon; Childes, Jana; Hillel, Allen; Schindler, Joshua

2016-07-01

To demonstrate the utility of electromyography (EMG) in the evaluation and management of treatment-resistant dysphonia. We report a case of refractory dysphonia in which EMG was used to identify and treat isolated cricothyroid (CT) dystonia. The patient, a healthy 43-year-old woman, presented with 9 months of progressive hoarseness. Her symptoms were present across vocal tasks but were particularly bothersome while dictating. On presentation, her voice was rated grade 3, roughness 3, breathiness 1, asthenia 0, and strain 3 (G3R3B1A0S3). Videostroboscopy was remarkable for hyperfunction. Voice therapy was not beneficial despite appropriate effort. Microdirect laryngoscopy revealed no evidence of structural pathology. The patient was referred for EMG because of her normal examination and failure to improve with therapy. The CT muscle demonstrated an increased latency of 750 ms in all vocal tasks. One month after CT injection with 3 units of botulinum toxin (BTX), her voice was improved. Perceptual voice evaluation was rated G1R1B0A0S1. Voice Handicap Index improved from 87 to 35. In the absence of structural pathology, EMG can be a useful adjunct in the diagnosis of dysphonia that persists despite adequate trials of voice therapy. To our knowledge, this is the only report of laryngeal dystonia due to isolated CT dysfunction successfully treated with BTX. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Epidemiological association of olfactory dysfunction with hearing loss and dysphonia in the Korean population

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Park, Jae Hong; Byeon, Hyung Kwon; Park, Ki Nam; Kim, Jae Wook; Lee, Seung Won; Han, Kyung-do; Chang, Jae Won; Kim, Won Shik; Koh, Yoon Woo; Ban, Myung Jin

2017-01-01

Abstract The aim of the study is to investigate the association between olfactory dysfunction (OD), hearing loss, and dysphonia. The cross-sectional data for 17,984 adults who completed the Korea National Health and Nutrition Examination Surveys (2010−12) were analyzed. OD, hearing loss, and dysphonia were assessed using self-reporting questionnaires. The association of OD with hearing loss and dysphonia was evaluated. Hearing loss and dysphonia were significantly more prevalent in patients with OD than in those without OD (hearing loss, 28.1% vs 11.3%; dysphonia, 11.1% vs 5.9%; both P dysphonia, and was greater in those with combined hearing loss and dysphonia than in both patients without these dysfunctions and in those with a single dysfunction (odds ratio 3.115, 95% confidence interval 1.973–4.917). OD was significantly associated with hearing loss and dysphonia. PMID:29382018

A branchial cyst of the pyriform fossa transoral laser resection: a case report.

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Abdelfattah, Hesham Mostafa; Ahmed, Mohammed Elrabie; Ahmed, Mona El-Rabie; Ahmed, Mohamed Abd El-Kader; Moussa, Abd-Elmateen

2016-02-01

Pyriform sinus malformations represent rare third and fourth branchial anomalies. Fistulae at the latter site were initially described and make up less than 1 % of all brachial anomalies. They may be discovered incidentally, or may present as a neck mass with recurrent infection, dysphagia, or airway compromise, and can be an unusual cause of dysphonia in infant and children. Here, we present a case of third branchial cyst located in pharyngeal wall of the left pyriform sinus which presented with dysphonia since birth in a 6-year-old girl. Transoral CO2 laser excision was carried out successfully with no communicating tract. The patient's dysphonia showed progressive regression at 1-year follow-up. Third branchial cyst in the left pyriform sinus (Bailey's type IV) is an unusual cause of dysphonia in pediatric. Our present case report is the first brachial cyst to be reported in the pyriform fossa and the second branchial anomalies to be excised transorally with CO2 laser.

Quantifying the cepstral peak prominence, a measure of dysphonia.

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Heman-Ackah, Yolanda D; Sataloff, Robert T; Laureyns, Griet; Lurie, Deborah; Michael, Deirdre D; Heuer, Reinhardt; Rubin, Adam; Eller, Robert; Chandran, Swapna; Abaza, Mona; Lyons, Karen; Divi, Venu; Lott, Joanna; Johnson, Jennifer; Hillenbrand, James

2014-11-01

The purpose of this study is to establish normative values for the smoothed cepstral peak prominence (CPPS) and its sensitivity and specificity as a measure of dysphonia. Prospective cohort study. Voice samples of running speech were obtained from 835 patients and 50 volunteers. Eight laryngologists and four speech-language pathologists performed perceptual ratings of the voice samples on the degree of dysphonia/normality using an analog scale. The mean of their perceptual ratings was used as the gold standard for the detection of the presence or absence of dysphonia. CPPS was measured using the CPPS algorithm of Hillenbrand, and the cut-off value for positivity that has the highest sensitivity and specificity for discriminating between normal and severely dysphonia voices was determined based on ROC-curve analysis. The cut-off value for normal for CPPS was set at 4.0 or higher, which gave a sensitivity of 92.4%, a specificity of 79%, a positive predictive value of 82.5%, and a negative predictive value of 90.8%. The area under the receiver operating characteristic (ROC) curve was 0.937 (P dysphonia, with the normal value of CPPS (Hillenbrand algorithm) of a running speech sample being defined as a value of 4.0 or higher. Copyright © 2014 The Voice Foundation. All rights reserved.

Early Motor Unit Disease Masquerading as Psychogenic Breathy Dysphonia: A Clinical Case Presentation

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Aronson, Arnold E.

1971-01-01

Presented is a study of a 20-year-old girl with mild, breathy dysphonia, previously diagnosed as psychogenic. In actuality, her voice change was a sign of early myasthenia gravis. It is pointed out that voice changes can be a first and only sign of early neurologic disease. (Author/KW)

Dysphonia risk screening protocol

Science.gov (United States)

Nemr, Katia; Simões-Zenari, Marcia; da Trindade Duarte, João Marcos; Lobrigate, Karen Elena; Bagatini, Flavia Alves

2016-01-01

OBJECTIVE: To propose and test the applicability of a dysphonia risk screening protocol with score calculation in individuals with and without dysphonia. METHOD: This descriptive cross-sectional study included 365 individuals (41 children, 142 adult women, 91 adult men and 91 seniors) divided into a dysphonic group and a non-dysphonic group. The protocol consisted of 18 questions and a score was calculated using a 10-cm visual analog scale. The measured value on the visual analog scale was added to the overall score, along with other partial scores. Speech samples allowed for analysis/assessment of the overall degree of vocal deviation and initial definition of the respective groups and after six months, the separation of the groups was confirmed using an acoustic analysis. RESULTS: The mean total scores were different between the groups in all samples. Values ranged between 37.0 and 57.85 in the dysphonic group and between 12.95 and 19.28 in the non-dysphonic group, with overall means of 46.09 and 15.55, respectively. High sensitivity and specificity were demonstrated when discriminating between the groups with the following cut-off points: 22.50 (children), 29.25 (adult women), 22.75 (adult men), and 27.10 (seniors). CONCLUSION: The protocol demonstrated high sensitivity and specificity in differentiating groups of individuals with and without dysphonia in different sample groups and is thus an effective instrument for use in voice clinics. PMID:27074171

Dysphonia risk screening protocol

Directory of Open Access Journals (Sweden)

Katia Nemr

2016-03-01

Full Text Available OBJECTIVE: To propose and test the applicability of a dysphonia risk screening protocol with score calculation in individuals with and without dysphonia. METHOD: This descriptive cross-sectional study included 365 individuals (41 children, 142 adult women, 91 adult men and 91 seniors divided into a dysphonic group and a non-dysphonic group. The protocol consisted of 18 questions and a score was calculated using a 10-cm visual analog scale. The measured value on the visual analog scale was added to the overall score, along with other partial scores. Speech samples allowed for analysis/assessment of the overall degree of vocal deviation and initial definition of the respective groups and after six months, the separation of the groups was confirmed using an acoustic analysis. RESULTS: The mean total scores were different between the groups in all samples. Values ranged between 37.0 and 57.85 in the dysphonic group and between 12.95 and 19.28 in the non-dysphonic group, with overall means of 46.09 and 15.55, respectively. High sensitivity and specificity were demonstrated when discriminating between the groups with the following cut-off points: 22.50 (children, 29.25 (adult women, 22.75 (adult men, and 27.10 (seniors. CONCLUSION: The protocol demonstrated high sensitivity and specificity in differentiating groups of individuals with and without dysphonia in different sample groups and is thus an effective instrument for use in voice clinics.

Dysphonia in nursing home and assisted living residents: prevalence and association with frailty.

Science.gov (United States)

G Nichols, Brent; Varadarajan, Varun; Bock, Jonathan M; Blumin, Joel H

2015-01-01

Previous studies of geriatric dysphonia prevalence have been limited to ambulatory outpatient and senior communities. Our goal was to identify prevalence of dysphonia in nursing home residents and assisted living residents and search for correlations between indices of dysphonia and indices of frailty. Prospective epidemiological survey. Residents of a vertically integrated senior care organization who were 65 or older and able to understand and complete the questionnaire were recruited to complete the voice handicap index 10 (VHI-10) to assess for dysphonia (VHI-10 > 10 = dysphonia) and Vulnerable Elders Survey 13 (VES-13), a validated instrument to assess for frailty (VES > 3 = frailty). A total of 119 residents were surveyed. Thirty-three percent of nursing home residents, and 25% of assisted living residents reported dysphonia with 29% of all respondents reporting dysphonia. The mean VHI-10 was 7.4, the median was 5, and the interquartile range was 2-12.5. There was a significant relationship between VHI-10 and VES-13 score (P = 0.029). There were no statistically significant relationships between frailty, age, or type of living and dysphonia or VHI-10. There is a high prevalence of voice dysfunction in assisted living and nursing home residents. The correlation between VHI-10 and VES-13 suggests that voice declines as frailty increases. Copyright © 2015 The Voice Foundation. All rights reserved.

Botulinum toxin efficacy in the treatment of patients with spasmodic dysphonia

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Svetel Marina

2007-01-01

Full Text Available Background/Aim. Spasmodic dysphonia (DS is a disabling speech disturbance appearing as the consequence of dystonic vocal folds contraction. Its intermittent appearance in the laryngeal muscles causes vocal function discontinuation. The quality of life of these patients is significantly disturbed. Surgical and a medical therapy appear to be inadequate and unsuccessful ones of no steady improvement. It is the botulinum toxin therapy that proved to be highly efficacious one, with the established improvement in 80−100% of patients. The aim of our study was to evaluate the efficacy of botulinum toxin therapy in patients with SD and to show our preliminary results. Methods. The study included 10 patients with adductor spasmodic dysphonia. After diagnostic procedures, botulinum toxin was applied either in one or both vocal folds, in doses of 12−16 units each. In our study we applied indirect technique originally developed by Hočevar and Pirtošek. Perceptive voice and speech analysis was performed prior to and after the instillation of botuline toxin as per structured Scale of pathological characteristics of voice and speech appearing in the spasmodic dysphonia. Results. The majority of our patients experienced both subjective improvement and the improvement in the terms of the quality of life, Voice Henolicap Index − (VHI that was rated as rather significant one (t = 3.562; p = 0.006. Conclusion. Regardless unquestionable improvement of definite phonation, further function restitution requires individual vocal therapy and psychotherapy. Vocal therapy includes structural vocal techniques which reduce degree of vocal tension and rapid changes in the power and the height of voice. Further investigations are necessary for the scope of the definition of a standardized therapeutically procedure for spasmodic dysphonia treatment which comprises multidisciplinary approach in diagnosis, therapy and treatment efficacy evaluation.

Quality of life, self-perceived dysphonia, and diagnosed dysphonia through clinical tests in teachers.

Science.gov (United States)

Bassi, Iara Barreto; Assunção, Ada Ávila; de Medeiros, Adriane Mesquita; de Menezes, Letícia Neiva; Teixeira, Letícia Caldas; Côrtes Gama, Ana Cristina

2011-03-01

To examine the impact of voice on the quality of life of teachers and to assess whether the degree of dysphonia and otorhinolaryngologists' (ORL) diagnostics are correlated with the quality of life. Eighty-eight female teachers from the municipal schools of Belo Horizonte who were in speech therapy at the Speech Therapy Clinic of the Hospital das Clínicas of Minas Gerais participated in the study. The variables studied were age, ORL diagnosis, perceptual-hearing assessment of voice through GRBAS scale, and vocal activities and participation profile (VAPP) protocol. Statistical analysis was performed through the descriptive analysis of the data and the Spearman coefficient of correlation. The average age of the participants was 38 years. Vocal deviation: degree 1-56 teachers (63.6%); degree 2-27 teachers (30.6%); and without vocal deviation-five teachers (5.6%). It was found that 57.9% of the teachers presented combined ORL diagnosis. No statistically significant relationship was observed among the ORL diagnosis, the degree of dysphonia, and the parameter values of quality of life assessed by VAPP. The examined participants of this study presented light degree of vocal deviation and ORL combined diagnosis. According to the figures obtained by VAPP, there was negative impact of voice on the quality of life of female teachers, but these impacts were not correlated with ORL diagnosis and grade of dysphonia. Copyright © 2011 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Section four: laryngitis and dysphonia.

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Hueston, William J; Kaur, Dipinpreet

2013-12-01

Acute laryngitis is most often caused by viral illnesses through direct inflammation of the vocal cords or from irritation due to postnasal drainage. Bacterial infections, such as acute epiglottitis, also can cause dysphonia but typically have other systemic symptoms as well as respiratory distress. Chronic laryngitis is characterized by symptoms lasting more than 3 weeks. Chronic vocal cord issues can be related to overuse or stress on the vocal cords resulting in nodules or polyps. Individuals in certain occupations, such as singers, school teachers, and chemical workers, are at greater risk of chronic laryngitis. The diagnostic approach to chronic laryngitis should include visualization of the vocal cords to rule out potential malignant lesions. For acute and chronic overuse symptoms, the best treatment is vocal rest. The use of antibiotics or decongestants should be discouraged. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

[The impact of vibratory stimulation therapy on voice quality in hyperfunctional occupational dysphonia].

Science.gov (United States)

Kosztyła-Hojna, Bożena; Kuryliszyn-Moskal, Anna; Rogowski, Marek; Moskal, Diana; Dakowicz, Agnieszka; Falkowski, Dawid; Kasperuk, Joanna

2012-01-01

Hyperfunctional dysphonia is the most frequent type of occupational functional dysphonia. Pharmacotherapy, physiotherapy and psychotherapy are used in the treatment of occupational dysphonia. Vibratory massages of the regions of the larynx relax the external muscles of neck, which have an indirect impact on the tension of the vocal folds. The aim of the study is to assess the impact of vibratory stimulation therapy on voice quality in patients with hyperfunctional occupational dysphonia treated pharmacologically. Forty patients with hyperfunctional occupational dysphonia treated phoniatrically in the Phoniatric Outpatient Clinic were included in the study. Patients were divided into two groups. Group I consisted of 20 patients treated pharmacologically. In group II, including 20 patients, apart from pharmacotherapy the vibratory stimulation therapy by the device of VR type (CyberBioMed LLC) was used. In the analysis of voice quality the evaluation of the vocal folds vibration using videolaryngostroboscopy and acoustic assessment of voice were conducted. The perceptual assessment of voice, the visualization of the vocal folds vibration in stroboscopic examination of the larynx and the acoustic assessment of voice enable the appropriate diagnostics of the clinical type and voice quality in hyperfunctional dysphonia. The tension of superficial and deep muscles of neck has the impact on the phonatory function of the larynx. Pharmacological treatment improves the voice quality in hyperfunctional occupational dysphonia. Pharmacological treatment combines with the relaxation of muscles of neck using the device of VR type significantly improve voice quality in hyperfunctional occupational dysphonia. Copyright © 2012 Polish Otolaryngology Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.

[Persistent dysphonia showing a laryngeal foreign body in a child].

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Hammoudi, K; Bakhos, D; Bakhos-Merieau, E; Pondaven, S; Lescanne, E

2011-07-01

Inhalation of a laryngotracheobronchial foreign body is a common pediatric emergency situation. It is a source of morbidity and even mortality, especially among children under 3 years of age. A 14-month-old child presented suddenly combining bitonal dysphonia and dyspnea. Given the persistence of symptoms after 1.5 months and the normality of examinations requested by his doctor (pH, cervical ultrasonography, cervical and thoracic radiography), an ENT opinion was sought. An aerodigestive tract endoscopy was carried out in the emergency setting, finding a glottic foreign body associated with subglottic granulomas. The foreign body extraction led to the immediate disappearance of dyspnea. Dysphonia gradually improved under Budesonide aerosols. The lack of penetration syndrome in the interrogation and non specific symptoms may lead to an important diagnosis and treatment delay with dramatic consequences in case of airway foreign body. Endoscopy under general anesthesia must be practiced if there is any doubt for a thorough examination of the airways. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Diagnosis of dysphonia among municipal employees: individual and work factors.

Science.gov (United States)

Bassi, Iara Barreto; Assunção, Ada Ávila

2015-05-01

To investigate the association between occupational status and the distribution of dysphonia. In 2009, a sample of 5646 (14%) of the population of 38,304 municipal employees of Belo Horizonte was obtained. A questionnaire was made available on an Internet Web site that could be entered only after the respondent had given consent. The response variable was drawn up with reference to the question: "Has a doctor ever told you that you have dysphonia?," for which the possible responses were yes or no. The following variables were included in the logistic regression model: sociodemographic data, work characteristics, and lifestyle habits. The associations relating to dysphonia were found to be different between men and women. Differing from men, occupational factors influenced the outcome among women. Among men, there were significant associations between dysphonia and sociodemographic characteristics, health-related factors, and lifestyle factors. Gender differentials should be taken into consideration in health promotion actions among this group of municipal employees. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Vocal nodules in a colombian teachers group with dysphonia

OpenAIRE

Andrés Felipe Alvarado Díaz; Carlos Eduardo Pinzón; José Rafael Tovar Cuevas; Adriana Fajardo Hoyos

2013-01-01

Objectives: This study determined the prevalence of vocal nodules associated with dysphonia in teachers aged from 35 to 65 years, taking into consideration both individual and occupational variables. Methodology: Descriptive study that included the information contained in 262 medical records of teachers diagnosed with dysphonia in occupational health consultations at the institutions that provide health services in Bogotá, Colombia from March 2009 to March 2012. The presence of laryngeal nod...

Does regular practice of physical activity reduce the risk of dysphonia?

Science.gov (United States)

Assunção, Ada Avila; de Medeiros, Adriane Mesquita; Barreto, Sandhi Maria; Gama, Ana Cristina Cortes

2009-12-01

The purpose of this study was to investigate the association between regular physical activity and the prevalence of dysphonia. A cross-sectional study was conducted with 3142 teachers from 129 municipal public schools in the city of Belo Horizonte, Brazil. The dependent variable, dysphonia, was classified (absent or present) according to reported symptoms (fatigue when speaking and loss of voice quality), their frequency (occasionally and daily), and duration (past 15 days). The independent variable was regular physical activity. The degree of association was estimated based on the prevalence ratio and a 95% confidence interval obtained by the Poisson regression adapted for cross-sectional studies. In the study sample, the prevalence of dysphonia in teachers was 15.63%. Nearly half (47.52%) of the teachers reported no regular practice of physical exercises. The remaining teachers (52.48%) walked and did physical exercises, sports, and other activities; 31.25% undertook these activities once or twice a week, and 21.23% exercised three or more times a week. Teachers who did not practice physical activity were more likely to present dysphonia compared to those that exercised three or more times a week. Regular physical activity was associated positively with the prevalence of dysphonia.

Dysphonia in adults with developmental stuttering: A descriptive study

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Anél Botha

2017-06-01

Objectives: This study aimed to describe the vocal characteristics of PWS. Method: Acoustic and perceptual data were collected during a comprehensive voice assessment. The severity of stuttering was also determined. Correlations between the stuttering severity instrument (SSI and the acoustic measurements were evaluated to determine the significance. Twenty participants were tested for this study. Result: Only two participants (10% obtained a positive Dysphonia Severity Index (DSI score of 1.6 or higher, indicating that no dysphonia was present, while 90% of participants (n = 18 scored lower than 1.6, indicating that those participants presented with dysphonia. Some participants presented with weakness (asthenia of voice (35%, while 65% presented with a slightly strained voice quality. Moderately positive correlations between breathiness and SSI (r = 0.40, p = 0.08 have been reported. In addition, participants with high SSI scores also scored a poor DSI of below 1.6, as observed by a moderate positive correlation between SSI and DSI (r = 0.41. Conclusion: The majority of PWS presented with dysphonia, evident in the perceptual or acoustic parameters of their voices. These results can be used for further investigation to create awareness and to establish intervention strategies for voice disorders among PWS.

Spasmodic dysphonia: a laryngeal control disorder specific to speech.

Science.gov (United States)

Ludlow, Christy L

2011-01-19

Spasmodic dysphonia (SD) is a rare neurological disorder that emerges in middle age, is usually sporadic, and affects intrinsic laryngeal muscle control only during speech. Spasmodic bursts in particular laryngeal muscles disrupt voluntary control during vowel sounds in adductor SD and interfere with voice onset after voiceless consonants in abductor SD. Little is known about its origins; it is classified as a focal dystonia secondary to an unknown neurobiological mechanism that produces a chronic abnormality of laryngeal motor neuron regulation during speech. It develops primarily in females and does not interfere with breathing, crying, laughter, and shouting. Recent postmortem studies have implicated the accumulation of clusters in the parenchyma and perivascular regions with inflammatory changes in the brainstem in one to two cases. A few cases with single mutations in THAP1, a gene involved in transcription regulation, suggest that a weak genetic predisposition may contribute to mechanisms causing a nonprogressive abnormality in laryngeal motor neuron control for speech but not for vocal emotional expression. Research is needed to address the basic cellular and proteomic mechanisms that produce this disorder to provide intervention that could target the pathogenesis of the disorder rather than only providing temporary symptom relief.

Describing pediatric dysphonia with nonlinear dynamic parameters

Science.gov (United States)

Meredith, Morgan L.; Theis, Shannon M.; McMurray, J. Scott; Zhang, Yu; Jiang, Jack J.

2008-01-01

Objective Nonlinear dynamic analysis has emerged as a reliable and objective tool for assessing voice disorders. However, it has only been tested on adult populations. In the present study, nonlinear dynamic analysis was applied to normal and dysphonic pediatric populations with the goal of collecting normative data. Jitter analysis was also applied in order to compare nonlinear dynamic and perturbation measures. This study’s findings will be useful in creating standards for the use of nonlinear dynamic analysis as a tool to describe dysphonia in the pediatric population. Methods The study included 38 pediatric subjects (23 children with dysphonia and 15 without). Recordings of sustained vowels were obtained from each subject and underwent nonlinear dynamic analysis and percent jitter analysis. The resulting correlation dimension (D2) and percent jitter values were compared across the two groups using t-tests set at a significance level of p = 0.05. Results It was shown that D2 values covary with the presence of pathology in children. D2 values were significantly higher in dysphonic children than in normal children (p = 0.002). Standard deviations indicated a higher level of variation in normal children’s D2 values than in dysphonic children’s D2 values. Jitter analysis showed markedly higher percent jitter in dysphonic children than in normal children (p = 0.025) and large standard deviations for both groups. Conclusion This study indicates that nonlinear dynamic analysis could be a viable tool for the detection and assessment of dysphonia in children. Further investigations and more normative data are needed to create standards for using nonlinear dynamic parameters for the clinical evaluation of pediatric dysphonia. PMID:18947887

Reduction of Parkinson's-related dysphonia by thyroplasty.

Science.gov (United States)

Roubeau, B; Bruel, M; de Crouy Chanel, O; Périé, S

2016-12-01

Parkinson's-related dysphonia has a negative impact on the quality of speech by increasing the effects of the associated dysarthria. When this dysphonia is related to vocal fold adduction defect, constituting a real glottic insufficiency, vocal fold medialization can be proposed after failure of intensive voice and speech therapy. Acoustic and aerodynamic voice and speech analysis techniques, perceptual evaluation and estimation of vocal handicap, associated with fiberoptic laryngoscopy were performed to determine the indication for vocal fold medialization in these patients with glottic insufficiency. Vocal fold medialization by Montgomery thyroplasty implant was performed under local anesthesia and neuroanalgesia in two patients with Parkinson's disease presenting a dysphonia refractory to speech therapy. Postoperative evaluation showed improvement of voice quality with an increased number of harmonics and improvement of aerodynamic parameters. Vocal fold medialization by Montgomery thyroplasty implant effectively improved voice quality in these two patients allowing a more effective vocal fold adduction. The reducing of the hypophonia has a positive effect on the quality of oral communication. The medialization thyroplasty technique, under local anesthesia, allows intraoperative control of the voice as well as removal of the implant when necessary. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

The Effect of Listener Experience and Anchors on Judgments of Dysphonia

Science.gov (United States)

Eadie, Tanya L.; Kapsner-Smith, Mara

2011-01-01

Purpose: To determine the effect of auditory anchors on judgments of overall severity (OS) and vocal effort (VE) in dysphonic speech when judgments are made by experienced and inexperienced listeners, and when self-rated by individuals with dysphonia (speaker-listeners). Method: Twenty individuals with dysphonia and 4 normal controls provided…

Epidemiological association of olfactory dysfunction with hearing loss and dysphonia in the Korean population: A cross-sectional study.

Science.gov (United States)

Park, Jae Hong; Byeon, Hyung Kwon; Park, Ki Nam; Kim, Jae Wook; Lee, Seung Won; Han, Kyung-do; Chang, Jae Won; Kim, Won Shik; Koh, Yoon Woo; Ban, Myung Jin

2017-11-01

The aim of the study is to investigate the association between olfactory dysfunction (OD), hearing loss, and dysphonia.The cross-sectional data for 17,984 adults who completed the Korea National Health and Nutrition Examination Surveys (2010-12) were analyzed. OD, hearing loss, and dysphonia were assessed using self-reporting questionnaires. The association of OD with hearing loss and dysphonia was evaluated.Hearing loss and dysphonia were significantly more prevalent in patients with OD than in those without OD (hearing loss, 28.1% vs 11.3%; dysphonia, 11.1% vs 5.9%; both P dysphonia, and was greater in those with combined hearing loss and dysphonia than in both patients without these dysfunctions and in those with a single dysfunction (odds ratio 3.115, 95% confidence interval 1.973-4.917).OD was significantly associated with hearing loss and dysphonia. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

The point-touch technique for botulinum toxin injection in adductor spasmodic dysphonia: quality of life assessment.

Science.gov (United States)

Morzaria, S; Damrose, E J

2011-07-01

Botulinum toxin injection under electromyographic guidance is the 'gold standard' for adductor spasmodic dysphonia treatment. The point-touch technique, an alternative injection method which relies on anatomical landmarks, is cheaper, quicker and more accessible, but has not yet gained widespread acceptance due to concerns about patient satisfaction. To assess swallowing and voice-related quality of life following point-touch botulinum toxin injection in adductor spasmodic dysphonia patients. Stanford University Voice and Swallowing Center. Prospective case series (evidence level four). Consecutive adductor spasmodic dysphonia patients with a stable botulinum toxin dose-response relationship were recruited prospectively. The Eating Assessment Tool and Voice-Related Quality of Life questionnaires were completed pre-treatment and at 10 and 30 per cent completion of the injection cycle, respectively. Thirty-seven patients completed follow up. The mean total botulinum toxin dose was 0.88 units. Pre-treatment Voice-Related Quality of Life questionnaire results reflected the burden of disease. Post-treatment Eating Assessment Tool and Voice-Related Quality of Life questionnaire results were collected at 2.53 and 7.84 weeks, respectively; the former showed an increase in dysphagia, albeit statistically insignificant, while the latter showed significantly improved scores (both domain and total). The point-touch technique is a viable alternative for botulinum toxin injection in the treatment of adductor spasmodic dysphonia.

Risk and protective factors for spasmodic dysphonia: a case-control investigation.

Science.gov (United States)

Tanner, Kristine; Roy, Nelson; Merrill, Ray M; Kimber, Kamille; Sauder, Cara; Houtz, Daniel R; Doman, Darrin; Smith, Marshall E

2011-01-01

Spasmodic dysphonia (SD) is a chronic, incurable, and often disabling voice disorder of unknown pathogenesis. The purpose of this study was to identify possible endogenous and exogenous risk and protective factors uniquely associated with SD. Prospective, exploratory, case-control investigation. One hundred fifty patients with SD and 150 medical controls (MCs) were interviewed regarding their personal and family histories, environmental exposures, illnesses, injuries, voice use patterns, and general health using a previously vetted and validated epidemiologic questionnaire. Odds ratios and multiple logistic regression analyses (α<0.15) identified several factors that significantly increased the likelihood of having SD. These factors included (1) a personal history of mumps, blepharospasm, tremor, intense occupational and avocational voice use, and a family history of voice disorders; (2) an immediate family history of meningitis, tremor, tics, cancer, and compulsive behaviors; and (3) an extended family history of tremor and cancer. SD is likely multifactorial in etiology, involving both genetic and environmental factors. Viral infections/exposures, along with intense voice use, may trigger the onset of SD in genetically predisposed individuals. Future studies should examine the interaction among genetic and environmental factors to determine the pathogenesis of SD. Copyright © 2011 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Mutation in TWINKLE in a Large Iranian Family with Progressive External Ophthalmoplegia, Myopathy, Dysphagia and Dysphonia, and Behavior Change.

Science.gov (United States)

Tafakhori, Abbas; Yu Jin Ng, Alvin; Tohari, Sumanty; Venkatesh, Byrappa; Lee, Hane; Eskin, Ascia; Nelson, Stanley F; Bonnard, Carine; Reversade, Bruno; Kariminejad, Ariana

2016-02-01

TWINKLE (c10orf2) gene is responsible for autosomal dominant progressive external ophthalmoplegia (PEO). In rare cases, additional features such as muscle weakness, peripheral neuropathy, ataxia, cardiomyopathy, dysphagia, dysphonia, cataracts, depression, dementia, parkinsonism, and hearing loss have been reported in association with heterozygous mutations of the TWINKLE gene. We have studied a large Iranian family with myopathy, dysphonia, dysphagia, and behavior change in addition to PEO in affected members. We identified a missense mutation c.1121G > A in the c10orf2 gene in all affected members. Early death is a novel feature seen in affected members of this family that has not been reported to date. The association of PEO, myopathy, dysphonia, dysphagia, behavior change and early death has not been previously reported in the literature or other patients with this mutation.

Parry-Romberg syndrome (progressive hemifacial atrophy) with spasmodic dysphonia--a rare association.

Science.gov (United States)

Mugundhan, K; Selvakumar, C J; Gunasekaran, K; Thiruvarutchelvan, K; Sivakumar, S; Anguraj, M; Arun, S

2014-04-01

Parry-Romberg syndrome is a rare clinical entity characterised by progressive hemifacial atrophy with appearance of 'saber'. Various neurological and otorhinolaryngological disorders are associated with this syndrome. The association of Parry -Romberg syndrome with Spasmodic dysphonia has rarely been reported. A 37 year old female presented with progressive atrophy of tissues of left side of face for 10 years and change in voice for 1 year. On examination, wasting and atrophy of tissues including tongue was noted on left side of the face. ENT examination revealed adductor spasmodic dysphonia. We report the rare association of Parry -Romberg syndrome with spasmodic dysphonia.

Abnormal striatal dopaminergic neurotransmission during rest and task production in spasmodic dysphonia.

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Simonyan, Kristina; Berman, Brian D; Herscovitch, Peter; Hallett, Mark

2013-09-11

Spasmodic dysphonia is a primary focal dystonia characterized by involuntary spasms in the laryngeal muscles during speech production. The pathophysiology of spasmodic dysphonia is thought to involve structural and functional abnormalities in the basal ganglia-thalamo-cortical circuitry; however, neurochemical correlates underpinning these abnormalities as well as their relations to spasmodic dysphonia symptoms remain unknown. We used positron emission tomography with the radioligand [(11)C]raclopride (RAC) to study striatal dopaminergic neurotransmission at the resting state and during production of symptomatic sentences and asymptomatic finger tapping in spasmodic dysphonia patients. We found that patients, compared to healthy controls, had bilaterally decreased RAC binding potential (BP) to striatal dopamine D2/D3 receptors on average by 29.2%, which was associated with decreased RAC displacement (RAC ΔBP) in the left striatum during symptomatic speaking (group average difference 10.2%), but increased RAC ΔBP in the bilateral striatum during asymptomatic tapping (group average difference 10.1%). Patients with more severe voice symptoms and subclinically longer reaction time to initiate the tapping sequence had greater RAC ΔBP measures, while longer duration of spasmodic dysphonia was associated with a decrease in task-induced RAC ΔBP. Decreased dopaminergic transmission during symptomatic speech production may represent a disorder-specific pathophysiological trait involved in symptom generation, whereas increased dopaminergic function during unaffected task performance may be explained by a compensatory adaptation of the nigrostriatal dopaminergic system possibly due to decreased striatal D2/D3 receptor availability. These changes can be linked to the clinical and subclinical features of spasmodic dysphonia and may represent the neurochemical basis of basal ganglia alterations in this disorder.

Brain structural changes in spasmodic dysphonia: A multimodal magnetic resonance imaging study.

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Kostic, Vladimir S; Agosta, Federica; Sarro, Lidia; Tomić, Aleksandra; Kresojević, Nikola; Galantucci, Sebastiano; Svetel, Marina; Valsasina, Paola; Filippi, Massimo

2016-04-01

The pathophysiology of spasmodic dysphonia is poorly understood. This study evaluated patterns of cortical morphology, basal ganglia, and white matter microstructural alterations in patients with spasmodic dysphonia relative to healthy controls. T1-weighted and diffusion tensor magnetic resonance imaging (MRI) scans were obtained from 13 spasmodic dysphonia patients and 30 controls. Tract-based spatial statistics was applied to compare diffusion tensor MRI indices (i.e., mean, radial and axial diffusivities, and fractional anisotropy) between groups on a voxel-by-voxel basis. Cortical measures were analyzed using surface-based morphometry. Basal ganglia were segmented on T1-weighted images, and volumes and diffusion tensor MRI metrics of nuclei were measured. Relative to controls, patients with spasmodic dysphonia showed increased cortical surface area of the primary somatosensory cortex bilaterally in a region consistent with the buccal sensory representation, as well as right primary motor cortex, left superior temporal, supramarginal and superior frontal gyri. A decreased cortical area was found in the rolandic operculum bilaterally, left superior/inferior parietal and lingual gyri, as well as in the right angular gyrus. Compared to controls, spasmodic dysphonia patients showed increased diffusivities and decreased fractional anisotropy of the corpus callosum and major white matter tracts, in the right hemisphere. Altered diffusion tensor MRI measures were found in the right caudate and putamen nuclei with no volumetric changes. Multi-level alterations in voice-controlling networks, that included regions devoted not only to sensorimotor integration, motor preparation and motor execution, but also processing of auditory and visual information during speech, might have a role in the pathophysiology of spasmodic dysphonia. Copyright © 2016 Elsevier Ltd. All rights reserved.

Dysphonia Severity Index in Typically Developing Indian Children.

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Pebbili, Gopi Kishore; Kidwai, Juhi; Shabnam, Srushti

2017-01-01

Dysphonia is a variation in an individual's quality, pitch, or loudness from the voice characteristics typical of a speaker of similar age, gender, cultural background, and geographic location. Dysphonia Severity Index (DSI) is a recognized assessment tool based on a weighted combination of maximum phonation time, highest frequency, lowest intensity, and jitter (%) of an individual. Although dysphonia in adults is accurately evaluated using DSI, standard reference values for school-age children have not been studied. This study aims to document the DSI scores in typically developing children (8-12 years). A total of 42 typically developing children (8-12 years) without complaint of voice problem on the day of testing participated in the study. DSI was computed by substituting the raw scores of substituent parameters: maximum phonation time, highest frequency, lowest intensity, and jitter% using various modules of CSL 4500 software. The average DSI values obtained in children were 2.9 (1.23) and 3.8 (1.29) for males and females, respectively. DSI values are found to be significantly higher (P = 0.027) for females than those for males in Indian children. This could be attributed to the anatomical and behavioral differences among females and males. Further, pubertal changes set in earlier for females approximating an adult-like physiology, thereby leading to higher DSI values in them. The mean DSI value obtained for male and female Indian children can be used as a preliminary reference data against which the DSI values of school-age children with dysphonia can be compared. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Acoustic and Perceptual Analyses of Adductor Spasmodic Dysphonia in Mandarin-speaking Chinese.

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Chen, Zhipeng; Li, Jingyuan; Ren, Qingyi; Ge, Pingjiang

2018-02-12

The objective of this study was to examine the perceptual structure and acoustic characteristics of speech of patients with adductor spasmodic dysphonia (ADSD) in Mandarin. Case-Control Study MATERIALS AND METHODS: For the estimation of dysphonia level, perceptual and acoustic analysis were used for patients with ADSD (N = 20) and the control group (N = 20) that are Mandarin-Chinese speakers. For both subgroups, a sustained vowel and connected speech samples were obtained. The difference of perceptual and acoustic parameters between the two subgroups was assessed and analyzed. For acoustic assessment, the percentage of phonatory breaks (PBs) of connected reading and the percentage of aperiodic segments and frequency shifts (FS) of vowel and reading in patients with ADSD were significantly worse than controls, the mean harmonics-to-noise ratio and the fundamental frequency standard deviation of vowel as well. For perceptual evaluation, the rating of speech and vowel in patients with ADSD are significantly higher than controls. The percentage of aberrant acoustic events (PB, frequency shift, and aperiodic segment) and the fundamental frequency standard deviation and mean harmonics-to-noise ratio were significantly correlated with the perceptual rating in the vowel and reading productions. The perceptual and acoustic parameters of connected vowel and reading in patients with ADSD are worse than those in normal controls, and could validly and reliably estimate dysphonia of ADSD in Mandarin-speaking Chinese. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Spasmodic Dysphonia: a Laryngeal Control Disorder Specific to Speech

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Ludlow, Christy L.

2016-01-01

Spasmodic dysphonia (SD) is a rare neurological disorder that emerges in middle age, is usually sporadic, and affects intrinsic laryngeal muscle control only during speech. Spasmodic bursts in particular laryngeal muscles disrupt voluntary control during vowel sounds in adductor SD and interfere with voice onset after voiceless consonants in abductor SD. Little is known about its origins; it is classified as a focal dystonia secondary to an unknown neurobiological mechanism that produces a chronic abnormality of laryngeal motor neuron regulation during speech. It develops primarily in females and does not interfere with breathing, crying, laughter, and shouting. Recent postmortem studies have implicated the accumulation of clusters in the parenchyma and perivascular regions with inflammatory changes in the brainstem in one to two cases. A few cases with single mutations in THAP1, a gene involved in transcription regulation, suggest that a weak genetic predisposition may contribute to mechanisms causing a nonprogressive abnormality in laryngeal motor neuron control for speech but not for vocal emotional expression. Research is needed to address the basic cellular and proteomic mechanisms that produce this disorder to provide intervention that could target the pathogenesis of the disorder rather than only providing temporary symptom relief. PMID:21248101

Case-control study of risk factors for spasmodic dysphonia: A comparison with other voice disorders.

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Tanner, Kristine; Roy, Nelson; Merrill, Ray M; Sauder, Cara; Houtz, Daniel R; Smith, Marshall E

2012-05-01

This epidemiology study examined risk factors uniquely associated with spasmodic dysphonia (SD). Case-control. A questionnaire was administered to 150 patients with SD (with and without coexisting vocal tremor) and 136 patients with other structural, neurological, and functional voice disorders (excluding SD and vocal tremor). Questions included personal and family medical histories, environmental exposures, trauma, illnesses, voice use habits, and the Short Form 36. Several factors were uniquely associated with SD (α = .05), including: 1) a personal history of cervical dystonia, sinus and throat illnesses, mumps, rubella, dust exposure, and frequent volunteer voice use, 2) a family history of voice disorders, 3) an immediate family history of vocal tremor and meningitis, and 4) an extended family history of head and neck tremor, ocular disease, and meningitis. Vocal tremor coexisted with SD in 29% of cases. Measles and mumps vaccines were protective for SD. SD is likely multifactorial and associated with several endogenous and exogenous factors. Certain viral exposures, voice use patterns, and familial neurological conditions may contribute to the onset of SD later in life. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

Subclavian Aberrant right artery aneurysm causing a common carotid trunk: findings in CT and MR

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Quiroga Gomez, S.; Alvarez Castells, A.; Dominguez Oronoz, R.; Gifre Bassols, L.

1995-01-01

We present a case of aberrant right subclavian artery aneurysm causing dysphagia, dysphonia, and Claude-Bernard-Horner's syndrome by compression of adjacent structures, initially diagnosed with plain chest radiography and barium-swallow examination. CT and MRI confirmed this vascular anomaly and showed a common carotid trunk, associated to aberrant subclavian artery in 29% of cases. (Author) 10 refs

Spasmodic dysphonia: let's look at that again.

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Murry, Thomas

2014-11-01

G. Paul Moore influenced the study of spasmodic dysphonia (SD) with his 1960 publication that examined the neurological, medical, and vocal fold behavior in a group of patients with adductor spasmodic dysphonia (ADSD). This review of advances in the diagnosis and treatment of SD follows a time line of research that can be traced in part to the early work of Moore et al. This article reviews the research in ADSD over the past 50 plus years. The capstone events that brought SD to its present day level of management by laryngologists and speech-language pathologists are highlighted. A look to the future to understand more of the disorder is offered for this debilitating disorder. Copyright © 2014 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Dysphonia in adults with developmental stuttering: A descriptive study.

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Botha, Anél; Ras, Elizbé; Abdoola, Shabnam; Van der Linde, Jeannie

2017-06-26

Persons with stuttering (PWS) often present with other co-occurring conditions. The World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF) proposes that it is important to understand the full burden of a health condition. A few studies have explored voice problems among PWS, and the characteristics of voices of PWS are relatively unknown. The importance of conducting future research has been emphasised. This study aimed to describe the vocal characteristics of PWS. Acoustic and perceptual data were collected during a comprehensive voice assessment. The severity of stuttering was also determined. Correlations between the stuttering severity instrument (SSI) and the acoustic measurements were evaluated to determine the significance. Twenty participants were tested for this study. Only two participants (10%) obtained a positive Dysphonia Severity Index (DSI) score of 1.6 or higher, indicating that no dysphonia was present, while 90% of participants (n = 18) scored lower than 1.6, indicating that those participants presented with dysphonia. Some participants presented with weakness (asthenia) of voice (35%), while 65% presented with a slightly strained voice quality. Moderately positive correlations between breathiness and SSI (r = 0.40, p = 0.08) have been reported. In addition, participants with high SSI scores also scored a poor DSI of below 1.6, as observed by a moderate positive correlation between SSI and DSI (r = 0.41). The majority of PWS presented with dysphonia, evident in the perceptual or acoustic parameters of their voices. These results can be used for further investigation to create awareness and to establish intervention strategies for voice disorders among PWS.

Current and emerging concepts in muscle tension dysphonia: a 30-month review.

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Altman, Kenneth W; Atkinson, Cory; Lazarus, Cathy

2005-06-01

The modern theory of hoarseness is that there are multifactorial etiologies contributing to the voice problem. The hypothesis of this study is that muscle tension dysphonia is multifactorial with various contributing etiologies. This project is a retrospective chart review of all patients seen in the Voice Speech and Language Service and Swallowing Center at our institution with a diagnosis of muscle tension (functional hypertensive) dysphonia over a 30-month period. A literature search and review is also performed regarding current and emerging concepts of muscle tension dysphonia. One hundred fifty subjects were identified (60% female, 40% male, with a mean age of 42.3 years). Significant factors in patient history believed to contribute to abnormal voice production were gastroesophageal reflux in 49%, high stress levels in 18%, excessive amounts of voice use in 63%, and excessive loudness demands on voice use in 23%. Otolaryngologic evaluation was performed in 82% of patients, in whom lesions, significant vocal fold edema, or paralysis/paresis was identified in 52.3%. Speech pathology assessment revealed poor breath support, inappropriately low pitch, and visible cervical neck tension in the majority of patients. Inappropriate intensity was observed in 23.3% of patients. This set of multiple contributing factors is discussed in the context of current and emerging understanding of muscle tension dysphonia. Results confirm multifactorial etiologies contributing to hoarseness in the patients identified with muscle tension dysphonia. An interdisciplinary approach to treating all contributing factors portends the best prognosis.

Psychological effects of dysphonia in voice professionals.

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Salturk, Ziya; Kumral, Tolgar Lutfi; Aydoğdu, Imran; Arslanoğlu, Ahmet; Berkiten, Güler; Yildirim, Güven; Uyar, Yavuz

2015-08-01

To evaluate the psychological effects of dysphonia in voice professionals compared to non-voice professionals and in both genders. Cross-sectional analysis. Forty-eight 48 voice professionals and 52 non-voice professionals with dysphonia were included in this study. All participants underwent a complete ear, nose, and throat examination and an evaluation for pathologies that might affect vocal quality. Participants were asked to complete the Turkish versions of the Voice Handicap Index-30 (VHI-30), Perceived Stress Scale (PSS), and the Hospital Anxiety and Depression Scale (HADS). HADS scores were evaluated as HADS-A (anxiety) and HADS-D (depression). Dysphonia status was evaluated by grade, roughness, breathiness, asthenia, and strain (GRBAS) scale perceptually. The results were compared statistically. Significant differences between the two groups were evident when the VHI-30 and PSS data were compared (P = .00001 and P = .00001, respectively). However, neither HADS score (HADS-A and HADS-D) differed between groups. An analysis of the scores in terms of sex revealed that females had significantly higher PSS scores (P = .006). The GRBAS scale revealed no difference between groups (P = .819, .931, .803, .655, and .803, respectively). No between-sex differences in the VHI-30 or HADS scores were evident We found that voice professionals and females experienced more stress and were more dissatisfied with their voices. 4. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Voice deviation, dysphonia risk screening and quality of life in individuals with various laryngeal diagnoses

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Nemr, Katia; Cota, Ariane; Tsuji, Domingos; Simões-Zenari, Marcia

2018-01-01

OBJECTIVES: To characterize the voice quality of individuals with dysphonia and to investigate possible correlations between the degree of voice deviation (D) and scores on the Dysphonia Risk Screening Protocol-General (DRSP), the Voice-Related Quality of Life (V-RQOL) measure and the Voice Handicap Index, short version (VHI-10). METHODS: The sample included 200 individuals with dysphonia. Following laryngoscopy, the participants completed the DRSP, the V-RQOL measure, and the VHI-10; subsequently, voice samples were recorded for auditory-perceptual and acoustic analyses. The correlation between the score for each questionnaire and the overall degree of vocal deviation was analyzed, as was the correlation among the scores for the three questionnaires. RESULTS: Most of the participants (62%) were female, and the mean age of the sample was 49 years. The most common laryngeal diagnosis was organic dysphonia (79.5%). The mean D was 59.54, and the predominance of roughness had a mean of 54.74. All the participants exhibited at least one abnormal acoustic aspect. The mean questionnaire scores were DRSP, 44.7; V-RQOL, 57.1; and VHI-10, 16. An inverse correlation was found between the V-RQOL score and D; however, a positive correlation was found between both the VHI-10 and DRSP scores and D. CONCLUSION: A predominance of adult women, organic dysphonia, moderate voice deviation, high dysphonia risk, and low to moderate quality of life impact characterized our sample. There were correlations between the scores of each of the three questionnaires and the degree of voice deviation. It should be noted that the DRSP monitored the degree of dysphonia severity, which reinforces its applicability for patients with different laryngeal diagnoses. PMID:29538494

Factors Associated With Patient-perceived Hoarseness in Spasmodic Dysphonia Patients.

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Hu, Amanda; Hillel, Al; Meyer, Tanya

2016-11-01

The American Academy of Otolaryngology-Head and Neck Surgery Clinical Practice Guidelines on Hoarseness distinguishes between hoarseness, which is a symptom perceived by the patient, and dysphonia, which is a diagnosis made by the clinician. Our objective was to determine factors that are associated with patient-perceived hoarseness in spasmodic dysphonia (SD) patients. Retrospective study. Adductor SD patients who presented for botulinum toxin injections from September 2011 to June 2012 were recruited. The main outcome variable, Voice Handicap Index-10 (VHI-10), was used to quantify patient-perceived hoarseness. Clinical data, Hospital Anxiety and Depression Scale (HADS), and VHI-10 were collected. Clinician-perceived dysphonia was measured by a speech-language pathologist with Consensus Auditory Perceptual Evaluation of Voice (CAPE-V). Statistical analysis included univariate analyses and multiple linear regression. One hundred thirty-nine SD patients had VHI-10 score of 26.0 ± 7.2 (mean ± standard deviation), disease duration of 10.5 + 7.0 years, CAPE-V overall score of 43.2 ± 21.8, HADS anxiety score of 6.7 ± 3.8, and HADS depression score of 3.6 ± 2.8. In univariate analyses, there were positive correlations (P dysphonia are associated with higher levels of patient-perceived hoarseness in SD patients. Hoarseness is a very personal symptom. Multiple factors determine its self-perception. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Psychological aspects of adductor spasmodic dysphonia: a prospective population controlled questionnaire study.

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Kaptein, A A; Hughes, B M; Scharloo, M; Hondebrink, N; Langeveld, T P M

2010-02-01

To examine psychosocial concomitants, illness perceptions, and treatment perceptions in patients with adductor spasmodic dysphonia. Prospective controlled cohort study. A tertiary care facility. Forty-nine out-patients (38 women, 11 men; average age of 52 years) with adductor spasmodic dysphonia completed a battery of reliable and validated psychometric assessment instruments. Control patients' data were derived from scores in questionnaires by samples in the formal Manuals of the questionnaires used. Psychosocial functioning, illness perceptions, and treatment perceptions. Scores on psychosocial measures were elevated in male patients especially, indicating levels of psychological morbidity significantly above those seen in the general population. Assessments of illness perceptions and treatment perceptions indicated that patients perceive that they have a very low degree of control over the disorder, and experience a high emotional impact from it. Voice Handicap Index scores illustrated substantial degrees of perceived handicap. Adductor spasmodic dysphonia is associated with significant negative psychosocial concomitants, coupled with low perceived control over the condition. Future research should elucidate the implications of illness perceptions and treatment perceptions for the biopsychosocial care of persons with adductor spasmodic dysphonia in order to improve self-management and enhance quality of life.

MUSCLE TENSION DYSPHONIA

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Irena Hočevar Boltežar

2004-07-01

Full Text Available Background. Muscle tension dysphonia (MTD is the cause of hoarseness in almost one half of the patients with voice disorders. The otorhinolaryngologic examination discovers no evident organic lesions in the larynx at least in the beginning of the voice problems. The reason for the hoarse voice is a disordered and maladjusted activity of the muscles taking part in phonation and/or articulation. In some patients, the irregular function of the larynx results in mucosal lesions on vocal folds. The factors participating in the development of MTD, directly or indirectly influence the quality of laryngeal mucosa, the activity of the phonatory muscles and/or increase of the vocal load. In the diagnostics and treatment of the MTD a phoniatrician, a speech and language therapist and a psychologist closely cooperate with the patient who must take an active role. The treatment is a long-lasting one but resulted in a high percentage of clinical success.Conclusions. Most likely, MTD is not a special disease but only a reflection of any disorder in the complicated system of regulation and realization of phonation. The prognosis of treatment is good when all unfavourable factors participating in development of MTD are eliminated and a proper professional voice- and psychotherapy started.

An analysis of occupational dysphonia diagnosed in the North-East of Poland.

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Kosztyła-Hojna, Bozena; Rogowski, Marek; Ruczaj, Jerzy; Pepiński, Witold; Lobaczuk-Sitnik, Anna

2004-01-01

The objective of the study was to evaluate factors predisposing to occupational dysphonia in a group of professional voice users. The study involved 374 patients treated in the Clinic of Otolaryngology and the Phoniatric Outpatient Clinic, Department of Otolaryngology, Medical University of Białystok in 1999--2001. Group I consisted of 309 patients qualified as professional voice users. The obtained results were compared with those yielded in a group of 65 persons of other occupations (group II). All the diagnosed patients neither smoked nor abused alcohol. Tobacco smokers, patients with chronic diseases of the respiratory system or individuals exposed to irritating vapors were excluded from the study. The clinical evaluation included phoniatric examinations with use of videoendoscopy (VIS) and videolaryngostroboscopy (VLSS) of the larynx. Based on the larynx endoscopic image the voice organ pathology was diagnosed in the patients as functional and/or organic dysphonia. The former comprised hyperfunctional or hypofunctional dysphonia and insufficiency of the glottis and the latter other laryngeal disturbances. In the statistical analysis chi2 parametric test of independence for two averages was used. Female teachers of primary and lower secondary schools, mean age 43 years, prevailed in the group of professional voice users, in which functional dysphonia was more common. In this group, the onset of organic changes was earlier than that of functional changes and was manifested by soft vocal nodules, edematous and inflammatory changes in the vocal fold mucosa. Functional dysphonia of 3 degrees, 4 degrees and even 5 degrees predominated in the group of professional voice users in the course of their employment.

Toward validation of the cepstral spectral index of dysphonia (CSID) as an objective treatment outcomes measure.

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Peterson, Elizabeth A; Roy, Nelson; Awan, Shaheen N; Merrill, Ray M; Banks, Russell; Tanner, Kristine

2013-07-01

To examine the validity of the Cepstral Spectral Index of Dysphonia (CSID) as an objective treatment outcomes measure of dysphonia severity. Pre- and posttreatment samples of sustained vowel and connected speech productions were elicited from 112 patients across six diagnostic categories: unilateral vocal fold paralysis, adductor spasmodic dysphonia, primary muscle tension dysphonia, benign vocal fold lesions, presbylaryngis, and mutational falsetto. Listener ratings of severity in connected speech were compared with a three-factor CSID model consisting of the cepstral peak prominence (CPP), the low-to-high spectral energy ratio, and its standard deviation. Two additional variables, the CPP standard deviation and gender, were included in the five-factor CSID model to estimate severity of vowels. CSID-estimated severity for sustained vowels and connected speech was strongly associated with listener ratings pretreatment, posttreatment, and change observed pre- to posttreatment. Spectrum effects were examined, and severity of dysphonia did not influence the relationship between listener perceived severity and CSID-estimated severity. The results confirm a robust relationship between listener perceived and CSID-derived dysphonia severity estimates in sustained vowels and connected speech across diverse diagnoses and severity levels and support the clinical utility of the CSID as an objective treatment outcomes measure. Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Acoustic correlate of vocal effort in spasmodic dysphonia.

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Eadie, Tanya L; Stepp, Cara E

2013-03-01

This study characterized the relationship between relative fundamental frequency (RFF) and listeners' perceptions of vocal effort and overall spasmodic dysphonia severity in the voices of 19 individuals with adductor spasmodic dysphonia. Twenty inexperienced listeners evaluated the vocal effort and overall severity of voices using visual analog scales. The squared correlation coefficients (R2) between average vocal effort and overall severity and RFF measures were calculated as a function of the number of acoustic instances used for the RFF estimate (from 1 to 9, of a total of 9 voiced-voiceless-voiced instances). Increases in the number of acoustic instances used for the RFF average led to increases in the variance predicted by the RFF at the first cycle of voicing onset (onset RFF) in the perceptual measures; the use of 6 or more instances resulted in a stable estimate. The variance predicted by the onset RFF for vocal effort (R2 range, 0.06 to 0.43) was higher than that for overall severity (R2 range, 0.06 to 0.35). The offset RFF was not related to the perceptual measures, irrespective of the sample size. This study indicates that onset RFF measures are related to perceived vocal effort in patients with adductor spasmodic dysphonia. These results have implications for measuring outcomes in this population.

Voice disorders (dysphonia) in public school female teachers working in Belo Horizonte: prevalence and associated factors.

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de Medeiros, Adriane Mesquita; Barreto, Sandhi Maria; Assunção, Ada Avila

2008-11-01

The objective of this study is to establish the prevalence of dysphonia and associated factors in public school female teachers working in Belo Horizonte. This cross-sectional study was conducted on a random sample of schools between May 2004 and July 2005. There were 2103 elementary education daytime teachers from 83 schools included in the study. Self-applied questionnaires were used for data collection. These included questions on social and demographic matters, general health and mental health (General Health Questionnaire-12 [GHQ-12]), the environment and organization of work, and voice-related aspects. The variable dysphonia was classified as absent, possible, or probable based on the association between frequency of fatigue when speaking and worsened voice quality during the past 15 days. Multinomial logistic regression was used to analyze factors independently associated with dysphonia in each response subgroup and in total. One third of the female teachers did not report voice symptoms during the past 15 days (33%). The prevalence of probable dysphonia was 15%, and the prevalence for possible dysphonia was 52%. Factors associated with probable dysphonia were presence of recent upper airway problems (odds ratio [OR]=5.95, 95% confidence interval [CI]=4.06-8.71), problems at work because of voice (OR=65.30, 95% CI=19.33-220.59), other activities with intense voice use (OR=1.71, 95% CI=1.08-2.71), high noise levels (OR=2.55, 95% CI=1.72-3.76), poor ventilation in the classroom (OR=2.00, 95% CI=1.24-3.22), current mental disorder (OR=3.20, 95% CI=2.18-4.70), sedentary life style (OR=1.94, 95% CI=1.21-3.09), and marriage (OR=1.70, 95% CI=1.16-2.47). Associations between probable dysphonia, poor working conditions, health-related aspects, and professional jeopardy indicate the complexity of dysphonia in female teachers and the need for collective intervention strategies.

The role of laryngoscopy in the diagnosis of spasmodic dysphonia.

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Daraei, Pedram; Villari, Craig R; Rubin, Adam D; Hillel, Alexander T; Hapner, Edie R; Klein, Adam M; Johns, Michael M

2014-03-01

Spasmodic dysphonia (SD) can be difficult to diagnose, and patients often see multiple physicians for many years before diagnosis. Improving the speed of diagnosis for individuals with SD may decrease the time to treatment and improve patient quality of life more quickly. To assess whether the diagnosis of SD can be accurately predicted through auditory cues alone without the assistance of visual cues offered by laryngoscopic examination. Single-masked, case-control study at a specialized referral center that included patients who underwent laryngoscopic examination as part of a multidisciplinary workup for dysphonia. Twenty-two patients were selected in total: 10 with SD, 5 with vocal tremor, and 7 controls without SD or vocal tremor. The laryngoscopic examination was recorded, deidentified, and edited to make 3 media clips for each patient: video alone, audio alone, and combined video and audio. These clips were randomized and presented to 3 fellowship-trained laryngologist raters (A.D.R., A.T.H., and A.M.K.), who established the most probable diagnosis for each clip. Intrarater and interrater reliability were evaluated using repeat clips incorporated in the presentations. We measured diagnostic accuracy for video-only, audio-only, and combined multimedia clips. These measures were established before data collection. Data analysis was accomplished with analysis of variance and Tukey honestly significant differences. Of patients with SD, diagnostic accuracy was 10%, 73%, and 73% for video-only, audio-only, and combined, respectively (P < .001, df = 2). Of patients with vocal tremor, diagnostic accuracy was 93%, 73%, and 100% for video-only, audio-only, and combined, respectively (P = .05, df = 2). Of the controls, diagnostic accuracy was 81%, 19%, and 62% for video-only, audio-only, and combined, respectively (P < .001, df = 2). The diagnosis of SD during examination is based primarily on auditory cues. Viewing combined audio and video

Vocal nodules in a colombian teachers group with dysphonia

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Andrés Felipe Alvarado Díaz

2013-12-01

Full Text Available Objectives: This study determined the prevalence of vocal nodules associated with dysphonia in teachers aged from 35 to 65 years, taking into consideration both individual and occupational variables. Methodology: Descriptive study that included the information contained in 262 medical records of teachers diagnosed with dysphonia in occupational health consultations at the institutions that provide health services in Bogotá, Colombia from March 2009 to March 2012. The presence of laryngeal nodules was based on the findings of a nasofibrolaryngoscopy procedure. Results: Nodules were found in 67 teachers, which corresponded to a rate of 25.5%, being apparently (highest observed rates associated primarily with the following variables: females, ages from 45 to 54 years, bilateral nodules, and teaching position (preschool and physical education. Of the teachers with nodules, 76.1% had fewer than five doctor's appointments, and 75% had more than 90 days of sick leave. Conclusion: A high percentage of teachers have vocal nodules associated with dysphonia. This may be apparently related to different variables such as sex, type of nodule, area and teaching position. Was observed only a statistically significant association among presence of nodules and age (p=0.018. In addition this disorder generates a large number of incapacities and employee absenteeism.

Long-term Effect of Sodium Oxybate (Xyrem®) in Spasmodic Dysphonia with Vocal Tremor

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Simonyan, Kristina; Frucht, Steven J.

2013-01-01

Background Symptoms of spasmodic dysphonia (SD) are usually managed successfully with botulinum toxin injections. Vocal tremor (VT), which accompanies SD, has a poor response to this treatment. Case Report We report a case of a female with SD and VT who became symptom-free for 10 months after the intake of a single dose of sodium oxybate (Xyrem®). The long-term treatment effect correlated with attenuated brain activity in the key regions of dystonic brain network. Discussion Our case demonstrates that the novel treatment of sodium oxybate may hold promise for SD patients, especially those who have associated VT. PMID:24386608

Long-Term Effect of Sodium Oxybate (Xyrem® in Spasmodic Dysphonia with Vocal Tremor

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Kristina Simonyan

2013-12-01

Full Text Available Background: Symptoms of spasmodic dysphonia (SD are usually managed successfully with botulinum toxin injections. Vocal tremor (VT, which accompanies SD, has a poor response to this treatment.Case Report: We report a case of a female with SD and VT who became symptom‐free for 10 months after the intake of a single dose of sodium oxybate (Xyrem®. The long‐term treatment effect correlated with attenuated brain activity in the key regions of dystonic brain network. Discussion: Our case demonstrates that the novel treatment of sodium oxybate may hold promise for SD patients, especially those who have associated VT.

Factors Associated with Dysphonia in High School Cheerleaders.

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Campbell, Shari L.; And Others

1988-01-01

Questionnaire responses from 146 high school cheerleaders indicated that acute, cheering-related dysphonia may be preceded or accompanied by a set of clinical signs that could be incorporated easily into a screening protocol for prospective cheerleaders. (Author/DB)

Toward the Development of an Objective Index of Dysphonia Severity: A Four-Factor Acoustic Model

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Awan, Shaheen N.; Roy, Nelson

2006-01-01

During assessment and management of individuals with voice disorders, clinicians routinely attempt to describe or quantify the severity of a patient's dysphonia. This investigation used acoustic measures derived from sustained vowel samples to predict dysphonia severity (as determined by auditory-perceptual ratings), for a diverse set of voice…

Speech Intelligibility in Severe Adductor Spasmodic Dysphonia

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Bender, Brenda K.; Cannito, Michael P.; Murry, Thomas; Woodson, Gayle E.

2004-01-01

This study compared speech intelligibility in nondisabled speakers and speakers with adductor spasmodic dysphonia (ADSD) before and after botulinum toxin (Botox) injection. Standard speech samples were obtained from 10 speakers diagnosed with severe ADSD prior to and 1 month following Botox injection, as well as from 10 age- and gender-matched…

Disfluency in Spasmodic Dysphonia: A Multivariate Analysis.

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Cannito, Michael P.; Burch, Annette Renee; Watts, Christopher; Rappold, Patrick W.; Hood, Stephen B.; Sherrard, Kyla

1997-01-01

This study examined visual analog scaling judgments of disfluency by normal listeners in response to oral reading by 20 adults with spasmodic dysphonia (SD) and nondysphonic controls. Findings suggest that although dysfluency is not a defining feature of SD, it does contribute significantly to the overall clinical impression of severity of the…

Pharyngeal Dystonia Mimicking Spasmodic Dysphonia.

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Shi, Lucy L; Simpson, C Blake; Hapner, Edie R; Jinnah, Hyder A; Johns, Michael M

2018-03-01

The aim of this study was to describe the presentation of pharyngeal dystonia (PD), which can occur as a focal or segmental dystonia with a primarily pharyngeal involvement for the discussion of treatment methods for controlling consequent symptoms. PD is specific to speech-related tasks. A retrospective medical record review of four patients with PD was performed. All patients were initially misdiagnosed with adductor spasmodic dysphonia and failed standard treatment with botulinum toxin type A (BTX). On laryngoscopy, the patients were discovered to have segmental or focal dystonia primarily affecting the pharyngeal musculature contributing to their vocal manifestations. A novel treatment regimen was designed, which involved directing BTX injections into the muscles involved in spasmodic valving at the oropharyngeal level. After titrating to an optimal dose, all patients showed improvement in their voice and speech with only mild dysphagia. These patients have maintained favorable results with repeat injections at 6- to 12-week intervals. PD, or dystonia with predominant pharyngeal involvement, is a rare entity with vocal manifestations that are not well described. It can be easily mistaken for spasmodic dysphonia. PD is specific to speech-related tasks. A novel method of BTX injections into the involved muscles results in a significant improvement in voice without significant dysphagia. Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Treatment for spasmodic dysphonia: limitations of current approaches

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Ludlow, Christy L.

2009-01-01

Purpose of review Although botulinum toxin injection is the gold standard for treatment of spasmodic dysphonia, surgical approaches aimed at providing long-term symptom control have been advancing over recent years. Recent findings When surgical approaches provide greater long-term benefits to symptom control, they also increase the initial period of side effects of breathiness and swallowing difficulties. However, recent analyses of quality-of-life questionnaires in patients undergoing regular injections of botulinum toxin demonstrate that a large proportion of patients have limited relief for relatively short periods due to early breathiness and loss-of-benefit before reinjection. Summary Most medical and surgical approaches to the treatment of spasmodic dysphonia have been aimed at denervation of the laryngeal muscles to block symptom expression in the voice, and have both adverse effects as well as treatment benefits. Research is needed to identify the central neuropathophysiology responsible for the laryngeal muscle spasms in order target treatment towards the central neurological abnormality responsible for producing symptoms. PMID:19337127

Chiropractic Care for a Patient with Spasmodic Dysphonia Associated with Cervical Spine Trauma

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Waddell, Roger K.

2005-01-01

Abstract Objective To discuss the diagnosis and response to treatment of spasmodic dysphonia in a 25-year-old female vocalist following an auto accident. Clinical Features The voice disorder and neck pain appeared after the traumatic incident. Examination of the cervical spine revealed moderate pain, muscle spasm and restricted joint motion at C-1 and C-5 on the left side. Cervical range of motion was reduced on left rotation. Bilateral manual muscle testing of the trapezius and sternocleidomastoid muscles, which share innervation with the laryngeal muscles by way of the spinal accessory nerve, were weak on the left side. Pre and post accident voice range profiles (phonetograms) that measure singing voice quality were examined. The pre- and post-accident phonetograms revealed significant reduction in voice intensity and fundamental frequency as measured in decibels and hertz. Intervention and Outcome Low-force chiropractic spinal manipulative therapy to C-1 and C-5 was employed. Following a course of care, the patient's singing voice returned to normal, as well as a resolution of her musculo- skeletal complaints. Conclusion It appears that in certain cases, the singing voice can be adversely affected if neck or head trauma is severe enough. This case proposes that trauma with irritation to the cervical spine nerve roots as they communicate with the spinal accessory, and in turn the laryngeal nerves, may be contributory in some functional voice disorders or muscle tension dysphonia. PMID:19674642

Gender differences in onabotulinum toxin A dosing for adductor spasmodic dysphonia.

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Lerner, Michael Z; Lerner, Benjamin A; Patel, Amit A; Blitzer, Andrew

2017-05-01

The objective of this study was to determine the influence of gender on onabotulinum toxin A dosing for the treatment of adductor spasmodic dysphonia symptoms. Retrospective review. A chart review of the senior author's database of botulinum toxin injections was performed. Patients diagnosed with adductor spasmodic dysphonia who received onabotulinum toxin A (BoNTA) injections to the thyroarytenoid muscle for at least 5 years were included for study. Patients who received alternate formulations of botulinum toxin (Myobloc, Dysport, or Xeomin) and patients with alternate diagnoses, such as abductor spasmodic dysphonia, tremor, and oromandibular dystonia, were excluded. The average BoNTA dose was calculated for each patient and statistical analysis was performed comparing the male and female groups. A total of 201 patients (52 males and 149 females) met inclusion criteria. The average follow-up times for the male and female groups were 10.2 ± 3.6 and 11.1 ± 4 years, respectively. The average BoNTA doses for the male and female groups were 0.6 ± 0.42 U and 1.3 ± 1.1 U, respectively. Statistical analysis was performed using an independent samples two-tailed t test yielding a P value of .0000000002. A large effect size was noted with Cohen's d = 0.85. The data from this retrospective chart review reveal a statistically and clinically significant correlation between female gender and higher average BoNTA dose for symptom control in adductor spasmodic dysphonia. Explanations for this observation are speculative and include a possible inverse relationship between optimal BoNTA dose and vocal fold mass and possibly greater neutralizing antibody formation among female patients. 4. Laryngoscope, 127:1131-1134, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

The Assessment Methods of Laryngeal Muscle Activity in Muscle Tension Dysphonia: A Review

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Khoddami, Seyyedeh Maryam; Nakhostin Ansari, Noureddin; Izadi, Farzad; Talebian Moghadam, Saeed

2013-01-01

The purpose of this paper is to review the methods used for the assessment of muscular tension dysphonia (MTD). The MTD is a functional voice disorder associated with abnormal laryngeal muscle activity. Various assessment methods are available in the literature to evaluate the laryngeal hyperfunction. The case history, laryngoscopy, and palpation are clinical methods for the assessment of patients with MTD. Radiography and surface electromyography (EMG) are objective methods to provide physiological information about MTD. Recent studies show that surface EMG can be an effective tool for assessing muscular tension in MTD. PMID:24319372

Tracing Spasmodic Dysphonia: The Source of Ludwig Traube's Priority.

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Lorch, Marjorie Perlman; Whurr, Renata

2016-08-01

Since the mid-20th century, one citation is given historical priority as the first description of spasmodic dysphonia (SD): Ludwig Traube's 1871 case of the "spastic form of nervous hoarseness." Our objective is to understand how this case serves as the foundation of understanding laryngeal movement disorders. The original German paper was located and translated. Bibliographical and bibliometric methods are used to determine the citation history of this original source over the past 140 years. Although secondary citations in contemporary publications typically credit Traube for establishing the clinical entity SD, his case does not conform to currently accepted diagnostic features. Citation patterns indicate the source of Traube's priority is publications by Arnold and Luchsinger, mid-20th-century ENT clinicians, particularly their influential 1965 textbook used to train US and UK clinicians on voice disorders for several generations. Sometimes secondary citations in medical literature lead to the inadvertent perpetuation of factual misrepresentation. The clinical picture of Traube's original case does not represent what clinicians would recognize as SD today. The rich 19th-century literature on voice disorders is a valuable resource for present day clinicians. © The Author(s) 2016.

Immediate effects of the Finnish resonance tube method on behavioral dysphonia.

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Paes, Sabrina Mazzer; Zambon, Fabiana; Yamasaki, Rosiane; Simberg, Susanna; Behlau, Mara

2013-11-01

To investigate the immediate effects of the Finnish resonance tube method for teachers with behavioral dysphonia. Twenty-five female teachers (m=39.9 years of age) with at least a 5-year history of dysphonia were included. Additional inclusion criteria were the diagnosis of chronic behavioral dysphonia with an indication for speech therapy and the absence of any prior speech therapy. Subjects produced three sets of 10 tokens of sustained phonation with a 1-minute rest interval between tokens into a 27-cm glass tube immersed in at least 2 cm of water. Voice samples were recorded before and after these sets. The effects of these exercises were evaluated by self-assessment, auditory perceptual analysis, and acoustic evaluation involving extraction of fundamental frequency and visual spectrographic analysis. Sixty-eight percent of the teachers reported increased phonatory comfort and 52% reported improved voice quality after performing the exercises. Perceptual analysis indicated improved voice quality in the samples of counting numbers, confirmed by decreased instability, subharmonics, noise in high frequencies, and the tendency for reduced low frequency noise on spectrographic evaluation. Additionally, mean fundamental frequency decreased. The Finnish resonance tube method increased phonatory comfort and vocal changes suggestive diminished hyperfunction. Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Effects of Voice Therapy on Laryngeal Motor Units During Phonation in Chronic Superior Laryngeal Nerve Paresis Dysphonia.

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Kaneko, Mami; Hitomi, Takefumi; Takekawa, Takashi; Tsuji, Takuya; Kishimoto, Yo; Hirano, Shigeru

2017-09-26

Injury to the superior laryngeal nerve can result in dysphonia, and in particular, loss of vocal range. It can be an especially difficult problem to address with either voice therapy or surgical intervention. Some clinicians and scientists suggest that combining vocal exercises with adjunctive neuromuscular electrical stimulation may enhance the positive effects of voice therapy for superior laryngeal nerve paresis (SLNP). However, the effects of voice therapy without neuromuscular electrical stimulation are unknown. The purpose of this retrospective study was to demonstrate the clinical effectiveness of voice therapy for rehabilitating chronic SLNP dysphonia in two subjects, using interspike interval (ISI) variability of laryngeal motor units by laryngeal electromyography (LEMG). Both patients underwent LEMG and were diagnosed with having 70% recruitment of the cricothyroid muscle, and 70% recruitment of the cricothyroid and thyroarytenoid muscles, respectively. Both patients received voice therapy for 3 months. Grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, stroboscopic examination, aerodynamic assessment, acoustic analysis, and Voice Handicap Index-10 were performed before and after voice therapy. Mean ISI variability during steady phonation was also assessed. After voice therapy, both patients showed improvement in vocal assessments by acoustic, aerodynamic, GRBAS, and Voice Handicap Index-10 analysis. LEMG indicated shortened ISIs in both cases. This study suggests that voice therapy for chronic SLNP dysphonia can be useful for improving SLNP and voice quality. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Is the perception of dysphonia severity language-dependent? A comparison of French and Italian voice assessments.

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Ghio, Alain; Cantarella, Giovanna; Weisz, Frédérique; Robert, Danièle; Woisard, Virginie; Fussi, Franco; Giovanni, Antoine; Baracca, Giovanna

2015-04-01

In this cross-language study, six Italian and six French voice experts evaluated perceptually the speech of 27 Italian and 40 French patients with dysphonia to determine if there were differences based on native language. French and Italian voice specialists agreed substantially in their evaluations of the overall grade of dysphonia and moderately concerning roughness and breathiness. No statistically significant effects were found related to the language of the speakers with the exception of breathiness, a finding that was interpreted as being due to different voice pathologies in the patient groups. It was concluded that the perception of the overall grade of dysphonia and breathiness is not language-dependent, whereas the significant difference in the perception of roughness may be related to a perception/adaption process.

Dysphonia Detected by Pattern Recognition of Spectral Composition.

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Leinonen, Lea; And Others

1992-01-01

This study analyzed production of a long vowel sound within Finnish words by normal or dysphonic voices, using the Self-Organizing Map, the artificial neural network algorithm of T. Kohonen which produces two-dimensional representations of speech. The method was found to be both sensitive and specific in the detection of dysphonia. (Author/JDD)

Coprevalence of Anxiety and Depression With Spasmodic Dysphonia: A Case-Control Study

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White, Laura J.; Hapner, Edie R.; Klein, Adam M.; Delgaudio, John M.; Hanfelt, John J.; Jinnah, H. A.; Johns, Michael M.

2012-01-01

Summary Introduction There is evidence supporting an association between depression and anxiety in patients with chronic disease. Spasmodic dysphonia (SD) is a chronic, incurable, and disabling voice disorder. Reported rates of depression and anxiety in SD range from 7.1% to 72%, with a maximum number of 18 patients. The goal of this study was to define the coprevalence of depression and anxiety with SD. Materials and Methods A single-institution case-control study was performed from May to July 2010. Consecutive patients with SD and benign voice disorders were enrolled prospectively. On enrollment, patients were asked to fill out a questionnaire that reviewed the duration of the voice disorder and personal history of anxiety and depression, including current and lifetime diagnosis. Results One hundred forty-six controls with benign voice disorders and 128 patients with SD were enrolled. Patients with SD were no more likely to be diagnosed with depression or anxiety than those of the control group (odds ratio [OR] = 0.985, 95% confidence interval [CI] = 0.59–1.63; and OR = 1.314; 95% CI 0.75–2.3, respectively). Additionally, duration of disease was a risk factor for depression in both the SD group and the control group, and the association was not significantly different between groups. Conclusion Patients with SD were no more likely to have depression or anxiety than those with other voice disorders. It is important for otolaryngologists to be aware of the increased rates of depression in patients diagnosed with chronic diseases, including voice disorders, and to refer to a psychiatrist when appropriate. PMID:22209056

Coprevalence of anxiety and depression with spasmodic dysphonia: a case-control study.

Science.gov (United States)

White, Laura J; Hapner, Edie R; Klein, Adam M; Delgaudio, John M; Hanfelt, John J; Jinnah, H A; Johns, Michael M

2012-09-01

There is evidence supporting an association between depression and anxiety in patients with chronic disease. Spasmodic dysphonia (SD) is a chronic, incurable, and disabling voice disorder. Reported rates of depression and anxiety in SD range from 7.1% to 72%, with a maximum number of 18 patients. The goal of this study was to define the coprevalence of depression and anxiety with SD. A single-institution case-control study was performed from May to July 2010. Consecutive patients with SD and benign voice disorders were enrolled prospectively. On enrollment, patients were asked to fill out a questionnaire that reviewed the duration of the voice disorder and personal history of anxiety and depression, including current and lifetime diagnosis. One hundred forty-six controls with benign voice disorders and 128 patients with SD were enrolled. Patients with SD were no more likely to be diagnosed with depression or anxiety than those of the control group (odds ratio [OR]=0.985, 95% confidence interval [CI]=0.59-1.63; and OR=1.314; 95% CI=0.75-2.3, respectively). Additionally, duration of disease was a risk factor for depression in both the SD group and the control group, and the association was not significantly different between groups. Patients with SD were no more likely to have depression or anxiety than those with other voice disorders. It is important for otolaryngologists to be aware of the increased rates of depression in patients diagnosed with chronic diseases, including voice disorders, and to refer to a psychiatrist when appropriate. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Comparison of voice quality in patients with GERD-related dysphonia or chronic cough.

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Domeracka-Kołodziej, Anna; Grabczak, Elżbieta M; Dąbrowska, Marta; Arcimowicz, Magdalena; Lachowska, Magdalena; Osuch-Wójcikiewicz, Ewa; Niemczyk, Kazimierz

2014-01-01

The aim was to compare a voice quality in patients with GERD-related dysphonia or chronic cough and to determine whether there is a relationship between the main symptom reported and voice quality. 249 consecutive patients diagnosed with GERD-related chronic cough or dysphonia were involved in this retrospective study and were divided into two main groups of men and women, and furthermore into groups of chronic cough and dysphonia. Laryngeal lesions were evaluated with videolaryngostroboscopy using Reflux Finding Score. Voice quality was assessed using GRBAS scale, sonograms, and multidimensional voice program (MDVP). All subjects were found to have vocal abnormalities both in subjective and objective voice analysis. Perceptual assessment of voice (GRBAS) did not reveal any differences between analyzed groups depending on the reported symptom. In MDVP analysis, the group of women with cough as the main symptom demonstrated significantly less abnormalities in VTI value. In men with cough as their main complaint, significantly less MDVP abnormalities were found in Jita, Jitt, RAP, PPQ, and sPPQ parameters. The comparison of voice perceptual assessment in patients with GERD-related dysphonia or chronic cough revealed no differences between analyzed groups. In objective voice analysis, the latter group presented lower degree of hoarseness in Yanagihara's scale. In objective MDVP analysis, the chronic cough group presented lower degree of abnormalities only in one of the noise related parameters in females and five frequency perturbation parameters in males. Copyright © 2013 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.

Reduction of Risk Factors in Patients with Behavioral Dysphonia After Vocal Group Therapy.

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Silva, Wégina Jordâna Nascimento da; Lopes, Leonardo Wanderley; Macedo, Anny Elizabety Ramalho de; Costa, Denise Batista da; Almeida, Anna Alice Figueiredo de

2017-01-01

The origin and development of dysphonia, particularly behavioral dysphonia, is associated with several risk factors. Here, we verified the effectiveness of group therapy in reducing the risk factors, and established the association between risk factors and sex, age, profession, and diagnosis of laryngeal disorders in patients with behavioral dysphonia. This is a descriptive, quantitative, field intervention study. Participants (n = 26, adult patients of both sexes), with a diagnosis of behavioral dysphonia, received group therapy intervention. Data for risk factors were collected pre- and posttherapy using the Vocal Screening Protocol. The data were analyzed using descriptive and inferential statistics (Student t test, chi-squared test or Spearman correlation test). The majority (80.8%, n = 21) of patients were female, 65.4% (n = 17) were not in a vocal profession, and 42.3% (n = 11) presented with a lesion in the membranous portion of the vocal fold. The number of personal risk factors decreased after group therapy (P = 0.04). In addition, age was correlated with total (P = 0.001), environmental (P = 0.002), and personal (P = 0.003) vocal risk factors posttherapy. This study revealed an association between the reduction of personal risk factors and vocal group therapy, and a correlation between age and total, environmental, and personal vocal risk factors posttherapy. Thus, maintenance and origins of the behaviors that modify the behavioral aspects of the participants directly influence the production of individual vocal habits. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Systematic review of the treatment of functional dysphonia and prevention of voice disorders.

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Ruotsalainen, Jani; Sellman, Jaana; Lehto, Laura; Verbeek, Jos

2008-05-01

To evaluate the effectiveness of interventions for treating functional dysphonia or preventing voice disorders in adults. We searched MEDLINE (1950 to 2006), EMBASE (1974 to 2006), CENTRAL (Issue 2 2006), CINAHL (1983 to 2006), PsychINFO (1967 to 2006), Science Citation Index (1986 to 2006), and the Occupational Health databases OSH-ROM (February 2006). Systematic review and meta-analysis of randomized controlled trials. Included studies evaluated the effectiveness of interventions for 1) treating functional/nonorganic dysphonia or 2) preventing voice disorders. We identified six randomized controlled trials about treatment and two about prevention. Two authors independently extracted data and assessed trial quality. A combination of direct and indirect voice therapy, compared with no intervention, improves self-reported (standardized mean difference -1.07; 95% CI -1.94 to -0.19), observer-rated (weighted mean difference [WMD] -13.00; 95% CI -17.92 to -8.08), and instrumentally assessed vocal functioning (WMD -1.20; 95% CI -2.37 to -0.03) in adults with functional dysphonia. Effects are reported to remain for at least 14 weeks. Effects are similar in patients and in teachers and student teachers screened for voice problems. We found two studies that did not show voice training, compared with no intervention, to have a preventive effective in improving self-reported vocal functioning. Assessment of publication bias showed that the real effect sizes are probably smaller. Comprehensive voice therapy is effective in improving vocal performance in adults with functional dysphonia. There is no evidence of effectiveness of voice training in preventing voice disorders.

Persistent dysphonia in two performers affecting the singing and projected speaking voice: a report on a collaborative approach to management.

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Baker, Janet

2002-01-01

The projected speaking voice and the singing voice are highly sensitive to external and internal influences, and teachers of spoken voice and singing are in a unique position to identify subtle and more serious vocal difficulties in their students. Persistent anomalies may herald early onset of changes in vocal fold structure, neurophysiological control, or emotional stability. Two cases are presented to illustrate the benefits of a collaborative approach to diagnosis and management. The first, a 21-year-old male drama and singing student with an abnormally high speaking voice and falsetto singing voice was found to have a psychogenic dysphonia referred to as "puberphonia" or "mutational falsetto". The second, a 34-year-old female alto with strained phonation and perceived stutter of the vocal folds was diagnosed with "adductor spasmodic dysphonia" or "focal laryngeal dystonia" of neurological origin.

Transcutaneous Electrical Nerve Stimulation (TENS) and Laryngeal Manual Therapy (LMT): Immediate Effects in Women With Dysphonia.

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Conde, Mariana de Cásisa Macedo; Siqueira, Larissa Thaís Donalonso; Vendramini, José Eduardo; Brasolotto, Alcione Ghedini; Guirro, Rinaldo Roberto de Jesus; Silverio, Kelly Cristina Alves

2018-05-01

This study aimed to verify the immediate effect of low-frequency transcutaneous electrical nerve stimulation (TENS) and laryngeal manual therapy (LMT) in musculoskeletal pain, voice quality, and self-reported signs in women with dysphonia. Thirty women with behavioral dysphonia were randomly divided into the TENS group and the LMT group. All participants fulfilled the pain survey and had their voices recorded to posterior perceptual and acoustic analysis before and after intervention. The TENS group received a unique low-frequency TENS session (20 minutes). The LMT group received LMT (20 minutes) with soft and superficial massage in the sternocleidomastoid muscle, suprahyoid muscles, and larynx. Afterward, the volunteers reported their voice, larynx, breathing, and articulatory signs. Pre and post data were compared by parametric and nonparametric tests. After TENS, a decrease in pain intensity in the posterior or anterior region of the neck, shoulders, upper or lower back, and masseter was observed. After LMT, a decrease in pain intensity in the neck anterior region, shoulders, lower back, and temporal region was observed. Also, after TENS, there was an improvement in vowel /a/ instability; after LMT, there was a general improvement in voice quality, decrease in tension, and decrease in breathiness in speech. Positive voice and laryngeal signs were reported after TENS, and positive laryngeal signs and articulation were reported after LMT. TENS and LMT may be used in voice treatment of women with behavioral dysphonia, and both may be considered important therapy resources that reduce musculoskeletal pain and cause positive laryngeal signs. Both TENS and LMT are able to partially improve voice quality, but TENS presented better results. Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Spasmodic dysphonia may respond to bilateral thalamic deep brain ...

African Journals Online (AJOL)

Background Spasmodic dysphonia is a primary focal dystonia manifested by loss of control of the vocal muscles during speech secondary to laryngeal muscle spasms. The pathophysiology is not well understood. Deep brain stimulation surgery (DBS) for other focal dystonias has been well reported. Methods We report the ...

Manual Therapy and Exercise to Improve Outcomes in Patients With Muscle Tension Dysphonia: A Case Series

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Archer, Kristin R.

2015-01-01

Background and Purpose Muscle tension dysphonia (MTD), a common voice disorder that is not commonly referred for physical therapy intervention, is characterized by excessive muscle recruitment, resulting in incorrect vibratory patterns of vocal folds and an alteration in voice production. This case series was conducted to determine whether physical therapy including manual therapy, exercise, and stress management education would be beneficial to this population by reducing excess muscle tension. Case Description Nine patients with MTD completed a minimum of 9 sessions of the intervention. Patient-reported outcomes of pain, function, and quality of life were assessed at baseline and the conclusion of treatment. The outcome measures were the numeric rating scale (NRS), Patient-Specific Functional Scale (PSFS), and Voice Handicap Index (VHI). Cervical and jaw range of motion also were assessed at baseline and postintervention using standard goniometric measurements. Outcomes Eight of the patients had no pain after treatment. All 9 of the patients demonstrated an improvement in PSFS score, with 7 patients exceeding a clinically meaningful improvement at the conclusion of the intervention. Three of the patients also had a clinically meaningful change in VHI scores. All 9 of the patients demonstrated improvement in cervical flexion and lateral flexion and jaw opening, whereas 8 patients improved in cervical extension and rotation postintervention. Discussion The findings suggest that physical therapists can feasibly implement an intervention to improve outcomes in patients with MTD. However, a randomized clinical trial is needed to confirm the results of this case series and the efficacy of the intervention. A clinical implication is the expansion of physical therapy to include referrals from voice centers for the treatment of MTD. PMID:25256740

Prevalence and Severity of Dysphonia in Patients with Cystic Fibrosis: A Pilot Study.

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Willis, John; Michael, Deirdre D; Boyer, Holly; Misono, Stephanie

2015-07-01

To assess the prevalence and severity of dysphonia in patients with cystic fibrosis sinusitis. We hypothesized that patients with CF sinusitis, compared with 2 control groups, would have higher self-reported prevalence of dysphonia and greater severity of dysphonia, according to patient-reported outcome measures as well as auditory-perceptual evaluation by expert listeners. Cross-sectional comparative pilot study. Academic tertiary care clinic. Analysis included 37 study participants: 17 patients with CF sinusitis, 10 healthy individuals, and 10 patients with non-CF sinusitis. All participants completed the 10-item Voice Handicap Index (VHI-10) questionnaire and provided voice samples. On all samples, 6 blinded speech-language pathologists independently performed auditory-perceptual evaluation, using Consensus Auditory-Perceptual Evaluation of Voice. To assess severity of sinonasal symptoms, we used the 20-item Sinonasal Outcome Test (SNOT-20). Standard parametric and nonparametric statistical analysis was performed. The differences between the 3 groups in prevalence of abnormal VHI-10 scores were not statistically significant. SNOT-20 scores were similar in the 2 sinusitis patient groups. VHI-10 scores were highest in patients with CF sinusitis, intermediate in patients with non-CF sinusitis, and lowest in healthy individuals (P = .005). Auditory-perceptual evaluation demonstrated greater overall severity of dysphonia in patients with CF sinusitis compared with the 2 control groups (P = .0005). Cystic fibrosis sinusitis appeared to be associated with worse vocal function as measured by patient self-report as well as auditory-perceptual evaluation of voice compared with patients with non-CF sinusitis and healthy controls. Further investigation in this area is warranted. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

Psychosocial Aspects of Adolescent Dysphonia: An Approach to Treatment.

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Beery, Quinter C.

1991-01-01

This paper presents an approach to voice therapy with adolescents, emphasizing the importance of psychosocial and family influences as they relate to vocal behavior. The goals of therapy for the adolescent with dysphonia usually follow an orderly sequence, first dealing with individual behavior and later with family and peer group influences. (JDD)

Aerodynamic Profiles of Women with Muscle Tension Dysphonia/Aphonia

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Gillespie, Amanda I.; Gartner-Schmidt, Jackie; Rubinstein, Elaine N.; Abbott, Katherine Verdolini

2013-01-01

Purpose: In this study, the authors aimed to (a) determine whether phonatory airflows and estimated subglottal pressures (est-P[subscript sub]) for women with primary muscle tension dysphonia/aphonia (MTD/A) differ from those for healthy speakers; (b) identify different aerodynamic profile patterns within the MTD/A subject group; and (c) determine…

[Dysphonia in children: Retrospective and comparative study between the late 1980s and today].

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Ruiz, Y; Orive, D; Coulombeau, B; Perouse, R

Child dysphonia is a frequent pathological situation which concerns 6 to 38 percent of a school attending population. Thus it demands a specific and adapted treatment. Because of its direct consequences on social, family and school lives, parents often seek advice from a speech specialist. This study focuses on the specificities of those individuals having diagnosed child dysphonia, as well as the treatment which can be given to them. Our work covers a period of twenty years of comparative studies. We have read through dr Coulombeau's files, from 2005 to 2011, and we have made up a series of questions addressed to the speech therapists having speech impaired children in their practice. We have cross-examined these data with those of Dr Cornut's, covering a period of seven years (1985-1991). The qualitative and quantitative studies which have been carried out enabled us to highlight the fact there has been a constant background of child dysphonia and an evolution in the offered treatments. Indeed, we have realised that the number of individuals having diagnosed child dysphonia are less and less operated on. In the same time people tend to ignore the offered treatments. Though the follow-ups to a prior visit at a speech therapist have decreased for twenty years, it still remains the most common treatment. Our analysis does not focus on the effects of the given treatments on a long term basis. It thus appears that a study consisting in analysing the development of these children through adulthood would be greatly accurate.

[Evaluation of the notification of dysphonia on the voice profesionals as a sentinel event in Navarra. Period 2013-2015.

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Arrizabalaga Baigorri, Sara; García López, Vega

2017-07-07

Among the lesions produced by the professional use of the voice since 2007, the Vocal Nodules (VN) are recognized in Spain as an Occupational Disease. With the aim of promoting its notification in Navarre, the Sentinel Program was incorporated in 2013 and, with this study, we seek to verify its efficacy. The study population were voice professionals reported for dysphonia as sentinel events during the years 2013 to 2015 in Navarre. Its effectiveness was validated by the cumulative incidence of 100,000 workers for each of the years and Positive Predictive Value as an indicator of suspicion. The declaration was verified as an occupational disease. In the period April 2013 to December, 110 cases were reported, 71 nominal and 39 non-nominal. The annual incidence increased from 9.0 cases per 100,000 to 13.4. Of the cases investigated, 63 were women and 8 men. The mean age was 40.8 years (38.5-43.1 95% CI). 58 cases (81.7%) corresponded to teachers. In 22 of the 71 nodules (31%) and 9 coincidences were notified as an occupational disease. We found a greater presence of nodules in professionals with extra work use of voice (OR 4.2 IC 1.3-14.3) and better evolution of pathologies other than VN (OR = 2.5 CI 1.1-5.8 ). The suspicion was confirmed as occupational in 54 cases (positive predictive value 76.1%). The centinel program is effective in reporting dysphonia although it is important to highlight the low declaration as occupational disease of the cases detected.

Vocal aging and adductor spasmodic dysphonia: Response to botulinum toxin injection

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Michael P Cannito

2008-03-01

Full Text Available Michael P Cannito, Joel C Kahane, Lesya ChornaSchool of Audiology and Speech-Language Pathology, The University of Memphis, Memphis, TN, USAAbstract: Aging of the larynx is characterized by involutional changes which alter its biomechanical and neural properties and create a biological environment that is different from younger counterparts. Illustrative anatomical examples are presented. This natural, non-disease process appears to set conditions which may influence the effectiveness of botulinum toxin injection and our expectations for its success. Adductor spasmodic dysphonia, a type of laryngeal dystonia, is typically treated using botulinum toxin injections of the vocal folds in order to suppress adductory muscle spasms which are disruptive to production of speech and voice. A few studies have suggested diminished response to treatment in older patients with adductor spasmodic dysphonia. This retrospective study provides a reanalysis of existing pre-to-post treatment data as function of age. Perceptual judgments of speech produced by 42 patients with ADSD were made by two panels of professional listeners with expertise in voice or fluency of speech. Results demonstrate a markedly reduced positive response to botulinum toxin treatment in the older patients. Perceptual findings are further elucidated by means of acoustic spectrography. Literature on vocal aging is reviewed to provide a specific set of biological mechanisms that best account for the observed interaction of botulinum toxin treatment with advancing age.Keywords: vocal aging, adductor spasmodic dysphonia, botulinum toxin, voice quality, speech fluency

A Randomized, Controlled Trial of Behavioral Voice Therapy for Dysphonia Related to Prematurity of Birth.

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Reynolds, Victoria; Meldrum, Suzanne; Simmer, Karen; Vijayasekaran, Shyan; French, Noel

2017-03-01

Dysphonia is a potential complication of prematurity. Preterm children may sustain iatrogenic laryngeal damage from medical intervention in the neonatal period, and further, adopt compensatory, maladaptive voicing behaviors. This pilot study aimed to evaluate the effects of a voice therapy protocol on voice quality in school-aged, very preterm (VP) children. Twenty-seven VP children with dysphonia were randomized to an immediate intervention group (n = 7) or a delayed-intervention, waiting list control group (n = 14). Following analysis of these data, a secondary analysis was conducted on the pooled intervention data (n = 21). Six participants did not complete the trial. Change to voice quality was measured via pre- and posttreatment assessments using the Consensus Auditory Perceptual Evaluation of Voice. The intervention group did not demonstrate statistically significant improvements in voice quality, whereas this was observed in the control group (P = 0.026). However, when intervention data were pooled including both the immediate and delayed groups following intervention, dysphonia severity was significantly lower (P = 0.026) in the treatment group. Dysphonia in most VP children in this cohort was persistent. These pilot data indicate that some participants experienced acceptable voice outcomes on spontaneous recovery, whereas others demonstrated a response to behavioral intervention. Further research is needed to identify the facilitators of and barriers to intervention success, and to predict those who may experience spontaneous recovery. Copyright © 2017 The Voice Foundation. All rights reserved.

Interarytenoid muscle botox injection for treatment of adductor spasmodic dysphonia with vocal tremor.

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Kendall, Katherine A; Leonard, Rebecca J

2011-01-01

Up to one-third of patients presenting with adductor spasmodic dysphonia will have an associated vocal tremor. These patients may not respond fully to treatment using thyroarytenoid (TA) muscle botulinum toxin (Botox) injection. Treatment failures are attributed to the involvement of multiple muscle groups in the tremor. This study evaluates the results of combined interarytenoid (IA) and TA muscle Botox injection in a group of 27 patients with adductor spasmodic dysphonia and vocal tremor and in four patients with severe vocal tremor alone. Patient-satisfaction data were reviewed retrospectively. Pre- and postinjection acoustic data were collected prospectively. Acoustic measures of fundamental frequency and cycle-by-cycle variability in frequency (jitter) and intensity (shimmer) were obtained from 15 patients' sustained vowel productions. Measures were collected after TA muscle injection, alone, and after combined TA and IA (TA+IA) muscle injections. In addition, two experienced voice clinicians blindly assessed tremor severity from recordings made for each patient in the two conditions. Patients were also queried regarding their satisfaction with the results of the injections and whether they desired to continue receiving TA+IA treatment. Significant improvement in all acoustic measures except for % jitter was observed after the TA+IA muscle injections. Listeners identified voice samples after TA+IA muscle injections as demonstrating less tremor in 73% of the paired comparisons. Sixty-seven percent of the patients with spasmodic dysphonia and vocal tremor wished to continue to receive IA muscle injections. Only one patient with severe vocal tremor wished to continue with injections. The addition of an IA muscle Botox injection to the treatment of patients with a combination adductor spasmodic dysphonia and vocal tremor may improve voice outcomes. Copyright © 2011 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Assessing the effectiveness of botulinum toxin injections for adductor spasmodic dysphonia: clinician and patient perception.

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Braden, Maia N; Johns, Michael M; Klein, Adam M; Delgaudio, John M; Gilman, Marina; Hapner, Edie R

2010-03-01

To determine the effectiveness of Botox treatment for adductor spasmodic dysphonia (ADSD), the clinician and patient judge changes in voice symptoms and the effect on quality of life. Currently, there is no standard protocol for determining the effectiveness of Botox injections in treating ADSD. Therefore, clinicians use a variety of perceptual scales and patient-based self-assessments to determine patients' impressions of severity and changes after treatments. The purpose of this study was to assess clinician-patient agreement of the effects of Botox on voice quality and quality of life in ADSD. Retrospective chart review of 199 randomly selected patients since 2004. Results indicated a weak correlation between the patient's assessment of voice impairment (EIS) and patient's quality of life impairment (Voice-Related Quality of Life [V-RQOL]) in the mild-moderate dysphonia severity group and the moderate-to-severe dysphonia group. There was a weak correlation between the patient's assessment of voice impairment EIS and the clinician's perceptual judgment of voice impairment (Consensus Auditory Perceptual Evaluation of Voice [CAPE-V]) only in the moderate to severe dysphonia group. There was a weak correlation between the patient's quality of life impairment (V-RQOL) and the clinician's perceptual judgment of voice impairment (CAPE-V) only in the severe to profound dysphonia group. The poor relationship among commonly used outcome measures leads us to question how best to assess the effectiveness of Botox in ADSD. Clinicians are required to document treatment outcomes, making it important to use scales that are valid, reliable, and sensitive to change. Future research directions include examining relationships between measures both before and after Botox injections, examining the specific factors that determine quality of life changes, and further research on specific parameters of the CAPE-V as well as comparing perceptual and quality of life scales with acoustic

Spasmodic dysphonia: onset, course, socioemotional effects, and treatment response.

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Tanner, Kristine; Roy, Nelson; Merrill, Ray M; Sauder, Cara; Houtz, Daniel R; Smith, Marshall E

2011-07-01

This investigation explored the onset, progression, socioemotional effects, and treatment outcomes of spasmodic dysphonia (SD). A cross-sectional epidemiological approach was used to examine questionnaire responses from 150 individuals with SD. Symptoms of SD (mean age at onset, 46 years) began gradually in 76% of cases and were progressive (ie, failed to plateau) in 34% of cases. Botulinum toxin A (Botox) helped to attenuate voice symptoms in 91% of cases; however, the scores on the Voice-Related Quality of Life questionnaire (V-RQOL) were not associated with this effect. The V-RQOL scores improved with time since symptom onset, independent of age and treatment. The patients with only SD experienced onset, course, and progression of symptoms similar to those of the patients with SD and coexisting vocal tremor. The symptoms of SD begin gradually and worsen over time. New evidence indicates that SD symptoms may continue to progress without plateau in at least a subset of patients. Individuals with SD and coexisting vocal tremor experience symptom trajectories similar to those of patients with SD only. Although Botox may attenuate voice symptoms, these effects do not appear to be strongly related to the V-RQOL scores. These results provide new and valuable insights regarding the onset, course, progression, and treatment of SD.

Vocal Parameters and Self-Perception in Individuals With Adductor Spasmodic Dysphonia.

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Rojas, Gleidy Vannesa E; Ricz, Hilton; Tumas, Vitor; Rodrigues, Guilherme R; Toscano, Patrícia; Aguiar-Ricz, Lílian

2017-05-01

The study aimed to compare and correlate perceptual-auditory analysis of vocal parameters and self-perception in individuals with adductor spasmodic dysphonia before and after the application of botulinum toxin. This is a prospective cohort study. Sixteen individuals with a diagnosis of adductor spasmodic dysphonia were submitted to the application of botulinum toxin in the thyroarytenoid muscle, to the recording of a voice signal, and to the Voice Handicap Index (VHI) questionnaire before the application and at two time points after application. Two judges performed a perceptual-auditory analysis of eight vocal parameters with the aid of the Praat software for the visualization of narrow band spectrography, pitch, and intensity contour. Comparison of the vocal parameters before toxin application and on the first return revealed a reduction of oscillation intensity (P = 0.002), voice breaks (P = 0.002), and vocal tremor (P = 0.002). The same parameters increased on the second return. The degree of severity, strained-strangled voice, roughness, breathiness, and asthenia was unchanged. The total score and the emotional domain score of the VHI were reduced on the first return. There was a moderate correlation between the degree of voice severity and the total VHI score before application and on the second return, and a weak correlation on the first return. Perceptual-auditory analysis and self-perception proved to be efficient in the recognition of vocal changes and of the vocal impact on individuals with adductor spasmodic dysphonia under treatment with botulinum toxin, permitting the quantitation of changes along time. Copyright © 2017. Published by Elsevier Inc.

Comparison of Perceptual Signs of Voice before and after Vocal Hygiene Program in Adults with Dysphonia

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Seyyedeh Maryam khoddami

2011-12-01

Full Text Available Background and Aim: Vocal abuse and misuse are the most frequent causes of voice disorders. Consequently some therapy is needed to stop or modify such behaviors. This research was performed to study the effectiveness of vocal hygiene program on perceptual signs of voice in people with dysphonia.Methods: A Vocal hygiene program was performed to 8 adults with dysphonia for 6 weeks. At first, Consensus Auditory- Perceptual Evaluation of Voice was used to assess perceptual signs. Then the program was delivered, Individuals were followed in second and forth weeks visits. In the last session, perceptual assessment was performed and individuals’ opinions were collected. Perceptual findings were compared before and after the therapy.Results: After the program, mean score of perceptual assessment decreased. Mean score of every perceptual sign revealed significant difference before and after the therapy (p≤0.0001. «Loudness» had maximum score and coordination between speech and respiration indicated minimum score. All participants confirmed efficiency of the therapy.Conclusion: The vocal hygiene program improves all perceptual signs of voice although not equally. This deduction is confirmed by both clinician-based and patient-based assessments. As a result, vocal hygiene program is necessary for a comprehensive voice therapy but is not solely effective to resolve all voice problems.

Exploring Genetic and Environmental Effects in Dysphonia: A Twin Study

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Simberg, Susanna; Santtila, Pekka; Soveri, Anna; Varjonen, Markus; Sala, Eeva; Sandnabba, N. Kenneth

2009-01-01

Purpose: To explore the existence of genetic effects as well as the interaction between potential genetic effects and a voice-demanding occupation on dysphonia. Method: One thousand seven hundred and twenty-eight Finnish twins (555 male; 1,173 female) born between 1961 and 1989 completed a questionnaire concerning vocal symptoms and occupation.…

Review of differential diagnosis and management of spasmodic dysphonia.

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Whurr, Renata; Lorch, Marjorie

2016-06-01

The recent literature on spasmodic dysphonia is reviewed with regard to pathogenesis, differential diagnosis, treatment options, audits, and current methods of management. Advances in technology have enabled clinicians to better understand the connection between brain and laryngeal function and dysfunction. Refinements in imaging and genetic investigation techniques have led to advances in the understanding of the underlying mechanism of this neurolaryngeal disorder. Development of diagnostic assessment tools and measures of quality of life hold the potential to improve treatment and care. Fifty articles published between 2014 and 2015 were selected for this review. The sources were drawn from several clinical specialties: 54% come under the scope of laryngology, 32% from neurology, and 14% from other areas. It remains poorly understood, misdiagnosed, and underdiagnosed. Its identification, diagnosis, treatment selection, and coordination of care require an expert specialist multidisciplinary team. More training is required to help people who have this chronic and psychosocially disabling voice disorder, which impinges on all aspects of their lives. Spasmodic dysphonia is now classified as a 'rare' disease in the United States. This designation will assist in international standards of diagnosis, assessment, treatment, and management.

A possible association between dysphonia and sleep duration: A cross-sectional study based on the Korean National Health and nutrition examination surveys from 2010 to 2012.

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Cho, Jung-Hae; Guilminault, Christian; Joo, Young-Hoon; Jin, Sang-Kyun; Han, Kyung-Do; Park, Chan-Soon

2017-01-01

Sleep is important in terms of good general health and appropriate sleep duration has been linked to quality-of-life. Dysphonia may impair communication and social relationships, and is thus also closely related to quality-of-life. No large-scale, cross-sectional epidemiological study of a sample representative of the population of an entire country has yet assessed the possible existence of a relationship between sleep duration and dysphonia. We investigated a possible association between subjective voice problems and self-reported sleep duration in South Korean subjects using 2010-2012 data from the Korean National Health and Nutrition Examination Survey (KNHANES). Cross-sectional data on 17,806 adults (7,578 males and 10,228 females) over the age of 19 years who completed the KNHANES were analyzed. All participants reported voice problems (if present) and their daily average sleep duration using a self-reporting questionnaire. Sleep duration was classified into five categories as follows: ≤5, 6, 7, 8, and ≥9 h/day. The overall prevalence of dysphonia was 6.8%; 5.7% in males and 7.7% in females. The prevalence for dysphonia by sleep duration exhibited a U-shape, with the lowest point being at sleep duration of 7-8h. After adjustment for covariates (age, sex, smoking status, alcohol consumption, regular exercise, low income, high-level education), a sleep duration of ≤5 h (OR = 1.454; 95% CI, 1.153-1.832) and a sleep duration of ≥9 h (OR = 1.365; 95% CI, 1.017-1.832) were significantly associated with dysphonia, compared to a sleep duration of 7 h. In terms of gender, males who slept for ≥9 h were at a 2-fold (OR = 2.028; 95% CI, 1.22-3.35) higher odds for dysphonia (pdysphonia ≥3 weeks in duration (long-term dysphonia). This is the first study to show that both short and long sleep duration were significantly associated with the development of dysphonia. The association between sleep duration and dysphonia was more marked in males than females. A

Tridimensional assessment of adductor spasmodic dysphonia pre- and post-treatment with Botulinum toxin.

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Dejonckere, P H; Neumann, K J; Moerman, M B J; Martens, J P; Giordano, A; Manfredi, C

2012-04-01

Spasmodic dysphonia voices form, in the same way as substitution voices, a particular category of dysphonia that seems not suited for a standardized basic multidimensional assessment protocol, like the one proposed by the European Laryngological Society. Thirty-three exhaustive analyses were performed on voices of 19 patients diagnosed with adductor spasmodic dysphonia (SD), before and after treatment with Botulinum toxin. The speech material consisted of 40 short sentences phonetically selected for constant voicing. Seven perceptual parameters (traditional and dedicated) were blindly rated by a panel of experienced clinicians. Nine acoustic measures (mainly based on voicing evidence and periodicity) were achieved by a special analysis program suited for strongly irregular signals and validated with synthesized deviant voices. Patients also filled in a VHI-questionnaire. Significant improvement is shown by all three approaches. The traditional GRB perceptual parameters appear to be adequate for these patients. Conversely, the special acoustic analysis program is successful in objectivating the improved regularity of vocal fold vibration: the basic jitter remains the most valuable parameter, when reliably quantified. The VHI is well suited for the voice-related quality of life. Nevertheless, when considering pre-therapy and post-therapy changes, the current study illustrates a complete lack of correlation between the perceptual, acoustic, and self-assessment dimensions. Assessment of SD-voices needs to be tridimensional.

Abnormal activation of the primary somatosensory cortex in spasmodic dysphonia: an fMRI study.

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Simonyan, Kristina; Ludlow, Christy L

2010-11-01

Spasmodic dysphonia (SD) is a task-specific focal dystonia of unknown pathophysiology, characterized by involuntary spasms in the laryngeal muscles during speaking. Our aim was to identify symptom-specific functional brain activation abnormalities in adductor spasmodic dysphonia (ADSD) and abductor spasmodic dysphonia (ABSD). Both SD groups showed increased activation extent in the primary sensorimotor cortex, insula, and superior temporal gyrus during symptomatic and asymptomatic tasks and decreased activation extent in the basal ganglia, thalamus, and cerebellum during asymptomatic tasks. Increased activation intensity in SD patients was found only in the primary somatosensory cortex during symptomatic voice production, which showed a tendency for correlation with ADSD symptoms. Both SD groups had lower correlation of activation intensities between the primary motor and sensory cortices and additional correlations between the basal ganglia, thalamus, and cerebellum during symptomatic and asymptomatic tasks. Compared with ADSD patients, ABSD patients had larger activation extent in the primary sensorimotor cortex and ventral thalamus during symptomatic task and in the inferior temporal cortex and cerebellum during symptomatic and asymptomatic voice production. The primary somatosensory cortex shows consistent abnormalities in activation extent, intensity, correlation with other brain regions, and symptom severity in SD patients and, therefore, may be involved in the pathophysiology of SD.

Articulatory Changes Following Treatment of Muscle Tension Dysphonia: Preliminary Acoustic Evidence

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Dromey, Christopher; Nissen, Shawn L.; Roy, Nelson; Merrill, Ray M.

2008-01-01

Purpose: Primary muscle tension dysphonia (MTD), a voice disturbance that occurs in the absence of structural or neurological pathology, may respond to manual circumlaryngeal techniques, which ostensibly alter the posture of the larynx and/or the configuration of the vocal folds without directly targeting supralaryngeal articulatory structures.…

Cortical sensorimotor alterations classify clinical phenotype and putative genotype of spasmodic dysphonia

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Battistella, Giovanni; Fuertinger, Stefan; Fleysher, Lazar; Ozelius, Laurie J.; Simonyan, Kristina

2017-01-01

Background Spasmodic dysphonia (SD), or laryngeal dystonia, is a task-specific isolated focal dystonia of unknown causes and pathophysiology. Although functional and structural abnormalities have been described in this disorder, the influence of its different clinical phenotypes and genotypes remains scant, making it difficult to explain SD pathophysiology and to identify potential biomarkers. Methods We used a combination of independent component analysis and linear discriminant analysis of resting-state functional MRI data to investigate brain organization in different SD phenotypes (abductor vs. adductor type) and putative genotypes (familial vs. sporadic cases) and to characterize neural markers for genotype/phenotype categorization. Results We found abnormal functional connectivity within sensorimotor and frontoparietal networks in SD patients compared to healthy individuals as well as phenotype- and genotype-distinct alterations of these networks, involving primary somatosensory, premotor and parietal cortices. The linear discriminant analysis achieved 71% accuracy classifying SD and healthy individuals using connectivity measures in the left inferior parietal and sensorimotor cortex. When categorizing between different forms of SD, the combination of measures from left inferior parietal, premotor and right sensorimotor cortices achieved 81% discriminatory power between familial and sporadic SD cases, whereas the combination of measures from the right superior parietal, primary somatosensory and premotor cortices led to 71% accuracy in the classification of adductor and abductor SD forms. Conclusions Our findings present the first effort to identify and categorize isolated focal dystonia based on its brain functional connectivity profile, which may have a potential impact on the future development of biomarkers for this rare disorder. PMID:27346568

Cortical sensorimotor alterations classify clinical phenotype and putative genotype of spasmodic dysphonia.

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Battistella, G; Fuertinger, S; Fleysher, L; Ozelius, L J; Simonyan, K

2016-10-01

Spasmodic dysphonia (SD), or laryngeal dystonia, is a task-specific isolated focal dystonia of unknown causes and pathophysiology. Although functional and structural abnormalities have been described in this disorder, the influence of its different clinical phenotypes and genotypes remains scant, making it difficult to explain SD pathophysiology and to identify potential biomarkers. We used a combination of independent component analysis and linear discriminant analysis of resting-state functional magnetic resonance imaging data to investigate brain organization in different SD phenotypes (abductor versus adductor type) and putative genotypes (familial versus sporadic cases) and to characterize neural markers for genotype/phenotype categorization. We found abnormal functional connectivity within sensorimotor and frontoparietal networks in patients with SD compared with healthy individuals as well as phenotype- and genotype-distinct alterations of these networks, involving primary somatosensory, premotor and parietal cortices. The linear discriminant analysis achieved 71% accuracy classifying SD and healthy individuals using connectivity measures in the left inferior parietal and sensorimotor cortices. When categorizing between different forms of SD, the combination of measures from the left inferior parietal, premotor and right sensorimotor cortices achieved 81% discriminatory power between familial and sporadic SD cases, whereas the combination of measures from the right superior parietal, primary somatosensory and premotor cortices led to 71% accuracy in the classification of adductor and abductor SD forms. Our findings present the first effort to identify and categorize isolated focal dystonia based on its brain functional connectivity profile, which may have a potential impact on the future development of biomarkers for this rare disorder. © 2016 EAN.

"King archie, who was quite grouchy" - a vocal dysphonia health education project O rei Sebastião que era muito resmungão

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Maria Rosário Dias

2013-02-01

Full Text Available PURPOSE: one major cause of dysphonia can be linked to the presence of vocal folds nodules - a condition commonly seen in children due to vocal misuse and/or vocal abuse. The present health education project, also directed to parents and educators, aims at making children (the project's chief target-population aware of how to make a correct use of their voice. METHOD: the target population includes parents, educators and children from both sexes and aged between five and eight years old. RESULT: a health education initiative was developed, which main instrument consists in a children's literature book, supplemented by an interactive CD. The instrument relies on a simple and easy-to-follow story where the issue of child dysphonia is addressed. CONCLUSIONS: the developed health education instrument is substantial for its chief target-population; it works as a suitable vehicle for promoting, in children, access, sensibility and awareness regarding aspects of one's voice one should be attentive to.

"King archie, who was quite grouchy" - a vocal dysphonia health education project O rei Sebastião que era muito resmungão

Directory of Open Access Journals (Sweden)

Maria Rosário Dias

2012-01-01

Full Text Available PURPOSE: one major cause of dysphonia can be linked to the presence of vocal folds nodules - a condition commonly seen in children due to vocal misuse and/or vocal abuse. The present health education project, also directed to parents and educators, aims at making children (the project's chief target-population aware of how to make a correct use of their voice. METHOD: the target population includes parents, educators and children from both sexes and aged between five and eight years old. RESULT: a health education initiative was developed, which main instrument consists in a children's literature book, supplemented by an interactive CD. The instrument relies on a simple and easy-to-follow story where the issue of child dysphonia is addressed. CONCLUSIONS: the developed health education instrument is substantial for its chief target-population; it works as a suitable vehicle for promoting, in children, access, sensibility and awareness regarding aspects of one's voice one should be attentive to.

Auditory-Perceptual and Acoustic Methods in Measuring Dysphonia Severity of Korean Speech.

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Maryn, Youri; Kim, Hyung-Tae; Kim, Jaeock

2016-09-01

The purpose of this study was to explore the criterion-related concurrent validity of two standardized auditory-perceptual rating protocols and the Acoustic Voice Quality Index (AVQI) for measuring dysphonia severity in Korean speech. Sixty native Korean subjects with various voice disorders were asked to sustain the vowel [a:] and to read aloud the Korean text "Walk." A 3-second midvowel portion of the sustained vowel and two sentences (with 25 syllables) were edited, concatenated, and analyzed according to methods described elsewhere. From 56 participants, both continuous speech and sustained vowel recordings had sufficiently high signal-to-noise ratios (35.5 dB and 37 dB on average, respectively) and were therefore subjected to further dysphonia severity analysis with (1) "G" or Grade from the GRBAS protocol, (2) "OS" or Overall Severity from the Consensus Auditory-Perceptual Evaluation of Voice protocol, and (3) AVQI. First, high correlations were found between G and OS (rS = 0.955 for sustained vowels; rS = 0.965 for continuous speech). Second, the AVQI showed a strong correlation with G (rS = 0.911) as well as OS (rP = 0.924). These findings are in agreement with similar studies dealing with continuous speech in other languages. The present study highlights the criterion-related concurrent validity of these methods in Korean speech. Furthermore, it supports the cross-linguistic robustness of the AVQI as a valid and objective marker of overall dysphonia severity. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

The effectiveness of voice therapy for teachers with dysphonia.

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Niebudek-Bogusz, E; Sznurowska-Przygocka, B; Fiszer, M; Kotyło, P; Sinkiewicz, A; Modrzewska, M; Sliwinska-Kowalska, M

2008-01-01

An incorrect voice emission is a risk factor for developing occupational voice disorders. The study aimed at assessing the effectiveness of voice therapy in female teachers with dysphonia. The study comprised 133 subjects with voice disorders, taking part in a vocal training programme. A reference group for the present study included 53 teachers with dysphonia. Questionnaire surveys, phoniatric examination and videostroboscopic evaluation were conducted at initial and control examination. In the study group, an improvement after the vocal training was noted in most of the reported symptoms and also in some quantitative parameters of phoniatric examinations compared to the findings for the reference group. The number of patients who assessed their voice as normal increased significantly after the vocal training (2.3 vs. 46.6%). A significant increase in the mean maximum phonation time, from 13.3 to 16.6 s, was observed. The same applied to voice frequency range (increase from 171 to 226.8 Hz). The outcomes of vocal training, such as a subjective improvement of voice quality and an increase in the quantitative parameters (prolonged maximum phonation time, extended voice range) seem to be important parameters for monitoring the effectiveness of training in correct voice emission. 2008 S. Karger AG, Basel.

Botulinum Toxin Dosing Trends in Spasmodic Dysphonia Over a 20-year Period.

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Namin, Arya W; Christopher, Kara M; Eisenbeis, John F

2017-01-01

The study aims to (1) identify the botulinum toxin (BTX) dosing trend in a cohort of patients who received at least 20 injections for the treatment of adductor spasmodic dysphonia (ADSD), (2) describe two distinct BTX dosing trends in treating ADSD (a "classic" dosing trend that initially decreases before stabilizing, and a "fluctuating" dosing trend), and (3) determine if patients with the "classic" dosing trend differed in age or in dosing intervals from those with the "fluctuating" dosing trend. This is a retrospective case series. Of 149 patients who received a total of 2484 BTX injections for the treatment of spasmodic dysphonia in 1993-2013, 49 patients received at least 20 injections. The BTX dose and the interval between doses were recorded. The mean dose of injections 1-20 was determined. The age at initial injection, initial dose, and interval in days between treatments were compared for the "fluctuating" and "classic" groups. The cohort exhibits a significant decrease in dose during the first 10-15 injections. The "fluctuating" group had a significantly shorter interval between injections (mean interval = 97.09 days, SD = 29.41; mean interval = 136.90 days, SD = 43.76, P = 0.002). The mean age at initial dose was not significantly different between the "classic" and "fluctuating" groups. The average BTX dose of patients with ADSD who receive long-term injections significantly decreases during the initial 10-15 injections before stabilizing. Patients who exhibit the "fluctuating" dosing pattern have a significantly shorter interval between injections than those with the "classic" dosing pattern. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Effect of Botulinum Toxin and Surgery among Spasmodic Dysphonia Patients : A Systematic Review

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van Esch, Babette F; Wegner, Inge; Stegeman, Inge; Grolman, Wilko

2017-01-01

OBJECTIVE: The effect of botulinum toxin among patients with adductor spasmodic dysphonia (AdSD) is temporary. To optimize long-term treatment outcome, other therapy options should be evaluated. Alternative treatment options for AdSD comprise several surgical treatments, such as thyroarytenoid

Evaluation of voice acoustic parameters related to the vocal-loading test in professionally active teachers with dysphonia.

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Niebudek-Bogusz, Ewa; Kotyło, Piotr; Sliwińska-Kowalska, Mariola

2007-01-01

Teachers are at risk of developing voice disorders. A clinical battery of vocal function tests should include non-invasive and accurate measurements. The quantitative methods (e.g., voice acoustic analysis) make it possible to objectively evaluate voice efficiency and outcomes of dysphonia treatment. To identify possible signs of vocal fatigue, acoustic waveform perturbations during sustained phonation were measured before and after the vocal-loading test in 51 professionally active female teachers with functional voice disorders, using IRIS software. All the participants were also subjected to laryngological/phoniatric examination involving videostroboscopy combined with self-estimation by voice handicap index (VHI)-based scale. The phoniatric examination revealed glottal insufficiency with bowed vocal folds in 35.2%, soft vocal nodules in 31.4%, and hyperfunctional dysphonia with a tendency towards vestibular phonation in 19.6% of the patients. In the VHI scale, 66% of the female teachers estimated their own voice problems as moderate disability. An acoustic analysis performed after the vocal-loading test showed an increased rate of abnormal frequency perturbation parameters (pitch perturbation quotient (Jitter), relative average perturbation (RAP), and pitch period perturbation quotient (PPQ)) compared to the pre-test outcomes. The same was true of pitch-intensity contour of vowel /a:/, an indication of voice instability during sustained phonation. The recorded impairments of voice acoustic parameters related to vocal loading provide further evidence of dysphonia. The voice acoustic analysis performed before and after the vocal-loading test can significantly contribute to objective voice examinations useful in diagnosis of dysphonia among teachers.

Functional Dysphonia during Mental Imagery: Testing the Trait Theory of Voice Disorders

Science.gov (United States)

van Mersbergen, Miriam; Patrick, Christopher; Glaze, Leslie

2008-01-01

Purpose: Previous research has proposed that persons with functional dysphonia (FD) present with temperamental traits that predispose them to their voice disorder. We investigated this theory in a controlled experiment and compared them with social anxiety (SA) and healthy control (HC) groups. Method: Twelve participants with FD, 19 participants…

Acoustic Variations in Adductor Spasmodic Dysphonia as a Function of Speech Task.

Science.gov (United States)

Sapienza, Christine M.; Walton, Suzanne; Murry, Thomas

1999-01-01

Acoustic phonatory events were identified in 14 women diagnosed with adductor spasmodic dysphonia (ADSD), a focal laryngeal dystonia that disturbs phonatory function, and compared with those of 14 age-matched women with no vocal dysfunction. Findings indicated ADSD subjects produced more aberrant acoustic events than controls during tasks of…

Relationship between adherence to speech therapy in patients with dysphonia and quality of life.

Science.gov (United States)

Duarte de Almeida, Letícia; Santos, Lívia Rodrigues; Bassi, Iara Barreto; Teixeira, Letícia Caldas; Côrtes Gama, Ana Cristina

2013-09-01

The present study analyzed if aspects of voice-related quality of life (VRQOL) were associated with adherence to voice therapy in teachers. Retrospective survey in which the medical records of 179 dysphonic teachers (62, abandonment group and 114, discharge group) who underwent speech therapy at the Speech Therapy Clinic at the Hospital das Clínicas of the Universidade Federal de Minas Gerais (AV-HCUFMG) were analyzed. Female teachers with dysphonia referred by Gerência de Saúde e Perícia Médica (Department of Health and Medical Analysis) of Belo Horizonte City Hall were included. The variables of interest were: age, number of voice therapy sessions attended (attendance), number of sessions missed (absence), type of dysphonia, and Vocal Activity and Protocol Profile (VAPP) scores administered during the first therapy session as a component of voice assessment. The chi-square test was used to assess categorical variables. For continuous variables, the Mann-Whitney test, a nonparametric test for independent samples, was used. The groups differed with regard to the type of dysphonia as well as the several parameters of the VAPP: vocal self-perception, effects at work, effects on daily communication, effects on emotion, and the total VAPP score. Individuals with less favorable VRQOL scores were less adherent to voice therapy compared with subjects with more favorable VRQOL. Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Interventions for treating functional dysphonia in adults.

Science.gov (United States)

Ruotsalainen, J H; Sellman, J; Lehto, L; Jauhiainen, M; Verbeek, J H

2007-07-18

Poor voice quality due to functional dysphonia can lead to a reduced quality of life. In occupations where voice use is substantial it can lead to a loss of employment. To evaluate the effectiveness of interventions to treat functional dysphonia in adults. We searched MEDLINE (PubMed, 1950 to 2006), EMBASE (1974 to 2006), CENTRAL (The Cochrane Library, Issue 2 2006), CINAHL (1983 to 2006), PsychINFO (1967 to 2006), Science Citation Index (1986 to 2006) and the Occupational Health databases OSH-ROM (to 2006). The date of the last search was 5(th) April 2006. Randomised controlled trials (RCTs) of interventions evaluating the effectiveness of treatments targeted at adults with functional dysphonia. For work-directed interventions interrupted time series and prospective cohort studies were also eligible. Two authors independently extracted data and assessed trial quality. Meta-analysis was performed where appropriate. We identified six randomised controlled trials including a total of 163 participants in intervention groups and 141 controls. One trial was high quality. Interventions were grouped into 1) Direct voice therapy 2) Indirect voice therapy 3) Combination of direct and indirect voice therapy and 4) Other treatments: pharmacological treatment and vocal hygiene instructions given by phoniatrist. No studies were found evaluating direct voice therapy on its own. One study did not show indirect voice therapy on its own to be effective when compared to no intervention. There is evidence from three studies for the effectiveness of a combination of direct and indirect voice therapy on self-reported vocal functioning (SMD -1.07; 95% CI -1.94 to -0.19), on observer-rated vocal functioning (WMD -13.00; 95% CI -17.92 to -8.08) and on instrumental assessment of vocal functioning (WMD -1.20; 95% CI -2.37 to -0.03) when compared to no intervention. The results of one study also show that the remedial effect remains significant for at least 14 weeks on self-reported vocal

Adductor spasmodic dysphonia: Relationships between acoustic indices and perceptual judgments

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Cannito, Michael P.; Sapienza, Christine M.; Woodson, Gayle; Murry, Thomas

2003-04-01

This study investigated relationships between acoustical indices of spasmodic dysphonia and perceptual scaling judgments of voice attributes made by expert listeners. Audio-recordings of The Rainbow Passage were obtained from thirty one speakers with spasmodic dysphonia before and after a BOTOX injection of the vocal folds. Six temporal acoustic measures were obtained across 15 words excerpted from each reading sample, including both frequency of occurrence and percent time for (1) aperiodic phonation, (2) phonation breaks, and (3) fundamental frequency shifts. Visual analog scaling judgments were also obtained from six voice experts using an interactive computer interface to quantify four voice attributes (i.e., overall quality, roughness, brokenness, breathiness) in a carefully psychoacoustically controlled environment, using the same reading passages as stimuli. Number and percent aperiodicity and phonation breaks correlated significanly with perceived overall voice quality, roughness, and brokenness before and after the BOTOX injection. Breathiness was correlated with aperidocity only prior to injection, while roughness also correlated with frequency shifts following injection. Factor analysis reduced perceived attributes to two principal components: glottal squeezing and breathiness. The acoustic measures demonstrated a strong regression relationship with perceived glottal squeezing, but no regression relationship with breathiness was observed. Implications for an analysis of pathologic voices will be discussed.

Queixas vocais e grau de disfonia em professoras do ensino fundamental Vocal complaints and degree of dysphonia in elementary school teachers

Directory of Open Access Journals (Sweden)

Luciana Lemos de Azevedo

2009-01-01

Full Text Available OBJETIVO: Realizar o levantamento das queixas vocais e grau de disfonia encontradas em professoras de uma Escola Municipal da Cidade de Betim. MÉTODOS: Foi realizada coleta de dados de 13 professoras do ensino fundamental, com idade entre 20 a 50 anos (média de 36 anos e carga horária mínima de 20 horas semanais, por meio de questionário aplicado e gravação de voz, no programa de análise acústica GRAM 5.7. Os dados foram analisados e as vozes classificadas por três fonoaudiólogas com experiência clínica na área, mínima de cinco anos. RESULTADOS: Das professoras incluídas no estudo, 30,77% apresentaram qualidade vocal sem alteração, 23,08% apresentaram disfonia discreta, 46,15% disfonia moderada e nenhuma apresentou disfonia severa. Intervalos de confiança de 95% estimaram proporções mínimas de 6,6% de professoras com disfonia discreta e 22,39% com disfonia moderada na população de referência. Independentemente do tipo de queixa vocal, o número total de queixas entre as professoras com disfonia moderada foi significantemente maior do que entre professoras sem alterações de voz. Não houve, no entanto, diferenças entre os grupos na distribuição das queixas específicas, quando estas foram analisadas isoladamente. CONCLUSÃO: A maioria dos professores da amostra apresentou qualidade vocal alterada, sendo o grau moderado o mais frequente. Queixas específicas parecem se distribuir igualmente entre professoras com e sem alteração de voz. Os resultados apontam a importância de projetos de saúde vocal para esta população.PURPOSE: The aim of this study was to survey vocal complaints and degree of dysphonia among teachers from a public elementary school at Betim, MG (Brazil. METHODS: Thirteen elementary school teachers with ages between 20 and 50 years (mean of 36 years old, who taught at least 20 hours a week, participated in the study. Data were obtained using a questionnaire and voice recording, analyzed on the

An examination of variations in the cepstral spectral index of dysphonia across a single breath group in connected speech.

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Watts, Christopher R; Awan, Shaheen N

2015-01-01

The purpose of this study was to use spectral and cepstral analyses of speech to investigate whether underlying physiological changes in voice result in changes in acoustic estimates of dysphonia severity in continuous speech contexts within a single breath group. The effect of dysphonia on acoustic estimates of dysphonia severity, frequency, relative intensity, and vocalization time across initial and terminal segments of a single breath group using a common clinical stimulus was investigated. Prospective quasi-experimental controlled design. Digitized recordings of the Consensus Auditory-Perceptual Evaluation of Voice sentence "We were away a year ago" were obtained from 20 treatment-seeking dysphonic individuals (females, mean age = 39 years) and 20 normal controls (females, mean age = 39 years). Each recorded sample was separated into the first four syllables ("We were away … ") and second four syllables ("…a year ago.") of the breath group. Cepstral and spectral measures, intensity measures, and temporal analyses were obtained and used in calculations of the Cepstral Spectral Index of Dysphonia (CSID, an acoustic estimate of dysphonia severity), fundamental frequency (F0), vocalization time, and relative vocal intensity (dB SLP). Statistical analyses were applied to calculations of change (delta [Δ]) in these measures from one breath group segment to the next. Results revealed a significant effect of group on measures of CSID and F0, but not relative intensity or vocalization time. Dysphonic speakers exhibited a significant increase in the CSID from the first to second breath group segment and limited variation in F0 compared with controls. These results may support the hypothesis that voice impairment increases in severity toward the termination of a breath group even within a short temporal frame (i.e., 2 seconds or less of connected speech), and that this portion of the breath group may be an important determinant of perceptual impressions. Further

Epiglottic abscess causing acute airway obstruction in an adult

International Nuclear Information System (INIS)

Vasileiadis, I.; Kapetanakis, S.; Vasileiadis, D.; Petousis, A.

2013-01-01

Acute epiglottitis is an acute inflammation in the supraglottic region of the oropharynx which is a potentially life-threatening condition leading to rapid upper airway obstruction. An infrequent sequel of acute epiglottitis is the epiglottic abscess. Less than 50 cases have been reported in the international literature and even less are the cases that acute surgical intervention was necessary to secure the airway. We report a young man with sudden onset of odynophagia, dysphonia and dyspnea and rapidly progression of upper airway obstruction. Clinical examination with fiberoptic nasopharyngolaryngoscope in emergency department demonstrated an epiglottic abscess. An urgent tracheostomy was performed in order to secure patient's airway and afterward, the patient underwent direct laryngoscopy and drainage of abscess and intravenous antibiotics were administrated. The diagnosis of epiglottic abscess should be considered in adult patients with odynophagia and dysphonia. Principles of treatment include aggressive airway management, surgical drainage of abscess and intravenous antibiotics. (author)

Vocal aging and adductor spasmodic dysphonia: Response to botulinum toxin injection

Science.gov (United States)

Cannito, Michael P; Kahane, Joel C; Chorna, Lesya

2008-01-01

Aging of the larynx is characterized by involutional changes which alter its biomechanical and neural properties and create a biological environment that is different from younger counterparts. Illustrative anatomical examples are presented. This natural, non-disease process appears to set conditions which may influence the effectiveness of botulinum toxin injection and our expectations for its success. Adductor spasmodic dysphonia, a type of laryngeal dystonia, is typically treated using botulinum toxin injections of the vocal folds in order to suppress adductory muscle spasms which are disruptive to production of speech and voice. A few studies have suggested diminished response to treatment in older patients with adductor spasmodic dysphonia. This retrospective study provides a reanalysis of existing pre-to-post treatment data as function of age. Perceptual judgments of speech produced by 42 patients with ADSD were made by two panels of professional listeners with expertise in voice or fluency of speech. Results demonstrate a markedly reduced positive response to botulinum toxin treatment in the older patients. Perceptual findings are further elucidated by means of acoustic spectrography. Literature on vocal aging is reviewed to provide a specific set of biological mechanisms that best account for the observed interaction of botulinum toxin treatment with advancing age. PMID:18488884

Vocal aging and adductor spasmodic dysphonia: response to botulinum toxin injection.

Science.gov (United States)

Cannito, Michael P; Kahane, Joel C; Chorna, Lesya

2008-01-01

Aging of the larynx is characterized by involutional changes which alter its biomechanical and neural properties and create a biological environment that is different from younger counterparts. Illustrative anatomical examples are presented. This natural, non-disease process appears to set conditions which may influence the effectiveness of botulinum toxin injection and our expectations for its success. Adductor spasmodic dysphonia, a type of laryngeal dystonia, is typically treated using botulinum toxin injections of the vocal folds in order to suppress adductory muscle spasms which are disruptive to production of speech and voice. A few studies have suggested diminished response to treatment in older patients with adductor spasmodic dysphonia. This retrospective study provides a reanalysis of existing pre-to-post treatment data as function of age. Perceptual judgments of speech produced by 42 patients with ADSD were made by two panels of professional listeners with expertise in voice or fluency of speech. Results demonstrate a markedly reduced positive response to botulinum toxin treatment in the older patients. Perceptual findings are further elucidated by means of acoustic spectrography. Literature on vocal aging is reviewed to provide a specific set of biological mechanisms that best account for the observed interaction of botulinum toxin treatment with advancing age.

Nonlinear dynamic-based analysis of severe dysphonia in patients with vocal fold scar and sulcus vocalis

Science.gov (United States)

Choi, Seong Hee; Zhang, Yu; Jiang, Jack J.; Bless, Diane M.; Welham, Nathan V.

2011-01-01

Objective The primary goal of this study was to evaluate a nonlinear dynamic approach to the acoustic analysis of dysphonia associated with vocal fold scar and sulcus vocalis. Study Design Case-control study. Methods Acoustic voice samples from scar/sulcus patients and age/sex-matched controls were analyzed using correlation dimension (D2) and phase plots, time-domain based perturbation indices (jitter, shimmer, signal-to-noise ratio [SNR]), and an auditory-perceptual rating scheme. Signal typing was performed to identify samples with bifurcations and aperiodicity. Results Type 2 and 3 acoustic signals were highly represented in the scar/sulcus patient group. When data were analyzed irrespective of signal type, all perceptual and acoustic indices successfully distinguished scar/sulcus patients from controls. Removal of type 2 and 3 signals eliminated the previously identified differences between experimental groups for all acoustic indices except D2. The strongest perceptual-acoustic correlation in our dataset was observed for SNR; the weakest correlation was observed for D2. Conclusions These findings suggest that D2 is inferior to time-domain based perturbation measures for the analysis of dysphonia associated with scar/sulcus; however, time-domain based algorithms are inherently susceptible to inflation under highly aperiodic (i.e., type 2 and 3) signal conditions. Auditory-perceptual analysis, unhindered by signal aperiodicity, is therefore a robust strategy for distinguishing scar/sulcus patient voices from normal voices. Future acoustic analysis research in this area should consider alternative (e.g., frequency- and quefrency-domain based) measures alongside additional nonlinear approaches. PMID:22516315

Assessment of dysphonia due to benign vocal fold lesions by acoustic and aerodynamic indices: a multivariate analysis.

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Cantarella, Giovanna; Baracca, Giovanna; Pignataro, Lorenzo; Forti, Stella

2011-04-01

The goal was to identify acoustic and aerodynamic indices that allow the discrimination of a benign organic dysphonic voice from a normal voice. Fifty-three patients affected by dysphonia caused by vocal folds benign lesions, and a control group were subjected to maximum phonation time (MPT) measurements, GRB perceptual evaluations and acoustic/aerodynamic tests. All analyzed variables except the airflow variation coefficient were significantly different between the two groups. The unique significant factors in the discrimination between healthy and dysphonic subjects were the aerodynamic indices of MPT and Glottal efficiency index, and the acoustic index Shimmer. These results show that a combination of three parameters can discriminate a voice deviance and highlight the importance of a multidimensional assessment for objective voice evaluation.

A comparison of the VHI, VHI-10, and V-RQOL for measuring the effect of botox therapy in adductor spasmodic dysphonia.

Science.gov (United States)

Morzaria, Sanjay; Damrose, Edward J

2012-05-01

Although disease-specific quality-of-life (QOL) instruments are an invaluable outcome measure in spasmodic dysphonia, there is no consensus on which QOL instrument should be used. To determine the responsiveness of the Voice Handicap Index (VHI), Voice Handicap Index-10 (VHI-10), and Voice-Related Quality of Life (V-RQOL) to the treatment effect of botulinum toxin (Botox) in adductor spasmodic dysphonia (ADSD). Stanford University Voice and Swallowing Center. Prospective case series (level of evidence=4). Consecutive ADSD patients with a stable Botox dose-response relationship were recruited prospectively. VHI, VHI-10, and V-RQOL scores were obtained pretreatment and during the middle third of the posttreatment injection cycle. Thrity-seven patients completed the follow-up. The average total Botox dose was 0.88 units. The average follow-up time after injection was 7.84 weeks. The pretreatment QOL scores reflected the burden of the disease. All the three instruments were highly correlated in subscale and total scores. After treatment, all three instruments showed significant improvement. The VHI, VHI-10, and V-RQOL all reflected the morbidity associated with ADSD and were significantly responsive to the effect of Botox therapy. The choice of instrument should be based on physician preference. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Articulatory Changes in Muscle Tension Dysphonia: Evidence of Vowel Space Expansion Following Manual Circumlaryngeal Therapy

Science.gov (United States)

Roy, Nelson; Nissen, Shawn L.; Dromey, Christopher; Sapir, Shimon

2009-01-01

In a preliminary study, we documented significant changes in formant transitions associated with successful manual circumlaryngeal treatment (MCT) of muscle tension dysphonia (MTD), suggesting improvement in speech articulation. The present study explores further the effects of MTD on vowel articulation by means of additional vowel acoustic…

Laryngeal Chondrosarcoma: A rare cause of critical upper airway obstruction.

LENUS (Irish Health Repository)

Tuite, K

2018-01-01

Laryngeal cancers are rare, encompassing around one percent of all cancers. Suspicion should be raised if a patient presents with classical signs and symptoms; i.e. dysphonia, inspiratory stridor, dysphagia, odynophagia, neck mass, or persistent cough. Laryngeal chondrosarcoma is a rare form of laryngeal cancer, the diagnosis of which can be difficult. The case in question describes an unusual presentation of one such case, and its subsequent investigation, management and outcome.

Intensified Voice Therapy: A New Model for the Rehabilitation of Patients Suffering from Functional Dysphonias

Science.gov (United States)

Fischer, Michael J.; Gutenbrunner, Christoph; Ptok, Martin

2009-01-01

The objective of this study was to evaluate a new intervention for chronic dysphonias, consisting of a 2-week outpatient treatment period using intensified voice therapy combined with elements of physical medicine, including physiotherapy (orthotherapy, detonisation and training of the trunk muscles, respiratory therapy and others), manual therapy…

Voice Onset Time for the Word-Initial Voiceless Consonant /t/ in Japanese Spasmodic Dysphonia-A Comparison With Normal Controls.

Science.gov (United States)

Yanagida, Saori; Nishizawa, Noriko; Mizoguchi, Kenji; Hatakeyama, Hiromitsu; Fukuda, Satoshi

2015-07-01

Voice onset time (VOT) for word-initial voiceless consonants in adductor spasmodic dysphonia (ADSD) and abductor spasmodic dysphonia (ABSD) patients were measured to determine (1) which acoustic measures differed from the controls and (2) whether acoustic measures were related to the pause or silence between the test word and the preceding word. Forty-eight patients with ADSD and nine patients with ABSD, as well as 20 matched normal controls read a story in which the word "taiyo" (the sun) was repeated three times, each differentiated by the position of the word in the sentence. The target of measurement was the VOT for the word-initial voiceless consonant /t/. When the target syllable appeared in a sentence following a comma, or at the beginning of a sentence following a period, the ABSD patients' VOTs were significantly longer than those of the ADSD patients and controls. Abnormal prolongation of the VOTs was related to the pause or silence between the test word and the preceding word. VOTs in spasmodic dysphonia (SD) may vary according to the SD subtype or speaking conditions. VOT measurement was suggested to be a useful method for quantifying voice symptoms in SD. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Spontaneous retropharynegeal hematoma: A case report and literature overview

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Ryu, Ji Hwa [Dept. of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of)

2014-02-15

A spontaneous retropharyngeal hematoma is a rare condition with a difficult diagnostic. This disease may rapidly progress to an airway obstruction. The author reports about a case of a 56-year-old man with an acute onset of sore throat, dysphonia and dyspnea. A retropharyngeal high attenuated soft tissue density could be seen on the neck CT. A rapid improvement of the retropharyngeal abnormality was seen on the 3 days follow-up MR imaging. Signal changes caused by blood products which were visible on the MRI images suggested the diagnosis of retropharyngeal hematoma. The patient was conservatively managed.

Spontaneous retropharynegeal hematoma: A case report and literature overview

International Nuclear Information System (INIS)

Ryu, Ji Hwa

2014-01-01

A spontaneous retropharyngeal hematoma is a rare condition with a difficult diagnostic. This disease may rapidly progress to an airway obstruction. The author reports about a case of a 56-year-old man with an acute onset of sore throat, dysphonia and dyspnea. A retropharyngeal high attenuated soft tissue density could be seen on the neck CT. A rapid improvement of the retropharyngeal abnormality was seen on the 3 days follow-up MR imaging. Signal changes caused by blood products which were visible on the MRI images suggested the diagnosis of retropharyngeal hematoma. The patient was conservatively managed.

Auditory-Perceptual Evaluation of Dysphonia: A Comparison Between Narrow and Broad Terminology Systems

DEFF Research Database (Denmark)

Iwarsson, Jenny

2017-01-01

of the terminology used in the multiparameter Danish Dysphonia Assessment (DDA) approach into the five-parameter GRBAS system. Methods. Voice samples illustrating type and grade of the voice qualities included in DDA were rated by five speech language pathologists using the GRBAS system with the aim of estimating...... terms and antagonists, reflecting muscular hypo- and hyperfunction. Key Words: Auditory-perceptual voice analysis–Dysphonia–GRBAS–Listening test–Voice ratings....

Prevalence of Perceived Dysphonia and Its Correlation With the Prevalence of Clinically Diagnosed Laryngeal Disorders: The Korea National Health and Nutrition Examination Surveys 2010-2012.

Science.gov (United States)

Byeon, Haewon

2015-10-01

This study investigated the prevalence of perceived dysphonia and its correlation with the prevalence of clinically diagnosed laryngeal disorders. Subjects were 8713 non-institutionalized civilian adults over the age of 19 (3810 men and 4912 women) who completed the laryngeal examination of the fifth Korea National Health and Nutrition Examination Survey. A Poisson regression was used to examine the association between perceived dysphonia and laryngeal disorders. Adjusting for covariates (age, sex, education level, income, occupation, alcohol drinking, and self-reported health status), those with perceived voice problems were 4.8 times (OR=4.75, 95% CI, 3.77-5.99) more likely to have laryngeal disorders than those without voice problems. In particular, the vocal fold pathology correlated with perceived dysphonia was: vocal fold nodules (OR=5.32, 95% CI, 3.43-8.26), vocal polyps (OR=3.73, 95% CI, 1.57-8.86), vocal cysts (OR=11.97, 95% CI, 1.97-72.72), Reinke's edema (OR=9.27, 95% CI, 4.77-18.00), laryngeal paralysis (OR=3.58, 95% CI, 1.56-8.26), laryngeal granulomas (OR=4.31, 95% CI, 1.01-18.80), epiglottic cyst (OR=2.94, 95% CI, 1.21-7.13), and laryngitis (OR=4.07, 95% CI, 2.91-5.69). People with self-perceived dysphonia had a high risk of laryngeal disorders. © The Author(s) 2015.

Spasmodic dysphonia follow-up with videolaryngoscopy and voice spectrography during treatment with botulinum toxin.

Science.gov (United States)

Esposito, Marcello; Dubbioso, R; Apisa, P; Allocca, R; Santoro, L; Cesari, U

2015-09-01

Spasmodic dysphonia (SD) is a focal dystonia of laryngeal muscles seriously impairing quality of voice. Adductor SD (ADSD) is the most common presentation of this disorder that can be identified by specialized phoniatricians and neurologists firstly on a clinical evaluation and then confirmed by videolaryngoscopy (VL). Botulinum toxin (BTX) injection with electromyographic guidance in muscles around vocal cords is the most effective treatment. Voice Handicap Index (VHI) questionnaire is the main tool to assess dysphonia and response to treatment. Objective of this study is to perform VL and voice spectrography (VS) to confirm the efficacy of BTX injections over time. 13 patients with ADSD were studied with VHI, VL and VS before and after 4 consecutive treatment with onobotulinumtoxin-A. For each treatment vocal improvement was proved by a significant reduction of VHI score and increase of maximum time phonation and harmonic-to-noise ratio while VL showed the absence of spasm in most of patients. No change of the response to BTX was found between injections. This study supports the efficacy of the treatment of SD with BTX with objective measurements and suggests that the efficacy of recurring treatments is stable over time.

Treatment of spasmodic dysphonia with a neuromodulating electrical implant.

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Pitman, Michael J

2014-11-01

To investigate the feasibility of an implantable electrical stimulation device to treat spasmodic dysphonia (SD) by neuromodulation of the muscle spindle gamma loop. Prospective case series. Five subjects underwent daily stimulation of the left thyroarytenoid muscle (TA) below the level of α-motor neuron activation (AMNA) for 5 consecutive days. Professional and patient voice evaluations were performed. Transcartilagenous placement of an implantable stimulation device lead was investigated in anesthetized porcine and cadaveric human models. Three of 5 subjects improved in all categories of evaluation. One subject improved in three of four categories. These four subjects described significant carryover of effect after treatment. The fifth subject evidenced improvement until contracting an upper respiratory infection on day 3. Transcartilagenous electrode placement into the porcine TA with muscle stimulation was successful. The electrode lead was passed from the cadaveric larynx to the mastoid tip in the subplatysma layer with an absence of tension. The symptoms of SD improve after electrical stimulation of the TA at levels below AMNA. This is likely through neuromodulation of the muscle spindle gamma loop. Implantation of an electrode into the TA with a postauricular implanted stimulator is feasible with modifications of an already existing device. With further investigation, such a device has the potential to deliver an alternative treatment for SD. 4. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Mixed Pyolaryngocele: A Rare Case of Deep Neck Infection

Directory of Open Access Journals (Sweden)

Rachid Mahdoufi

2017-07-01

Full Text Available Introduction: Pyolaryngocele is a very rare and serious complication of laryngocele. It can present as deep neck space infection and mislead the diagnosis. Our aim is to bring this unusual entity to the attention of surgeons and describe its clinical features. Case Report: We report a case of a 45-year-old male patient with a five-week history of neck swelling, dysphonia, dyspnea and odynophagia. An urgent CT scan showed a mixed pyolaryngocele. The management consisted of a high dose antibiotic and an excision of the residual laryngocele via an external approach. Conclusion: A pyolaryngocele is an unusual complication of laryngocele, which becomes secondarily infected, causing many symptoms. Removing the laryngocele is still the best treatment option to prevent this complication and recurrence.

Hypertrophic anterior cervical osteophytes causing dysphagia and airway obstruction.

Science.gov (United States)

Lin, Harrison W; Quesnel, Alicia M; Holman, Allison S; Curry, William T; Rho, Michael B

2009-10-01

Hyperostosis of anterior cervical vertebral osteophytes can produce otolaryngological symptoms ranging from mild dysphagia, dysphonia, and foreign body sensation to severe food impaction and stridulous dyspnea. Airway compromise necessitating a tracheostomy is very rare. We discuss the case of an elderly man who presented with progressive dysphagia and a large hypopharyngeal mass as his initial manifestations of hypertrophic anterior cervical osteophytes. After a biopsy of the mass, the patient went into airway distress due to bilateral vocal fold fixation by the enlarging mass and consequently required a surgical airway. A combined team approach to the removal of the osteophytes successfully resolved his symptoms. The clinical, diagnostic, radiologic, and therapeutic principles involved in this case are presented and discussed. The recognition of hypertrophic osteophytes as a potential cause of common otolaryngological symptoms in the elderly population is paramount, as these symptoms can rapidly progress and lead to life-threatening airway obstruction. Medical and surgical interventions can be employed for the treatment of hypertrophic anterior cervical osteophytes, and they often result in favorable outcomes.

Unilateral versus bilateral thyroarytenoid Botulinum toxin injections in adductor spasmodic dysphonia: a prospective study

Science.gov (United States)

Upile, Tahwinder; Elmiyeh, Behrad; Jerjes, Waseem; Prasad, Vyas; Kafas, Panagiotis; Abiola, Jesuloba; Youl, Bryan; Epstein, Ruth; Hopper, Colin; Sudhoff, Holger; Rubin, John

2009-01-01

Objectives In this preliminary prospective study, we compared unilateral and bilateral thyroarytenoid muscle injections of Botulinum toxin (Dysport) in 31 patients with adductor spasmodic dysphonia, who had undergone more than 5 consecutive Dysport injections (either unilateral or bilateral) and had completed 5 concomitant self-rated efficacy and complication scores questionnaires related to the previous injections. We also developed a Neurophysiological Scoring (NPS) system which has utility in the treatment administration. Method and materials Data were gathered prospectively on voice improvement (self-rated 6 point scale), length of response and duration of complications (breathiness, cough, dysphagia and total voice loss). Injections were performed under electromyography (EMG) guidance. NPS scale was used to describe the EMG response. Dose and unilateral/bilateral injections were determined by clinical judgment based on previous response. Time intervals between injections were patient driven. Results Low dose unilateral Dysport injection was associated with no significant difference in the patient's outcome in terms of duration of action, voice score (VS) and complication rate when compared to bilateral injections. Unilateral injections were not associated with any post treatment total voice loss unlike the bilateral injections. Conclusion Unilateral low dose Dysport injections are recommended in the treatment of adductor spasmodic dysphonia. PMID:19852852

Unilateral versus bilateral thyroarytenoid Botulinum toxin injections in adductor spasmodic dysphonia: a prospective study

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Abiola Jesuloba

2009-10-01

Full Text Available Abstract Objectives In this preliminary prospective study, we compared unilateral and bilateral thyroarytenoid muscle injections of Botulinum toxin (Dysport in 31 patients with adductor spasmodic dysphonia, who had undergone more than 5 consecutive Dysport injections (either unilateral or bilateral and had completed 5 concomitant self-rated efficacy and complication scores questionnaires related to the previous injections. We also developed a Neurophysiological Scoring (NPS system which has utility in the treatment administration. Method and materials Data were gathered prospectively on voice improvement (self-rated 6 point scale, length of response and duration of complications (breathiness, cough, dysphagia and total voice loss. Injections were performed under electromyography (EMG guidance. NPS scale was used to describe the EMG response. Dose and unilateral/bilateral injections were determined by clinical judgment based on previous response. Time intervals between injections were patient driven. Results Low dose unilateral Dysport injection was associated with no significant difference in the patient's outcome in terms of duration of action, voice score (VS and complication rate when compared to bilateral injections. Unilateral injections were not associated with any post treatment total voice loss unlike the bilateral injections. Conclusion Unilateral low dose Dysport injections are recommended in the treatment of adductor spasmodic dysphonia.

Differentiating between adductor and abductor spasmodic dysphonia using airflow interruption

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Hoffman, Matthew R.; Jiang, Jack J.; Rieves, Adam L.; McElveen, Kelsey A.B.; Ford, Charles N.

2009-01-01

Objective To measure the laryngeal resistance (RL), subglottal pressure (Ps), and mean flow rate (MFR) of adductor (ADSD) and abductor (ABSD) spasmodic dysphonia patients using the airflow interrupter. Methods The RL of six ABSD and seven ADSD patients was measured using the airflow interrupter, a noninvasive device designed to measure MFR and Ps via mechanical balloon valve interruption. Subjects performed ten trials at each of two intensity levels, with each trial consisting of a sustained /a/ during which phonation was interrupted for 500 ms. Laryngeal resistance was calculated as subglottal pressure divided by airflow. Results Mean RL for the ADSD and ABSD subtypes at 65 dB were 24.78 cmH2O/l/s and 14.51 cmH2O/l/s, respectively (p = 0.04). Mean RL at 70 dB were 40.02 cmH2O/l/s and 15.84 cmH2O/l/s (p = 0.014). Ps for the ADSD and ABSD subtypes at 65 dB were 10.23 cmH2O and 8.32 cmH2O, respectively (p = 0.582). At the 70 dB level, Ps were 12.39 cmH2O and 11.78 cmH2O (p = 0.886). MFR for the ADSD and ABSD subtypes at 65 dB were 435 ml/s and 746 ml/s (p = 0.205). Mean MFR at 70 dB were 518 ml/s and 848 ml/s (p = 0.198). Conclusion Noninvasive measurements of RL may be useful for differentiating between ADSD and ABSD. This simple objective test which produces a quantitative output could be used to evaluate laryngeal function in patients with spasmodic dysphonia. PMID:19554636

Non-functioning parathyroid cystic tumour: malignant or not? Report of a case.

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Cocorullo, G; Scerrino, G; Melfa, G; Raspanti, C; Rotolo, G; Mannino, V; Richiusa, P; Cabibi, D; Giannone, A G; Porrello, C; Gulotta, G

2017-01-01

Parathyroid carcinoma (PC) is a very rare endocrine tumour, usually characterized by symptoms such as a neck mass, dysphonia, severe hypercalcemia exceeding 140 mg/L and elevated serum parathyroid hormone levels, even more than 5 times the upper limit of normal. Non-functioning parathyroid cancer is extremely rare and, in this case, its pre-operative diagnosis is often difficult. A 54-year old female patient, referring dysphagia and dysphonia, underwent neck ultrasound and neck CT. A left thyroid nodule, probably cystic, was found. It presented caudal extent on anterior mediastinum causing compression of the left lateral wall of the trachea. The preoperative calcemia was into the normal range. The patient underwent left thyroid lobectomy. Histological exam showed a cystic lesion, immunohistochemically originating from parathyroid that oriented for carcinoma. The 18 months follow-up did not show a residual-recurrent disease. The parathyroid origin of a neck lesion could not be suspected before surgery when specific laboratory tests are not available and clinical effects of hyperparathyroidism syndrome are not present. Histological features are not always sufficient for the differential diagnosis between the parathyroid adenoma and carcinoma. The immunohistochemistry is an useful tool that can aid to reach the definite diagnosis.

Mutations in THAP1 (DYT6) and generalised dystonia with prominent spasmodic dysphonia: a genetic screening study

DEFF Research Database (Denmark)

Djarmati, Ana; Schneider, Susanne A; Lohmann, Katja

2009-01-01

-onset generalised dystonia with spasmodic dysphonia. This combination of symptoms might be a characteristic feature of DYT6 dystonia and could be useful in the differential diagnosis of DYT1, DYT4, DYT12, and DYT17 dystonia. In addition to the identified mutations, a rare non-coding substitution in THAP1 might...

Laryngeal myofascial pain syndrome as a new diagnostic entity of dysphonia.

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Jung, Soo Yeon; Park, Hae Sang; Bae, Hasuk; Yoo, Jeong Hyun; Park, Hyung Jun; Park, Kee Duk; Kim, Han Su; Chung, Sung Min

2017-04-01

To consider the feasibility of diagnosing intrinsic laryngeal muscle myofascial pain syndrome (MPS) in dysphonic patients who demonstrated immediate symptom and stroboscopic finding improvement after laryngeal electromyography (LEMG) without further treatment. A chart review of patients who showed subtle vocal fold movement abnormalities on a stroboscopic examination and underwent ultrasonography (US)-guided LEMG was performed. Patients with vocal fold paralysis, mucosal lesions, spasmodic dysphonia, and vocal tremor on stroboscopic examination were excluded. Among them, patients with normal EMG findings were included in this study. The patients who reported voice symptom improvement after LEMG without further treatment were placed in laryngeal MPS (LMPS) group and the other patients were placed in non-laryngeal MPS (non-MPS) group. Predisposing factors, voice symptom, symptom-duration, and stroboscopic findings of these patients were reviewed. Among the 16 patients, LEMG findings were normal, five (31%) were included in the LMPS group and the other 11 patients (69%) were included in the non-MPS group. All LMPS group patients had a history of voice abuse and reported odynophonia. The Korean Voice Handicap Index-10 score decreased significantly after US-guided LEMG without additional treatment in the LMPS group. The stroboscopic findings revealed that vocal fold hypomobility was the most common finding in the LMPS group, and two patients showed a muscle tension dysphonia pattern. The LMPS groups showed improvement of vocal fold mobility on 1-week stroboscopic evaluation. LMPS is a potential diagnosis for patients with vocal fold hypomobility finding on stroboscopic findings but with normal EMG results. Diagnosis of LMPS could be considered in patients who showed symptom and vocal fold movement improvement after LEMG. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The Effects of Amplification on Vocal Dose in Teachers with Dysphonia.

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Assad, Joana Perpetuo; Gama, Ana Cristina Côrtes; Santos, Juliana Nunes; de Castro Magalhães, Max

2017-11-06

The purpose of this study was to determine if voice amplification influenced vocal dose in female teachers with dysphonia. This was an experimental study with comparative intrasubjects in which 15 individuals were compared in two different moments: condition 1 (C1) without voice amplification and condition 2 (C2) with voice amplification. All of them were female, kindergarten and elementary school teachers who presented organic or functional dysphonia. The search was carried out at the school where the teachers work. The professional voice use was considered the teachers' activity for a continuous period of two classes (average recording time of 96 minutes, with no difference in time between C1 and C2). To measure the dose we used the vocal dosimeter composed of a microphone, an accelerometer fixed to the neck, and a portable unit that stores the vocal data. The phonation data (intensity, fundamental frequency, phonation percentage, cycle dose, and distance dose) were analyzed by the equipment software (VoxLog). The use of vocal amplification in teachers promotes a reduction of the fundamental frequency (295.6-267.7 Hz), the voice intensity (96.2-93.3 dB sound pressure level), the cycle doses (489.4-345.2 thousand cycles per second), and distance doses (3,800-2,300 m). The vocal amplification allows the teacher to maintain the same phonation time (phonation percentage) but decreases the number of vocal fold oscillations (cycle dose) and the total distance traveled by the vocal fold tissue during phonation (distance dose), reducing the exposure of the vocal folds to voice trauma. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Liquid-type Botulinum Toxin Type A in Adductor Spasmodic Dysphonia: A Prospective Pilot Study.

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Cha, Wonjae; Jang, Jeon Yeob; Wang, Soo-Geun; Kang, Ji-Heon; Jo, Min-Gyu

2017-05-01

Botulinum toxin (BTX) has been widely used to treat adductor spasmodic dysphonia (ADSD). Most commercially available forms of BTX require reconstitution before use, which may increase the risk of contamination and requires careful titration. Recently, a liquid-type BTX type A (BTX-A) has been developed, which should simplify the procedure and enhance its efficacy. Herein, we present a prospective pilot study to investigate the efficacy and safety of liquid-type BTX-A in the treatment of ADSD. Twenty-six consecutive liquid-type BTX-A injections were performed in 12 patients with ADSD. We included as a control group 34 consecutive patients with ADSD who had previously undergone 52 vocal fold injection procedures with freeze-dried-type BTX-A. All patients in both groups had improvement of symptoms related to ADSD and period of normal voice. Most patients experienced breathiness, and the onset time, the peak response time, and the duration of breathiness were similar in both groups. The duration of effect (days) was 96.96 ± 18.91 and 77.38 ± 18.97 in the freeze-dried-type and the liquid-type groups, and the duration of benefit (days) was 80.02 ± 18.24 and 62.69 ± 19.73 in the freeze-dried-type and the liquid-type groups. To compare the efficacy between the freeze-dried-type and the liquid-type BTX-A, the sessions of the unilateral vocal fold injection were included and were categorized as group A (1 ~ 2 units BTX-A) and group B (2 ~ 3 units BTX-A), according to the dose per vocal fold. There was no significant difference of effect time between freeze-dried-type and liquid-type BTX-A groups. No adverse events related to BTX or vocal fold injection were reported. Liquid-type BTX-A is safe and effective for the treatment of spasmodic dysphonia. With the advantages of simple preparation, storage, and reuse and animal protein-free constituents, liquid-type BTX-A may be a good option in the treatment of spasmodic dysphonia. Copyright © 2017 The

Vocal outcome after endoscopic thyroarytenoid myoneurectomy in patients with adductor spasmodic dysphonia.

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Gandhi, Sachin; Remacle, Marc; Mishra, Prasun; Desai, Vrushali

2014-12-01

Spasmodic dysphonia (SD) remains one of the most difficult of laryngeal pathologies to treat. With limited role for speech therapy, various surgical modalities have been tried with various success rates. The objective of the study is to report the results of vocal outcome after thyroarytenoid myoneurectomy in patients of adductor spasmodic dysphonia (ASD). 15 patients of ASD were selected. GRBAS, and voice handicap index (VHI) were used for perceptual evaluation of voice. Thyroarytenoid myoneurectomy was performed by vaporizing the muscular layer of the vocal fold with CO2 laser, at an intensity of 6 W with 1.2 mm diameter in scanner mode. Voice analysis was repeated at 12, 24 and 48 months follow-up. Preoperative GRBAS scores and VHI score of all the patients were poor. At 12 months 12/15 (80 %) patients having strain score of 0. There was marked improvement in VHI scores at 6 months. 10/15 (67 %) patients have been followed up for 24 months. 5/10 (50 %) patients have strain (S) value of 0. VHI scoring of 5/10 (50 %) patients was <30. Two of the four patients completed 48 months follow-up had a strain (S) value of 0, one patient has strain value of 1 and one patient had strain value of 2. 2/4 patients had VHI score of <30; one patient had that of 40. Trans-oral CO2 laser thyroarytenoid myoneurectomy shows significant long-term improvement in voice quality in terms of reduced speech brakes, effort and strain in voice.

A microsurgical anterior cervical approach and the immediate impact of mechanical retractors: A case control study

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Rodrigo Ramos-Zúñiga

2015-01-01

Full Text Available Introduction: A microsurgical anterior cervical approach with discectomy and fusion (MACDF is one of the most widely used procedures for treating radicular disorders. This approach is highly successful; however, it is not free from complications. These can be associated with soft tissue injuries. Aim of the Study: The recognition of the risks for these complications should be identified for timely prevention and safe treatment. Materials and Methods: Study Design: Retrospective case control study. This study includes a retrospective case series of 37 patients, paying special attention to immediate complications related to the use of mechanical retraction of soft tissue (dysphagia, dysphonia, esophageal lesions and local hematoma; and a comparative analysis of the outcomes after changes in the retraction method. Results: All selected cases had a positive neurological symptom response in relation to neuropathic pain. Dysphagia and dysphonia were found during the first 72 h in 94.1% of the cases in which automatic mechanical retraction was used for more than one hour during the surgical procedure. A radical change was noted in the reduction of the symptoms after the use of only manual protective blades without automatic mechanical retraction: 5.1% dysphagia and 0% dysphonia in the immediate post-operative period, P = 0.001. Conclusions: Soft tissue damage due to the use of automatic retractors in MACDF is not minor and leads to general discomfort in the patient in spite of good neurological results. These problems most often occur when automatic retractors are used continuously for more than 1 hour, as well as when they are used in multiple levels. Dysphagia, dysphonia and local pain decreased with the use of transient manual blades for retraction, and with intermittent release following minimally invasive principles.

Quantifying Dysphonia Severity Using a Spectralcepstral-Based Acoustic Index: Comparisons with Auditory-Perceptual Judgements from the CAPE-V

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Awan, Shaheen N.; Roy, Nelson; JettE, Marie E.; Meltzner, Geoffrey S.; Hillman, Robert E.

2010-01-01

This study investigated the relationship between acoustic spectral/cepstral measures and listener severity ratings in normal and disordered voice samples. CAPE-V sentence samples and the vowel /[script]/were elicited from eight normal speakers and 24 patients with varying degrees of dysphonia severity. Samples were analysed for measures of the…

The Mayo Clinic Arizona Spasmodic Dysphonia Experience: A Demographic Analysis of 718 Patients.

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Patel, Alpen B; Bansberg, Stephen F; Adler, Charles H; Lott, David G; Crujido, Lisa

2015-11-01

Analyze demographic data collected over a 25-year experience of 718 patients with spasmodic dysphonia (SD) who have been treated with botulinum toxin-A (BoNT-A) and compare our data with previously published studies. Seven hundred eighteen patients with SD were treated with 6621 BoNT-A injections at Mayo Clinic Arizona between 1989 and 2014. All patients were treated by the same physician team. Background demographic data for each patient were recorded. Of 718 patients, 557 patients were female (77.6%). Six hundred sixty of 718 (91.8%) patients had adductor SD (AdSD), and 58 of 718 (8.1%) patients had abductor SD (AbSD). Average age of onset was 51 years. Of 718 patients, 378 (52.6%) had vocal tremor (VT); VT was present in 54.4% of AdSD patients and 32.1% of AbSD patients. Thirty-seven of 718 (5.2%) patients had other dystonias, including cervical dystonia (2.3%), blepharospasm (1.4%), limb dystonia (1.1%), and oromandibular dystonia (0.3%). A positive family history of SD was present in only 6 of 718 patients (0.8%) and of other dystonias in 11 of 718 patients (1.5%). Spasmodic dysphonia is a chronic and potentially disabling focal laryngeal dystonia. The Mayo Clinic Arizona SD experience compares to prior reports and reveals a female preponderance, onset in middle age, infrequent hereditary pattern, high co-occurrence of VT, and low co-occurrence of other dystonias. © The Author(s) 2015.

Vocal Function Exercises for Muscle Tension Dysphonia: Auditory-Perceptual Evaluation and Self-Assessment Rating.

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Jafari, Narges; Salehi, Abolfazl; Izadi, Farzad; Talebian Moghadam, Saeed; Ebadi, Abbas; Dabirmoghadam, Payman; Faham, Maryam; Shahbazi, Mehdi

2017-07-01

Muscle tension dysphonia (MTD) is a functional dysphonia, which appears with an excessive tension in the intrinsic and extrinsic laryngeal musculatures. MTD can affect voice quality and quality of life. The purpose of the present study was to assess the effectiveness of vocal function exercises (VFEs) on perceptual and self-assessment ratings in a group of 15 subjects with MTD. The study comprised 15 subjects with MTD (8 men and 7 women, mean age 39.8 years, standard deviation 10.6, age range 24-62 years). All participants were native Persian speakers who underwent a 6-week course of VFEs. The Voice Handicap Index (VHI) (the self-assessment scale) and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scale (perceptual rating of voice quality) were used to compare pre- and post-VFEs. GRBAS data of patients before and after VFEs were compared using Wilcoxon signed-rank test, and VHI data of patients pre- and post-VFEs were compared using Student paired t test. These perceptual parameters showed a statistically significant improvement in subjects with MTD after voice therapy (significant at P self-assessment ratings measurements (with the VHI). As a result, the data provide evidence regarding the efficacy of VFEs in the treatment of patients with MTD. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

[Comparison of cepstral coefficients to other voice evaluation parameters in patients with occupational dysphonia].

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Niebudek-Bogusz, Ewa; Strumiłło, Paweł; Wiktorowicz, Justyna; Sliwińska-Kowalska, Mariola

2013-01-01

BACKGROUND Special consideration has recently been given to cepstral analysis with mel-frequency cepstral coefficients (MFCCs). The aim of this study was to assess the applicability of MFCCs in acoustic analysis for diagnosing occupational dysphonia in comparison to subjective and objective parameters of voice evaluation. The study comprised 2 groups, one of 55 female teachers (mean age: 45 years) with occupational dysphonia confirmed by videostroboscopy and 40 female controls with normal voice (mean age: 43 years). The acoustic samples involving sustained vowels "a" and four standardized sentences were analyzed by computed analysis of MFCCs. The results were compared to acoustic parameters of jitter and shimmer groups, noise to harmonic ratio, Yanagihara index evaluating the grade of hoarseness, the aerodynamic parameter: maximum phonation time and also subjective parameters: GRBAS perceptual scale and Voice Handicap Index (VHI). The compared results revealed differences between the study and control groups, significant for MFCC2, MFCC3, MFCC5, MFCC6, MFCC8, MFCC10, particularly for MFCC6 (p teachers correlated with all eight objective parameters, also showed the significant relation with perceptual voice feature A (asthenity) of subjective scale GRBAS, characteristic of weak tired voice. The cepstral analysis with mel frequency cepstral coefficients is a promising tool for evaluating occupational voice disorders, capable of reflecting the perceptual voice features better than other methods of acoustic analysis.

Back-and-Forth Methodology for Objective Voice Quality Assessment: From/to Expert Knowledge to/from Automatic Classification of Dysphonia

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Fredouille, Corinne; Pouchoulin, Gilles; Ghio, Alain; Revis, Joana; Bonastre, Jean-François; Giovanni, Antoine

2009-12-01

This paper addresses voice disorder assessment. It proposes an original back-and-forth methodology involving an automatic classification system as well as knowledge of the human experts (machine learning experts, phoneticians, and pathologists). The goal of this methodology is to bring a better understanding of acoustic phenomena related to dysphonia. The automatic system was validated on a dysphonic corpus (80 female voices), rated according to the GRBAS perceptual scale by an expert jury. Firstly, focused on the frequency domain, the classification system showed the interest of 0-3000 Hz frequency band for the classification task based on the GRBAS scale. Later, an automatic phonemic analysis underlined the significance of consonants and more surprisingly of unvoiced consonants for the same classification task. Submitted to the human experts, these observations led to a manual analysis of unvoiced plosives, which highlighted a lengthening of VOT according to the dysphonia severity validated by a preliminary statistical analysis.

Back-and-Forth Methodology for Objective Voice Quality Assessment: From/to Expert Knowledge to/from Automatic Classification of Dysphonia

Directory of Open Access Journals (Sweden)

Corinne Fredouille

2009-01-01

Full Text Available This paper addresses voice disorder assessment. It proposes an original back-and-forth methodology involving an automatic classification system as well as knowledge of the human experts (machine learning experts, phoneticians, and pathologists. The goal of this methodology is to bring a better understanding of acoustic phenomena related to dysphonia. The automatic system was validated on a dysphonic corpus (80 female voices, rated according to the GRBAS perceptual scale by an expert jury. Firstly, focused on the frequency domain, the classification system showed the interest of 0–3000 Hz frequency band for the classification task based on the GRBAS scale. Later, an automatic phonemic analysis underlined the significance of consonants and more surprisingly of unvoiced consonants for the same classification task. Submitted to the human experts, these observations led to a manual analysis of unvoiced plosives, which highlighted a lengthening of VOT according to the dysphonia severity validated by a preliminary statistical analysis.

The Consequences of Spasmodic Dysphonia on Communication-Related Quality of Life: A Qualitative Study of the Insider's Experiences

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Baylor, C.R.; Yorkston, K.M.; Eadie, T.L.

2005-01-01

The purpose of this study was to explore the biopsychosocial consequences of spasmodic dysphonia (SD) as experienced by people with SD. Qualitative research methods were used to investigate the insider's perspective of living with SD. Six adults with SD participated in face-to-face phenomenological interviews. The results are summarized in a model…

Acoustic and capacity analysis of voice academic teachers with diagnosed hyperfunctional dysphonia by using DiagnoScope Specialist software.

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Zielińska-Bliźniewska, Hanna; Pietkiewicz, Piotr; Miłoński, Jarosław; Urbaniak, Joanna; Olszewski, Jurek

2013-01-01

The aim of the study was to assess the acoustic and capacity analyses of voice in academic teachers with hyperfunctional dysphonia using DiagnoScope Specialist software. The study covered 46 female academic teachers aged 34-48 years. The women were diagnosed with hyperfunctional dysphonia (with absence of organic pathologies). Having obtained the informed consent, a primary medical history was taken, videolaryngoscopic and stroboscopic examinations were performed and diagnostic voice acoustic and capacity analyses were carried out using DiagnoScope Specialist software. The acoustic analysis carried out of academic teachers with diagnosed hyperfunctional dysphonia showed enhancement in the following parameters: fundamental frequency (FO) by 1.2%; relative average perturbation (Jitter by 100.0% and RAP by 81.8%); relative amplitude perturbation quotient (APQ) by 2.9%; non-harmonic to harmonic ratio (U2H) by 16.0%; and noise to harmonic ratio (NHR) by 13.4%. A decrease of 2.5% from normal values was noted in relative amplitude perturbation (Shimmer). Formant frequencies also showed reduction (F1 by 10.7%, F2 by 5.1%, F3 by 2.2%, and F4 by 3.5%). The harmonic perturbation quotient (HPQ) was 0.8% lower and the residual harmonic perturbation quotient (RHPQ) 16.8% lower, with the residual to harmonic (R2H) decreasing by 35.1 per cent; the sub-harmonic to harmonic (S2H) by 2.4%; and the Yanagihara coefficient by 20.2%. The capacity analysis with the DiagnoScope Specialist software showed figures significantly lower than normal values of the following parameters: phonation time, true phonation time, phonation break coefficients, vocal capacity coefficient and mean vocal capacity. Copyright © 2013 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.

Effects of type II thyroplasty on adductor spasmodic dysphonia.

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Sanuki, Tetsuji; Yumoto, Eiji; Minoda, Ryosei; Kodama, Narihiro

2010-04-01

Type II thyroplasty, or laryngeal framework surgery, is based on the hypothesis that the effect of adductor spasmodic dysphonia (AdSD) on the voice is due to excessively tight closure of the glottis, hampering phonation. Most of the previous, partially effective treatments have aimed to relieve this tight closure, including recurrent laryngeal nerve section or avulsion, extirpation of the adductor muscle, and botulinum toxin injection, which is currently the most popular. The aim of this study was to assess the effects of type II thyroplasty on aerodynamic and acoustic findings in patients with AdSD. Case series. University hospital. Ten patients with AdSD underwent type II thyroplasty between August 2006 and December 2008. Aerodynamic and acoustic analyses were performed prior to and six months after surgery. Mean flow rates (MFRs) and voice efficiency were evaluated with a phonation analyzer. Jitter, shimmer, the harmonics-to-noise ratio (HNR), standard deviation of the fundamental frequency (SDF0), and degree of voice breaks (DVB) were measured from each subject's longest sustained phonation sample of the vowel /a/. Voice efficiency improved significantly after surgery. No significant difference was found in the MFRs between before and after surgery. Jitter, shimmer, HNR, SDF0, and DVB improved significantly after surgery. Treatment of AdSD with type II thyroplasty significantly improved aerodynamic and acoustic findings. The results of this study suggest that type II thyroplasty provides relief from voice strangulation in patients with AdSD. Copyright 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. Published by Mosby, Inc. All rights reserved.

Communication‐related affective, behavioral, and cognitive reactions in speakers with spasmodic dysphonia

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Vanryckeghem, Martine

2017-01-01

Objectives To investigate the self‐perceived affective, behavioral, and cognitive reactions associated with communication of speakers with spasmodic dysphonia as a function of employment status. Study Design Prospective cross‐sectional investigation Methods 148 Participants with spasmodic dysphonia (SD) completed an adapted version of the Behavior Assessment Battery (BAB‐Voice), a multidimensional assessment of self‐perceived reactions to communication. The BAB‐Voice consisted of four subtests: the Speech Situation Checklist for A) Emotional Reaction (SSC‐ER) and B) Speech Disruption (SSC‐SD), C) the Behavior Checklist (BCL), and D) the Communication Attitude Test for Adults (BigCAT). Participants were assigned to groups based on employment status (working versus retired). Results Descriptive comparison of the BAB‐Voice in speakers with SD to previously published non‐dysphonic speaker data revealed substantially higher scores associated with SD across all four subtests. Multivariate Analysis of Variance (MANOVA) revealed no significantly different BAB‐Voice subtest scores as a function of SD group status (working vs. retired). Conclusions BAB‐Voice scores revealed that speakers with SD experienced substantial impact of their voice disorder on communication attitude, coping behaviors, and affective reactions in speaking situations as reflected in their high BAB scores. These impacts do not appear to be influenced by work status, as speakers with SD who were employed or retired experienced similar levels of affective and behavioral reactions in various speaking situations and cognitive responses. These findings are consistent with previously published pilot data. The specificity of items assessed by means of the BAB‐Voice may inform the clinician of valid patient‐centered treatment goals which target the impairment extended beyond the physiological dimension. Level of Evidence 2b PMID:29299525

Communication-related affective, behavioral, and cognitive reactions in speakers with spasmodic dysphonia.

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Watts, Christopher R; Vanryckeghem, Martine

2017-12-01

To investigate the self-perceived affective, behavioral, and cognitive reactions associated with communication of speakers with spasmodic dysphonia as a function of employment status. Prospective cross-sectional investigation. 148 Participants with spasmodic dysphonia (SD) completed an adapted version of the Behavior Assessment Battery (BAB-Voice), a multidimensional assessment of self-perceived reactions to communication. The BAB-Voice consisted of four subtests: the Speech Situation Checklist for A) Emotional Reaction (SSC-ER) and B) Speech Disruption (SSC-SD), C) the Behavior Checklist (BCL), and D) the Communication Attitude Test for Adults (BigCAT). Participants were assigned to groups based on employment status (working versus retired). Descriptive comparison of the BAB-Voice in speakers with SD to previously published non-dysphonic speaker data revealed substantially higher scores associated with SD across all four subtests. Multivariate Analysis of Variance (MANOVA) revealed no significantly different BAB-Voice subtest scores as a function of SD group status (working vs. retired). BAB-Voice scores revealed that speakers with SD experienced substantial impact of their voice disorder on communication attitude, coping behaviors, and affective reactions in speaking situations as reflected in their high BAB scores. These impacts do not appear to be influenced by work status, as speakers with SD who were employed or retired experienced similar levels of affective and behavioral reactions in various speaking situations and cognitive responses. These findings are consistent with previously published pilot data. The specificity of items assessed by means of the BAB-Voice may inform the clinician of valid patient-centered treatment goals which target the impairment extended beyond the physiological dimension. 2b.

Botulinum Toxin in Secondarily Nonresponsive Patients with Spasmodic Dysphonia.

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Mor, Niv; Tang, Christopher; Blitzer, Andrew

2016-09-01

Chemodenervation with botulinum toxin (BoNT) has been effective and well tolerated for all types of dystonia for >30 years. We reviewed outcomes of our patients treated with BoNT serotype A (BoNT-A) for spasmodic dysphonia (SD) who became secondarily nonresponsive. We found that 8 of 1400 patients became nonresponsive to BoNT-A (0.57%), which is lower than the secondary nonresponse rate in other dystonias. After a cessation period, 4 of our patients resumed BoNT-A injections, and recurrence of immunoresistance was not seen in any of them. When compared with patients with other dystonias, patients with SD receive extremely low doses of BoNT. Small antigen challenge may explain the lower rate of immunoresistance and long-lasting efficacy after BoNT-A is restarted among secondary nonresponsive patients with SD. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

[Stimuli phrases of adductor spasmodic dysphonia phonatory break in mandarin Chinese].

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Ge, Pingjiang; Ren, Qingyi; Chen, Zhipeng; Cheng, Qiuhui; Sheng, Xiaoli; Wang, Ling; Chen, Shaohua; Zhang, Siyi

2015-12-01

To investigate the characteristics of adductor spasmodic dysphonia phonatory break in mandarin Chinese and select the stimuli phrases. Thirty-eight patients with adductor spasmodic dysphonia were involved in this study. Standard phrase " fù mŭ xīn" and a speech corpus in mandarin Chinese with 229 syllables covering all vowel and constant of mandarin Chinese were selected. Every patient read the phrases above twice in normal speed and comfortable voice. Two auditory perpetual speech pathologists marked phonatory break syllables respectively. The frequency of phonatory break syllables and their located phrases were calculated, rated and described. The phrases including the most phonatory break syllables were selected as stimuli phrases, the phonatory break frequency of which was also higher than that of standard phrase "fù mŭ xīn". Phonatory break happened in the reading of all patients. The average number of phonatory break syllables was 14 (3-33). Phonatroy break occurred when saying 177 (77.3%) syllables in the speech corpus. The syllables "guŏ, rén, zāng, diàn, chē, gè, guăn, a, bā, ne, de" broke in 23.1%-41.0% patients. These syllables belonged to the phrases "pĭng guŏ, huŏ chē, shì de, nĭ shì gè hăo rén, wŏ mén shì yŏu zŏng shì bă qĭn shì nong dé hĕn zāng, wŏ mén nà biān yŏu wăng qiú yùn dong chăng, cān gŭan, jiŭ bā hé yī gè miàn bāo dìan, tā shì duō me kāng kăi a,wŏ yīng gāi zài xìn lĭ xiĕ yī xiē shén mē ne?". Thirty-seven patients (97.3%) had phonatory break in above mentioned words. Ratios of these words phonatory break also were more than "fù mŭ xīn". Adductor spasmodic dysphonic patients exhibited different degrees of phonatory break in mandarine Chinese. The phrases" shì de, pĭng guŏ, huŏ chē, nĭ shì gè hăo rén, wŏ mén nà biān yŏu wăng qiú yùn dong chăng, cān gŭan, jiŭ bā hé yī gè miàn bāo dìan, tā shì duō me kāng kăi a" were recommended as stimuli

[Occupational dysphonia management in different countries of the European Union and throughout the world].

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Niebudek-Bogusz, Ewa

2009-01-01

Teachers are significantly more likely to develop multiple voice problems than non-teachers. The article presents methods for the diagnoses and treatment of occupational dysphonia in different countries of the European Union and throughout the world. Conclusions comprise the implications concerning the model of dysphonic teachers management in Poland, putting strong emphasis on the necessity for multidimensional therapy in collaboration with otolaryngologist/phoniatrician, logopedist/speech therapist and also psychologist/physiotherapist. The importance of training professional voice users in vocal hygiene and healthy voice habits has also been emphasized.

Treatment Efficacy of Electromyography versus Fiberscopy-Guided Botulinum Toxin Injection in Adductor Spasmodic Dysphonia Patients: A Prospective Comparative Study

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Kim, Jae Wook; Park, Jae Hong; Park, Ki Nam; Lee, Seung Won

2014-01-01

Introduction. This study prospectively evaluates and compares the treatment efficacy of botulinum toxin injection under electromyography guidance (EMG group) and percutaneous botulinum toxin injection under flexible fiberscopic guidance (fiberscopy group). Methods. Thirty patients with adductor spasmodic dysphonia (ADSD), who had never received treatment, were randomly allocated into EMG- or fiberscopy-guided botulinum toxin injections between March 2008 and February 2010. We assessed acoustic and aerodynamic voice parameters, and the voice handicap index (VHI) before injection and at 1, 3, and 6 months after injection. Results. The mean total dosage of botulinum toxin was similar for both groups: 1.7 ± 0.5 U for the EMG group and 1.8 ± 0.4 U for the fiberscopy group (P > 0.05). There were no significant differences in outcomes between the two groups in either the duration of effectiveness or complications such as breathy voice and aspiration. Conclusion. Botulinum toxin injection under fiberscopic guidance is a viable alternative to EMG-guided botulinum toxin injection for the treatment of adductor spasmodic dysphonia when EMG equipment is unavailable. PMID:25383369

Treatment Efficacy of Electromyography versus Fiberscopy-Guided Botulinum Toxin Injection in Adductor Spasmodic Dysphonia Patients: A Prospective Comparative Study

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Jae Wook Kim

2014-01-01

Full Text Available Introduction. This study prospectively evaluates and compares the treatment efficacy of botulinum toxin injection under electromyography guidance (EMG group and percutaneous botulinum toxin injection under flexible fiberscopic guidance (fiberscopy group. Methods. Thirty patients with adductor spasmodic dysphonia (ADSD, who had never received treatment, were randomly allocated into EMG- or fiberscopy-guided botulinum toxin injections between March 2008 and February 2010. We assessed acoustic and aerodynamic voice parameters, and the voice handicap index (VHI before injection and at 1, 3, and 6 months after injection. Results. The mean total dosage of botulinum toxin was similar for both groups: 1.7 ± 0.5 U for the EMG group and 1.8 ± 0.4 U for the fiberscopy group (P>0.05. There were no significant differences in outcomes between the two groups in either the duration of effectiveness or complications such as breathy voice and aspiration. Conclusion. Botulinum toxin injection under fiberscopic guidance is a viable alternative to EMG-guided botulinum toxin injection for the treatment of adductor spasmodic dysphonia when EMG equipment is unavailable.

Multidimensional assessment of strongly irregular voices such as in substitution voicing and spasmodic dysphonia: a compilation of own research.

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Moerman, Mieke; Martens, Jean-Pierre; Dejonckere, Philippe

2015-04-01

This article is a compilation of own research performed during the European COoperation in Science and Technology (COST) action 2103: 'Advance Voice Function Assessment', an initiative of voice and speech processing teams consisting of physicists, engineers, and clinicians. This manuscript concerns analyzing largely irregular voicing types, namely substitution voicing (SV) and adductor spasmodic dysphonia (AdSD). A specific perceptual rating scale (IINFVo) was developed, and the Auditory Model Based Pitch Extractor (AMPEX), a piece of software that automatically analyses running speech and generates pitch values in background noise, was applied. The IINFVo perceptual rating scale has been shown to be useful in evaluating SV. The analysis of strongly irregular voices stimulated a modification of the European Laryngological Society's assessment protocol which was originally designed for the common types of (less severe) dysphonia. Acoustic analysis with AMPEX demonstrates that the most informative features are, for SV, the voicing-related acoustic features and, for AdSD, the perturbation measures. Poor correlations between self-assessment and acoustic and perceptual dimensions in the assessment of highly irregular voices argue for a multidimensional approach.

Treatment efficacy of electromyography versus fiberscopy-guided botulinum toxin injection in adductor spasmodic dysphonia patients: a prospective comparative study.

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Kim, Jae Wook; Park, Jae Hong; Park, Ki Nam; Lee, Seung Won

2014-01-01

This study prospectively evaluates and compares the treatment efficacy of botulinum toxin injection under electromyography guidance (EMG group) and percutaneous botulinum toxin injection under flexible fiberscopic guidance (fiberscopy group). Thirty patients with adductor spasmodic dysphonia (ADSD), who had never received treatment, were randomly allocated into EMG- or fiberscopy-guided botulinum toxin injections between March 2008 and February 2010. We assessed acoustic and aerodynamic voice parameters, and the voice handicap index (VHI) before injection and at 1, 3, and 6 months after injection. The mean total dosage of botulinum toxin was similar for both groups: 1.7 ± 0.5 U for the EMG group and 1.8 ± 0.4 U for the fiberscopy group (P > 0.05). There were no significant differences in outcomes between the two groups in either the duration of effectiveness or complications such as breathy voice and aspiration. Botulinum toxin injection under fiberscopic guidance is a viable alternative to EMG-guided botulinum toxin injection for the treatment of adductor spasmodic dysphonia when EMG equipment is unavailable.

Assessment of the influence of osteopathic myofascial techniques on normalization of the vocal tract functions in patients with occupational dysphonia.

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Marszałek, Sławomir; Niebudek-Bogusz, Ewa; Woźnicka, Ewelina; Malińska, Joanna; Golusiński, Wojciech; Śliwińska-Kowalska, Mariola

2012-06-01

Occupational voice disorders are accompanied by increased tension of the external laryngeal muscle which changes the position of the larynx and consequently disturbs the conditions of functioning of the vocal tract. The aim of the study is to assess the use of osteopathic procedures in the diagnosis and treatment of occupational dysphonia. Study subjects included 40 teachers with chronic diseases of the voice organ (38 women and 2 men) aged from 39 to 59 (mean age: 48.25). Before and after the voice therapy the osteopathic examination according to Libermann's protocol was performed as well as phoniatric examination including laryngovideostroboscopy (LVSS), assessment of the maximum phonation time (MPT) and the Voice Handicap Index (VHI) score. The voice therapy, scheduled and supervised by a laryngologist-phoniatrician and conducted by a speech-language pathologist, was supplemented with osteopathic myofascial rehabilitation of the larynx. The chi-square McNemar test and non-parametric Wilcoxon matched pairs test were applied in the statistical assessment. The applied interdisciplinary treatment including osteopathic and vocal therapy resulted in a statistically significant decrease in tenderness of muscles raising the larynx (cricothyroid ligament, sternocleidomastoid muscles, and pharyngeal constrictor muscles) and in lowering the tonus (geniohyoid muscles, pharyngeal constrictor muscles and sternocleidomastoid muscles). A significant improvement was also observed in the case of dysfunction of the cricothyroid joint examined during glissando and yawning, as well as in asymmetry of the thyrohyoid apparatus. Moreover, the therapy resulted in significantly better normalization of the head position and better control of the centre of gravity of the body. Statistically significant post-therapy improvement was observed in the phoniatric examination, including VHI scores, MPT results and parameters of videostroboscopic examination. The use of osteopathic therapy helps

HOARSENESS AMONG SCHOOL-AGE CHILDREN

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Robert Šifrer

2004-02-01

Full Text Available Background. The prevalence of dysphonia in schoolchildren has been reported to be from 7.1% to 23.3% and in adolescents from 0 to 80%. In Slovenia, the study on prevalence of dysphonia in schoolchildren has not been performed yet.Methods. The voice samples of 100 4th-graders and 102 8thgraders of elementary school were recorded. A lay judge and a professional assessed independently degree of hoarseness in the voice samples. One to three months after the recording, the dysphonic children were invited to an otorhinolaryngologic examination in order to find out the cause of dysphonia. All children and their parents answered the questionnaires on illnesses and vocal habits that might cause hoarseness. The prevalence of these unfavourable factors was compared between the group of children with long lasting hoarseness and the children without it.Results. At voice samples’ recording there were 34.2% dysphonic children. One to three months later, there were still 14.9% children with hoarse voice. The most frequent causes for acute dysphonia were acute respiratory infection and exacerbation of chronic laryngitis. The most frequent causes for persistent dysphonia were allergic catarrhal laryngitis, muscle tension dysphonia with or without vocal nodules and mutational voice disorder. The fast speaking rate appeared to be characteristic for children with long lasting dysphonia.Conclusions. Dysphonia in school-age children is the result of diseases of upper respiratory tract and/or functional voice disorders. Both causes of dysphonia could be successfully treated if they are detected early and the children are advised to see an otorhinolaryngologist. Adolescence is an ideal period for treatment of functional voice disorders. It is also the period when the children must decide for their future profession.

Parents' Evaluations of Their Children's Dysphonia: The Mamas and the Papas.

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Amir, Ofer; Wolf, Michael; Mick, Liron; Levi, Omer; Primov-Fever, Adi

2015-07-01

This study aimed to evaluate the validity and reliability of a Hebrew translation of the Pediatric Voice Handicap Index (pVHI). It also examined differences between mothers and fathers in evaluating their child's dysphonia. Observational design. The pVHI was first translated and adapted to Hebrew. The translated version was, then, administered to a group of 141 parents of children aged younger than 14 years. Fifty-eight parents had a dysphonic child, and 83 had a nondysphonic child. Based on the parents' responses to the pVHI, statistical analyses were performed, evaluating validity and reliability, as well as group differences. Following, a subset of the participants, in which only cases where the responses of both parents were available, was examined for evaluating differences between the responses of mothers (n = 46) and fathers (n = 46). Statistical analyses revealed high reliability of the Hebrew version of the pVHI (Cronbach alpha = .97). Parents of the dysphonic children rated their children significantly higher than parents of the nondysphonic group (P  0.05). The Hebrew version of the pVHI is a reliable tool for quantifying parents' perception of their child's voice handicap. Mothers of dysphonic children evaluate their children's voice handicap more severely than fathers, whereas both parents of nondysphonic children perform this evaluation similarly. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

A Computerized Tomography Study of Vocal Tract Setting in Hyperfunctional Dysphonia and in Belting.

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Saldias, Marcelo; Guzman, Marco; Miranda, Gonzalo; Laukkanen, Anne-Maria

2018-04-03

Vocal tract setting in hyperfunctional patients is characterized by a high larynx and narrowing of the epilaryngeal and pharyngeal region. Similar observations have been made for various singing styles, eg, belting. The voice quality in belting has been described to be loud, speech like, and high pitched. It is also often described as sounding "pressed" or "tense". The above mentioned has led to the hypothesis that belting may be strenuous to the vocal folds. However, singers and teachers of belting do not regard belting as particularly strenuous. This study investigates possible similarities and differences between hyperfunctional voice production and belting. This study concerns vocal tract setting. Four male patients with hyperfunctional dysphonia and one male contemporary commercial music singer were registered with computerized tomography while phonating on [a:] in their habitual speaking pitch. Additionally, the singer used the pitch G4 in belting. The scannings were studied in sagittal and transversal dimensions by measuring lengths, widths, and areas. Various similarities were found between belting and hyperfunction: high vertical larynx position, small hypopharyngeal width, and epilaryngeal outlet. On the other hand, belting differed from dysphonia (in addition to higher pitch) by a wider lip and jaw opening, and larger volumes of the oral cavity. Belting takes advantage of "megaphone shape" of the vocal tract. Future studies should focus on modeling and simulation to address sound energy transfer. Also, they should consider aerodynamic variables and vocal fold vibration to evaluate the "price of decibels" in these phonation types. Copyright © 2018. Published by Elsevier Inc.

Stage of readiness of patients with behavioral dysphonia in pre and post-group voice therapy assessments.

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Costa, Bianca Oliveira Ismael da; Silva, Priscila Oliveira Costa; Pinheiro, Renata Serrano de Andrade; Silva, Hêmmylly Farias da; Almeida, Anna Alice Figueirêdo de

2017-08-10

To verify the efficacy of group voice therapy in the stage of readiness and identify which items of the URICA-Voice range are more sensitive to post-therapy change in patients with behavioral dysphonia. An intervention study was conducted on 49 patients with behavioral dysphonia. An eclectic approach to group therapy was implemented over eight sessions, the first and last sessions consisting of assessments. The URICA-Voice range was used to evaluate the stage of readiness at pre- and post-therapy assessments. A descriptive and inferential statistical analysis was implemented for the results. Most participants were female, did not make professional use of voice, and had membranous vocal fold lesions. Most of them were in the Contemplation stage at in both moments, pre- and post-therapy. There was no significant change in the comparison of pre- and post-therapy scores. The majority of patients showed a reduction in the stage of readiness and some advanced to a higher stage. In the comparison of URICA-V range items, seven questions had equal or inferior responses in the post-therapy assessment. There was no statistical difference when comparing the pre- and post-therapy total average score of the URICA-Voice range. There were significant changes in the stage of readiness of patients in pre- and post-group speech therapy assessments.

Long-Term Follow-Up of Patients with Spasmodic Dysphonia and Improved Voice despite Discontinuation of Treatment.

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Geneid, Ahmed; Lindestad, Per-Åke; Granqvist, Svante; Möller, Riitta; Södersten, Maria

2016-01-01

To evaluate voice function in patients with adductor spasmodic dysphonia (AdSD) who discontinued botulinum toxin (BTX) treatment because they felt that their voice had improved sufficiently. Twenty-eight patients quit treatment in 2004, of whom 20 fulfilled the inclusion criteria for the study, with 3 subsequently excluded because of return of symptoms, leaving 17 patients (11 males, 6 females) included in this follow-up study. A questionnaire concerning current voice function and the Voice Handicap Index were completed. Audio-perceptual voice assessments were done by 3 listeners. The inter- and intrarater reliabilities were r > 0.80. All patients had a subjectively good stable voice, but with differences in their audio-perceptual voice assessment scores. Based on the pre-/posttreatment auditory scores on the overall degree of AdSD, patients were divided into 2 subgroups showing more and less improvement, with 10 and 7 patients, respectively. The subgroup with more improvement had shorter duration from the onset of symptoms until the start of BTX treatment, and included 7 males compared to only 4 males in the subgroup with less improvement. It seems plausible that the symptoms of spasmodic dysphonia may decrease over time. Early intervention and male gender seem to be important factors for long-term reduction of the voice symptoms of AdSD. © 2016 S. Karger AG, Basel.

Comparison Between Vocal Function Exercises and Voice Amplification.

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Teixeira, Letícia Caldas; Behlau, Mara

2015-11-01

To compare the effectiveness of vocal function exercises (VFEs) versus voice amplification (VA) after a 6-week therapy for teachers diagnosed with behavioral dysphonia. A total of 162 teachers with behavioral dysphonia were randomly allocated into two intervention groups and one control group (CG). Outcomes were assessed using auditory-perceptual evaluation of voice, laryngeal status assessment, self-ratings of the impact of dysphonia, and acoustic analysis. The VFE group showed effective changes across treatment outcome measures: overall severity of dysphonia relative to the CG, laryngeal evaluation, and self-perceived dysphonia. The VA group showed positive outcomes in some measures of self-rated dysphonia. The CG had poorer outcomes across self-assessment dimensions. The VFE method is effective in treating the behavioral dysphonia of teachers, can change the overall severity and the self-perception of the impact of dysphonia, and the laryngeal evaluation outcomes. The use of a voice amplifier is effective as a preventive measure because it results in an improved self-perception of dysphonia, especially in the work-related dimension. One case of dysphonia aggravation can be prevented in every three patients with behavioral dysphonia engaged in VFE, and one case in every five patients using VA. The lack of a therapeutic intervention worsens teachers' behavioral dysphonia in a period of 6 weeks. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Abnormal Structure–Function Relationship in Spasmodic Dysphonia

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Ludlow, Christy L.

2012-01-01

Spasmodic dysphonia (SD) is a primary focal dystonia characterized by involuntary spasms in the laryngeal muscles during speech production. Although recent studies have found abnormal brain function and white matter organization in SD, the extent of gray matter alterations, their structure–function relationships, and correlations with symptoms remain unknown. We compared gray matter volume (GMV) and cortical thickness (CT) in 40 SD patients and 40 controls using voxel-based morphometry and cortical distance estimates. These measures were examined for relationships with blood oxygen level–dependent signal change during symptomatic syllable production in 15 of the same patients. SD patients had increased GMV, CT, and brain activation in key structures of the speech control system, including the laryngeal sensorimotor cortex, inferior frontal gyrus (IFG), superior/middle temporal and supramarginal gyri, and in a structure commonly abnormal in other primary dystonias, the cerebellum. Among these regions, GMV, CT and activation of the IFG and cerebellum showed positive relationships with SD severity, while CT of the IFG correlated with SD duration. The left anterior insula was the only region with decreased CT, which also correlated with SD symptom severity. These findings provide evidence for coupling between structural and functional abnormalities at different levels within the speech production system in SD. PMID:21666131

Auricular hematoma cases caused by mobile phones

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Halil E. Özel, MD

2015-12-01

Full Text Available We report auricular hematoma cases caused by mobile phones. A 32-year-old male and a 23-year-old female presented with auricular hematoma, having no significant histories of trauma. The patients underwent simple hematoma aspiration. Hematoma re-accumulated in the first case. Incision and drainage were performed, and then auricular skin was stabilized by suturing a gauze pad over the area. Both patients recovered without sequelae after treatment. Judging from these cases, we want to postulate that prolonged mobile phone use may cause auricular hematoma.

Alterations in CNS Activity Induced by Botulinum Toxin Treatment in Spasmodic Dysphonia: An H[subscript 2][superscript 15]O PET Study

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Ali, S. Omar; Thomassen, Michael; Schulz, Geralyn M.; Hosey, Lara A.; Varga, Mary; Ludlow, Christy L.; Braun, Allen R.

2006-01-01

Speech-related changes in regional cerebral blood flow (rCBF) were measured using H[subscript 2][superscript 15]O positron-emission tomography in 9 adults with adductor spasmodic dysphonia (ADSD) before and after botulinum toxin (BTX) injection and 10 age- and gender-matched volunteers without neurological disorders. Scans were acquired at rest…

[The prevalence, causes and specific features of voice disturbances in teachers].

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Orlova, O S; Vasilenko, Iu S; Zakharova, A F; Samokhvalova, L O; Kozlova, P A

2000-01-01

The paper analyzes voice disturbances, their causes and specific features in teachers based on the questionnaires filled by 934 general educational school teachers. The teachers have been found to associate voice disturbances not only with changes in the voice timbre, but with different subjective feelings that make their professional activity difficult. The major factors that cause voice disturbances are the voice overloads that differ in teachers of different specialities, their inability to use the voice, psychoemotional stresses, and frequent colds, as well as a combination of several factors. The incidence of vocal apparatus diseases does not tend to decrease, which makes it necessary to implement combined medical and pedagogical prophylactic measures to prevent dysphonia.

Ortner’s syndrome: a case report and literature review

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Bruno Landim Dutra

2015-08-01

Full Text Available AbstractThe authors report the case of a 55-year-old female, hypertensive, smoker patient presenting with dysphonia, dysphagia and persistent dry cough. Laryngoscopy diagnosed left vocal cord paralysis. Computed tomography demonstrated saccular aneurysm of the inferior wall of the aortic arch, stretching the left recurrent laryngeal nerve, a finding compatible with Ortner’s syndrome.

Efficacy of Water Resistance Therapy in Subjects Diagnosed With Behavioral Dysphonia: A Randomized Controlled Trial.

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Guzman, Marco; Jara, Rodrigo; Olavarria, Christian; Caceres, Paloma; Escuti, Geordette; Medina, Fernanda; Medina, Laura; Madrid, Sofia; Muñoz, Daniel; Laukkanen, Anne-Maria

2017-05-01

The purpose of the present study was to determine the efficacy of water resistance therapy (WRT) in a long-term period of voice treatment in subjects diagnosed with voice disorders. Twenty participants, with behavioral dysphonia, were randomly assigned to one of two treatment groups: (1) voice treatment with WRT, and (2) voice treatment with tube phonation with the distal end in air (TPA). Before and after voice therapy, participants underwent aerodynamic, electroglottographic, acoustic, and auditory-perceptual assessments. The Voice Handicap Index and self-assessment of resonant voice quality were also performed. The treatment included eight voice therapy sessions. For the WRT group, the exercises consisted of a sequence of five phonatory tasks performed with a drinking straw submerged 5 cm into water. For the TPA, the exercises consisted of the same phonatory tasks, and all of them were performed into the same straw but the distal end was in air. Wilcoxon test showed significant improvements for both groups for Voice Handicap Index (decrease), subglottic pressure (decrease), phonation threshold pressure (decrease), and self-perception of resonant voice quality (increase). Improvement in auditory-perceptual assessment was found only for the TPA group. No significant differences were found for any acoustic or electroglottographic variables. No significant differences were found between WRT and TPA groups for any variable. WRT and TPA may improve voice function and self-perceived voice quality in individuals with behavioral dysphonia. No differences between these therapy protocols should be expected. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Effective dysphonia detection using feature dimension reduction and kernel density estimation for patients with Parkinson's disease.

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Shanshan Yang

Full Text Available Detection of dysphonia is useful for monitoring the progression of phonatory impairment for patients with Parkinson's disease (PD, and also helps assess the disease severity. This paper describes the statistical pattern analysis methods to study different vocal measurements of sustained phonations. The feature dimension reduction procedure was implemented by using the sequential forward selection (SFS and kernel principal component analysis (KPCA methods. Four selected vocal measures were projected by the KPCA onto the bivariate feature space, in which the class-conditional feature densities can be approximated with the nonparametric kernel density estimation technique. In the vocal pattern classification experiments, Fisher's linear discriminant analysis (FLDA was applied to perform the linear classification of voice records for healthy control subjects and PD patients, and the maximum a posteriori (MAP decision rule and support vector machine (SVM with radial basis function kernels were employed for the nonlinear classification tasks. Based on the KPCA-mapped feature densities, the MAP classifier successfully distinguished 91.8% voice records, with a sensitivity rate of 0.986, a specificity rate of 0.708, and an area value of 0.94 under the receiver operating characteristic (ROC curve. The diagnostic performance provided by the MAP classifier was superior to those of the FLDA and SVM classifiers. In addition, the classification results indicated that gender is insensitive to dysphonia detection, and the sustained phonations of PD patients with minimal functional disability are more difficult to be correctly identified.

Long-term Evaluation of Type 2 Thyroplasty with Titanium Bridges for Adductor Spasmodic Dysphonia.

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Sanuki, Tetsuji; Yumoto, Eiji

2017-07-01

Objectives Standard treatments of adductor spasmodic dysphonia (AdSD) provide temporary relief of symptoms. Type 2 thyroplasty offers a long-term solution; however, long-term voice outcome data are lacking. The objective of this study was to assess the long-term voice outcomes of type 2 thyroplasty with titanium bridges through use of a validated voice questionnaire. Study Design Case series with chart review. Setting University hospital. Subjects and Methods Forty-seven consecutively enrolled patients with AdSD underwent type 2 thyroplasty with titanium bridges between August 2006 and November 2014. Questionnaires were completed during regularly scheduled follow-ups and, in some cases, were sent to patients who missed follow-up appointments. In 2015, questionnaires were mailed to all 47 patients and included a Voice Handicap Index-10 evaluation, as well as questions on postoperative vocal symptoms, surgical site, and status of the implanted titanium bridges. Results Of 47 patients with AdSD, 31 (66%) completed the questionnaires. The average follow-up interval was 41.3 months. No patient reported experiencing an adverse event around the surgical site, and almost all were satisfied with their voices postoperatively. The mean postoperative (>3 years) Voice Handicap Index-10 score improved significantly, from 26.3 to 9.4 (n = 17, P = .0009). Conclusions Type 2 thyroplasty for AdSD significantly improved patient quality of life and voice symptoms and continued to do so long after the surgery. The results of this study suggest that type 2 thyroplasty provides relief from vocal symptoms in patients with AdSD for >3 years.

Correlation of the Dysphonia Severity Index (DSI), Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), and Gender in Brazilians With and Without Voice Disorders.

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Nemr, Katia; Simões-Zenari, Marcia; de Souza, Glaucia S; Hachiya, Adriana; Tsuji, Domingos H

2016-11-01

This study aims to analyze the Dysphonia Severity Index (DSI) in Brazilians with or without voice disorders and investigate DSI's correlation with gender and auditory-perceptual evaluation data obtained via the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) protocol. A total of 66 Brazilian adults from both genders participated in the study, including 24 patients with dysphonia confirmed on laryngeal examination (dysphonic group [DG]) and 42 volunteers without voice or hearing complaints and without auditory-perceptual voice disorders (nondysphonic group [NDG]). The vocal tasks included in CAPE-V and DSI were performed and recorded. Data were analyzed by means of the independent t test, the Mann-Whitney U test, and Pearson correlation at the 5% significance level. Differences were found in the mean DSI values between the DG and the NDG. Differences were also found in all DSI items between the groups, except for the highest frequency parameter. In the DG, a moderate negative correlation was detected between overall dysphonia severity (CAPE-V) and DSI value, and between breathiness and DSI value, and a weak negative correlation was detected between DSI value and roughness. In the NDG, the maximum phonation time was higher among males. In both groups, the highest frequency parameter was higher among females. The DSI discriminated among Brazilians with or without voice disorders. A correlation was found between some aspects of the DSI and the CAPE-V but not between DSI and gender. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Ortner's syndrome: a case report and literature review

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Dutra, Bruno Landim; Campos, Lenilton da Costa; Marques, Helder de Castro; Vilela, Vagner Moyses; Duque, Andre Geraldo da Silva

2015-01-01

The authors report the case of a 55-year-old female, hypertensive, smoker patient presenting with dysphonia, dysphagia and persistent dry cough. Laryngoscopy diagnosed left vocal cord paralysis. Computed tomography demonstrated saccular aneurysm of the inferior wall of the aortic arch, stretching the left recurrent laryngeal nerve, a finding compatible with Ortner's syndrome. (author)

Ortner's syndrome: a case report and literature review

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Dutra, Bruno Landim; Campos, Lenilton da Costa; Marques, Helder de Castro; Vilela, Vagner Moyses, E-mail: brunolandim@yahoo.com.br [Universidade Federal de Juiz de Fora (HU/UFJF), MG (Brazil). Hospital Universitario. Unidade de Radiologia e Diagnostico por Imagem; Carvalho, Rodolfo Elias Diniz da Silva [Centro de Diagnostico Medico (CRM), Sao Mateus, ES (Brazil); Duque, Andre Geraldo da Silva [Axial Medicina Diagnostica, Belo Horizonte, MG (Brazil)

2015-07-15

The authors report the case of a 55-year-old female, hypertensive, smoker patient presenting with dysphonia, dysphagia and persistent dry cough. Laryngoscopy diagnosed left vocal cord paralysis. Computed tomography demonstrated saccular aneurysm of the inferior wall of the aortic arch, stretching the left recurrent laryngeal nerve, a finding compatible with Ortner's syndrome. (author)

Muscle tension dysphonia in Vietnamese female teachers.

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Nguyen, Duong Duy; Kenny, Dianna T; Tran, Ninh Duy; Livesey, Jonathan R

2009-03-01

There has been no published research on muscle tension dysphonia (MTD) in speakers who use a tonal language. Using a sample of 47 Northern Vietnamese female primary school teachers with MTD, we aimed to discover whether professional voice users of tonal languages presented with the same symptoms of MTD as speakers of nontonal languages and whether they presented with additional symptoms as a result of speaking a tonal language. The vocal characteristics were assessed by use of a questionnaire and expert perceptual evaluation. Laryngeal features were assessed by photolaryngoscopy. The results showed that MTD was associated with a larger number of vocal symptoms than previously reported. However, the participants did not have the same vocal symptoms reported in English speakers, for example, hard glottal attack, pitch breaks, unusual speech rate, and glottal fry. Factor analysis of the vocal symptoms revealed three factors: "vocal fatigue/hyperfunction," "physical discomfort," and "voice quality," all of which demonstrated high reliability. The major laryngeal characteristic was a glottal gap. The glottal shapes observed included: 44.7% had an incomplete closure, 29.8% a posterior gap, 12.8% an hourglass-shaped gap, 8.5% a spindle-shaped gap, and 4.3% had complete glottal closure. The findings implied a potential contribution of linguistic-specific factors and teaching-related factors to the presentation of this voice disorder in this group of teachers.

The treatment of muscle tension dysphonia: a comparison of two treatment techniques by means of an objective multiparameter approach.

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Van Lierde, Kristiane M; De Bodt, Marc; Dhaeseleer, Evelien; Wuyts, Floris; Claeys, Sofie

2010-05-01

The purpose of the present study is to measure the effectiveness of two treatment techniques--vocalization with abdominal breath support and manual circumlaryngeal therapy (MCT)--in patients with muscle tension dysphonia (MTD). The vocal quality before and after the two treatment techniques was measured by means of the dysphonia severity index (DSI), which is designed to establish an objective and quantitative correlate of the perceived vocal quality. The DSI is based on the weighted combination of the following set of voice measurements: maximum phonation time (MPT), highest frequency, lowest intensity, and jitter. The repeated-measures analysis of variance (ANOVA) revealed a significant difference between the objective overall vocal quality before and after MCT. No significant differences were measured between the objective overall vocal quality before and after vocalization with abdominal breath support. This study showed evidence that MCT is an effective treatment technique for patients with elevated laryngeal position, increased laryngeal muscle tension, and MTD. The precise way in which MCT has an effect on vocal quality has not been addressed in this experiment, but merits study. Further research into this topic could focus on electromyography (EMG) recordings in relation to vocal improvements with larger sample of subjects. (c) 2010 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

[Professional dysphonia and its risk factors in the material of the outpatient clinic of the Department of Otolaryngology, Medical Academy of Białystok].

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Kosztyła-Hojna, Bozena; Rogowski, Marek; Ruczaj, Jan; Pepiński, Witold

2004-01-01

Occurrence of professional dysphonia was analysed in a group of 309 patients treated in the Phoniatric Outpatient Clinic, Department of Otolaryngology, Medical Academy in Białystok through the period of 1999-2001. In a group of professional voice users female teachers of primary schools and lower secondary schools predominated. Obtained results were compared with those from a group of 65 persons of other occupations. In the both groups other harmful factors affecting the voice organ were excluded. The clinical assessment included subjective and objective laryngological examination using videolaryngostroboscopy. The clinical material was evaluated in a view of functional and organic disorders of the voice organ. Early occurrence and aggravation of functional changes in the larynx was recorded in non professional voice users in the course of their seniority. In professional patients organic changes were more common and occurred earlier than functional disorders. Severity of dysphonia was related to the larynx pathology, especially of a functional character.

Comparison of cepstral coefficients to other voice evaluation parameters in patients with occupational dysphonia

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Ewa Niebudek-Bogusz

2013-12-01

Full Text Available Background: Special consideration has recently been given to cepstral analysis with mel-frequency cepstral coefficients (MFCCs. The aim of this study was to assess the applicability of MFCCs in acoustic analysis for diagnosing occupational dysphonia in comparison to subjective and objective parameters of voice evaluation. Materials and Methods: The study comprised 2 groups, one of 55 female teachers (mean age: 45 years with occupational dysphonia confirmed by videostroboscopy and 40 female controls with normal voice (mean age: 43 years. The acoustic samples involving sustained vowels "a" and four standardized sentences were analyzed by computed analysis of MFCCs. The results were compared to acoustic parameters of jitter and shimmer groups, noise to harmonic ratio, Yanagihara index evaluating the grade of hoarseness, the aerodynamic parameter: maximum phonation time and also subjective parameters: GRBAS perceptual scale and Voice Handicap Index (VHI. Results: The compared results revealed differences between the study and control groups, significant for MFCC2, MFCC3, MFCC5, MFCC6, MFCC8, MFCC10, particularly for MFCC6 (p < 0.001 and MFCC8 (p < 0.009, which may suggest their clinical applicability. In the study group, MFCC4, MFCC8 and MFCC10 correlated significantly with the major objective parameters of voice assessment. Moreover, MFCC8 coefficient, which in the female teachers correlated with all eight objective parameters, also showed the significant relation with perceptual voice feature A (asthenity of subjective scale GRBAS, characteristic of weak tired voice. Conclusions: The cepstral analysis with mel frequency cepstral coefficients is a promising tool for evaluating occupational voice disorders, capable of reflecting the perceptual voice features better than other methods of acoustic analysis. Med Pr 2013;64(6:805–816

Effective Dysphonia Detection Using Feature Dimension Reduction and Kernel Density Estimation for Patients with Parkinson’s Disease

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Yang, Shanshan; Zheng, Fang; Luo, Xin; Cai, Suxian; Wu, Yunfeng; Liu, Kaizhi; Wu, Meihong; Chen, Jian; Krishnan, Sridhar

2014-01-01

Detection of dysphonia is useful for monitoring the progression of phonatory impairment for patients with Parkinson’s disease (PD), and also helps assess the disease severity. This paper describes the statistical pattern analysis methods to study different vocal measurements of sustained phonations. The feature dimension reduction procedure was implemented by using the sequential forward selection (SFS) and kernel principal component analysis (KPCA) methods. Four selected vocal measures were projected by the KPCA onto the bivariate feature space, in which the class-conditional feature densities can be approximated with the nonparametric kernel density estimation technique. In the vocal pattern classification experiments, Fisher’s linear discriminant analysis (FLDA) was applied to perform the linear classification of voice records for healthy control subjects and PD patients, and the maximum a posteriori (MAP) decision rule and support vector machine (SVM) with radial basis function kernels were employed for the nonlinear classification tasks. Based on the KPCA-mapped feature densities, the MAP classifier successfully distinguished 91.8% voice records, with a sensitivity rate of 0.986, a specificity rate of 0.708, and an area value of 0.94 under the receiver operating characteristic (ROC) curve. The diagnostic performance provided by the MAP classifier was superior to those of the FLDA and SVM classifiers. In addition, the classification results indicated that gender is insensitive to dysphonia detection, and the sustained phonations of PD patients with minimal functional disability are more difficult to be correctly identified. PMID:24586406

Behavior Assessment Battery: A Pilot Study of the Affective, Behavioral, and Cognitive Correlates Surrounding Spasmodic Dysphonia.

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Vanryckeghem, Martine; Hoffman Ruddy, Bari; Lehman, Jeffrey

2016-01-01

This study investigates if adults with adductor spasmodic dysphonia (ADSD) report to experience anxiety and voice problems in particular situations, indicate the presence of negative speech-associated attitude, and/or the use of coping behaviors, by means of the Behavior Assessment Battery (BAB) modified for voice. Thirty-two participants with ADSD and 32 adults without a voice disorder participated in this study. Each person completed four different BAB-Voice subtests. These standardized self-report tests are adaptations of the original BAB for people who stutter and explore an individual's speech-related belief, negative emotional reaction to and speech problems in particular speech situations, and the use of concomitant behaviors. Individuals with spasmodic dysphonia (SD) scored statistically significantly higher compared to typical speakers on all BAB subtests, indicating that individuals with SD report being significantly more anxious and experiencing significantly more voice problems in particular speech circumstances. They also reported a significant amount of negative speech-associated attitude and the use of a significant number of coping behaviors. Internal reliability was good for three of the four BAB subtests. The BAB is capable of reflecting the dimensions that surround the disorder of SD. The self-report measures have the potential to augment the observations made by the clinician and may lead to a more diverse and all-encompassing therapy for the person suffering from SD. Future research with a revised version of the BAB-Voice will continue to explore the validity, reliability, and replicability of the initial data. Published by Elsevier Inc.

Involuntary movements in the elderly. Parkinson's disease and other causes.

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Miller, J Q

1986-03-01

Dyskinesia is usually lifelong and progressive; therefore, physicians generally see the disorder in elderly patients. Medical treatment must be carefully selected on the basis of the cause of the dyskinesia. Parkinsonian dyskinesia is well controlled by drug therapy. However, patients can become less responsive to a drug after years of use and may experience unwelcome side effects. Cerebellar tremor is extremely disabling because it worsens with activity, but no satisfactory therapy is available. Senile, essential, and familial tremors are also intensified by action, but they can often be suppressed with a mild tranquilizer or a beta blocker. Drug treatment of blepharospasm and spastic dysphonia has been disappointing: Facial or laryngeal surgery is sometimes required. Tardive dyskinesia is caused by neuroleptic drugs, so the only therapy for the disorder is withdrawal of the offending drug.

Case report: Infective endocarditis caused by Brevundimonas vesicularis

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Chen Tun-Chieh

2006-12-01

Full Text Available Abstract Background There are few reports in the literature of invasive infection caused by Brevundimonas vesicularis in patients without immunosuppression or other predisposing factors. The choice of antimicrobial therapy for bacteremia caused by the pathogen requires more case experience to be determined. Case presentation The case of a 40-year-old previously healthy man with subacute endocarditis proposed to be contributed from an occult dental abscess is described. The infection was found to be caused by B. vesicularis on blood culture results. The patient recovered without sequelae after treatment with ceftriaxone followed by subsequent ciprofloxacin therapy owing to an allergic reaction to ceftriaxone and treatment failure with ampicillin/sulbactam. Conclusion To our knowledge, this is the first report of B. vesicularis as a cause of infective endocarditis. According to an overview of the literature and our experience, we suggest that third-generation cephalosporins, piperacillin/tazobactam, and ciprofloxacin are effective in treating invasive B. vesicularis infections, while the efficacy of ampicillin-sulbactam needs further evaluation.

Inharmonicity Analysis: A Novel Physical Method for Acoustic Screening of Dysphonia

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Matteson, Sam; Lu, Fang-Ling

2008-10-01

In the United States 6.8% of men, women, and children report current voice problems and approximately 29% will report some problems during their lifetime. Often this dysphonia is due to pathologies of the vocal folds. The authors (a physicist and a speech pathologist) describe an interdisciplinary approach that shows promise of detecting physiological abnormalities of the vocal folds from an analysis of the Fourier spectrum of spoken ``tokens.'' The underlying principle maintains that the normal human vocal fold is a linear oscillator that emits overtones that are very nearly precise integral values of the fundamental. Physiological problems of the vocal folds, however, introduce mechanical non-linearities that manifest themselves as frequency deviations from the ideal harmonic (that is, integral) values. The authors quantify this inharmonicity, describing and illustrating how one can obtain and analyze such data. They outline, as well, a proposed program to assess the clinical sensitivity and significance of the analysis discussed in this work.

Psychiatric comorbidity in patients with spasmodic dysphonia: a controlled study

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Gündel, H; Busch, R; Ceballos‐Baumann, A; Seifert, E

2007-01-01

Objectives To study the prevalence of psychiatric comorbidity assessed by a structured clinical interview in patients with spasmodic dysphonia (SD) compared with patients suffering from vocal fold paralysis (VFP). Methods In 48 patients with SD and 27 patients with VFP, overall psychiatric comorbidity was studied prospectively using the Structured Clinical Interview for DSM‐IV Axis I disorders. Physical disability and psychometric variables were assessed with standardised self‐rating questionnaires. Results 41.7% of SD subjects and 19.5% of the control group met DSM‐IV clinical criteria for current psychiatric comorbidity (p<0.05). Significant predictors of psychiatric comorbidity in SD were severity of voice impairment and subjective assessment of “satisfaction with health”. As a limitation, the severity of voice impairment in patients with SD was nearly twice as high, and their illness had lasted nearly twice as long. Conclusions We found a high prevalence of psychiatric comorbidity in patients with SD. The significant correlation between current psychiatric comorbidity and the extent of voice pathology may point to an especially strong interaction between somatic and psychiatric complaints in SD. PMID:17615166

Spasmodic Dysphonia in Multiple Sclerosis Treatment With Botulin Toxin A: A Pilot Study.

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Di Stadio, Arianna; Bernitsas, Evanthia; Restivo, Domenico Antonio; Alfonsi, Enrico; Marchese-Ragona, Rosario

2018-04-09

This study aims to evaluate the effect of botulin toxin A in patients with multiple sclerosis (MS) affected by spasmodic dysphonia (SD) and to show the safety and effectiveness of this treatment in long-term observation. This is a pilot study on three relapsing-remitting MS patients with SD and their response to botulin toxin A. None of the patients reported dysphagia or other adverse events. Significant improvement was observed in terms of both voice quality and laryngostroboscopy results. The treatment effect was durable for 6-8 months. Botulin toxin A is a safe treatment that can be successfully used to treat SD in patients with MS. Larger studies are necessary to confirm our results. Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Herbal hepatotoxicity: suspected cases assessed for alternative causes.

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Teschke, Rolf; Schulze, Johannes; Schwarzenboeck, Alexander; Eickhoff, Axel; Frenzel, Christian

2013-09-01

Alternative explanations are common in suspected drug-induced liver injury (DILI) and account for up to 47.1% of analyzed cases. This raised the question of whether a similar frequency may prevail in cases of assumed herb-induced liver injury (HILI). We searched the Medline database for the following terms: herbs, herbal drugs, herbal dietary supplements, hepatotoxic herbs, herbal hepatotoxicity, and herb-induced liver injury. Additional terms specifically addressed single herbs and herbal products: black cohosh, Greater Celandine, green tea, Herbalife products, Hydroxycut, kava, and Pelargonium sidoides. We retrieved 23 published case series and regulatory assessments related to hepatotoxicity by herbs and herbal dietary supplements with alternative causes. The 23 publications comprised 573 cases of initially suspected HILI; alternative causes were evident in 278/573 cases (48.5%). Among them were hepatitis by various viruses (9.7%), autoimmune diseases (10.4%), nonalcoholic and alcoholic liver diseases (5.4%), liver injury by comedication (DILI and other HILI) (43.9%), and liver involvement in infectious diseases (4.7%). Biliary and pancreatic diseases were frequent alternative diagnoses (11.5%), raising therapeutic problems if specific treatment is withheld; pre-existing liver diseases including cirrhosis (9.7%) were additional confounding variables. Other diagnoses were rare, but possibly relevant for the individual patient. In 573 cases of initially assumed HILI, 48.5% showed alternative causes unrelated to the initially incriminated herb, herbal drug, or herbal dietary supplement, calling for thorough clinical evaluations and appropriate causality assessments in future cases of suspected HILI.

Mitochondrial Myopathy: A Rare Cause of Early-Onset Vocal Fold Atrophy

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Kelly, Elizabeth A.; Bock, Jonathan M.; Peltier, Amanda C.; Oh, Shin J.; Garrett, C. Gaelyn

2014-01-01

Objectives We present the second published case of laryngeal involvement in mitochondrial myopathy. Methods A patient with laryngeal involvement of mitochondrial myopathy is presented, together with a literature review. Results A 41-year-old man presented with progressive breathy dysphonia. His brother had mitochondrial myopathy. Biopsy of the biceps muscle demonstrated cytochrome C oxidase–negative ragged blue fibers confirming mitochondrial myopathy. Videostroboscopy showed marked vocal fold atrophy, but subsequent injection laryngoplasty did not significantly improve the patient’s voice, despite improved postoperative glottic closure. Conclusions Mitochondrial myopathy should be considered in the differential diagnosis of severe early-onset vocal fold atrophy. PMID:23577570

Subsidence over AML and its causes - A case study

International Nuclear Information System (INIS)

Peng, S.S.; Lin, P.M.; Hsiung, S.M.

1988-01-01

Subsidence over abandoned mined lands can be attributed to several causes. For purposes of compensation and liability and developing remedial measures, it is essential to identify the real causes. The detailed procedures for a subsidence investigation and the keys to identify and determine the causes and severity of the damages are illustrated and discussed through a case study in this paper. A subsidence check list has been developed for investigation purposes. The case discussed in this paper is a mining-related subsidence. The associated subsidence index was 60%. The damage to the dwelling was due to tension. The major damage was developed within two days. A crackmeter was installed on the exterior wall to monitor the house movement. An inclinometer casing and a Sondex casing were installed in a borehole to monitor the ground movement. The results of the geotechnical instrumentation are presented to illustrate the procedures developed for investigating the subsidence cases over the abandoned mine lands

Laryngeal Schwannoma: A Case Presentation and Review of the Mayo Clinic Experience.

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Romak, Jonathan J; Neel, H Bryan; Ekbom, Dale C

2017-01-01

The aim of this study was to clarify the nature of laryngeal schwannomas through review of the experience of a single institution during a 104-year period. This is a retrospective case series. The Mayo Clinic, Rochester, Minnesota clinical and surgical pathology database was reviewed for the years 1985-2011. Four cases of laryngeal schwannoma were identified. These cases were pooled with a previously published series of laryngeal schwannomas treated at our institution between 1907 and 1986. The characteristics of all 11 cases were studied, and relevant literature was reviewed. A total of 11 cases of schwannoma of the larynx were identified. The mean age at presentation was 48 years (range 12-73 years). The most common presenting symptoms were dysphonia and dysphagia. The most frequently involved primary site was the false vocal fold (six patients), followed by the aryepiglottic fold (three), epiglottis (two), subglottis (two), ventricle (one), true vocal fold (one) and postcricoid region (one). The mean maximal tumor diameter was 2.5 cm. In all but one case, surgical excision was curative with no recurrence during recorded follow up ranging from 1 to 17 years. Laryngeal schwannomas, although rare, should be considered in the differential diagnosis of laryngeal tumors. They occur most frequently in the false vocal fold and present most commonly with dysphonia and/or dysphagia. Surgical excision is the treatment of choice. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Correlation of the Voice Handicap Index-10 (VHI-10) and Voice-Related Quality of Life (V-RQOL) in patients with dysphonia.

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Romak, Jonathan J; Orbelo, Diana M; Maragos, Nicolas E; Ekbom, Dale C

2014-03-01

This study examines the correlation between two voice-specific patient-reported outcome measures: the Voice Handicap Index-10 (VHI-10) and Voice-Related Quality of Life (V-RQOL). Retrospective chart review. Eight hundred four patients presenting to our voice clinic between May 2009 and August 2011. All patients completed the VHI-10 and V-RQOL in a single sitting. Correlation between the two scales was examined using Spearman rank analysis. Calculated VHI-10 score was derived from V-RQOL score by direct conversion equation and compared with measured VHI-10 score. Receiver Operating Characteristic (ROC) curves were derived for diagnostic groups. Spearman correlation coefficient between the VHI-10 and V-RQOL was -0.91 (P dysphonia (V-RQOL AUC = 0.536 [SE ± 0.026]; VHI-10 AUC = 0.508 [SE ± 0.26]; P = 0.018) groups, with the V-RQOL showing relatively greater sensitivity. The VHI-10 and V-RQOL are highly correlated. However, VHI-10 score cannot be calculated from V-RQOL score using the tested equation. The V-RQOL may be more sensitive than the VHI-10 in detecting the impact of presbyphonia and muscle tension dysphonia. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Endophthalmitis caused by Acinetobacter baumanni: a case series.

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Roy, R; Panigrahi, P; Malathi, J; Pal, S S; Nandi, K; Patil, A; Nigam, E; Arora, V

2013-03-01

To profile the etiology, clinical outcomes and drug sensitivity patterns in endophthalmitis caused by Acinetobacter baumanni. Retrospective analysis of all the cases of Acinetobacter baumanni endophthalmitis presenting to tertiary referral care ophthalmic hospital in Eastern India from January 2009 to December 2011 were done. A total of four cases were included in the study. Out of the four cases one was post traumatic and the rest were post cataract surgery. All the cases underwent vitreoretinal surgical intervention followed by intravitreal antibiotics. A. Baumanni was isolated from vitreous in all the cases. Among all the drugs tested bacteria were found sensitive to ciprofloxacin (100 %) whereas all tested resistant to ceftazidime. Out of the four cases one had to be eviscerated, another developed retinal detachment post vitrectomy, one was phthisical at final followup, and only one patient achieved a vision of 20/200 with clear media and attached retina at final visit. A. Baumanni is a very rare cause of endophthalmitis with poor visual and anatomical outcomes. Ciprofloxacin should be considered as first the line intravitreal antibiotic.

Aerodynamic profiles of women with muscle tension dysphonia/aphonia.

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Gillespie, Amanda I; Gartner-Schmidt, Jackie; Rubinstein, Elaine N; Abbott, Katherine Verdolini

2013-04-01

In this study, the authors aimed to (a) determine whether phonatory airflows and estimated subglottal pressures (est-Psub) for women with primary muscle tension dysphonia/aphonia (MTD/A) differ from those for healthy speakers; (b) identify different aerodynamic profile patterns within the MTD/A subject group; and (c) determine whether results suggest new understanding of pathogenesis in MTD/A. Retrospective review of aerodynamic data collected from 90 women at the time of primary MTD/A diagnosis. Aerodynamic profiles were significantly different for women with MTD/A as compared with healthy speakers. Five distinct profiles were identified: (a) normal flow, normal est-Psub; (b) high flow, high est-Psub; (c) low flow, normal est-Psub; (d) normal flow, high est-Psub; and (e) high flow, normal est-Psub. This study is the first to identify distinct subgroups of aerodynamic profiles in women with MTD/A and to quantitatively identify a clinical phenomenon sometimes described in association with it-"breath holding"-that is shown by low airflow with normal est-Psub. Results were consistent with clinical claims that diverse respiratory and laryngeal functions may underlie phonatory patterns associated with MTD/A. One potential mechanism, based in psychobiological theory, is introduced to explain some of the variability in aerodynamic profiles of women with MTD/A.

Morell Mackenzie's Contribution to the Description of Spasmodic Dysphonia.

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Lorch, Marjorie Perlman; Whurr, Renata

2016-12-01

Since the middle of the 20th century, most discussions of spasmodic dysphonia (SD) reference a paper by Ludwig Traube published in1871 as the first historical citation, crediting him with priority for this clinical syndrome. However, our recent research has determined that the original observation by Traube was published in 1864 and does not in fact describe what is currently recognized as SD. It appears that many clinics throughout Europe and North America were investigating and publishing observations on a range of voice disorders. The wider context of work on laryngeal disorders in the 1860s-1870s is considered. One of Traube's contemporaries, Morell Mackenzie, made significant contributions to the understanding of laryngeal movement disorder and its consequences for the voice. These will be examined to gain a clearer focus on the characterization of this disorder. The clinical descriptions published by Morrell Mackenzie in the 1860s provide details that conform quite closely to our current-day understanding of SD. The citation of Traube's "hysterical" patient links to mid 20th-century views of the functional nature of SD and the utility of psychiatric treatment. The description presented by Mackenzie is consistent with current views of SD as a movement disorder. © The Author(s) 2016.

Two Cases of Vulvovaginitis Caused by Shigella flexneri and Shigella sonnei: a Case Report

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Gülçin Bayramoğlu

2012-03-01

Full Text Available Vulvovaginitis caused by Shigella species (Shigella spp. has rarely been reported. This paper describes two cases of prepubertal vulvovaginitis, presenting with a bloody and purulent vaginal discharge, separately caused by ampicillin-resistant Shigella flexneri and trimethoprim-sulfomethoxazole-resistant Shigella sonnei. Our conclusions are that Shigella spp. is the potential cause of vulvovaginitis in prepubertal girls in developing countries where these pathogens are endemic, and identification of the bacteria and making antibiotic susceptibility testing in these cases should not be overlooked.

The Comparison of Thyroarytenoid Muscle Myectomy and Type II Thyroplasty for Spasmodic Dysphonia.

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Nomoto, Masaki; Tokashiki, Ryoji; Hiramatsu, Hiroyuki; Konomi, Ujimoto; Motohashi, Rei; Sakurai, Eriko; Toyomura, Fumimasa; Ueda, Yuri; Inoue, Shun; Tsukahara, Kiyoaki; Suzuki, Mamoru

2015-07-01

Surgical treatments for adductor spasmodic dysphonia include bilateral thyroarytenoid muscle myectomy (TAM) and type II thyroplasty (TPII), both of which are commonly performed. The present study aimed to compare the effects of TAM and TPII. Retrospective study. Subjects were 30 and 35 patients who underwent TAM and TPII, between March 2008 and November 2012. Voice quality was evaluated based on "voice handicap index 10 (VHI10)" and auditory impressions before and 6 months after surgery using five parameters: "strangulation," "interruption," "tremor," "grade," and "breathiness." Comparison of the two procedures revealed significant improvements in VHI10, strangulation, interruption, and tremor, and a significant decline in breathiness after surgery. In particular, VHI10 was improved by more than six points in 90% of patients with TAM, and 96% with TPII. No significant difference was observed between the severities of two procedures preoperatively. Comparison of each postoperative score between the two procedures revealed that TAM significantly improved strangulation, interruption, and tremor, and significantly worsened breathiness, with no significant difference in VHI10. Scatter plots (x: preoperative scores; y: postoperative scores) and regression lines of evaluation items demonstrated that TAM is more effective than TPII in severe cases. Compared with TPII, TAM tends to improve strangulation, interruption, and tremor; however, it tends to worsen breathiness postoperatively. Postoperative VHI10 scores did not differ significantly between the two procedures. Given favorable improvement rates, both surgical procedures were considered effective. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Botulinum toxin treatment of false vocal folds in adductor spasmodic dysphonia: Functional outcomes.

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Simpson, C Blake; Lee, Christopher T; Hatcher, Jeanne L; Michalek, Joel

2016-01-01

Supraglottic injection of botulinum toxin (Botox) has been described as an effective treatment for adductor spasmodic dysphonia (ADSD). Anecdotal evidence suggests that the patients have little to no breathiness after injection, but no formal longitudinal studies have been carried out to date. The purpose of this study was to examine the voice outcomes in patients with ADSD after supraglottic Botox injection. Retrospective case series. Patients with ADSD who were treated with supraglottic Botox injections completed a qualitative self-evaluation of voice function after injection using the percentage of normal function (PNF) scale, a validated, quantitative scale from 0% (no function) to 100% (normal function). Posttreatment voice improvement after injection was determined using a Voice Handicap Index-10 (VHI-10) questionnaire. A total of 198 supraglottic injections were performed between July 2011 and October 2014. Twenty-five questionnaires were completed. Mean postinjection PNF was 95.0% ± 8.4% and was significantly increased from the preinjection mean PNF (62.5%) ± 22.6% (P < 0.001). The mean best VHI-10 for all injections was 7.23. In 19 of 25 patients (76%), there was no reduction in PNF in the early postinjection period. In the remaining six patients (24%), the decline in mean vocal function was 9.2%. Supraglottic Botox injection is an effective treatment for ADSD. Postinjection voice is significantly improved, and the majority of patients do not experience breathy voice/decline in vocal function after injection. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Primary laryngeal localization of multiple myeloma: A case report

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Allegra, Eugenia; Marino, Nicol?; Modica, Domenico; Emmanuele, Carmela; Saita, Vincenzo

2017-01-01

Multiple myeloma is a lymphoproliferative disease that may involve the bone marrow as well as extramedullary soft tissues. However, laryngeal localization of multiple myeloma is extremely rare. We herein present the case of a 68-year-old male patient with a history of dyspnea, dysphonia and dysphagia. Laryngoscopic examination revealed a lesion involving the right glottis and right vestibular (false) vocal fold, with absence of ipsilateral laryngeal motility and constriction of the airway. Co...

Laryngeal dystonia gravidarum: sudden onset of adductor spasmodic dysphonia in pregnancy.

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Ankola, Ashish; Sulica, Lucian; Murry, Thomas

2013-12-01

The purpose of this study was to identify the presence or absence of known factors related to onset of adductor spasmodic dysphonia (ADSD) in a population with sudden onset during or after pregnancy. Retrospective review. A review of 350 patient records identified five patients with sudden onset of ADSD related to pregnancy. An age-matched group with sudden onset of ADSD not related to pregnancy served as controls. All subjects completed a 20-question survey of risk factors relevant to ADSD. The average age of onset in both groups was 31 years. Three had onset of ADSD in the postpartum period, the other two during pregnancy. Significantly increased avocational voice use was found in the pregnant group compared to the control group. There was a significant difference in the two groups regarding cumulative risk factors traditionally associated with ADSD. Sudden onset of ADSD can occur in pregnancy in women with clinical profiles that differ from traditional ADSD patients. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Laryngeal manual therapy palpatory evaluation scale: A preliminary study to examine its usefulness in diagnosis of occupational dysphonia

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Ewelina Woźnicka

2017-04-01

Full Text Available Background: The aim of this study has been to assess the larynx and soft tissue around the vocal tract in a group of people with healthy voice, and in a group of patients with occupational dysphonia using the new laryngeal manual therapy palpatory evaluation scale (LMTPE. Material and Methods: The examinations were performed in a study (dysphonic group of professional voice users who had developed voice disorders (N = 51 and in the control group of normophonic subjects (N = 50. All the participants underwent perceptual voice assessment and examination by means of the LMTPE scale. Additionally, phoniatric examination including VHI (Voice Handicap Index questionnaire, GRBAS (the Grade of hoarseness, Roughness, Breathiness, Asthenic, Strained perceptual evaluation, maximum phonation time (MPT measurement and videostroboscopy was performed in the study group. Results: The comparison of the LMTPE total score showed that the results of the study group were significantly poorer than those of controls (p < 0.001. In the study group, correlations were found between the LMTPE results and the VHI scores (p < 0.05, perceptual evaluation by the GRBAS (p < 0.05 and the objective parameter MPT (p < 0.05. Conclusions: The study has proven that the LMTPE scale is characterized by the high score of Cronbach’s α ratio estimating the reliability of the test. The results have confirmed that the LMTPE scale seems to be a valuable tool, useful in diagnostics of occupational dysphonia, particularly of hyperfunction origin. Med Pr 2017;68(2:179–188

Adherence to Voice Therapy Recommendations Is Associated With Preserved Employment Fitness Among Teachers With Work-Related Dysphonia.

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Rinsky-Halivni, Lilah; Klebanov, Miriam; Lerman, Yehuda; Paltiel, Ora

2017-05-01

Referral to voice therapy and recommendations for voice rest and microphone use are common interventions in occupational medicine aimed at preserving the working capability of teachers with occupation-related voice problems. Research on the impact of such interventions in terms of employment is lacking. This study examined changes in fitness (ie, ability) to work of dysphonic teachers referred to an occupational clinic and evaluated employment outcomes following voice therapy, voice rest, and microphone use. A historical prospective study was carried out. Of 365 classroom teachers who were first referred to a regional occupational medicine clinic due to dysphonia between January 2007 and December 2012, 156 were sampled and 153 were followed-up for an average of 5 years (range 2-8). Data were collected from medical records and from interviews conducted in 2014 aimed at assessing employment status. Logistic regression models were used to assess associations between interventions and employment outcomes. Survival analyses were performed to evaluate the association between participating in voice therapy and length of retained employment fitness. Thirty-four (22.2%) teachers suffered declines in working capabilities due to dysphonia. Voice therapy was demonstrated as being a protective factor against such declines (odds ratio = 0.05 [0.01-0.27]). Adherence to recommendation of voice therapy was teachers occurred within 20 months after referral. Unlike voice therapy, voice rest and microphone use were not associated with retention of working capabilities. Voice therapy, especially when instituted early, is a strong predictor for retaining fitness for employment among dysphonic teachers. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

An unusual osteomyelitis caused by Moraxella osloensis: A case report

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Nidal J. Alkhatib

Full Text Available Introduction: Moraxella osloensis is a gram-negative coccobacillus, that is saprophytic on skin and mucosa, and rarely causing human infections. Reported cases of human infections usually occur in immunocompromised patients. Presentation of case: We report the second case of M. osloensis-caused-osteomyelitis in literature, occurring in a young healthy man. The organism was identified by sequencing analysis of the 16S ribosomal RNA gene. Our patient was treated successfully with surgical debridement and intravenous third-generation cephalosporins. Discussion: M. osloensis has been rarely reported to cause local or invasive infections. Our case report is the second case in literature and it is different from the previously reported case in that our patient has no chronic medical problems, no history of trauma, with unique presentation and features on the MRI and intraoperative finding. Conclusion: Proper diagnosis is essential for appropriate treatment of osteomyelitis. RNA gene sequence analysis is the primary method of M. osloensis diagnosis. M. osloensis is usually susceptible to simple antibiotics. Keywords: Moraxella osloensis, Osteomyelitis, Case report

Septicemia caused by Vibrio parahemolyticus: a case report.

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Hsu, G J; Young, T; Peng, M Y; Chang, F Y; Chou, M Y

1993-11-01

Vibrio parahemolyticus is a halophilic marine vibrio commonly associated with outbreaks of acute gastroenteritis which also sometimes causes serious wound infection. It is an uncommon cause of septicemia. A few reports suggest that patients with chronic liver disease and leukemia are more susceptible. A case of liver cirrhosis with septicemia caused by this organism is discussed. The patient's condition rapidly deteriorated, and he died 12 hours after admission.

Central voice production and pathophysiology of spasmodic dysphonia.

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Mor, Niv; Simonyan, Kristina; Blitzer, Andrew

2018-01-01

Our ability to speak is complex, and the role of the central nervous system in controlling speech production is often overlooked in the field of otolaryngology. In this brief review, we present an integrated overview of speech production with a focus on the role of central nervous system. The role of central control of voice production is then further discussed in relation to the potential pathophysiology of spasmodic dysphonia (SD). Peer-review articles on central laryngeal control and SD were identified from PUBMED search. Selected articles were augmented with designated relevant publications. Publications that discussed central and peripheral nervous system control of voice production and the central pathophysiology of laryngeal dystonia were chosen. Our ability to speak is regulated by specialized complex mechanisms coordinated by high-level cortical signaling, brainstem reflexes, peripheral nerves, muscles, and mucosal actions. Recent studies suggest that SD results from a primary central disturbance associated with dysfunction at our highest levels of central voice control. The efficacy of botulinum toxin in treating SD may not be limited solely to its local effect on laryngeal muscles and also may modulate the disorder at the level of the central nervous system. Future therapeutic options that target the central nervous system may help modulate the underlying disorder in SD and allow clinicians to better understand the principal pathophysiology. NA.Laryngoscope, 128:177-183, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

The effect of unilateral thalamic deep brain stimulation on the vocal dysfunction in a patient with spasmodic dysphonia: interrogating cerebellar and pallidal neural circuits.

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Poologaindran, Anujan; Ivanishvili, Zurab; Morrison, Murray D; Rammage, Linda A; Sandhu, Mini K; Polyhronopoulos, Nancy E; Honey, Christopher R

2018-02-01

Spasmodic dysphonia (SD) is a neurological disorder of the voice where a patient's ability to speak is compromised due to involuntary contractions of the intrinsic laryngeal muscles. Since the 1980s, SD has been treated with botulinum toxin A (BTX) injections into the throat. This therapy is limited by the delayed-onset of benefits, wearing-off effects, and repeated injections required every 3 months. In a patient with essential tremor (ET) and coincident SD, the authors set out to quantify the effects of thalamic deep brain stimulation (DBS) on vocal function while investigating the underlying motor thalamic circuitry. A 79-year-old right-handed woman with ET and coincident adductor SD was referred to our neurosurgical team. While primarily treating her limb tremor, the authors studied the effects of unilateral, thalamic DBS on vocal function using the Unified Spasmodic Dysphonia Rating Scale (USDRS) and voice-related quality of life (VRQOL). Since dystonia is increasingly being considered a multinodal network disorder, an anterior trajectory into the left thalamus was deliberately chosen such that the proximal contacts of the electrode were in the ventral oralis anterior (Voa) nucleus (pallidal outflow) and the distal contacts were in the ventral intermediate (Vim) nucleus (cerebellar outflow). In addition to assessing on/off unilateral thalamic Vim stimulation on voice, the authors experimentally assessed low-voltage unilateral Vim, Voa, or multitarget stimulation in a prospective, randomized, doubled-blinded manner. The evaluators were experienced at rating SD and were familiar with the vocal tremor of ET. A Wilcoxon signed-rank test was used to study the pre- and posttreatment effect of DBS on voice. Unilateral left thalamic Vim stimulation (DBS on) significantly improved SD vocal dysfunction compared with no stimulation (DBS off), as measured by the USDRS (p dysphonia. A Phase 1 pilot trial (DEBUSSY; clinical trial no. NCT02558634, clinicaltrials.gov) is

Correlation among the dysphonia severity index (DSI), the RBH voice perceptual evaluation, and minimum glottal area in female patients with vocal fold nodules.

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Hussein Gaber, Ammar Gaber; Liang, Fa-Ya; Yang, Jin-Shan; Wang, Ya-Jing; Zheng, Yi-Qing

2014-01-01

To investigate the clinical significance and correlation of the dysphonia severity index (DSI), the RBH (roughness [R]; breathiness [B]; hoarseness [H]) perceptual voice quality evaluation, and minimum glottal area (MGA) in patients with vocal fold nodules and validate the practicality of the DSI further. The DSI evaluation, the voice RBH perceptual evaluation, and the MGA were performed on 30 female patients with vocal fold nodules (the patient group) and 30 female volunteers with normal voices (the control group). The DSI determination was calculated using the following formula: DSI = 0.13 × MPT + 0.0053 × F(0)-High - 0.26 × I-Low - 1.18 × Jitter(%) + 12.4. The RBH evaluation was graded according to four scales. The MGA was measured by KayPENTAX Kips (7105) software. The differences among the DSI, the RBH grade, and MGA of the patients were compared. The median DSI values of the patient group and the control group were -0.81 and 3.79, respectively, and the difference was statistically significant (P dysphonia in female patients with vocal nodules has significant clinical application and good correlation with MGA measurement. Copyright © 2014 The Voice Foundation. All rights reserved.

Neural correlates of dystonic tremor: A multimodal study of voice tremor in spasmodic dysphonia

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Kirke, Diana N.; Battistella, Giovanni; Kumar, Veena; Rubien-Thomas, Estee; Choy, Melissa; Rumbach, Anna; Simonyan, Kristina

2016-01-01

Tremor, affecting a dystonic body part, is a frequent feature of adult-onset dystonia. However, our understanding of dystonic tremor pathophysiology remains ambiguous, as its interplay with the main co-occurring disorder, dystonia, is largely unknown. We used a combination of functional MRI, voxel-based morphometry and diffusion-weighted imaging to investigate similar and distinct patterns of brain functional and structural alterations in patients with dystonic tremor of voice (DTv) and isolated spasmodic dysphonia (SD). We found that, compared to controls, SD patients with and without DTv showed similarly increased activation in the sensorimotor cortex, inferior frontal (IFG) and superior temporal gyri, putamen and ventral thalamus, as well as deficient activation in the inferior parietal cortex and middle frontal gyrus (MFG). Common structural alterations were observed in the IFG and putamen, which were further coupled with functional abnormalities in both patient groups. Abnormal activation in left putamen was correlated with SD onset; SD/DTv onset was associated with right putaminal volumetric changes. DTv severity established a significant relationship with abnormal volume of the left IFG. Direct patient group comparisons showed that SD/DTv patients had additional abnormalities in MFG and cerebellar function and white matter integrity in the posterior limb of the internal capsule. Our findings suggest that dystonia and dystonic tremor, at least in the case of SD and SD/DTv, are heterogeneous disorders at different ends of the same pathophysiological spectrum, with each disorder carrying a characteristic neural signature, which may potentially help development of differential markers for these two conditions. PMID:26843004

Neural correlates of dystonic tremor: a multimodal study of voice tremor in spasmodic dysphonia.

Science.gov (United States)

Kirke, Diana N; Battistella, Giovanni; Kumar, Veena; Rubien-Thomas, Estee; Choy, Melissa; Rumbach, Anna; Simonyan, Kristina

2017-02-01

Tremor, affecting a dystonic body part, is a frequent feature of adult-onset dystonia. However, our understanding of dystonic tremor pathophysiology remains ambiguous as its interplay with the main co-occurring disorder, dystonia, is largely unknown. We used a combination of functional MRI, voxel-based morphometry and diffusion-weighted imaging to investigate similar and distinct patterns of brain functional and structural alterations in patients with dystonic tremor of voice (DTv) and isolated spasmodic dysphonia (SD). We found that, compared to controls, SD patients with and without DTv showed similarly increased activation in the sensorimotor cortex, inferior frontal (IFG) and superior temporal gyri, putamen and ventral thalamus, as well as deficient activation in the inferior parietal cortex and middle frontal gyrus (MFG). Common structural alterations were observed in the IFG and putamen, which were further coupled with functional abnormalities in both patient groups. Abnormal activation in left putamen was correlated with SD onset; SD/DTv onset was associated with right putaminal volumetric changes. DTv severity established a significant relationship with abnormal volume of the left IFG. Direct patient group comparisons showed that SD/DTv patients had additional abnormalities in MFG and cerebellar function and white matter integrity in the posterior limb of the internal capsule. Our findings suggest that dystonia and dystonic tremor, at least in the case of SD and SD/DTv, are heterogeneous disorders at different ends of the same pathophysiological spectrum, with each disorder carrying a characteristic neural signature, which may potentially help development of differential markers for these two conditions.

Brain Activity in Patients With Adductor Spasmodic Dysphonia Detected by Functional Magnetic Resonance Imaging.

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Kiyuna, Asanori; Kise, Norimoto; Hiratsuka, Munehisa; Kondo, Shunsuke; Uehara, Takayuki; Maeda, Hiroyuki; Ganaha, Akira; Suzuki, Mikio

2017-05-01

Spasmodic dysphonia (SD) is considered a focal dystonia. However, the detailed pathophysiology of SD remains unclear, despite the detection of abnormal activity in several brain regions. The aim of this study was to clarify the pathophysiological background of SD. This is a case-control study. Both task-related brain activity measured by functional magnetic resonance imaging by reading the five-digit numbers and resting-state functional connectivity (FC) measured by 150 T2-weighted echo planar images acquired without any task were investigated in 12 patients with adductor SD and in 16 healthy controls. The patients with SD showed significantly higher task-related brain activation in the left middle temporal gyrus, left thalamus, bilateral primary motor area, bilateral premotor area, bilateral cerebellum, bilateral somatosensory area, right insula, and right putamen compared with the controls. Region of interest voxel FC analysis revealed many FC changes within the cerebellum-basal ganglia-thalamus-cortex loop in the patients with SD. Of the significant connectivity changes between the patients with SD and the controls, the FC between the left thalamus and the left caudate nucleus was significantly correlated with clinical parameters in SD. The higher task-related brain activity in the insula and cerebellum was consistent with previous neuroimaging studies, suggesting that these areas are one of the unique characteristics of phonation-induced brain activity in SD. Based on FC analysis and their significant correlations with clinical parameters, the basal ganglia network plays an important role in the pathogenesis of SD. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Considerations for initial dosing of botulinum toxin in treatment of adductor spasmodic dysphonia.

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Rosow, David E; Parikh, Punam; Vivero, Richard J; Casiano, Roy R; Lundy, Donna S

2013-06-01

To assess the effect on voice improvement and duration of breathiness based on initial dose of onabotulinum toxin A (BTX-A) in the management of adductor spasmodic dysphonia (SD) and to compare voice outcomes for initial bilaterally injected doses of 1.25 units (group A) vs 2.5 units (group B) of BTX-A. Case series with chart review of patients with adductor SD treated at a tertiary care facility from 1990 to 2011. Academic subspecialty laryngology practice. Demographic data (age and sex), voice rating, duration of voice improvement, and breathiness were evaluated and compared between groups A and B using the Student t test and χ(2) analysis. Of 478 patients identified, 305 (223 in group A, 82 in group B) patients met inclusion criteria. The average age was 56.2 years in group A and 57.4 years in group B (P = .5). The female to male ratio was 2.91 for group A vs 3.56 for group B (P = .61). Good voice outcomes (grade 3 or 4) were reported by 91% of group A patients vs 94% of group B (P = .75). The average duration of voice improvement was 99.7 days for group A and 108.3 days for group B (P = .54). The average duration of breathiness was 10.88 days for group A vs 15.42 days for group B (P = .02). Patients injected with 1.25 units bilaterally had a statistically significant shorter duration of breathiness without a statistically significant difference in clinical effectiveness or voice outcome. It is therefore recommended that a relatively low initial BTX-A dose be used with subsequent titration to achieve improved voice outcomes.

Qualidade de Vida em Voz: estudo na doença de Parkinson idiopática e na Disfonia Espasmódica Adutora Quality of life in voice: a study in Parkinson's disease and in adductor spasmodic dysphonia

Directory of Open Access Journals (Sweden)

Bárbara Pereira Lopes

2012-01-01

Full Text Available OBJETIVO: avaliar o impacto causado pela alteração vocal na qualidade de vida (QV dos pacientes com doença de Parkinson (DP idiopática e com disfonia espasmódica adutora (DEA. MÉTODO: o estudo foi realizado com 56 indivíduos do sexo feminino, dos quais 28 compunham o grupo controle; 14, o grupo de DEA, no período anterior ao tratamento com toxina botulínica; e 14, o grupo de DP idiopática. Os participantes preencheram o questionário de Qualidade de Vida em Voz (QVV validado para o português brasileiro. Para verificar a diferença entre as médias dos grupos foi utilizado o método de análise de variância por postos de Kruskal-Wallis e o teste de Tamhane para comparações múltiplas, com significância PURPOSE: to evaluate the impact of voice disorders on quality of life of patients with idiopathic Parkinson's disease and with adductor spasmodic dysphonia. METHOD: the study consisted of 56 females, 28 in the control group; 14, the adductor spasmodic dysphonia group in the period prior to treatment with botulinum toxin; and 14, the group of idiopathic Parkinson's disease. The participants filled in the Voice-Related Quality of life (V-RQOL questionnaire validated for Brazilian Portuguese. To check the difference between averages of the groups it was used the method of analysis of variance by Kruskal-Wallis and Tamhane test for multiple comparisons, with significance <0.05. RESULTS: the average age of the groups were 66.18 for the control group, 67.21 for the Parkinson's disease group and 59.7 for the adductor spasmodic dysphonia group, with no statistical difference between the groups. In the V-RQOL protocol the mean domain social-emotional, physical functioning and total score were higher in the control group, followed by group of Parkinson's disease and, finally, the group of adductor spasmodic dysphonia with statistically significant difference between them. In addition, there was statistical difference for each pair of groups

Qualidade de Vida em Voz: estudo na doença de Parkinson idiopática e na disfonia espasmódica adutora Quality of life in voice: a study in Parkinson's disease and in adductor spasmodic dysphonia

Directory of Open Access Journals (Sweden)

Bárbara Pereira Lopes

2013-04-01

Full Text Available OBJETIVO: avaliar o impacto causado pela alteração vocal na qualidade de vida (QV dos pacientes com doença de Parkinson (DP idiopática e com disfonia espasmódica adutora (DEA. MÉTODO: o estudo foi realizado com 56 indivíduos do sexo feminino, dos quais 28 compunham o grupo controle; 14, o grupo de DEA, no período anterior ao tratamento com toxina botulínica; e 14, o grupo de DP idiopática. Os participantes preencheram o questionário de Qualidade de Vida em Voz (QVV validado para o português brasileiro. Para verificar a diferença entre as médias dos grupos foi utilizado o método de análise de variância por postos de Kruskal-Wallis e o teste de Tamhane para comparações múltiplas, com significância PURPOSE: to evaluate the impact of voice disorders on quality of life of patients with idiopathic Parkinson's disease and with adductor spasmodic dysphonia. METHOD: the study consisted of 56 females, 28 in the control group; 14, the adductor spasmodic dysphonia group in the period prior to treatment with botulinum toxin; and 14, the group of idiopathic Parkinson's disease. The participants filled in the Voice-Related Quality of life (V-RQOL questionnaire validated for Brazilian Portuguese. To check the difference between averages of the groups it was used the method of analysis of variance by Kruskal-Wallis and Tamhane test for multiple comparisons, with significance <0.05. RESULTS: the average age of the groups were 66.18 for the control group, 67.21 for the Parkinson's disease group and 59.7 for the adductor spasmodic dysphonia group, with no statistical difference between the groups. In the V-RQOL protocol the mean domain social-emotional, physical functioning and total score were higher in the control group, followed by group of Parkinson's disease and, finally, the group of adductor spasmodic dysphonia with statistically significant difference between them. In addition, there was statistical difference for each pair of groups

Hemobilia caused by a ruptured hepatic cyst: a case report

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Dutta Sudhir

2011-01-01

Full Text Available Abstract Introduction Hemobilia is a rare cause of upper gastrointestinal bleeding. More than 50% of hemobilia cases are related to iatrogenic trauma from hepatobiliary procedures, and needle biopsy of the liver represents the most common cause. A minority of hemobilia cases are due to hepatobiliary disorders such as cholangitis, hepatobiliary cancers, choledocholithiasis, and vascular abnormalities in the liver. The classic presentation of hemobilia is the triad of right upper quadrant (biliary pain, obstructive jaundice, and upper gastrointestinal bleeding. We report a rare case of hemobilia caused by a spontaneous hepatic cyst rupture, where our patient presented without the classical symptoms, in the absence of therapeutic or pathological coagulopathy, and in the absence of spontaneous or iatrogenic trauma. Case presentation A 91-year-old African-American woman was referred to our out-patient gastroenterology clinic for evaluation of mild epigastric pain and intermittent melena. An abdominal computed tomography scan was remarkable for multiple hepatic cysts. Esophagogastroduodenoscopy revealed multiple blood clots at the ampulla of Vater. Endoscopic retrograde cholangiopancreatography showed a single 18 mm-sized filling defect in the common hepatic duct wall at the junction of the right and left hepatic duct, adjacent to one of the hepatic cysts. The ruptured hepatic cyst communicated to the bile ducts and was the cause of hemobilia with an atypical clinical presentation. Conclusion Hemobilia is an infrequent cause of upper gastrointestinal bleeding and rarely occurs due to hepatic cyst rupture. To the best of our knowledge, this is only the second case report in the literature that describes hemobilia due to hepatic cyst rupture. However, it is the first case in the literature of hemobilia due to hepatic cyst rupture in the absence of iatrogenic or spontaneous trauma, and in the absence of a spontaneous or pathological coagulopathy.

[Granular cell tumor of the larynx in the child. Case report].

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Cuestas, Giselle; Rodríguez, Verónica; Doormann, Flavia; Bellia Munzón, Patricio; Bellia Munzón, Gastón

2018-02-01

Laryngeal tumors are uncommon in children, accounting only for 2% of the laryngeal anomalies. Ninety-eight percent are benign; the most frequent ones are recurrent respiratory papillomatosis and haemangioma. Granular cell tumor, also called Abrikossoff tumor, is an unusual benign neoplasm, especially in the larynx. Clinical manifestations depend on the size and location of the tumor. Dysphonia is the main presenting symptom. The diagnosis is confirmed by the biopsy. The treatment of choice is surgery. We present a 9-year-old girl with dysphonia and exertion dyspnea due to a granular cell tumor of the larynx, and we emphasize the importance of considering the endoscopic evaluation of the airway in every child with progressive or persistent dysphonia in order to determine the etiology. Sociedad Argentina de Pediatría.

Analysis on causes of visual fatigue in 3 502 cases

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Yue-Lan Feng

2016-02-01

Full Text Available AIM:To observe the reason of visual fatigue in Inner Mongolian in order to provide the epidemiological data for the prevention and treatment of asthenopia.METHODS:This was a retrospective case-controlled study. From January 2011 to December 2014, all the clinical data of 3 502 patients who were diagnosed as asthenopia aged 7～50 was analyzed. The subjects were divided into 4 groups according to the age:(17～20 years old: 712 cases;(221～30 years old: 603 cases;(331～40 years old:694 cases;(441～50 years old:1 493 cases. The patients were examed for the conditions of anterior and posterior segment, Schirmer Ⅰ test, break-up time, computer optometry, subjective refraction, horizontal convergence and divergence, distance and near phoria, near point of convergence, accommodative convergence/accommodation ratio, accommodative facility, relative accommodation, amplitude of accommodation and accommodative response. The causes for asthenopia were analyzed by Kruskal-wallis H test first, then comparisons among groups were conducted by Nemenyi test. RESULTS:The causes for asthenopia were eye-related diseases(49.37%, ametropia(23.36%, accommodation and convergence function problem(21.70%, disorders of extraocular muscles function(5.57%. Kruskal-wallis H test showed significant differences on the prevalence of asthenopia caused by different reasons of the four groups(PPCONCLUSION: The causes of asthenopia are eye-related diseases, ametropia, accommodation and convergence function problem and disorders of extraocular muscles function.

Acute abdomen caused by ingested chicken wishbone: a case report

OpenAIRE

Hoxha, Faton T; Hashani, Shemsedin I; Komoni, Driton S; Gashi-Luci, Lumturije H; Kurshumliu, Fisnik I; Hashimi, Medita SH; Krasniqi, Avdyl S

2009-01-01

Introduction An ingested foreign body often passes the gastrointestinal tract without any complications. Foreign bodies, such as dentures, fish bones, chicken bones, and toothpicks, have been known to cause perforation of the GI tract. Case presentation We are presenting a case of a fifty-year-old male with acute abdomen; diffuse fibro purulent peritonitis, i.e. ileum perforation, caused by accidentally ingesting a chicken wishbone. He was treated surgically with ileum resection, and temporar...

Two Cases of Vulvovaginitis Caused by Shigella flexneri and Shigella sonnei: a Case Report

OpenAIRE

Bayramoğlu, Gülçin; Aydın, Faruk; Karagüzel, Gülay; İmamoğlu, Mustafa; Ökten, Ayşenur

2014-01-01

Vulvovaginitis caused by Shigella species (Shigella spp.) has rarely been reported. This paper describes two cases of prepubertal vulvovaginitis, presenting with a bloody and purulent vaginal discharge, separately caused by ampicillin-resistant Shigella flexneri and trimethoprim-sulfomethoxazoleresistant Shigella sonnei. Our conclusions are that Shigella spp. is the potential cause of vulvovaginitis in prepubertal girls in developing countries where these pathogens are endemic, and identifica...

Two Cases of Vulvovaginitis Caused by Shigella flexneri and Shigella sonnei: a Case Report

OpenAIRE

Bayramoğlu, Gülçin; Aydın, Faruk; Karagüzel, Gülay; İmamoğlu, Mustafa; Ökten, Ayşenur

2012-01-01

Vulvovaginitis caused by Shigella species (Shigella spp.) has rarely been reported. This paper describes two cases of prepubertal vulvovaginitis, presenting with a bloody and purulent vaginal discharge, separately caused by ampicillin-resistant Shigella flexneri and trimethoprim-sulfomethoxazoleresistant Shigella sonnei. Our conclusions are that Shigella spp. is the potential cause of vulvovaginitis in prepubertal girls in developing countries where these pathogens are endemic, and identifica...

Ectopic pancreas causing partial gastric outlet obstruction: a case ...

African Journals Online (AJOL)

Ectopic pancreas causing partial gastric outlet obstruction: a case report and review of literature. ... Nigerian Journal of Surgery ... Gastric outlet obstruction resulting from ectopic pancreas in an adult is the first of its kind in our center; we, therefore, present this case to describe the challenges faced with diagnosis, treatment, ...

Laryngeal neurinoma. Differential diagnosis of submucosal laryngeal tumors; Neurinoma laringeo. Diagnostico diferencial de tumoraciones submucosas laringeas

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Higuera, A.; Palomo, V.; Munoz, R.; Sanchez, F.

2002-07-01

Laryngeal neurinoma is a rare benign tumor that appears as a submucosal mass, generally in the supraglottic region. We report the case of a patient with dysphonia of long evolution caused by a neurinoma. We discuss the radiological findings of the tumor and the value of computed tomography (CT) in the diagnosis of this and other submucosal laryngeal lesions. (Author) 16 refs.

Laryngeal neurinoma. Differential diagnosis of submucosal laryngeal tumors

International Nuclear Information System (INIS)

Higuera, A.; Palomo, V.; Munoz, R.; Sanchez, F.

2002-01-01

Laryngeal neurinoma is a rare benign tumor that appears as a submucosal mass, generally in the supraglottic region. We report the case of a patient with dysphonia of long evolution caused by a neurinoma. We discuss the radiological findings of the tumor and the value of computed tomography (CT) in the diagnosis of this and other submucosal laryngeal lesions. (Author) 16 refs

Value of Laryngeal Electromyography in Spasmodic Dysphonia Diagnosis and Therapy.

Science.gov (United States)

Yang, Qingwen; Xu, Wen; Li, Yun; Cheng, Liyu

2015-07-01

To investigate the role of laryngeal electromyography (LEMG) in the diagnosis and treatment of spasmodic dysphonia (SD). The clinical manifestations, characteristics of motor unit potentials (MUPs), recruitment potentials, and laryngeal nerve evoked potentials (EPs) in LEMG, as well as the changes after botulinum toxin (BTX) treatment, were analyzed in 39 patients with adductor SD. The main clinical manifestations were a strained voice and phonation interruptions; in addition, the patients displayed hyper-adducted vocal folds during phonation. LEMG revealed significantly increased amplitudes of the thyroarytenoid muscle MUPs. The recruitment potentials were in a dense bunch, discharging full interference patterns with significantly increased amplitudes; the mean and maximum amplitude of recruitment potentials were 3090 μV and 5000 μV, respectively. The amplitude of EPs of thyroarytenoid muscle increased significantly; the mean and maximum amplitudes were 10.3 mV and 26.3 mV, respectively. After BTX was injected, the LEMG revealed denervation changes, and the EPs weakened or disappeared in the injected muscle. SD could be diagnosed, and the therapeutic efficacy of SD treatments could be evaluated based on clinical characteristics combined with LEMG characteristics. The increased amplitudes of the recruitment potentials and EPs of the thyroarytenoid muscle were the characteristic indexes. After BTX was injected, denervated potential characteristics appeared in the muscles. © The Author(s) 2015.

Diagnostic Delays in Spasmodic Dysphonia: A Call for Clinician Education.

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Creighton, Francis X; Hapner, Edie; Klein, Adam; Rosen, Ami; Jinnah, Hyder A; Johns, Michael M

2015-09-01

Spasmodic dysphonia (SD) is a rare but often debilitating disease. Due to lack of awareness among practitioners and lack of well-defined diagnostic criteria, it can be difficult for patients with SD to receive a diagnosis and subsequent treatment. There is currently no literature documenting the efficacy of the medical community in recognizing and diagnosing this disorder. We aimed to quantify the patients' experiences with obtaining a diagnosis of SD. One hundred seven consecutive patients with SD completed questionnaires about their experiences with SD. Patients were recruited either during outpatient laryngology visits or during participation in a National Institutes of Health funded study investigating SD. It took patients an average of 4.43 years (53.21 months) to be diagnosed with SD after first going to a physician with vocal symptoms. Patients had to see an average of 3.95 physicians to receive a diagnosis of SD. Patients (31.4%) had been prescribed medications other than botulinum toxin to treat their symptoms. Patients (30%) attempted alternative therapies for treatment of SD, such as chiropractor or dietary modification. Despite advances in diagnostic modalities in medicine, the diagnosis of SD still remains elusive. Objective criteria for the diagnosis of SD and increased clinician education are warranted to address this diagnostic delay. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

The Effectiveness of the Comprehensive Voice Rehabilitation Program Compared With the Vocal Function Exercises Method in Behavioral Dysphonia: A Randomized Clinical Trial.

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Pedrosa, Vanessa; Pontes, Antônio; Pontes, Paulo; Behlau, Mara; Peccin, Stella Maria

2016-05-01

To evaluate the effectiveness of the Comprehensive Voice Rehabilitation Program (CVRP) compared with Vocal Function Exercises (VFEs) to treat functional dysphonia. This is a randomized blinded clinical trial. Eighty voice professionals presented with voice complaints for more than 6 months with a functional dysphonia diagnosis. Subjects were randomized into two voice treatment groups: CVRP and VFE. The rehabilitation program consisted of six voice treatment sessions and three assessment sessions performed before, immediately after, and 1 month after treatment. The outcome measures were self-assessment protocols (Voice-Related Quality of Life [V-RQOL] and Voice Handicap Index [VHI]), perceptual evaluation of vocal quality, and a visual examination of the larynx, both blinded. The randomization process produced comparable groups in terms of age, gender, signs, and symptoms. Both groups had positive outcome measures. The CVRP effect size was 1.09 for the V-RQOL, 1.17 for the VHI, 0.79 for vocal perceptual evaluation, and 1.01 for larynx visual examination. The VFE effect size was 0.86 for the V-RQOL, 0.62 for the VHI, 0.48 for the vocal perceptual evaluation, and 0.51 for larynx visual examination. Only 10% of the patients were lost over the study. Both treatment programs were effective. The probability of a patient improving because of the CVRP treatment was similar to that of the VFE treatment. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Causes of primary amenorrhea: a report of 295 cases in Thailand.

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Tanmahasamut, Prasong; Rattanachaiyanont, Manee; Dangrat, Chongdee; Indhavivadhana, Suchada; Angsuwattana, Surasak; Techatraisak, Kitirat

2012-01-01

The aim of this study was to determine the prevalence of etiologic causes of primary amenorrhea in Thailand. A retrospective study was performed using 295 complete medical records of women with primary amenorrhea who attended the Gynecologic Endocrinology Clinic, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand from September 1992 to February 2009. The three most common causes of primary amenorrhea were Müllerian agenesis (39.7%), gonadal dysgenesis (35.3%), and hypogonadotropic hypogonadism (9.2%). Amongst 88 cases of gonadal dysgenesis, 59 cases (67.0%) incurred abnormal karyotype including 45X (n=21), mosaic (n=31), and others (n=7). The present study has currently been the largest case series of primary amenorrhea. Müllerian agenesis is the most prevalent cause in our study, while gonadal dysgenesis is the most common cause in the largest-scale study in the USA. Hence, racial, genetic and environmental factors could play roles in the cause of primary amenorrhea. © 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.

Inferring speaker attributes in adductor spasmodic dysphonia: ratings from unfamiliar listeners.

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Isetti, Derek; Xuereb, Linnea; Eadie, Tanya L

2014-05-01

To determine whether unfamiliar listeners' perceptions of speakers with adductor spasmodic dysphonia (ADSD) differ from control speakers on the parameters of relative age, confidence, tearfulness, and vocal effort and are related to speaker-rated vocal effort or voice-specific quality of life. Twenty speakers with ADSD (including 6 speakers with ADSD plus tremor) and 20 age- and sex-matched controls provided speech recordings, completed a voice-specific quality-of-life instrument (Voice Handicap Index; Jacobson et al., 1997), and rated their own vocal effort. Twenty listeners evaluated speech samples for relative age, confidence, tearfulness, and vocal effort using rating scales. Listeners judged speakers with ADSD as sounding significantly older, less confident, more tearful, and more effortful than control speakers (p < .01). Increased vocal effort was strongly associated with decreased speaker confidence (rs = .88-.89) and sounding more tearful (rs = .83-.85). Self-rated speaker effort was moderately related (rs = .45-.52) to listener impressions. Listeners' perceptions of confidence and tearfulness were also moderately associated with higher Voice Handicap Index scores (rs = .65-.70). Unfamiliar listeners judge speakers with ADSD more negatively than control speakers, with judgments extending beyond typical clinical measures. The results have implications for counseling and understanding the psychosocial effects of ADSD.

Case report

African Journals Online (AJOL)

raoul

2011-08-17

Aug 17, 2011 ... The patient underwent voice reeducation with partial improvement after six months. Pan African ... Laryngoscopy confirmed a right vocal cord palsy that explained the dysphonia. Chest ... They often presented at the stage of complications such as compression of adjacent structures: dysphagia if esophageal.

Parkinsonism caused by adverse drug reactions: a case series

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Agaba Emmanuel I

2011-03-01

Full Text Available Abstract Introduction Parkinsonism puts a high direct cost burden on both patient and caregiver. Several reports of drug-induced parkinsonism have been published, but to the best of our knowledge, there has not been any report of quinine or halothane inducing parkinsonism. Case presentation We describe two cases of parkinsonism possibly caused by adverse drug reaction to quinine in a 29-year-old black Nigerian woman and to halothane in a 36-year-old black Hausa (Nigerian man who received it as general anaesthesia for appendicectomy in our teaching hospital. Conclusion These are two unusual cases of parkinsonism caused by adverse drug reactions to high-dose quinine and to halothane as general anaesthesia. We consider that these two cases are important in bringing this potential side-effect to the attention of both pharmacologists and primary care physicians as these are two of the most commonly used medications in our clinics. We conclude that parkinsonism should be included among the adverse drug reactions to high-dose quinine and halothane general anaesthetic.

Differences in botulinum toxin dosing between patients with adductor spasmodic dysphonia and essential voice tremor.

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Orbelo, Diana M; Duffy, Joseph R; Hughes Borst, Becky J; Ekbom, Dale; Maragos, Nicolas E

2014-01-01

To explore possible dose differences in average botulinum toxin (BTX) given to patients with adductor spasmodic dysphonia (ADSD) compared with patients with essential voice tremor (EVT). A retrospective study compared the average BTX dose injected in equal doses to the thyroarytenoid (TA) muscles of 51 patients with ADSD with 52 patients with EVT. Those with ADSD received significantly higher total doses (6.80 ± 2.79 units) compared with those with EVT (5.02 ± 1.65 units). Dose at time of first injection, age at time of first injection, gender, year of first injection, and average time between injections were included in multivariate analysis but did not interact with total average dose findings. Patients with ADSD may need relatively higher doses of BTX injections to bilateral TA muscles compared with patients with EVT. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Functional reinnervation of vocal folds after selective laryngeal adductor denervation-reinnervation surgery for spasmodic dysphonia.

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DeConde, Adam S; Long, Jennifer L; Armin, Bob B; Berke, Gerald S

2012-09-01

Selective laryngeal adductor denervation-reinnervation surgery (SLAD-R) offers a viable surgical alternative for patients with adductor spasmodic dysphonia refractory to botulinum toxin injections. SLAD-R selectively denervates the symptomatic thyroarytenoid muscle by dividing the distal adductor branch of the recurrent laryngeal nerve (RLN), and preventing reinnervation, by the proximal RLN and maintaining vocal fold bulk and tone by reinnervating the distal RLN with the ansa cervicalis. We present a patient who had previously undergone successful SLAD-R but presented 10 years postoperatively with a new regional dystonia involving his strap muscles translocated to his reinnervated larynx by his previous ansa-RLN neurorraphy. The patient's symptomatic vocal fold adduction resolved completely on division of the ansa-RLN neurorraphy confirming successful selective functional reinnervation of vocal fold adductors by the ansa cervicalis. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Combined Functional Voice Therapy in Singers With Muscle Tension Dysphonia in Singing.

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Sielska-Badurek, Ewelina; Osuch-Wójcikiewicz, Ewa; Sobol, Maria; Kazanecka, Ewa; Rzepakowska, Anna; Niemczyk, Kazimierz

2017-07-01

The purpose of this study was to evaluate vocal tract function and the voice quality in singers with muscle tension dysphonia (MTD) after undergoing combined functional voice therapy of the singing voice. This is a prospective, randomized study. Forty singers (29 females and 11 males, mean age: 24.6 ± 8.8 years) with MTD were enrolled in the study. The study group consisted of 20 singers who underwent combined functional voice therapy (10-15 individual sessions, 30-40 minutes each). Singers who did not opt for vocal rehabilitation consisted of the control group. Effects of rehabilitation were assessed with videolaryngostroboscopy, palpation of the vocal tract structures, flexible fiberoptic evaluation of the pharynx and the larynx, perceptual speaking and singing voice assessment, acoustic analysis, maximal phonation time, and the Voice Handicap Index. After combined functional voice therapy in the study group, great improvement was noticed in palpation of the vocal tract structures (P singing range obtained from acoustic analysis of glissando (P singing. Development of palpation and perceptual singing voice examination protocols enables one to compare results before and after rehabilitation in clinics. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Everyday listeners' impressions of speech produced by individuals with adductor spasmodic dysphonia.

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Nagle, Kathleen F; Eadie, Tanya L; Yorkston, Kathryn M

2015-01-01

Individuals with adductor spasmodic dysphonia (ADSD) have reported that unfamiliar communication partners appear to judge them as sneaky, nervous or not intelligent, apparently based on the quality of their speech; however, there is minimal research into the actual everyday perspective of listening to ADSD speech. The purpose of this study was to investigate the impressions of listeners hearing ADSD speech for the first time using a mixed-methods design. Everyday listeners were interviewed following sessions in which they made ratings of ADSD speech. A semi-structured interview approach was used and data were analyzed using thematic content analysis. Three major themes emerged: (1) everyday listeners make judgments about speakers with ADSD; (2) ADSD speech does not sound normal to everyday listeners; and (3) rating overall severity is difficult for everyday listeners. Participants described ADSD speech similarly to existing literature; however, some listeners inaccurately extrapolated speaker attributes based solely on speech samples. Listeners may draw erroneous conclusions about individuals with ADSD and these biases may affect the communicative success of these individuals. Results have implications for counseling individuals with ADSD, as well as the need for education and awareness about ADSD. Copyright © 2015 Elsevier Inc. All rights reserved.

A false case of infection caused by Dicrocoelium dendriticum

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Cinzia Rossi

2011-09-01

Full Text Available We describe a false case of infection caused by Dicrocoelium dendriticum, a cosmopolite trematode that can infect human bile ducts but tends to live in cattle or other grazing mammals. Our aim is to stress the relevance of adequate diagnostic methods and of exact medical history in order to detect any possible clinical case.

Voice disorders in the workplace: productivity in spasmodic dysphonia and the impact of botulinum toxin.

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Meyer, Tanya K; Hu, Amanda; Hillel, Allen D

2013-11-01

treatment of SD, and 72 patients were currently working and had undergone BTX therapy for at least 1 year at the time of the analysis. Currently employed patients reported a mean 4.4% decrease in work missed (absenteeism), a 28.1% decrease in work impairment (presenteeism), a 29.4% decrease in work productivity, and a 21.4% decrease in activity impairment (P best, as compared to their worst voicing period over their last BTX injection cycle. Presenteeism accounted for the major component of the percent work productivity impairment calculation. There was neither apparent shift in job categories nor any change in the vocal demands of their employment over the course of their disease. Among patients that have worked during their diagnosis of SD, greater than 98% report that BTX injections helped them at work. Patients with SD reported that their vocal dysfunction caused a significant negative effect on work productivity and increase in activity impairment. There was a significant improvement in their voice-related work parameters from their worst to best voicing periods over their last BTX injection cycle. Patients undergoing long-term BTX treatment report a positive effect of this treatment in their workplace. Spasmodic dysphonia is a meaningful model in which to study the effects of voice disorders on work productivity and employment patterns. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Eagle Syndrome Causing Vascular Compression with Cervical Rotation: Case Report

International Nuclear Information System (INIS)

Demirtaş, Hakan; Kayan, Mustafa; Koyuncuoğlu, Hasan Rıfat; Çelik, Ahmet Orhan; Kara, Mustafa; Şengeze, Nihat

2016-01-01

Eagle syndrome is a condition caused by an elongated styloid process. Unilateral face, neck and ear pain, stinging pain, foreign body sensation and dysphagia can be observed with this syndrome. Rarely, the elongated styloid process may cause pain by compressing the cervical segment of the internal carotid and the surrounding sympathetic plexus, and that pain spreading along the artery can cause neurological symptoms such as vertigo and syncope. In this case report we presented a very rare eagle syndrome with neurological symptoms that occurred suddenly with cervical rotation. The symptoms disappeared as suddenly as they occurred, with the release of pressure in neutral position. We also discussed CT angiographic findings of this case. Radiological diagnosis of the Eagle syndrome that is manifested with a wide variety of symptoms and causes diagnostic difficulties when it is not considered in the differential diagnosis is easy in patients with specific findings. CT angiography is a fast and effective examination in terms of showing compression in patients with the Eagle syndrome that is considered to be atypical and causes vascular compression

Wooden beverage cases cause little damage to bottle caps

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R. Bruce Anderson; William C. Miller

1973-01-01

Wooden beverage cases cause little damage to aluminum resealable caps during distribution. A study at bottling plants and distribution warehouses showed that an average of 1 bottle out of 4,000 has cap damage. Most of the damage was attributed to handling at the warehouse and in transit. Some recommendations are given for improvement of wooden beverage cases to prevent...

Disease-specific self-efficacy in spasmodic dysphonia patients.

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Hu, Amanda; Isetti, Derek; Hillel, Allen D; Waugh, Patricia; Comstock, Bryan; Meyer, Tanya K

2013-03-01

Self-efficacy (SE) is an optimistic self-belief that one can perform a novel task. This concept involves empowerment, self-esteem, and adaptation to a stressful situation. SE is a strong predictor of health behaviors. Our objectives were to study SE in spasmodic dysphonia (SD) and to develop a disease-specific SE-SD scale. Prospective study. Academic hospital. Disease-specific SE-SD items were developed with laryngologists, speech pathologists, and SD patients. These items, General SE Scale, Voice Handicap Index-10 (VHI-10), Consensus Auditory Perceptual Evaluation of Voice (CAPE-V), and Hospital Anxiety and Depression Scale (HADS), were administered to SD patients who presented for botulinum toxin injections. One hundred forty-five SD patients (mean age 59.5 ± 13.6 years) had a general SE score (Cronbach's α = 0.894) of 33.4 ± 5.2 out of 40. This was negatively correlated with HADS-A (r = -0.42, P < 0.001) and HADS-D (r = -0.42, P < .001), but not correlated with VHI-10 (r = -0.098, P = .243) and CAPE-V (r = -0.047, P = .57). Factor analysis selected 8 items from the general SE scale and 5 disease-specific SE-SD items to generate a 13-item disease-specific SE-SD scale (Cronbach's α = 0.907). Disease-specific SE-SD score was 42.1 ± 6.9 out of 52 and was negatively correlated with VHI-10 (r = -0.19, P = .005), HADS-A (r = -0.43, P < .001), and HADS-D (r = -0.57, P < .001), but not correlated with CAPE-V (r = -0.024, P = .60). SD patients established on botulinum toxin injections have high degrees of general and disease-specific SE. Patients with higher SE-SD demonstrate lower vocal handicap and lower levels of anxiety and depression. A 13-item disease-specific SE-SD scale has been developed.

Dysfunctional ectopic thyroid gland: A case report

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Stokić Edita

2014-01-01

Full Text Available Introduction. Lingual thyroid gland is a rare anomaly of thyroid gland development, occurring more frequently in females. If it causes local symptomatology such as dysphagia, dysphonia or dyspnea it is diagnosed in childhood, however, if it is asymptomatic it is usually diagnosed in adulthood. Case Outline. We present a 23-year-old female patient in whom we diagnosed lingual thyroid gland coincidentally during diagnostic procedures of a concomitant disease. The application of 131I scintigraphy showed an oval field of intensive accumulation of radio markers in the zone of medial face line, around tongue base, with the absence of thyroid gland in its physiological position. Functional testing proved primary hypothyroidism and we started the application of substitution therapy. The application of levothyroxine resulted in reaching euthyroid state and the reduction of thyroid gland size. Conclusion. We present a very rare anomaly of the thyroid gland, and so far there have been no clear attitudes about further treatment. The general condition of the patient, age, the size of ectopic thyroid gland and the existence of local symptomatology or complications represent the factors that have influence on the choice of treatment method.

Endometrioid endometrial carcinoma indirectly caused by pituitary prolactinoma: a case report.

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Nishino, Kimihiro; Niwa, Yuri; Mizutani, Teruyuki; Shimizu, Ken; Hayashi, Kazumasa; Chaya, Jyunya; Kato, Noriko; Yamamuro, Osamu

2013-01-01

We present the case of a 44-year-old nulliparous woman who experienced irregular menstrual cycles for about 10 years and developed both pituitary prolactinoma and endometrioid endometrial carcinoma. In premenopausal women, hyperprolactinemia causes hypogonadism by inhibiting secretion of gonadotropin-releasing hormone and thus suppressing luteinizing hormone levels, which can cause menstrual disorders ranging from amenorrhea, oligomenorrhea and chronic anovulatory cycle to short luteal phase of the menstrual cycle. A chronic anovulatory menstrual cycle is the most common cause of long-term exposure of the endometrium to endogenous estrogen without adequate opposition from progestins, which can lead to endometrioid endometrial carcinoma. In this case, pituitary prolactinoma may have caused the chronic anovulatory cycle and indirectly led to the endometrioid endometrial carcinoma. In patients for whom the cause of irregular menstruation and chronic anovulatory cycle is suspected to be hyperprolactinemia, explorations of both the hypophysis and endometrium are essential.

Endometrioid Endometrial Carcinoma Indirectly Caused by Pituitary Prolactinoma:A Case Report

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Kimihiro Nishino

2013-01-01

Full Text Available We present the case of a 44-year-old nulliparous woman who experienced irregular menstrual cycles for about 10 years and developed both pituitary prolactinoma and endometrioid endometrial carcinoma. In premenopausal women, hyperprolactinemia causes hypogonadism by inhibiting secretion of gonadotropin-releasing hormone and thus suppressing luteinizing hormone levels, which can cause menstrual disorders ranging from amenorrhea, oligomenorrhea and chronic anovulatory cycle to short luteal phase of the menstrual cycle. A chronic anovulatory menstrual cycle is the most common cause of long-term exposure of the endometrium to endogenous estrogen without adequate opposition from progestins, which can lead to endometrioid endometrial carcinoma. In this case, pituitary prolactinoma may have caused the chronic anovulatory cycle and indirectly led to the endometrioid endometrial carcinoma. In patients for whom the cause of irregular menstruation and chronic anovulatory cycle is suspected to be hyperprolactinemia, explorations of both the hypophysis and endometrium are essential.

Pediatric ocular trauma caused by recreational drones: two case reports.

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Spitzer, Nicole; Singh, Jasleen K

2018-03-14

Drones are increasingly being used by children and adults recreationally and commercially. The propeller blades when spinning at high speeds may cause serious harm to the eye and orbital structures. We report 2 cases of injuries to the eye and orbital structures caused by drones. Copyright © 2018. Published by Elsevier Inc.

First case of bacteremia caused by Moellerella wisconsensis: case report and a review of the literature.

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Cardentey-Reyes, A; Jacobs, F; Struelens, M J; Rodriguez-Villalobos, H

2009-12-01

Moellerella wisconsensis, a member of the Enterobacteriaceae family, is rarely isolated in clinical specimens. We report here a case of M. wisconsensis infection in a 46-year-old cirrhotic patient with acute cholecystitis. This is the first reported case of a M. wisconsensis infection in Belgium and the first reported case of human bacteremia caused by this bacterium. Our case report is followed by a review of the literature.

Assessment of Grade of Dysphonia and Correlation With Quality of Life Protocol.

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Spina, Ana Lúcia; Crespo, Agrício Nubiato

2017-03-01

The main objective of this study is to check the correlation between vocal self-assessment and results of the Voice-Related Quality of Life (V-RQOL) protocol, and whether there is a correlation between perceptual vocal assessment made by voice therapists and the results from the V-RQOL protocol. The study included 245 subjects with vocal complaints. This was a prospective analytical clinical study. Vocal perceptual assessment of each subject with dysphonia was made by three voice therapists, followed by self-assessment made by the subjects themselves, and the application of the V-RQOL protocol. The results have shown poor level of agreement between vocal assessment made by the voice therapists and self-assessment made by the subjects. The statistical analysis indicated that the results of V-RQOL protocol showed significant correlation with the vocal assessment made by the voice therapists and the self-assessment by the subjects. The agreement between the assessments was low and variable; age, gender, professional voice use, and clinical laryngoscopic diagnosis did not influence the agreement level. Protocol V-RQOL is sensitive to vocal assessment made by the voice therapists and self-assessment made by the patient. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Voice Disorders: Etiology and Diagnosis.

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Martins, Regina Helena Garcia; do Amaral, Henrique Abrantes; Tavares, Elaine Lara Mendes; Martins, Maira Garcia; Gonçalves, Tatiana Maria; Dias, Norimar Hernandes

2016-11-01

Voice disorders affect adults and children and have different causes in different age groups. The aim of the study is to present the etiology and diagnosis dysphonia in a large population of patients with this voice disorder.for dysphonia of a large population of dysphonic patients. We evaluated 2019 patients with dysphonia who attended the Voice Disease ambulatories of a university hospital. Parameters assessed were age, gender, profession, associated symptoms, smoking, and videolaryngoscopy diagnoses. Of the 2019 patients with dysphonia who were included in this study, 786 were male (38.93%) and 1233 were female (61.07). The age groups were as follows: 1-6 years (n = 100); 7-12 years (n = 187); 13-18 years (n = 92); 19-39 years (n = 494); 41-60 years (n = 811); and >60 years (n = 335). Symptoms associated with dysphonia were vocal overuse (n = 677), gastroesophageal symptoms (n = 535), and nasosinusal symptoms (n = 497). The predominant professions of the patients were domestic workers, students, and teachers. Smoking was reported by 13.6% patients. With regard to the etiology of dysphonia, in children (1-18 years old), nodules (n = 225; 59.3%), cysts (n = 39; 10.3%), and acute laryngitis (n = 26; 6.8%) prevailed. In adults (19-60 years old), functional dysphonia (n = 268; 20.5%), acid laryngitis (n = 164; 12.5%), and vocal polyps (n = 156; 12%) predominated. In patients older than 60 years, presbyphonia (n = 89; 26.5%), functional dysphonia (n = 59; 17.6%), and Reinke's edema (n = 48; 14%) predominated. In this population of 2019 patients with dysphonia, adults and women were predominant. Dysphonia had different etiologies in the age groups studied. Nodules and cysts were predominant in children, functional dysphonia and reflux in adults, and presbyphonia and Reinke's edema in the elderly. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Chronic Diarrhea and Pancolitis Caused by Paracoccidioidomycosis: A Case Report

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Eduar A. Bravo

2010-01-01

Full Text Available South American blastomycosis is a systemic micosis caused by infection with Paracoccidioides brasiliensis. The most frequently affected sites are the lower lip buccal mucous membrane, palate, tongue, sublingual region, lymph glands, and lungs. However, colonic involvement is not a common expression of Paracoccidioidomycosis. We report a case of chronic diarrhea and pancolitis caused by Paracoccidioidomycosis with fatal outcome.

A large giant cell tumor of the larynx: case report and review of the literature.

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Arndt, Andrew; LeBlanc, Rachelle; Spafford, Peter

2017-04-04

Giant cell tumors (GCTs) are typically found in the metaphyseal-epiphyseal area of long bones but can also occur in the head and neck region. GCT of the larynx is a rare entity with only 42 reported cases in the international literature. Furthermore, to the best of our knowledge this is the largest laryngeal GCT reported in the literature to date. GCT of the larynx can present with dysphonia, dyspnea, and/or dysphagia and should be considered in the differential diagnosis of a neck mass. This case report describes a giant cell tumor of the left thyroid cartilage in a 30-year-old man who initially presented with dysphonia and dysphagia. Computed tomography (CT) revealed a 5 × 5.7 cm mass centered on the left thyroid cartilage, which was further diagnosed by histopathology as giant cell tumour by open biopsy. The patient was counselled on treatment options and it was decided to proceed with a surgical approach. The patient consented to and successfully underwent a total laryngectomy (TL). Currently the patient has no evidence of disease at 13 months follow-up, has an optimal prosthetic voice, and is able to tolerate all textures of foods. GCTs of the larynx have a good prognosis and can be treated successfully through complete resection of the tumor, negating the need for adjunctive therapy such as radiation, chemo or denosumab therapy.

An open-label study of sodium oxybate in Spasmodic dysphonia.

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Rumbach, Anna F; Blitzer, Andrew; Frucht, Steven J; Simonyan, Kristina

2017-06-01

Spasmodic dysphonia (SD) is a task-specific laryngeal dystonia that affects speech production. Co-occurring voice tremor (VT) often complicates the diagnosis and clinical management of SD. Treatment of SD and VT is largely limited to botulinum toxin injections into laryngeal musculature; other pharmacological options are not sufficiently developed. Open-label study. We conducted an open-label study in 23 SD and 22 SD/VT patients to examine the effects of sodium oxybate (Xyrem), an oral agent with therapeutic effects similar to those of alcohol in these patients. Blinded randomized analysis of voice and speech samples assessed symptom improvement before and after drug administration. Sodium oxybate significantly improved voice symptoms (P = .001) primarily by reducing the number of SD-characteristic voice breaks and severity of VT. Sodium oxybate further showed a trend for improving VT symptoms (P = .03) in a subset of patients who received successful botulinum toxin injections for the management of their SD symptoms. The drug's effects were observed approximately 30 to 40 minutes after its intake and lasted about 3.5 to 4 hours. Our study demonstrated that sodium oxybate reduced voice symptoms in 82.2% of alcohol-responsive SD patients both with and without co-occurring VT. Our findings suggest that the therapeutic mechanism of sodium oxybate in SD and SD/VT may be linked to that of alcohol, and as such, sodium oxybate might be beneficial for alcohol-responsive SD and SD/VT patients. 4 Laryngoscope, 127:1402-1407, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Effect of Botulinum Toxin and Surgery among Spasmodic Dysphonia Patients.

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van Esch, Babette F; Wegner, Inge; Stegeman, Inge; Grolman, Wilko

2017-02-01

Objective The effect of botulinum toxin among patients with adductor spasmodic dysphonia (AdSD) is temporary. To optimize long-term treatment outcome, other therapy options should be evaluated. Alternative treatment options for AdSD comprise several surgical treatments, such as thyroarytenoid myotomy, thyroplasty, selective laryngeal adductor denervation-reinnervation, laryngeal nerve crush, and recurrent laryngeal nerve resection. Here, we present the first systematic review comparing the effect of botulinum toxin with surgical treatment among patients diagnosed with AdSD. Data Sources MEDLINE (PubMed), EMBASE, and the Cochrane Library. Methods Articles were reviewed by 2 independent authors, and data were compiled in tables for analysis of the objective outcome (voice expert evaluation after voice recording), the subjective outcome (patient self-assessment scores), and voice-related quality of life (Voice Health Index scores). Results No clinical trials comparing both treatment modalities were identified. Single-armed studies evaluated either the effect of botulinum toxin or surgical treatment. Thirteen studies reported outcomes after botulinum toxin treatment (n = 419), and 9 studies reported outcomes after surgical treatment (n = 585 patients). A positive effect of bilateral botulinum toxin injections was found for the objective voice outcome, subjective voice outcome, and quality of life. The duration of the beneficial effect ranged from 15 to 18 weeks. Surgical treatment had an overall positive effect on objective voice improvement, subjective voice improvement, and quality of live. Conclusion No preference for one treatment could be demonstrated. Prospective clinical trials comparing treatment modalities are recommended to delineate the optimal outcomes by direct comparison.

Botulinum Toxin-A Dosing Trends for Adductor Spasmodic Dysphonia at a Single Institution Over 10 Years.

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Bradley, Joseph P; Barrow, Emily M; Hapner, Edie R; Klein, Adam M; Johns, Michael M

2017-05-01

This study aimed to identify the changes in dosing of botulinum toxin-A for adductor spasmodic dysphonia (ADSD) over a prolonged period. This is a retrospective chart review. One hundred thirteen subjects treated for ADSD from 2003 to 2013 were identified from a clinical database. Subject age, gender, and total injection dose amount were all recorded for all subjects who had at least 10 injections. Fifty-four subjects met criteria for inclusion. There were no age or gender differences in the starting dose for subjects. Dosing decreased significantly compared with the second dose (5.05 ± 1.623 Units), by the sixth dose (4.26 ± 1.698 Units), and continued through the 10th dose (4.08 ± 2.019 Units) (P < 0.005 for all). Botulinum toxin-A dosing for ADSD decreases consistently over subsequent injections after the initial two dose titrations. Copyright © 2017. Published by Elsevier Inc.

A Case of Persistent Hiccup after Laparoscopic Cholecystectomy

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Elisa Grifoni

2013-01-01

Full Text Available A 79-year-old man, with history of recent laparoscopic cholecystectomy, came to our attention for persistent hiccup, dysphonia, and dysphagia. Noninvasive imaging studies showed a nodular lesion in the right hepatic lobe with transdiaphragmatic infiltration and increased tracer uptake on positron emission tomography. Suspecting a malignant lesion and given the difficulty of performing a percutaneous transthoracic biopsy, the patient underwent surgery. Histological analysis of surgical specimen showed biliary gallstones surrounded by exudative inflammation, resulting from gallbladder rupture and gallstones spillage as a complication of the previous surgical intervention. This case highlights the importance of considering such rare complication after laparoscopic cholecystectomy.

Homicidal commotio cordis caused by domestic violence: A report of two cases.

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Mu, Jiao; Zhang, Ji; Liu, Liang; Dong, Hongmei

2016-04-01

Commotio cordis is a rare and fatal mechano-electric arrhythmogenic syndrome, occurring mainly during sports activities. The present study describes two cases of sudden death due to homicidal commotio cordis caused violence from an intimate partner. The two decedents were both young women. They suffered from physical abuse by their intimate partner and collapsed immediately after being punched in the precordium. Electrocardiograms were recorded at the hospital and showed ventricular fibrillation in one case. An autopsy was performed in each case, and no structural cardiac damage, evident lesions of other internal organs or underlying diseases were found. Combined with the negative toxicological analysis, it was concluded that the cause of death was commotio cordis due to a blunt force to the anterior chest. To the best of the authors' knowledge, there is no published report on commotio cordis caused by physical abuse from an intimate partner. The accurate diagnosis of the cause of death is emphasised, as it is important for judicial fairness. © The Author(s) 2015.

Keratitis caused by the recently described new species Aspergillus brasiliensis: two case reports

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Vágvölgyi Csaba

2010-02-01

Full Text Available Abstract Introduction Human infections caused by Aspergillus brasiliensis have not yet been reported. We describe the first two known cases of fungal keratitis caused by Aspergillus brasiliensis. Case presentations A 49-year-old Indian Tamil woman agricultural worker came with pain and defective vision in the right eye for one month. Meanwhile, a 35-year-old Indian Tamil woman presented with a history of a corneal ulcer involving the left eye for 15 days. The fungal strains isolated from these two cases were originally suspected to belong to Aspergillus section Nigri based on macro- and micromorphological characteristics. Molecular identification revealed that both isolates represent A. brasiliensis. Conclusion The two A. brasiliensis strains examined in this study were part of six keratitis isolates from Aspergillus section Nigri, suggesting that this recently described species may be responsible for a significant proportion of corneal infections caused by black Aspergilli. The presented cases also indicate that significant differences may occur between the severities of keratitis caused by individual isolates of A. brasiliensis.

Intraabdominal abscess caused by Stenotrophomonas maltophilia: A case report

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Toyomitsu Sawai

Full Text Available Introduction: Stenotrophomonas maltophilia usually causes nosocomial infections, but intraabdominal abscesses or organ/space surgical site infection (SSI secondary to this organism has been rarely reported. Here, we reported a rare case of SSI that presented as intraabdominal abscess caused by S. maltophilia. Presentation of case: A 68-year-old woman presented to our hospital with transverse colon cancer. Further work up with abdominal computed tomography (CT revealed left renal cell carcinoma. Transverse colon resection and left kidney partial resection were performed. On post-operative day 10, she started to have fever at 38 °C and repeat abdominal CT showed intraabdominal abscess. Empiric treatment with piperacillin/tazobactam (TAZ/PIPC was initiated. However, fever persisted and the abscess size did not change despite 10 days of antibiotic. On post-operative day 20, drainage of intraabdominal abscess was performed. TAZ/PIPC was then shifted to meropenem (MEPM. After two days, S. maltophilia was identified in the culture of the abscess, and MEPM was shifted to minocycline (MINO. Fever disappeared after 7 days of treatment and abdominal CT after 14 days showed almost complete resolution of the abscess. Discussion: S. maltophilia is a multi-drug resistant, aerobic, non-glucose fermenting, non-sporulating, Gram-negative bacillus. S. maltophilia may cause a variety of infections, but intraabdominal abscesses as a manifestation of SSI due to this organism is relative rare. Conclusion: Although usually a non-pathogenic organism or colonizer, S. maltophilia can cause organ/space SSI in an immunocompromised host. Therefore, clinicians should be aware of the possibility that S. maltophilia may cause organ/space SSI. Keywords: Stenotrophomonas maltophilia, Intraabdominal abscess, Surgical site infections

Type II thyroplasty changes cortical activation in patients with spasmodic dysphonia.

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Tateya, Ichiro; Omori, Koichi; Kojima, Hisayoshi; Naito, Yasushi; Hirano, Shigeru; Yamashita, Masaru; Ito, Juichi

2015-04-01

Spasmodic dysphonia (SD) is a complex neurological communication disorder characterized by a choked, strain-strangled vocal quality with voice stoppages in phonation. Its symptoms are exacerbated by situations where communication failures are anticipated, and reduced when talking with animals or small children. Symptoms are also reduced following selected forms of treatment. It is reasonable to assume that surgical alteration reducing symptoms would also alter brain activity, though demonstration of such a phenomenon has not been documented. The objective of this study is to reveal brain activity of SD patients before and after surgical treatment. We performed lateralization thyroplasties on three adductor SD patients and compared pre- and post-operative positron emission tomography recordings made during vocalization. Pre-operatively, cordal supplementary motor area (SMA), bilateral auditory association areas, and thalamus were activated while reading aloud. Such activity was not observed in normal subjects. Type II thyroplasty was performed according to Isshiki's method and the strained voice was significantly reduced or eliminated in all three patients. Post-operative PET showed normal brain activation pattern with a significant decrease in cordal SMA, bilateral auditory association areas and thalamus, and a significant increase in rostral SMA compared with pre-operative recordings. This is the first report showing that treatment to a peripheral organ, which reverses voice symptoms, also reverses dysfunctional patterns of the central nervous system in patients with SD. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Endoscopic laser thyroarytenoid myoneurectomy in patients with adductor spasmodic dysphonia: a pilot study on long-term outcome on voice quality.

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Tsuji, Domingos Hiroshi; Takahashi, Marystella Tomoe; Imamura, Rui; Hachiya, Adriana; Sennes, Luiz Ubirajara

2012-09-01

Adductor spasmodic dysphonia (ADSD) is a focal laryngeal dystonia, which compromises greatly the quality of life of the patients involved. It is a severe vocal disorder characterized by spasms of laryngeal muscles during speech, producing phonatory breaks, forced, strained and strangled voice. Its symptoms result from involuntary and intermittent contractions of thyroarytenoid muscle during speech, which causes vocal fold to strain, pressing each vocal fold against the other and increasing glottic resistance. Botulinum toxin injection remains the gold-standard treatment. However, as injections should be repeated periodically leading to voice quality instability, a more definitive procedure would be desirable. In this pilot study we report the long-term vocal quality results of endoscopic laser thyroarytenoid myoneurectomy. Prospective study. Surgery was performed in 15 patients (11 females and four males), aged between 29 and 73 years, diagnosed with ADSD. Voice Handicap Index (VHI) was obtained before and after surgery (median 31 months postoperatively). A significant improvement in VHI was observed after surgery, as compared with baseline values (P=0.001). The median and interquartile range for preoperative VHI was 99 and 13, respectively and 24 and 42, for postoperative VHI. Subjective improvement of voice as assessed by the patients showed median improvement of 80%. Because long-term follow-up showed significant improvement of voice quality, this innovative surgical technique seems a satisfactory alternative treatment of ADSD patients who seek a definite improvement of their condition. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Impacto na qualidade vocal da miectomia parcial e neurectomia endoscópica do músculo tireoaritenóideo em paciente com disfonia espasmódica de adução Impact in vocal quality in partial myectomy and neurectomy endoscopic of thyroarytenoid muscle in patients with adductor spasmodic dysphonia

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Domingos Hiroshi Tsuji

2006-04-01

Full Text Available A disfonia espasmódica de adução é um distúrbio vocal grave, caracterizado por espasmos dos músculos laríngeos durante a fonação, produzindo voz quebrada, tensa, forçada e estrangulada. Seus sintomas decorrem da contração intermitente e involuntária dos músculos tireoaritenóideos durante a fonação, o que resulta em pregas vocais tensas, pressionadas uma contra a outra, e no aumento da resistência glótica. OBJETIVO: Apresentar os resultados preliminares do impacto na qualidade vocal da cirurgia de Neurectomia do ramo tireoaritenóideo do laríngeo inferior, via endoscópica, associada à miectomia parcial do músculo tireoaritenóideo com laser de CO2. MATERIAL E MÉTODO: A cirurgia foi realizada em 7 pacientes (6 mulheres e 1 homem, com idades variando entre 22 e 75 anos, com diagnóstico de disfonia espasmódica de adução. Os pacientes foram submetidos ao VHI (Voice Handicap Index no pré e pós-operatório. RESULTEDOS E CONCLUSÃO: A melhora vocal foi conseguida em todos os pacientes estudados não ocorrendo deterioração da qualidade vocal ao longo do período pós-operatório. Houve uma diferença evidente no VHI antes e após a cirurgia. Essa técnica cirúrgica mostrou-se eficaz e inovadora no tratamento da disfonia espasmódica de adução.Impact in vocal quality in partial myectomy and neurectomy endoscopic of thyroarytenoid muscle in patients with adductor spasmodic dysphonia the adductor spasmodic dysphonia is a severe vocal disorder characterized by muscle laryngeal spasms during speech, producing phonatory breaks, forced, strained and strangled voice. Its symptoms come from involuntary and intermittent contractions of thyroarytenoid muscle during speech, which causes vocal fold strain, pressed one against another and increased glottic resistance. AIM: report the results in the impact in vocal quality in neurectomy of the thyroarytenoid branch of the inferior laryngeal nerve by endoscopic route associated with

Brain activity related to phonation in young patients with adductor spasmodic dysphonia.

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Kiyuna, Asanori; Maeda, Hiroyuki; Higa, Asano; Shingaki, Kouta; Uehara, Takayuki; Suzuki, Mikio

2014-06-01

This study investigated the brain activities during phonation of young patients with adductor spasmodic dysphonia (ADSD) of relatively short disease duration (<10 years). Six subjects with ADSD of short duration (mean age: 24. 3 years; mean disease duration: 41 months) and six healthy controls (mean age: 30.8 years) underwent functional magnetic resonance imaging (fMRI) using a sparse sampling method to identify brain activity during vowel phonation (/i:/). Intragroup and intergroup analyses were performed using statistical parametric mapping software. Areas of activation in the ADSD and control groups were similar to those reported previously for vowel phonation. All of the activated areas were observed bilaterally and symmetrically. Intergroup analysis revealed higher brain activities in the SD group in the auditory-related areas (Brodmann's areas [BA] 40, 41), motor speech areas (BA44, 45), bilateral insula (BA13), bilateral cerebellum, and middle frontal gyrus (BA46). Areas with lower activation were in the left primary sensory area (BA1-3) and bilateral subcortical nucleus (putamen and globus pallidus). The auditory cortical responses observed may reflect that young ADSD patients control their voice by use of the motor speech area, insula, inferior parietal cortex, and cerebellum. Neural activity in the primary sensory area and basal ganglia may affect the voice symptoms of young ADSD patients with short disease duration. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Review on Laryngeal Palpation Methods in Muscle Tension Dysphonia: Validity and Reliability Issues.

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Khoddami, Seyyedeh Maryam; Ansari, Noureddin Nakhostin; Jalaie, Shohreh

2015-07-01

Laryngeal palpation is a common clinical method for the assessment of neck and laryngeal muscles in muscle tension dysphonia (MTD). To review the available laryngeal palpation methods used in patients with MTD for the assessment, diagnosis, or document of treatment outcomes. A systematic review of the literature concerning palpatory methods in MTD was conducted using the databases MEDLINE (PubMed), ScienceDirect, Scopus, Web of science, Web of knowledge and Cochrane Library between July and October 2013. Relevant studies were identified by one reviewer based on screened titles/abstracts and full texts. Manual searching was also used to track the source literature. There were five main as well as miscellaneous palpation methods that were different according to target anatomical structures, judgment or grading system, and using tasks. There were only a few scales available, and the majority of the palpatory methods were qualitative. Most of the palpatory methods evaluate the tension at both static and dynamic tasks. There was little information about the validity and reliability of the available methods. The literature on the scientific evidence of muscle tension indicators perceived by laryngeal palpation in MTD is scarce. Future studies should be conducted to investigate the validity and reliability of palpation methods. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Perioperative complications and safety of type II thyroplasty (TPII) for adductor spasmodic dysphonia.

Science.gov (United States)

Mizoguchi, Kenji; Hatakeyama, Hiromitsu; Yanagida, Saori; Nishizawa, Noriko; Oridate, Nobuhiko; Fukuda, Satoshi; Homma, Akihiro

2017-05-01

Type II thyroplasty (TPII) is one of the surgical options offered in the management of adductor spasmodic dysphonia (AdSD); however, there have been no detailed reports of its safety and associated complications during the perioperative period. Our aim was to assess the complications and safety of TPII. TPII was performed for consecutive 15 patients with AdSD from April 2012 through May 2014. We examined retrospectively the perioperative complications, the degree of surgical invasion, and recovery process from surgery. All patients underwent successful surgery under only local anesthesia. Vocal fold erythema was observed in 14 patients and vocal fold edema in 10 patients; however, all of them showed complete resolution within 1 month. No patient experienced severe complications such as acute airway distress or hemorrhage. Fourteen patients were able to have oral from the 1st postoperative morning, with the remaining patient able to have oral intake from the 2nd postoperative day. In addition, no patient experienced aspiration postoperatively. In conclusion, only minor complications were observed in association with TPII in this study. No dysphagia was observed postoperatively, which is an advantage over other treatments. The results of our study suggest that TPII is a safe surgical treatment for AdSD.

Primary Mesenteric Lipoma Causing Closed Loop Bowel Obstruction: A Case Report

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Heong-Ieng Wong

2005-03-01

Full Text Available Primary mesenteric lipoma is rare, with fewer than 50 cases described in English-language literature, and those causing bowel obstructions are even more uncommon. The long stalk of the lipoma that caused secondary volvulus and rapid ischemic change in our patient is worth reporting because of its rarity and distinctive picture in emergency abdominal computed tomography.

Factors influencing botulinum toxin dose instability in spasmodic dysphonia patients.

Science.gov (United States)

Rosow, David E; Pechman, Amanda; Saint-Victor, Sandra; Lo, Kaming; Lundy, Donna S; Casiano, Roy R

2015-05-01

Many patients with spasmodic dysphonia (SD) see consistent effects from botulinum toxin (BTX) injections of the same dose, whereas others require dosage changes over time. We sought to determine whether demographics (age and gender) or environmental factors (smoking) affect the long-term stability of BTX dosing in these patients. Retrospective review. Charts of all patients undergoing BTX injection for adductor SD were reviewed. Dosage change, defined as whether there was any difference in total dosage used between two beneficial injections, was used as a measure of dosing stability. Beneficial injections were indicated by a voice rating score of at least three of four and any non-zero duration of improved voice. Logistic regression analysis was performed to determine whether age, gender, smoking status, or duration of treatment correlated with odds of having a dosage change. A total of 211 patients were ultimately included. Age, gender, and smoking status were all found to have no correlative effect on dosing stability. The only factor that was predictive of dose stability was the number of previous beneficial injections, as every additional injection led to decreased odds of a change in dosage for the next injection (odds ratio=0.964; 95% confidence interval=0.947-0.981). Dosage of BTX injections for long-term treatment of SD has a significant propensity to remain stable over time. Factors such as age, gender, and smoking status do not appear to influence the dosage stability. These findings should allow for better patient counseling regarding expectations for their long-term treatment. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Infective endocarditis causing mitral valve stenosis - a rare but deadly complication: a case report.

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Hart, Michael A; Shroff, Gautam R

2017-02-17

Infective endocarditis rarely causes mitral valve stenosis. When present, it has the potential to cause severe hemodynamic decompensation and death. There are only 15 reported cases in the literature of mitral prosthetic valve bacterial endocarditis causing stenosis by obstruction. This case is even more unusual due to the mechanism by which functional mitral stenosis occurred. We report a case of a 23-year-old white woman with a history of intravenous drug abuse who presented with acute heart failure. Transthoracic echocardiography failed to show valvular vegetation, but high clinical suspicion led to transesophageal imaging that demonstrated infiltrative prosthetic valve endocarditis causing severe mitral stenosis. Despite extensive efforts from a multidisciplinary team, she died as a result of her critical illness. The discussion of this case highlights endocarditis physiology, the notable absence of stenosis in modified Duke criteria, and the utility of transesophageal echocardiography in clinching a diagnosis. It advances our knowledge of how endocarditis manifests, and serves as a valuable lesson for clinicians treating similar patients who present with stenosis but no regurgitation on transthoracic imaging, as a decision to forego a transesophageal echocardiography could cause this serious complication of endocarditis to be missed.

Cranial dural arteriovenous fistula as a rare cause of tinnitus – case report

International Nuclear Information System (INIS)

Kuśmierska, Małgorzata; Gać, Paweł; Nahorecki, Artur; Szuba, Andrzej; JaŸwiec, Przemysław

2013-01-01

Tinnitus, occurring at least once in a lifetime in about 10–20% of the population, is an important clinical problem with complex etiology. Rare causes of tinnitus include cranial dural arteriovenous fistulas (DAVFs), which are usually small lesions consisting of abnormal connections between branches of dural arteries and venous sinuses or veins. Authors present a case of a 44-year-old woman with persistent, unilateral, treatment-resistant pulsatile tinnitus caused by a small dural arteriovenous fistula revealed in computed tomography angiography. Computed tomography angiography is a useful diagnostic method that in some cases allows for establishing the cause of unilateral, pulsatile tinnitus

Cranial dural arteriovenous fistula as a rare cause of tinnitus – case report

Energy Technology Data Exchange (ETDEWEB)

Kuśmierska, Małgorzata; Gać, Paweł [Department of Medical Radiology and Imaging Diagnostics, 4th Military Clinical Hospital, Wrocław (Poland); Nahorecki, Artur [Department of Internal Diseases, 4th Military Clinical Hospital, Wrocław (Poland); Szuba, Andrzej [Department of Internal Diseases, 4th Military Clinical Hospital, Wrocław (Poland); Medical University, Wrocław (Poland); JaŸwiec, Przemysław [Department of Medical Radiology and Imaging Diagnostics, 4th Military Clinical Hospital, Wrocław (Poland)

2013-07-01

Tinnitus, occurring at least once in a lifetime in about 10–20% of the population, is an important clinical problem with complex etiology. Rare causes of tinnitus include cranial dural arteriovenous fistulas (DAVFs), which are usually small lesions consisting of abnormal connections between branches of dural arteries and venous sinuses or veins. Authors present a case of a 44-year-old woman with persistent, unilateral, treatment-resistant pulsatile tinnitus caused by a small dural arteriovenous fistula revealed in computed tomography angiography. Computed tomography angiography is a useful diagnostic method that in some cases allows for establishing the cause of unilateral, pulsatile tinnitus.

Os acromiale causing shoulder impingement syndrome: a case report

International Nuclear Information System (INIS)

Romero, I.; Rodriguez, A.; Roca, M.; Garcia, Y.

2001-01-01

Shoulder impingement syndrome is caused by repeated mechanical trauma to the rotator cuff due to encroachment of the coracoacromial ligament; in most cases, it is a primary lesion. Os acromiale, an anatomic variant of the shoulder structures, is one of the predisposing factors for the development of this entity. We present a case of os acromiale complicated by complete rupture of the tendon of the supraspinatus muscle and luxation of the long head of the biceps tendon. We stress the importance of magnetic resonance in the study of this anatomic variant and in the detection of complications or associated lesions. (Author) 10 refs

A case of laryngeal neurofibroma associated with neurofibromatosis type 2

International Nuclear Information System (INIS)

Cihangiroglu, M.; Yilmaz, S.; Yildirim, H.; Ozdemir, H.; Altinsoy, B.; Ogur, E.

2002-01-01

Purpose: Laryngeal neurofibromas have been reported in 16 patients with NF1, and schwannomas, in two patient with NF1 and 2 patients with NF2. To the best our knowledge our case is the first to document a laryngeal neurofibroma in a patient with NF2. Another unique feature of our case is the coexistence of multiple intramedullary tumors, which has not previously been reported in a patient with a laryngeal neurofibroma. Material and methods: A 32-year-old woman presented with a history of cataract, hoarseness and dysphonia since childhood, which had recently become worse. The patient also had hearing disability for low frequencies. Results: Laryngoscopy revealed a 2x2x3.5 cm smooth-surfaced submucosal supraglottic mass. On CT of the neck, the lesion was seen as a round and well-defined hypopharyngeal mass extended through and obliterating the left supraglottic space. It was hypodense on unenhanced CT images and slightly enhanced with IV contrast administration. On MR imaging, the mass was heterogeneously hypointense on T1-weighted images and hyperintense on T2-weighted images, with moderate homogenous enhancement after gadolinium administration. Bilateral vestibular schwannomas and multiple intramedullary masses (presumed to be ependymoma or astrocytoma) were delineated on these MR images The patient was diagnosed as having NF-2 and the laryngeal mass was totally resected. On histopathological examination, the mass were consistent with neurofibroma. Conclusion: Dysphonia and hoarseness may be the only presenting symptoms suggesting the possibility of a laryngeal nerve sheath tumor, and neurofibroma should be included in differential diagnosis of laryngeal masses in patients with NF2. (authors)

Case series of unusual causes intestinal obstruction in infants and ...

African Journals Online (AJOL)

Introduction Many of the causes of intestinal obstruction arise from ... In this work, we report eight unusual cases of intestinal ..... lymph is considered to be the result of an imbalance ... During fetal life, midgut communicates with the yolk sac.

Prosthetic joint infection caused by Pasteurella multocida: a case series and review of literature.

Science.gov (United States)

Honnorat, Estelle; Seng, Piseth; Savini, Hélène; Pinelli, Pierre-Olivier; Simon, Fabrice; Stein, Andreas

2016-08-20

Pasteurella multocida is a well-recognized zoonotic agent following dog or cat bites or scratches. Nevertheless, prosthetic joint infection caused by P. multocida are rarely reported. We report here a series of six cases of prosthetic joint infection caused by P. multocida managed at a referral centre for the treatment of bone and joint infection in southern France. We also reviewed the 26 cases reported in literature. The mean age of our cases was 74 years [±8.2, range 63-85]. In majority of our cases (5 cases) were associated with knee prostheses and one case with a hip prosthesis. Most of cases occurred after cat or dog scratches or licks or contact. Diagnoses of prosthetic joint infection caused by P. multocida were made by positive cultures of surgical biopsies or needle aspiration. Mean time delay between prosthetic joint implantation and infection onset was 7.6 years (±5.12 years, range 2-17). Local inflammation, which occurred in all six cases, was the most frequent clinical symptom, followed by pain in five cases, fever and swollen joints in four cases, and a fistula with purulent discharge inside the wound in two cases. The mean time of antibiotic therapy was 8 months. Surgical treatment with prosthesis removal was performed in three cases. Six of our cases were in remission without apparent relapse at 3 years after end of treatment. Prosthetic joint infections caused by P. multocida usually occur after animal scratches or bites, but can occasionally occur after a short animal lick. These infections are usually resulting from a contiguous infection and localized in the knee. An early antibiotic therapy after surgical debridement could avoid prosthetic withdrawal, notably in elderly patients. Patients with prosthetic joints should be warned that animals are potential sources of serious infection and urgent medical advice should be sought if they are bitten or scratched.

Sclerotherapy for a simple renal cyst causing hydronephrosis: A case report

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Kang, Ji Hun; Park, Sang Woo; Chang, Il Soo; Hwang, Jin Ho; Jung, Sung Il [Dept. Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul (Korea, Republic of)

2017-05-15

A simple renal cyst usually remains asymptomatic and requires no invasive treatment. Occasionally, however, some cysts may cause pain, hematuria, hypertension, or obstruction of the collecting system. We describe a case of a 50-year-old man who presented with hydronephrosis caused by an ipsilateral simple renal cyst without any stone or significant mass in the urinary system. The patient was eventually treated successfully with sclerotherapy.

Oral mite anaphylaxis caused by mite-contaminated okonomiyaki/ pancake-mix in Japan: 8 case reports and a review of 28 reported cases.

Science.gov (United States)

Takahashi, Kentaro; Taniguchi, Masami; Fukutomi, Yuma; Sekiya, Kiyoshi; Watai, Kentaro; Mitsui, Chihiro; Tanimoto, Hidenori; Oshikata, Chiyako; Tsuburai, Takahiro; Tsurikisawa, Naomi; Minoguchi, Kenji; Nakajima, Hiroshi; Akiyama, Kazuo

2014-03-01

Anaphylaxis after the ingestion of foods contaminated with mites has recently been recognized. Case series and case reports thus far have shown that mite-contaminated wheat flour is the major cause of oral mite anaphylaxis. However, we have found 8 cases of oral mite anaphylaxis which were caused by mite-contaminated okonomiyaki-mix, a savory Japanese style pancake mix, in our hospital. In addition to our 8 cases, the databases of MEDLINE and ICHUSHI were systematically searched for patients with oral mite anaphylaxis in Japan. Thirty-six patients including our 8 cases with oral mite anaphylaxis were identified. Thirty-four out of 36 cases (94%) ingested okonomiyaki or takoyaki, prepared at home using okonomiyaki-mix or takoyaki-mix which was previously opened and stored for months at ambient temperature. Microscopic examination of culprit mixes of 16 cases including our 1 case revealed contamination of mites such as Dermatophagoides farina (Der f) (5 cases), Tyrophagus putrescentiae (Tyr p) (4 cases), and Dermatophagoides pteronyssinus (Der p) (3 cases). The specific IgE to each mite is generally upregulated in these patients. Especially, the titers of specific IgE to Der p and Der f were more than class 2 in all cases. Mite-contaminated flavored flour is the major cause of oral mite anaphylaxis in Japan.

Dysphonia secondary to traumatic avulsion of the vocal fold in infants

OpenAIRE

Cavalli, L.; Bray, D.; Eze, N.; Hartley, B. E. J.

2010-01-01

Objective: Airway compromise due to paediatric intubation injuries is well documented; however, intubation injuries may also cause severe voice disorders. We report our experience and review the world literature on the voice effects of traumatic paediatric intubation. Case series: We report five cases of children referred to Great Ormond Street Hospital for Children who suffered traumatic avulsion of the vocal fold at the time of, or secondary to, endotracheal intubation. All children had sig...

Perceptual structure of adductor spasmodic dysphonia and its acoustic correlates.

Science.gov (United States)

Cannito, Michael P; Doiuchi, Maki; Murry, Thomas; Woodson, Gayle E

2012-11-01

To examine the perceptual structure of voice attributes in adductor spasmodic dysphonia (ADSD) before and after botulinum toxin treatment and identify acoustic correlates of underlying perceptual factors. Reliability of perceptual judgments is considered in detail. Pre- and posttreatment trial with comparison to healthy controls, using single-blind randomized listener judgments of voice qualities, as well as retrospective comparison with acoustic measurements. Oral readings were recorded from 42 ADSD speakers before and after treatment as well as from their age- and sex-matched controls. Experienced judges listened to speech samples and rated attributes of overall voice quality, breathiness, roughness, and brokenness, using computer-implemented visual analog scaling. Data were adjusted for regression to the mean and submitted to principal components factor analysis. Acoustic waveforms, extracted from the reading samples, were analyzed and measurements correlated with perceptual factor scores. Four reliable perceptual variables of ADSD voice were effectively reduced to two underlying factors that corresponded to hyperadduction, most strongly associated with roughness, and hypoadduction, most strongly associated with breathiness. After treatment, the hyperadduction factor improved, whereas the hypoadduction factor worsened. Statistically significant (P<0.01) correlations were observed between perceived roughness and four acoustic measures, whereas breathiness correlated with aperiodicity and cepstral peak prominence (CPPs). This study supported a two-factor model of ADSD, suggesting perceptual characterization by both hyperadduction and hypoadduction before and after treatment. Responses of the factors to treatment were consistent with previous research. Correlations among perceptual and acoustic variables suggested that multiple acoustic features contributed to the overall impression of roughness. Although CPPs appears to be a partial correlate of perceived

MR findings of infectious myositis caused by vibrio vulnificus: case report

Energy Technology Data Exchange (ETDEWEB)

Lee, Joon Ho; Na, Jae Boem [Gyeongsang National University College of Medicine, Jinju (Korea, Republic of)

2003-03-01

Vibrio vulnificus infection is a fatal disease occurring after the consumption of seafood in patients with underlying liver disease. Inflammation of the skin, subcutanous fat and fascia disseminates from the lower extremity to the trunk and upper extremity. Infection myositis caused by vibrio vulnificus is rare, and its MR findings have not been reported. We report these in a case of infectious myositis caused by vibrio vulnificus involving both lower extremities.

MR findings of infectious myositis caused by vibrio vulnificus: case report

International Nuclear Information System (INIS)

Lee, Joon Ho; Na, Jae Boem

2003-01-01

Vibrio vulnificus infection is a fatal disease occurring after the consumption of seafood in patients with underlying liver disease. Inflammation of the skin, subcutanous fat and fascia disseminates from the lower extremity to the trunk and upper extremity. Infection myositis caused by vibrio vulnificus is rare, and its MR findings have not been reported. We report these in a case of infectious myositis caused by vibrio vulnificus involving both lower extremities

Shortened cortical silent period in adductor spasmodic dysphonia: evidence for widespread cortical excitability.

Science.gov (United States)

Samargia, Sharyl; Schmidt, Rebekah; Kimberley, Teresa Jacobson

2014-02-07

The purpose of this study was to compare cortical inhibition in the hand region of the primary motor cortex between subjects with focal hand dystonia (FHD), adductor spasmodic dysphonia (AdSD), and healthy controls. Data from 28 subjects were analyzed (FHD n=11, 53.25 ± 8.74 y; AdSD: n=8, 56.38 ± 7.5 y; and healthy controls: n=941.67 ± 10.85 y). All subjects received single pulse TMS to the left motor cortex to measure cortical silent period (CSP) in the right first dorsal interosseus (FDI) muscle. Duration of the CSP was measured and compared across groups. A one-way ANCOVA with age as a covariate revealed a significant group effect (p<0.001). Post hoc analysis revealed significantly longer CSP duration in the healthy group vs. AdSD group (p<0.001) and FHD group (p<0.001). These results suggest impaired intracortical inhibition is a neurophysiologic characteristic of FHD and AdSD. In addition, the shortened CSP in AdSD provides evidence to support a widespread decrease in cortical inhibition in areas of the motor cortex that represent an asymptomatic region of the body. These findings may inform future investigations of differential diagnosis as well as alternative treatments for focal dystonias. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Ochronosis as an unusual cause of valvular defect: a case report

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Steverding Dietmar

2009-11-01

Full Text Available Abstract Introduction Alkaptonuria (also known as ochronosis is a genetic disorder characterised by the accumulation of homogentisic acid deposits in connective tissue. In rare cases, ochronosis can cause valvular heart disease. Case presentation We present the case of a 68-year-old Caucasian man with alkaptonuria-associated degenerative valvular defects with aortic, mitral and tricuspid valve insufficiency. The patient did not have any cardiac complaints and was referred to our clinic for evaluation of a conspicuous new heart murmur. Conclusion This case report shows that early diagnosis of cardiovascular ochronosis gives us the opportunity to use conservative treatment to slow down the progression of valvular dysfunction.

An unusual foreign body as cause of chronic sinusitis: a case report

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Dinerman Harry

2010-05-01

Full Text Available Abstract Introduction The presence of a foreign body in the nose is a relatively uncommon occurrence. Many unusual foreign bodies in the nose have been reported in the literature, but no case of a nasal packing occurring as a foreign body in the nasal cavity for a prolonged time has been found. Case presentation We describe a unique case of the largest foreign body left in situ in the nasal cavity for over 10 years. Our patient was a 71-year-old Caucasian man with diabetes. Because of this, he was at high risk of developing complications from the foreign body and the chronic sinusitis. Amazingly, though, the foreign body had not caused any symptoms on our patient for many years, except for nasal discharge during the last few years. To the best of our knowledge, this is the first case in the literature of such a large intra-nasal foreign body described in an adult without mental illness and without trauma that remained in situ for such a long time. Conclusion Undoubtedly, even illnesses with no complications could prove difficult for clinicians to diagnose. Clinicians should recognize the underlying causes that are responsible for the symptoms of chronic sinusitis and a unilateral nasal discharge should be assumed to be caused by an intra-nasal foreign body until proven otherwise.

Gender-Based Violence Causing Severe Multiple Injuries; a Case Report

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Adalard Falschung

2018-04-01

Full Text Available Introduction: Gender-based violence (GBV against women has been identified as a global health and development issue. We reported a case of GBV causing sever, multiple injuries in a middle-aged female. Case report: A 47-year-old woman presented to emergency room with disturbed level of consciousness, shortness of breath and multiple patches of skin discoloration. On examination, the patient was semi-conscious, with multiple ecchymosis and bilateral decreased air entry. Computed tomography scan of the neck and chest showed six rib fractures on the left side, and eight rib fractures on the right side, sternal fracture, manubriosternal dislocation, bilateral hemothorax, fracture of body of eleventh thoracic vertebra, and fracture of cervical spine of fifth and seventh vertebrae. The patient was intubated and admitted to intensive care unit. She was discharged with good health condition after 23 days of hospital admission. Conclusion: GBV is still a cause of severe trauma that puts the patient’s life at risk.

Asthma caused by potassium aluminium tetrafluoride: a case series.

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Laštovková, Andrea; Klusáčková, Pavlina; Fenclová, Zdenka; Bonneterre, Vincent; Pelclová, Daniela

2015-01-01

The objective of this study is to describe a case-series of potassium aluminium tetrafluoride (KAlF(4))-induced occupational asthma (OA) and/or occupational rhinitis (OR). The study involves five patients from a heat-exchanger production line who were examined (including specific inhalation challenge tests) for suspected OA and/or OR caused by a flux containing almost 100% KAlF(4) - with fluorides' workplace air concentrations ranging between 1.7 and 2.8 mg/m(3). No subject had a previous history of asthma. All five patients had a positive specific challenge test (three patients were diagnosed with OA alone, one with OR and one with both OR and OA). At the follow-up visit, after three years on average, all patients needed permanent corticosteroid therapy (four topical, one oral). After elimination from the exposure, only one of the observed subjects gave an indication of an improvement, two subjects stabilized and two worsened. Our case series focuses on the correlation between patients' exposure to fluorides in air-conditioner production and the subsequent occurrence of OR/OA. Currently, it is uncertain whether these OR/OA were caused by hypersensitivity or irritation.

Intractable vomiting caused by vertebral artery compressing the medulla: A case report

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Lauren Gorton

2015-01-01

Full Text Available Vertebral artery compressing the medulla and causing intractable vomiting has only been reported once previously. We report a case of a 69-year-old woman with intractable nausea and vomiting causing a 50 pound weight loss and who failed medical management and whose symptoms were completely reversed following microvascular decompression (MVD.

Cause Analysis of Flow Accelerated Corrosion and Erosion-Corrosion Cases in Korea Nuclear Power Plants

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Lee, Y. S.; Lee, S. H. [Korea Hydro and Nuclear Power Co., Ltd., Gyeongju (Korea, Republic of); Hwang, K. M. [KEPCO Engineering and Construction Company, Gimcheon (Korea, Republic of)

2016-08-15

Significant piping wall thinning caused by Flow-Accelerated Corrosion (FAC) and Erosion-Corrosion (EC) continues to occur, even after the Mihama Power Station unit 3 secondary pipe rupture in 2004, in which workers were seriously injured or died. Nuclear power plants in many countries have experienced FAC and EC-related cases in steam cycle piping systems. Korea has also experienced piping wall thinning cases including thinning in the downstream straight pipe of a check valve in a feedwater pump line, the downstream elbow of a control valve in a feedwater flow control line, and failure of the straight pipe downstream of an orifice in an auxiliary steam return line. Cause analyses were performed by reviewing thickness data using Ultrasonic Techniques (UT) and, Scanning Electron Microscope (SEM) images for the failed pipe, and numerical simulation results for FAC and EC cases in Korea Nuclear Power Plants. It was concluded that the main cause of wall thinning for the downstream pipe of a check valve is FAC caused by water vortex flow due to the internal flow shape of a check valve, the main cause of wall thinning for the downstream elbow of a control valve is FAC caused by a thickness difference with the upstream pipe, and the main cause of wall thinning for the downstream pipe of an orifice is FAC and EC caused by liquid droplets and vortex flow. In order to investigate more cases, additional analyses were performed with the review of a lot of thickness data for inspected pipes. The results showed that pipe wall thinning was also affected by the operating condition of upstream equipment. Management of FAC and EC based on these cases will focus on the downstream piping of abnormal or unusual operated equipment.

Typhoid fever as a cause of opportunistic infection: case report

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Tumminia Salvatore

2006-02-01

Full Text Available Abstract Background Typhoid fever is a systemic infection caused by the bacterium Salmonella enterica subspecies enterica serotype typhi, which is acquired by ingestion of contaminated food and water. Each year the disease affects at least 16 million persons world-wide, most of whom reside in the developing countries of Southeast Asia and Africa. In Italy the disease is uncommon with a greater number of cases in Southern regions than in Northern ones. Case presentation We report on a 57-year-old Sri-Lankan male affected by typhoid fever, the onset of which was accompanied by oropharyngeal candidiasis. This clinical sign was due to a transient cell-mediated immunity depression (CD4+ cell count was 130 cells/mm3 probably caused by Salmonella typhi infection. Human immunodeficiency virus infection was ruled out. Diagnosis of typhoid fever was made by the isolation of Salmonella typhi from two consecutive blood cultures. The patient recovered after a ten days therapy with ciprofloxacin and his CD4+ cell count improved gradually until normalization within 3 weeks. Conclusion Our patient is the first reported case of typhoid fever associated with oropharyngeal candidiasis. This finding suggests a close correlation between Salmonella typhi infection and transitory immunodepression.

[Rare cause for severe hypertriglyceridemia - case 9/2013].

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Kahl, Sabine; Roden, Michael; Mörike, Klaus; Müssig, Karsten

2013-11-01

We report on a 48-year-old female patient with recently developed severe hypertriglyceridemia. Medical history was remarkable for breast cancer with breast-preserving surgery and chemoradiotherapy. The patient has been treated with 20 mg tamoxifen per day for three months. Laboratory results showed hypertriglyeridemia, hypercholesterolemia and lowered HDL-cholesterol. Findings were consistent with a drug-induced hypertriglyceridemia caused by anti-estrogenic therapy with tamoxifen. After consulting the patient's gynaecologist, we discontinued tamoxifen treatment. Thereupon, triglyceride levels fell consistently. There were no signs of pancreatitis, serum amylase and lipase were in the normal range. Patients with pre-diagnosed metabolic disorders, especially dyslipidemia and type 2 diabetes, should undergo regular controls of serum triglycerides during tamoxifen treatment. Also, one should keep in mind that a subacute, severe rise in serum triglyceride levels may be caused, in rare cases, by tamoxifen treatment. © Georg Thieme Verlag KG Stuttgart · New York.

Clinical experience with patients with spasmodic dysphonia and primary Meige syndrome.

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Pedrero-Escalas, María Fernanda; García-López, Isabel; Santiago-Pérez, Susana; Vivancos, Francisco; Gavilán, Javier

2018-04-28

Meige syndrome (MS) is part of the group of segmental cranial dystonias, which affect more than two cranial muscle groups. Specifically, blepharospasm is associated with another cranial dystonia (oromandibular, cervical or laryngeal). The aim of this paper was to report our experience in patients with spasmodic dysphonia (SD) associated with primary MS. A retrospective study involving 8 patients between May 2010 and June 2015. Variables recorded were: age, sex, associated dystonia, electromyographic pattern in laryngeal muscles and treatment given. Outcomes after treatment were assessed using GRBAS(i) scale and VHI-30 questionnaire, always provided by the same examiner. Fifty-six patients with MS were treated in the Neurology Department. Eight patients of 56 were diagnosed with SD (prevalence of 14%). All of our patients had adductor SD. The median age was 71years. All the patients were treated with intralaryngeal botulinum toxin under electromyographic control. Clinically relevant improvements were found after treatment on both the GRBAS(i) scale and the VHI-30 questionnaire. In the study of SD, we should always rule out an association with MS. From the point of view of otorhinolaryngology, the joint use of the GRBAS(i) scale and the VHI-30 questionnaire are useful, reliable and efficient methods for assessing progress and response to treatment. Laryngeal infiltration under electromyographic control with botulinum toxin is the therapeutic alternative that provides better results. The management of SD associated with MS does not differ from isolated SD. Copyright © 2018 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Publicado por Elsevier España, S.L.U. All rights reserved.

Spontaneous pharyngo-laryngeal hematoma and anticoagulation. A case report

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Marleny CASASOLA-GIRÓN

2016-03-01

Full Text Available Introduction and Objective: Spontaneous pharyngeal-laryngeal hematoma shows the importance of a complete ENT examination in the face of symptoms of banal appearance and a correct history that, in the case reported, unveiled the therapeutic use of anticoagulants. Case description: A 55 year old woman comes to emergency because of unexplained dysphagia. The inspection shows the presence of a hematoma in the pharyngeal-laryngeal region that, after the anticoagulant therapy was reversed, evolved favorably with conservative treatment. Discussion: In this case, apart from medical management performed by the hematology department, we focus our therapeutic approach in the protection of the airway and the prevention of a possible massive bleeding. Determining which patients require endotracheal intubation or tracheostomy and hemostatic surgery is the key to treatment. Conclusions: The anticoagulant therapy involves several complications that ENT specialists must consider in the face of clinical symptoms of dysphagia, dysphonia, dyspnea or signs of bleeding and they must know the possibilities of performance depending on the severity of each case.

Budd-chiari syndrome caused by diaphragmatic hernia of the liver: a case report

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Song, Jae Min; Yoon, Jung Won; Kim, Jae Wook; Chung, Woo Kyoung; Chung, Hee Sun; Kim, Joo Hyung; Choi, Jun Ho; Kim, Seung Ho [Armed Forces Capital Hospital, Seongnam (Korea, Republic of)

2007-01-15

Budd-Chiari syndrome is an uncommon disorder, and it is caused by obstruction of the hepatic venous out-flow or inferior vena cava above the hepatic vein. It may result from a large number of conditions, including primary congenital obstructions of the hepatic veins or inferior vena cava by webs or bands. Secondary causes include trauma, polycythemia vera, chronic leukemia, pregnancy, tumors and use of oral contraceptives. No definitive etiologic factors have been identified in two thirds of all cases. We recently experienced a case of Budd-Chiari syndrome caused by diaphragmatic hernia in 21-year-old man. Postoperative follow up CT showed normal venous flow after reintroduction of the liver into the abdominal cavity and closure of the diaphragm defect.

Budd-chiari syndrome caused by diaphragmatic hernia of the liver: a case report

International Nuclear Information System (INIS)

Song, Jae Min; Yoon, Jung Won; Kim, Jae Wook; Chung, Woo Kyoung; Chung, Hee Sun; Kim, Joo Hyung; Choi, Jun Ho; Kim, Seung Ho

2007-01-01

Budd-Chiari syndrome is an uncommon disorder, and it is caused by obstruction of the hepatic venous out-flow or inferior vena cava above the hepatic vein. It may result from a large number of conditions, including primary congenital obstructions of the hepatic veins or inferior vena cava by webs or bands. Secondary causes include trauma, polycythemia vera, chronic leukemia, pregnancy, tumors and use of oral contraceptives. No definitive etiologic factors have been identified in two thirds of all cases. We recently experienced a case of Budd-Chiari syndrome caused by diaphragmatic hernia in 21-year-old man. Postoperative follow up CT showed normal venous flow after reintroduction of the liver into the abdominal cavity and closure of the diaphragm defect

Death caused by heat stroke: Case report

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Savić Slobodan

2014-01-01

Full Text Available Introduction. Heat stroke is the most dangerous among numerous disorders caused by elevated environmental temperature. It is characterized by an increased body temperature of over 40°C, the dysfunction of the central nervous system and the development of multiple organ failure. The aim of this paper was to highlight problems in the clinical and post-mortal diagnosis of fatal heat stroke. Case Outline. A 20-year-old male was found unconscious on the street; on admission at the Emergency Center, Clinical Center of Serbia, Belgrade, he was in a coma. The body temperature of 40°C was maintained despite the applied therapy, meningeal signs were negative, tachycardia with gallop rhythm, hypotension, bleeding from the nose and mouth, and presence of skin bruises. Laboratory findings: highly elevated LDH and creatine kinase, elevated serum creatinine, AST, and signs of DIC. Lethal outcome occurred 6 hours after admission, and the case remained clinically unsolved. Autopsy showed signs of hemorrhagic diathesis, brain and pulmonary edema, and microscopic examination revealed general congestion, internal bleeding in various organs, cerebral edema, massive blood aspiration and pulmonary edema. Toxicological and bacteriological examinations were negative. Based on these findings and subsequently obtained data on the conditions at the workplace where the young man had a part-time job, it was concluded that the violent death was caused by heat stroke. Conclusion. Since heat stroke is associated with a high mortality rate and high incidence of serious and permanent organ damage in survivors, it is important to make the diagnosis of heat stroke as quickly as possible and apply appropriate treatment. Misdiagnosis of heat stroke, and consequently inadequate treatment, with a potential fatal outcome for the patient, can be the reason for blaming doctors for the legal offense of medical malpractice in failing to administer first aid.

Middle ear osteoma causing progressive facial nerve weakness: a case report

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Curtis, Kate; Bance, Manohar; Carter, Michael; Hong, Paul

2014-01-01

Introduction Facial nerve weakness is most commonly due to Bell’s palsy or cerebrovascular accidents. Rarely, middle ear tumor presents with facial nerve dysfunction. Case presentation We report a very unusual case of middle ear osteoma in a 49-year-old Caucasian woman causing progressive facial nerve deficit. A subtle middle ear lesion was observed on otoscopy and computed tomographic images demonstrated an osseous middle ear tumor. Complete surgical excision resulted in the partial recovery...

Remote transient Lactobacillus animalis bacteremia causing prosthetic hip joint infection: a case report

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R. Somayaji

2016-11-01

Full Text Available Abstract Background Lactobacillus spp. are uncommon pathogens in immunocompetent hosts, and even rarer causes of prosthetic device infections. Case presentation A case of chronic hip prosthetic joint infection (PJI caused by L. animalis is described. This occurred 5 years after a transient bacteremia with the same organism. Whole genome sequencing of both isolates proved this PJI infection resulted from this remote bacteremia. Conclusions We document that prosthetic joint infections may be a consequence of bacteremia as much as 3 years before the onset of symptoms.

VAT EVASION INLEBANON: CASES AND MAIN CAUSES

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Rana Ismail

2012-07-01

Full Text Available The Value Added Tax (VAT is a very important source oftreasuryrevenuesinLebanon. It was initially introduced inLebanon in order to reduce the budgetdeficit and help contain the debt. However, VAT evasion growth inLebanon isleading to significant VAT revenue losses because of its size and frequency.In this paper, we will highlight the contribution of VAT to the treasury revenue. Inaddition, our research has led to figure out the most significant VAT evasion casesand the way tax payers evade paying their required VAT or try to have an illegalrefund. From these tax evasion cases, we will pinpoint the main causes of suchevasions and propose solutions to limit as much as possible VAT evasion inLebanon.

Cause and Prevention of Playground Injuries and Litigation; Case Studies.

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Frost, Joe L.; Sweeney, Theodora B.

This study examined 187 playground injuries and 13 fatalities that resulted in lawsuits between 1981 and 1995, taken from the files of two expert witnesses on playground safety who testified in the cases. The data are presented by geographic location, nature of injuries, cause of injuries/fatalities, playground equipment implicated, location of…

Runaway reactions. Part 2 Causes of Accidents in selected CSB case histories Part 2

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GYENES ZSUZSANNA; CARSON PHILLIP

2017-01-01

Part 1 briefly discussed the basic thermochemistry of reactive chemicals, the statistics of accidents involving runaway reactions, and general control measures to minimise risk and mitigate the consequences. The present paper highlights the main causes of major accidents from runaway reactions with illustrative case histories to link theory and practice. It also discusses lessons learned from these accidents, which are very similar in the cases studied. The main causes are management deficien...

Vocal characteristics of congenital anterior glottic webs in children: A case report.

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Shah, Jay; White, Katherine; Dohar, Joseph

2015-06-01

This case report describes a 5-year-old girl with chronic dysphonia and high-pitched voice since birth. Vocal quality was noted to be harsh. Videostroboscopy revealed significant hyperfunction and a Type II congenital anterior glottic web. Endoscopic division of the anterior glottic web was performed with significant improvement in vocal quality and quality of life. This paper describes methods of analyzing, diagnosing, and treating anterior glottic web with a focus on quality of life. Also, unique acoustic and aerodynamic voice features are identified. No other descriptions of a voice characteristic for anterior glottic web currently exist in the literature. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Intussusceptions as acute abdomen caused by Burkitt lymphoma: a case report

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Hoxha, Faton T; Hashani, Shemsedin I; Krasniqi, Avdyl S; Kurshumliu, Fisnik I; Komoni, Driton S; Hasimja, Shpresa M; Maxhuni, Mehmet

2009-01-01

Introduction Burkitt's lymphoma is a highly malignant, aggressive and rapidly growing B-cell neoplasm, which has low long-term survival rates. The abdomen is the most frequent onset site of non endemic Burkitt's lymphoma. Symptoms are often misleading and make diagnosis difficult. Ileum intussusception as acute abdomen caused by Burkitt lymphoma is rare. Case presentation We are presenting a case of a 16 year-old male with acute abdomen, which three weeks prior initially has been surgically t...

An open-label study of sodium oxybate (Xyrem®) in spasmodic dysphonia

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Rumbach, Anna F.; Blitzer, Andrew; Frucht, Steven J.; Simonyan, Kristina

2016-01-01

Objective Spasmodic dysphonia (SD) is a task-specific laryngeal dystonia that affects speech production. Co-occurring voice tremor (VT) often complicates the diagnosis and clinical management of SD. Treatment of SD and VT is largely limited to botulinum toxin injections into laryngeal musculature; other pharmacological options are not sufficiently developed. Study Design and Methods We conducted an open-label study in 23 SD and 22 SD/VT patients to examine the effects of sodium oxybate (Xyrem®), an oral agent with therapeutic effects similar to those of alcohol in these patients. Blinded randomized analysis of voice and speech samples assessed symptom improvement before and after drug administration. Results Sodium oxybate significantly improved voice symptoms (p = 0.001) primarily by reducing the number of SD-characteristic voice breaks and severity of VT. Sodium oxybate further showed a trend for improving VT symptoms (p = 0.03) in a subset of patients who received successful botulinum toxin injections for the management of their SD symptoms. The drug’s effects were observed approximately 30–40 min after its intake and lasted about 3.5–4 hours. Conclusion Our study demonstrated that sodium oxybate reduced voice symptoms in 82.2% of alcohol-responsive SD patients both with and without co-occurring VT. Our findings suggest that the therapeutic mechanism of sodium oxybate in SD and SD/VT may be linked to that of alcohol and as such sodium oxybate might be beneficial for alcohol-responsive SD and SD/VT patients. PMID:27808415

Pial Arteriovenous Fistula Caused by Trauma: A Case Report.

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Nomura, Seiji; Ishikawa, Osamu; Tanaka, Kentaro; Otani, Ryohei; Miura, Keisuke; Maeda, Keiichiro

2015-01-01

We report an extremely rare case of pial arteriovenous fistula (AVF) caused by trauma. A 61-year-old man suffered from brain contusion by a traffic accident. He was neurologically normal on admission. However, his headache gradually worsened, and partial seizures occurred thereafter. He presented with general tonic seizure 7 days after the head injury. Magnetic resonance imaging demonstrated the exacerbation of brain edema and an abnormal vein near the contusion. Subsequent angiography showed a pial AVF, which was considered to be responsible for the brain edema. After treatment of the AVF by direct surgery, the brain edema was ameliorated. We should take into consideration the formation of vascular disease in cases with unexpected worsening of edema after brain injury.

Adrenal Insufficiency as a Cause of Acute Liver Failure: A Case Report

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Jamshid Vafaeimanesh

2013-01-01

Full Text Available Introduction. Many diseases and conditions can contribute to elevated liver enzymes. Common causes include viral and autoimmune hepatitis, fatty liver, and bile duct diseases, but, in uncommon cases like liver involvement in endocrine disorders, liver failure is also seen. Adrenal insufficiency is the rarest endocrine disorder complicating the liver. In the previously reported cases of adrenal insufficiency, mild liver enzymes elevation was seen but we report a case with severe elevated liver enzymes and liver failure due to adrenal insufficiency. Based on our knowledge, this is the first report in this field. Case Report. A 39-year-old woman was referred to emergency ward due to drowsiness and severe fatigue. Her laboratory tests revealed prothrombin time: 21 sec, alanine aminotransferase (ALT: 2339 IU/L, aspartate aminotransferase (AST: 2002 IU/L, and ALP: 90 IU/L. No common cause of liver involvement was discovered, and eventually, with diagnosis of adrenal insufficiency and corticosteroid therapy, liver enzymes and function became normal. Finally, the patient was discharged with good general condition. Conclusion. With this report, we emphasize adrenal insufficiency (primary or secondary as a reason of liver involvement in unexplainable cases and recommend that any increase in the liver enzymes, even liver failure, in these patients should be observed.

Disfonias: relação S/Z e tipos de voz Dysphonias: S/Z ratio and types of voice

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Carla Aparecida Cielo

2008-12-01

Full Text Available OBJETIVO: verificar o resultado da relação s/z e do tipo de voz em pacientes com diagnóstico de disfonias orgânico-funcionais (DOF e disfonias funcionais por uso incorreto da voz (DFUIV, bem como a ocorrência das diferentes patologias dentro das DOF. MÉTODOS: 70 indivíduos, de ambos os sexos, entre cinco e 65 anos de idade, atendidos numa clínica-escola, cadastrados em Banco de Dados, entre 1998 e 2006, com DOF e DFUIV, ambos classificados em três subgrupos: casos em que a relação s/z indicava hipercontração, normalidade, e falta de coaptação das pregas vocais durante a fonação. Os tipos de voz foram classificados conforme a ocorrência em: sem alteração; ruidosa; ruidosa, comprimida e/ou apresentando alteração de f0h; ruidosa e/ou apresentando alteração de f0h; e comprimida. RESULTADOS: ocorrência significativa de DOF e de DOF com nódulos vocais; nas DOF e DFUIV, ocorrência significante de relação s/z normal com tempos isolados de /s/ e /z/ abaixo do normal e voz ruidosa. CONCLUSÕES: O resultado da relação s/z foi estatisticamente significativo a favor da faixa de normalidade estabelecida, tanto nos pacientes com diagnóstico de DOF, quanto naqueles com DFUIV, sendo que, em ambos os grupos de pacientes, a voz ruidosa foi a mais freqüente. Dentro das DOF, os nódulos vocais foram significativamente mais freqüentes do que as demais patologias.PURPOSE: to check the result of s/z ratio and types of voice in patients with diagnosis of organic-functional dysphonias (DOF and functional dysphonias by incorrect use of voice (DFUIV, as well as the occurrence of the various pathologies within the DOF. METHODS: 70 subjects of both genders, between 5 and 65 years old, seen in a clinic-school, registered in a data bank from 1998 to 2006, with DOF and DFUIV, both classified in three sub-groups: cases in which the s/z ratio indicated hypercontraction, normality and lack of coaptation of the vocal folds during phonation

Perforated duodenal diverticulum caused by Bezoar: A case report

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Lee, Eun Jung; Moon, Sung Kyoung; Park, Seong Jin; Lim, Joo Won; Lee, Dong Ho; Ko, Young Tae [Dept. of Radiology, College of Medicine, Kyung Hee University, Seoul (Korea, Republic of)

2013-11-15

Duodenal diverticulum is common, but its perforation is a rare complication. Duodenal diverticulum perforation requires prompt treatments because of its high mortality rate. However, an accurate diagnosis is difficult to make due to nonspecific symptoms and signs. It can be misdiagnosed as pancreatitis, cholecystitis, or peptic ulcer. Herein, we report a case of perforated duodenal diverticulum caused by bezoar in a 33-year-old woman whom was diagnosed by abdomen computed tomography and ultrasonography.

Pial Arteriovenous Fistula Caused by Trauma: A Case Report

OpenAIRE

NOMURA, Seiji; ISHIKAWA, Osamu; TANAKA, Kentaro; OTANI, Ryohei; MIURA, Keisuke; MAEDA, Keiichiro

2015-01-01

We report an extremely rare case of pial arteriovenous fistula (AVF) caused by trauma. A 61-year-old man suffered from brain contusion by a traffic accident. He was neurologically normal on admission. However, his headache gradually worsened, and partial seizures occurred thereafter. He presented with general tonic seizure 7 days after the head injury. Magnetic resonance imaging demonstrated the exacerbation of brain edema and an abnormal vein near the contusion. Subsequent angiography showed...

Perforated duodenal diverticulum caused by Bezoar: A case report

International Nuclear Information System (INIS)

Lee, Eun Jung; Moon, Sung Kyoung; Park, Seong Jin; Lim, Joo Won; Lee, Dong Ho; Ko, Young Tae

2013-01-01

Duodenal diverticulum is common, but its perforation is a rare complication. Duodenal diverticulum perforation requires prompt treatments because of its high mortality rate. However, an accurate diagnosis is difficult to make due to nonspecific symptoms and signs. It can be misdiagnosed as pancreatitis, cholecystitis, or peptic ulcer. Herein, we report a case of perforated duodenal diverticulum caused by bezoar in a 33-year-old woman whom was diagnosed by abdomen computed tomography and ultrasonography.

A rare cause of abdominal lymphadenopathy--tularemia: report of two pediatric cases.

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Gülhan, Belgin; Tezer, Hasan; Kanık-Yüksek, Saliha; Kılıç, Selçuk; Senel, Emrah

2014-01-01

Tularemia caused by Francisella tularensis occurs worldwide in the northern hemisphere, with great variation in geographic and temporal occurrence. It generally presents as an acute febrile disease with the major clinical presentations including the six classic forms of tularemia: ulceroglandular, glandular, oculoglandular, oropharyngeal, typhoidal, and pneumonic. In contrast to European countries, where the ulceroglandular form is more prominent, the oropharyngeal form is the most common presentation in Turkey. We present rare cases of oropharyngeal tularemia in a 16-year-old boy and nine-year-old girl. To the best of our knowledge, these are the firstly described abdominal lymphadenopathy cases from Turkey. The second case was admitted with erythema nodosum, and abdominal lymphadenopathy was detected during the investigation. Excisional lymph node biopsy revealed abdominal tularemia. It is necessary to consider tularemia in the differential diagnosis of abdominal lymphadenopathy in tularemia regions. We also conclude that oropharyngeal tularemia can cause lymphadenopathy in any part of the gastrointestinal tract.

Hydatidosis as a cause of acute appendicitis: a case report

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Maryam Hajizadeh

2013-02-01

Full Text Available Acute appendicitis is considered the most common cause of emergency surgery in children and young adults. The association between parasitic infections and appendicitis has been widely investigated. Hydatidosis, a zoonotic helminthic disease caused by the larval stage of the Echinococcus granulosus, may cause illness in intermediate hosts, generally human and herbivorous animals. This disease is considered hyper endemic in northwest of Iran and is a serious public health problem. Hydatidosis predominantly is located in internal organs especially liver and lung but is considered a rare cause of acute appendicitis. Our aim was to study hydatid cyst that causes appendicitis. In this retrospective descriptive, 275 appendectomies performed during the years 2007-2012 in Tabriz Emam Reza hospital. Depending on the clinical notes, serological method, laboratory, surgical findings and attention to the histopathologic results, we found a patient with appendiceal hydatidosis. Acute appendicitis of hydatidosis origin is not seen frequently even in the hyper endemic area. Therefore, described an unusual cases of hydatidosis, should be considered in the differential diagnoses of appendicitis also education on how to prevent hydatidosis and eradication of stray dogs should be included in training programs to avoid and decrease the appendectomy operations.

A rare case of allergic bronchopulmonary mycosis caused by Alternaria alternata.

NARCIS (Netherlands)

Chowdhary, A.; Agarwal, K.; Randhawa, H.S.; Kathuria, S.; Gaur, S.N.; Najafzadeh, M.J.; Roy, P.; Arora, N.; Khanna, G.; Meis, J.F.G.M.

2012-01-01

A rare case of allergic bronchopulmonary mycosis (ABPM), caused by Alternaria alternata, is reported in an immunocompetent resident of Delhi. Her complaints included a generalized, urticarial skin rash and occasional pain in the right lower chest. Her differential count showed eosinophils, 22%;

Small Bowel Obstruction Caused by Aloe vera Bezoars: A Case Report.

Science.gov (United States)

Hong, In Taik; Cha, Jae Myung; Ki, Hye Jin; Kwak, Min Seob; Yoon, Jin Young; Shin, Hyun Phil; Jeoun, Jung Won; Choi, Sung Il

2017-05-25

Small bowel obstruction is a clinical condition commonly caused by postoperative adhesion, volvulus, intussusceptions, and hernia. Small bowel obstruction due to bezoars is clinically uncommon, accounting for approximately 2-4% of all obstructions. Computed tomography (CT) is a useful method in diagnosing the cause of small bowel obstruction. However, small bowel obstruction caused by bezoars may not be detected by an abdominal CT examination. Herein, we report a rare case of small bowel obstruction by Aloe vera bezoars, which were undetected by an abdominal CT. Phytobezoars should be included in the differential diagnosis of small bowel obstruction in patients with predisposing factors, such as excessive consumption of high-fiber food and diabetes.

A young man with myelosuppression caused by clindamycin: a case report.

Science.gov (United States)

Morales, Manuel Polanco; Carvallo, Anna Paola Thome; Espinosa, Karla Adriana Bautista; Murillo, Edgar Enrique Meza

2014-01-05

Clindamycin is used to treat various bacterial infections, but its administration can cause anaphylaxis, liver reactions, pseudomembranous colitis, and peripheral blood cytopenias (anemia, neutropenia, and thrombocytopenia), alone or in combination. We report the case of a patient with a recurrent infection of the tonsils who received clindamycin. Pancytopenia, a previously unreported hematological disorder related to clindamycin use, was observed in conjunction with the infection and clindamycin treatment. One month prior to hospitalization, a 22-year-old man of Hispanic origin had a tonsillar infection and cough and began to have anal pain. These conditions became exacerbated three weeks later, coinciding with a new tonsillar infection, frequent nonproductive cough, and febrile syndrome. He received clindamycin for four days prior to his admission, without improvement. While hospitalized, he was found to have fever, tonsillar abscess, hemorrhoid thrombosis, and anal fissure; the latter was immediately resected under general anesthesia. Before surgery, our patient's blood count showed intense leukoneutropenia and mild thrombocytopenia that increased 12 hours later, along with the establishment of anemia. A bone marrow study showed decreased cell content, micromegakaryocytes, and an interruption of the differentiation of granulocytes and erythroblasts. Post-surgery, our patient received metronidazole, meropenem, and amikacin along with acetaminophen, ketoprofen, omeprazole, and pegfilgrastim, with resulting clinical and hematological improvement. Our experience with this patient establishes that well-documented clinical cases should be the basis for identifying and publicizing unknown or uncommon undesirable effects of drugs. We report that, in some individuals, clindamycin can cause pancytopenia, a complication that in our patient's case was caused by direct injury of his hematopoietic tissue.

Ectopic lymphocytic thyroiditis: A case report and treatment options

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Irami Araujo-Filho

2017-12-01

Full Text Available The presence of ectopic thyroid tissue is a rare entity. Non-gland migration occurs during the early stages of embryogenesis to the normal cervical location. Thus, ectopic tissue is lodged, in general, in the path of the thyroglossal duct in the middle line of the neck. The most common location is in the lingual zone, being the lingual thyroid. This, in most cases, will be asymptomatic. However, it is able to manifest itself with symptoms of dysphagia, dysphonia, obstruction of the upper airways or hemorrhage at any moment between childhood and adulthood. This article is a review of this disease, targeting mainly conduct, still very controversial in the literature. [Arch Clin Exp Surg 2017; 6(4.000: 221-227

First case of pneumonia caused by Cupriavidus pauculus in an infant in the Gulf Cooperation Council.

Science.gov (United States)

Yahya, Raghda; Alyousef, Wafaa; Omara, Abdelwahab; Alamoudi, Suha; Alshami, Alanoud; Abdalhamid, Baha

2017-02-28

Cupriavidus pauculus is an emerging organism causing infections in immunocompromised and immunocompetent patients. We report a C.pauculus pneumonia case susceptible to cefepime in an infant with end-stage renal failure. To our knowledge, this is the first case report of C. pauculus causing respiratory infections in the Gulf Cooperation Council.

Embolization of gastroduodenal artery pseudoaneurysm caused by chronic pancreatitis: a case report

International Nuclear Information System (INIS)

Kim, Se Jong; Ko, Kang Seok; Park, Byung Lan; Kim, Byong Geun; Kim, Jae Kyu

1993-01-01

Pseudoaneurysm due to chronic pancreatitis is uncommon, but it can cause recurrent and massive hemorrhage. Because of high morbidity and mortality associated with the pseudoaneurysm, early detection and treatment is essential. Surgical ligation or resection of the aneurysm has a high mortality and therefore, transcatheter embolization is preferably carried out. We report a case in which gastroduodenal artery pseudoaneurysm caused by chronic pancreatitis was successfully treated by transcatheter embolization using Gelfoam and Gianturco spring coils

Embolization of gastroduodenal artery pseudoaneurysm caused by chronic pancreatitis: a case report

Energy Technology Data Exchange (ETDEWEB)

Kim, Se Jong; Ko, Kang Seok; Park, Byung Lan; Kim, Byong Geun [Kwangju Christian Hospital, Gwangju (Korea, Republic of); Kim, Jae Kyu [College of Medicine, Chonnam National Univrsity, Gwangju (Korea, Republic of)

1993-01-15

Pseudoaneurysm due to chronic pancreatitis is uncommon, but it can cause recurrent and massive hemorrhage. Because of high morbidity and mortality associated with the pseudoaneurysm, early detection and treatment is essential. Surgical ligation or resection of the aneurysm has a high mortality and therefore, transcatheter embolization is preferably carried out. We report a case in which gastroduodenal artery pseudoaneurysm caused by chronic pancreatitis was successfully treated by transcatheter embolization using Gelfoam and Gianturco spring coils.

A SEVERE CASE OF ACUTE NECROTIC PANCREATITIS CAUSED BY DUODENAL CYST DUPLICATION

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Gabriel Constantinescu

2018-03-01

Full Text Available Introduction. Duodenal duplication cyst (DDC is a rare congenital malformation that appears in the embryonic development of the digestive tract. It is a benign condition usually diagnosed in infancy and early childhood, being a rare and difficult diagnosis in adult population. DDC is a recognized cause of duodenal obstruction, acute pancreatitis, obstructive jaundice and even digestive hemorrhage. Case presentation. We report the case of a young adult male with abdominal pain history, who presents with recurrent episodes of acute severe necrotic pancreatitis. The abdominal computed tomography scan revealed a Balthazar C necrotic pancreatitis with partial thrombosis of the splenic vein and a cystic mass in the second part of the duodenum. The endoscopic ultrasonography (EUS established that the duodenal cystic lesion came from the second layer, meaning the submucosa. We performed endoscopic cystotomy with complete evacuation of the fluid content into the duodenum, with favorable clinical outcome. Conclusions. The particularity of the case is represented by the low incidence of this pathology and the rare form of presentation, meaning acute pancreatitis probably from pancreatic ductular hypertension caused by the DDC.

A case of fetal intestinal volvulus without malrotation causing severe anemia.

Science.gov (United States)

Nakagawa, Tomoko; Tachibana, Daisuke; Kitada, Kohei; Kurihara, Yasushi; Terada, Hiroyuki; Koyama, Masayasu; Sakae, Yukari; Morotomi, Yoshiki; Nomura, Shiho; Saito, Mika

2015-01-01

Fetal intestinal volvulus without malrotation is a rare, life-threatening disease. Left untreated, hemorrhage from necrotic bowel tissue will lead to severe fetal anemia and even intrauterine death. We encountered a case of fetal intestinal volvulus causing severe anemia, which was diagnosed postnatally and successfully treated with surgical intervention.

Considerações teóricas sobre a relação entre respiração oral e disfonia Theoretical considerations on the relationship between mouth breathing and dysphonia

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Juliana Gomes Tavares

2008-01-01

Full Text Available Sabe-se que a respiração oral pode ocasionar diversas alterações ósseas, posturais, musculares e funcionais, como também, alterações na qualidade e/ou comportamento vocal. Estas alterações podem comprometer a comunicação oral, na qual a voz não consegue desempenhar seu papel básico de transmissão da mensagem verbal e emocional do indivíduo. O indivíduo com respiração oral pode apresentar ressonância nasalizada e a voz pode apresentar alterações no traço de sonoridade, hiper ou hiponasal, ou rouca. A partir de pesquisa nas bases de dados LILACS, SciELO, livros, revistas especializadas sobre o tema, buscamos fazer uma revisão na literatura sobre a relação entre respiração oral e disfonia, analisando a influência das alterações causadas pela respiração oral na qualidade e/ou comportamento vocal. No entanto, foi possível observar que a respiração oral promove uma série de alterações estruturais significativas que refletem nas funções estomatognáticas, interferindo também na fonação. Contudo, poucos autores relatam a possível correlação entre esses dois parâmetros (respiração oral e disfonia.It is known that mouth breathing can lead to several bone, postural, muscular and functional alterations, and also changes on vocal quality and/or vocal behavior. These alterations can compromise oral communication, in which the voice cannot perform its basic role on the transmission of an individual's verbal and emotional message. Individuals with mouth breathing can present hiper or hiponasal resonance, changes on voicing features and hoarseness. From researches on LILACS and SciELO databases, books and specialized magazines about the subject, it was carried a literature review about the relationship between mouth breathing and dysphonia, analyzing the influence of alterations caused by mouth breathing on vocal quality and/or vocal behavior. It was possible observe that mouth breathing promotes several

Purulent Pericarditis Caused by Streptococcus Milleri Strains; the Gained Experience from Nine Reported Cases

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Ilias A. Kouerinis

2015-12-01

Full Text Available Bacterial pericarditis caused by Streptococcus Milleri Group (SMG strains is a particularly exceptional pathology. All the eight previous reported cases were under the care of medical teams and the seven existed reports in medical journals were more or less from this perspective. Herein, we reported a unique case of a pericardial-cutaneous fistula resulting from a recurrent purulent pericardial effusion caused by SMG strains, which had been treated with open surgical drainage two months before. A thorough review of the surgical treatment options and the results has also been presented.

Minithyrotomy with radiofrequency-induced thermotherapy for the treatment of adductor spasmodic dysphonia.

Science.gov (United States)

Desai, Shaun C; Park, Andrea M; Chernock, Rebecca D; Paniello, Randal C

2016-10-01

A simple, safe and effective surgical alternative for treating adductor spasmodic dysphonia (ADSD) would appeal to many patients. This study evaluates a new option, using radiofrequency-induced thermotherapy (RFITT) of the thyroarytenoid muscle (TA) via the minithyrotomy approach to reduce the force of adduction. Fifteen dogs were used. In part 1, the optimal RFITT power settings, exposure time, probe location, and number of passes were determined. Part 2 compared laryngeal adductor pressures (LAPs) at baseline; immediately postintervention; and at 1, 3, or 6 months postintervention. Interventions included RFITT via the transcervical minithyrotomy approach (n = 15), transoral RFITT (n = 3), botulinum toxin (Botox) injection (n = 3), or no-intervention controls (n = 3). Postintervention induced phonation and histologic analyses were performed as well. In the minithyrotomy RFITT group, the mean LAP was 30.3% of baseline immediately posttreatment. At 1, 3, and 6 months postoperatively, the mean LAPs were 24.9%, 44.8%, and 43.5%, respectively. Transoral RFITT reduced LAP to 56.6% of baseline immediately posttreatment, but returned to normal in the 1 and 3 month animals. The Botox injections dropped the LAP to 57% of baseline at 1 month, but returned to normal at 3 months. Mucosal waves, based on induced phonation stroboscopy, were present at the terminal date in all animals. Thirteen of 15 transcervical RFITT preparations (87%) showed no injury to the lamina propria, whereas 80% showed evidence of TA muscle atrophy and fibrosis. Minithyrotomy RFITT is a feasible technique that shows encouraging long-term results for the potential treatment of patients with ADSD. N/A. Laryngoscope, 126:2325-2329, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Anticholinergic Toxic Syndrome Caused by Atropa Belladonna Fruit (Deadly Nightshade): A Case Report

Science.gov (United States)

Demirhan, Abdullah; Tekelioğlu, Ümit Yaşar; Yıldız, İsa; Korkmaz, Tanzer; Bilgi, Murat; Akkaya, Akcan; Koçoğlu, Hasan

2013-01-01

Atropa Belladonna poisoning may lead to anticholinergic syndrome. Ingestion of high amounts of the plant may cause lethargy, coma, and even a serious clinical picture leading to death. In this case report, we aimed to present a case with anticholinergic syndrome that developed after ingestion of the fruit called “Deadly Nightshade” in our country. PMID:27366377

Autochthonous Case of Eosinophilic Meningitis Caused by Angiostrongylus cantonensis, France, 2016.

Science.gov (United States)

Nguyen, Yann; Rossi, Benjamin; Argy, Nicolas; Baker, Catherine; Nickel, Beatrice; Marti, Hanspeter; Zarrouk, Virginie; Houzé, Sandrine; Fantin, Bruno; Lefort, Agnès

2017-06-01

We report a case of a 54-year-old Moroccan woman living in France diagnosed with eosinophilic meningitis caused by Angiostrongylus cantonensis. Diagnosis was based on clinical symptoms and confirmed by testing of serum and cerebrospinal fluid samples. Physicians should consider the risk for A. cantonensis infection outside of endemic areas.

Asthma caused by potassium aluminium tetrafluoride: a case series

OpenAIRE

LA?TOVKOV?, Andrea; KLUS??KOV?, Pavlina; FENCLOV?, Zdenka; BONNETERRE, Vincent; PELCLOV?, Daniela

2015-01-01

The objective of this study is to describe a case-series of potassium aluminium tetrafluoride (KAlF4)-induced occupational asthma (OA) and/or occupational rhinitis (OR). The study involves five patients from a heat-exchanger production line who were examined (including specific inhalation challenge tests) for suspected OA and/or OR caused by a flux containing almost 100% KAlF4 ? with fluorides? workplace air concentrations ranging between 1.7 and 2.8?mg/m3. No subject had a previous history o...

Skin ulcers caused by Serratia marcescens: three cases and a review of the literature.

Science.gov (United States)

Veraldi, Stefano; Nazzaro, Gianluca

2016-08-01

Serratia marcescens is a Gram-negative, encapsulated, motile, anaerobic, non-sporulating bacillus that belongs to the Enterobacteriaceae family. It is found in water, soil, plants, food, and garbage. S. marcescens is an opportunistic pathogen. It usually causes nosocomial infections, such as lung and genitourinary infections, sinusitis, otitis, endocarditis, and sepsis. Skin infections caused by S. marcescens are rare. To describe three new cases of skin ulcers of the leg caused by S. marcescens and review the relevant literature. We investigated three patients admitted for ulcers on the leg. In two patients, post-traumatic aetiology was concluded. The modality of infection was not identified for the other patient. One patient was diabetic. All patients recovered with specific antibiotic therapy (ciprofloxacin, ceftriaxone and levofloxacin, respectively). Skin ulcers due to S. marcescens are very rare. The three cases presented here add to the limited literature of skin infections caused by S. marcescens.

A Case of Fetal Intestinal Volvulus without Malrotation Causing Severe Anemia

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Tomoko Nakagawa

2015-01-01

Full Text Available Fetal intestinal volvulus without malrotation is a rare, life-threatening disease. Left untreated, hemorrhage from necrotic bowel tissue will lead to severe fetal anemia and even intrauterine death. We encountered a case of fetal intestinal volvulus causing severe anemia, which was diagnosed postnatally and successfully treated with surgical intervention.

Otomastoiditis caused by Candida auris: Case report and literature review.

Science.gov (United States)

Choi, Hyoung Il; An, Jin; Hwang, Jae Joon; Moon, Soo-Youn; Son, Jun Seong

2017-08-01

Fungal otomastoiditis is a rare disease, but can be fatal for immunocompromised patients. Recently, there have been increasing cases of otologic infection caused by Candida auris. Candida auris can be easily misdiagnosed for other species and treatment is difficult due to multidrug resistance. Clinician should be aware of this rare pathogen, and it should be treated with appropriate antifungal agent with surgical debridement. © 2017 Blackwell Verlag GmbH.

Dental erosion caused by gastroesophageal reflux disease: a case report

OpenAIRE

Cengiz, Seda; Cengiz, M ?nan?; Sara?, Y ?inasi

2009-01-01

Introduction Chronic regurgitation of gastric acids in patients with gastroesophageal reflux disease may cause dental erosion, which can lead in combination with attrition or bruxism to extensive loss of coronal tooth tissue. Case presentation This clinical report describes treatment of severe tooth wear of a gastroesophageal reflux disease patient who is 54-year-old Turkish male patient. After his medical treatment, severe tooth wear, bruxism and decreased vertical dimensions were determined...

A PULMONARY INFECTION CAUSED BY MYCOBACTERIUM PEREGRINUM– A CASE REPORT.

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Tatina T. Todorova

2015-12-01

Full Text Available Mycobacterium peregrinum is a member of the group of rapidly growing Nontuberculous Mycobacteria (NTM. It can be found in high frequency in natural and laboratory environments and is considered to be uncommonrare pathogen for both immunocompetent and immunosuppressed individuals. Currently, pulmonary infections caused by Mycobacterium peregrinum are unusual and diagnosed only in limited number of cases. Here, we present a clinical case of elderly man (72 years with 1 month history of non-specific respiratory symptomatic. The patient was without underlying immunosuppressive condition or lung disease. Chest X-ray demonstrated persistent pleural effusion, opacities and cavitations in the right lobe. One of the sputum culturesgrewa rapidly growing mycobacterium and the isolated strain was found to be Mycobacterium peregrinumas identified by molecular genetic detection (PCR and DNA strip technology. To our knowledge, this is the third case in the world to report Mycobacterium peregrinumas a possible causative agent of pulmonary infection.

Case Report - Analgesic nephropathy as a cause of end‑stage renal ...

African Journals Online (AJOL)

Analgesic nephropathy is a subtle but significant cause of chronic renal failure. There is paucity of data on analgesic nephropathy in Nigeria. This case presentation is to highlight the need to have high index of suspicion in patients at risk of developing analgesic nephropathy. In March 2009 a 55‑year‑old businessman was ...

Postmortem computed tomography for detecting causes of sudden death in infants and children. Retrospective review of cases

International Nuclear Information System (INIS)

Oyake, Yuji; Aoki, Takeshi; Shiotani, Seiji; Kohno, Mototsugu; Ohashi, Noriyoshi; Akutsu, Hiroyoshi; Yamazaki, Kentaro

2006-01-01

The aim of this study was to investigate the usefulness of postmortem computed tomography (PMCT) in detecting causes of sudden death in infants and children. Our subjects were 15 nontraumatically deceased patients (nine boys and six girls, ranging in age from 20 days after birth to 12 years old, mean age 1.6 years), who had been in a state of cardiopulmonary arrest on arrival at our hospital. PMCT was performed within 2 h after certification of death: head (15 cases), chest (11 cases), and abdomen (12 cases). Blood was collected from 11 of the patients at the time of cardiopulmonary resuscitation. An autopsy was conducted on two. PMCT did not show any traumatic changes indicating child abuse. It was difficult to presume the cause of death with PMCT alone, but the cause of death in 14 of 15 cases could be presumed by combining information from their medical history, clinical course before death, PMCT findings, laboratory data, and bacterial culture. The remaining subject was classified as cause unknown. The causes of sudden death in infants and children were detected at a high rate when we comprehensively investigated the PMCT and other examination findings. (author)

Effect of geographical and ethnic variation on Dysphonia Severity Index: a study of Indian population.

Science.gov (United States)

Jayakumar, T; Savithri, S R

2012-01-01

Dysphonia Severity Index (DSI) is a widely used multiparametric approach to objectively quantify the voice quality. Few research groups have investigated the test-retest, interobserver variability, and influence of age and gender. They have also verified the application of DSI in various voice rehabilitation conditions. However, all these studies have been conducted on European population. There is a possibility of variation in the basic parameters of DSI across geographical and ethnic groups. Hence, the present study evaluated DSI in Indian population. One hundred twenty voluntary participants (60 males, 60 females) who had G(0) on the Grade, Roughness, Breathiness, Aesthenia, Strain (GRBAS) scale participated in the study (age range of 18-25 years, M=21.8, standard deviation=2.7). Maximum phonation time (MPT), frequency intensity, and jitter measurements were made using CSL 4500 (Kay Elemetrics, Pine Brook, NJ). Results showed noticeable difference between Indian and European population on MPT, Highest frequency (F(0)-High), and DSI values. Significant gender difference was also observed on MPT and F(0)-High. Test-retest reliability showed >95% for all the parameters. The MPT decrement lead to a reduction in the overall DSI value in both the genders. These results of the study caution voice professionals to reinvestigate and establish their own norms for their geographical and ethnic groups. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Patient perceptions of factors leading to spasmodic dysphonia: a combined clinical experience of 350 patients.

Science.gov (United States)

Childs, Lesley; Rickert, Scott; Murry, Thomas; Blitzer, Andrew; Sulica, Lucian

2011-10-01

Spasmodic dysphonia (SD) is an idiopathic voice disorder that is characterized by either a strained, strangled voice quality or a breathy voice with aphonic segments of connected speech. It has been suggested that environmental factors play a role in triggering the onset. Clinical observation suggests that some patients associate onset with specific events or factors while others do not. The purpose of this study was to examine a large database of SD patients to determine if specific triggers are associated with the onset of SD. Retrospective chart review. A total of 350 charts of patients with SD were identified and were categorized as either "sudden onset" or "gradual onset." One hundred sixty-nine recalled their circumstances surrounding onset. Forty-five percent of these patients described the onset as sudden. Patient perceptions of inciting events in the sudden onset group were identified 77% of the time and 2% of the time in the gradual onset group. The most common factors identified were stress (42%), upper respiratory infection (33%), and pregnancy and parturition (10%). Thirty-five percent of SD patients perceive their disorder to have a sudden onset with identified inciting events. This prevalence raises questions regarding possible behavioral and environmental factors surrounding the onset of this disorder. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

A Case of Apparent Contact Dermatitis Caused by Toxocara Infection

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Rosanna Qualizza

2014-01-01

Full Text Available Infection from Toxocara species may give rise to a large array of clinical symptoms, including apparent manifestations of allergy such as asthma, urticaria/angioedema, and dermatitis. We report a case, thus far not described, of contact dermatitis attributed to nickel allergy but caused by Toxocara infection. The patient was a 53-year-old woman presenting from 10 years a dermatitis affecting head, neck, and thorax. Patch tests initially performed gave a positive result to nickel, but avoidance of contact with nickel did not result in recovery. The patient referred to our Allergy Service in 2010 because of dermatitis to feet. Patch testing confirmed the positive result for nickel, but expanding the investigation a positive result for IgG antibodies to Toxocara was detected by Western blotting and ELISA. Treatment with mebendazole achieved immediate efficacy on feet dermatitis. Then, two courses of treatment with albendazole resulted in complete regression of dermatitis accompanied by development of negative ELISA and Western blotting for Toxocara antibodies. This report adds another misleading presentation of Toxocara infection as apparent contact dermatitis caused by nickel and suggests bearing in mind, in cases of contact dermatitis not responding to avoidance of the responsible hapten and to medical treatment, the possible causative role of Toxocara.

Subacute Bacterial Endocarditis Caused by Cardiobacterium hominis: A Case Report

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Davie Wong

2015-01-01

Full Text Available Cardiobacterium hominis, a member of the HACEK group of organisms, is an uncommon but important cause of subacute bacterial endocarditis. First-line therapy is a third-generation cephalosporin due to rare beta-lactamase production. The authors report a case involving endovascular infection due to C hominis that initially tested resistant to third-generation cephalosporins using an antibiotic gradient strip susceptibility method (nitrocephin negative, but later proved to be susceptible using broth microdilution reference methods (a ‘major’ error. There are limited studies to guide susceptibility testing and interpretive breakpoints for C hominis in the medical literature, and the present case illustrates some of the issues that may arise when performing susceptibility testing for fastidious organisms in the clinical microbiology laboratory.

Laryngeal Chondrosarcoma as a Rare Cause of Subglottic Stenosis

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Kerem Kökoğlu

2014-01-01

Full Text Available Laryngeal chondrosarcoma (CS is a very rare entity. It is usually seen in 50–80-year olds. It is developed from cricoid cartilage largely. Patients have laryngeal CS complaint of respiratuvar distress, dysphonia, and dysphagia generally. A submucous mass is usually seen in physical examination with an intact mucosa. Distant metastasis is rare in CSs. Main treatment is surgical excision. An 82-year-old patient who has respiratuvar distress is presented in this paper and laryngeal CS is reviewed in the light of the literature.

Liver injury caused by a herbal and dietary supplement: a case report

African Journals Online (AJOL)

We present a case of a previously healthy male admitted with acute hepatitis while using a body building supplement. An exhaustive laboratory workup for causes of hepatitis was unrevealing. He responded well to withdrawal of the supplement and a course of corticosteroids.

A case of newborn with community acquired pneumonia caused by Cupriavidus pauculus.

Science.gov (United States)

Aydın, Banu; Dilli, Dilek; Zenciroğlu, Ayşegül; Okumuş, Nurullah; Ozkan, Sengül; Tanır, Gönül

2012-01-01

Cupriavidus pauculus is a gram-negative, aerobic, non-spore forming, non-fermentative motile bacillus. The bacillus can be isolated from water, bottled mineral water, and water from ultrafiltration systems in hospital setting. C. pauculus rarely causes human infections, however it may be an infectious agent especially in immunocompromised individuals. In this report, we present the first case of community acquired pneumonia caused by C. pauculus in a previously healthy newborn who was hospitalized in neonatal intensive care unit on postnatal day 16 because of respiratory distress.

Intestinal volvulus and perforation caused by multiple magnet ingestion: report of a case.

Science.gov (United States)

Ilçe, Zekeriya; Samsum, Hakan; Mammadov, Emil; Celayir, Sinan

2007-01-01

Ingested magnets can cause intestinal fistulas, perforation, and obstruction. There have been reports of magnet ingestion causing intestinal volvulus, but multiple magnet ingestion causing perforation and intestinal volvulus in a child is very unusual. We report the case of a 4-year-old girl, who ingested four magnets she acquired as toys, which caused intestinal volvulus and perforation as a result of pressure necrosis, several days after ingestion. At surgery we repaired two perforations, but additional bowel resection was not required. The patient was discharged on postoperative day 10. If multiple magnet ingestion is suspected in a child, the child must be monitored carefully. If there are signs of obstruction, emergency surgery is mandatory.

Work-related voice disorder

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Paulo Eduardo Przysiezny

2015-04-01

Full Text Available INTRODUCTION: Dysphonia is the main symptom of the disorders of oral communication. However, voice disorders also present with other symptoms such as difficulty in maintaining the voice (asthenia, vocal fatigue, variation in habitual vocal fundamental frequency, hoarseness, lack of vocal volume and projection, loss of vocal efficiency, and weakness when speaking. There are several proposals for the etiologic classification of dysphonia: functional, organofunctional, organic, and work-related voice disorder (WRVD.OBJECTIVE: To conduct a literature review on WRVD and on the current Brazilian labor legislation.METHODS: This was a review article with bibliographical research conducted on the PubMed and Bireme databases, using the terms "work-related voice disorder", "occupational dysphonia", "dysphonia and labor legislation", and a review of labor and social security relevant laws.CONCLUSION: WRVD is a situation that frequently is listed as a reason for work absenteeism, functional rehabilitation, or for prolonged absence from work. Currently, forensic physicians have no comparative parameters to help with the analysis of vocal disorders. In certain situations WRVD may cause, work disability. This disorder may be labor-related, or be an adjuvant factor to work-related diseases.

Case of Cytomegalovirus Infection Causing Isolated Oculomotor Nerve Palsy

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Halil Sen

2014-06-01

Full Text Available The third cranial nerve is called the oculomotor nerve. The pathology is revealed by limitation of eye movement inward-up-down, mydriasis, loss of light reflex and ptosis. Oculomotor nerve pathologies are frequently seen in neurology practice and are situations that may be very difficult for differential diagnosis. Differential diagnosis first involves disqualifying intracranial etiologies by imaging because these intracranial etiologies may be situations that can result in death and should be primarily evaluated. If intracranial events are ruled out, generally rarer etiologic reasons with generally difficult differentiation should be researched. Viral infections are among the rare etiological reasons causing 3rd cranial nerve involvement. Our case was a 71-year old female with etiological research due to 3rd cranial nerve palsy. The patient with diabetes-linked immune deficiency was found to have cranial nerve involvement developed secondary to cytomegalovirus (CMV infection. We report this case as 3rd cranial nerve involvement is rarely observed developing linked to CMV infection.

A case of native valve endocarditis caused by Burkholderia cepacia without predisposing factors

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Han Seong

2011-05-01

Full Text Available Abstract Background Infective endocarditis is rarely caused by Burkholderia cepacia. This infection is known to occur particularly in immunocompromised hosts, intravenous heroin users, and in patients with prosthetic valve replacement. Most patients with Burkholderia cepacia endocarditis usually need surgical treatment in addition to antimicrobial treatment. Case Presentation Here, we report the case of a patient who developed Burkholderia cepacia-induced native valve endocarditis with consequent cerebral involvement without any predisposing factors; she was successfully treated by antimicrobial agents only. Conclusion In this report, we also present literature review of relevant cases.

Case Report: Life-threatening angiomyxoma of the larynx | Yaman ...

African Journals Online (AJOL)

Also, he had suffered from dysphagia, dysphonia, cough, and obstructive sleep apnea in the supine position for 6 months. He was operated on via transoral approach under general anesthesia with orotracheal intubation. The mass was encapsulated and completely removed. The histopathologic diagnosis was reported as ...

Lingual Thyrod: Case Report | Sonigra | East African Medical Journal

African Journals Online (AJOL)

A sixteen year old male presented with progressive dysphagia, dysphonia and haemoptysis over eight months. Radionuclide studies and computed tomographic scans confirmed an only functional thyroid gland at the base of tongue which was excised wholly via mandibular split transoral route and patient put on thyroxin ...

Abnormal motor cortex excitability during linguistic tasks in adductor-type spasmodic dysphonia.

Science.gov (United States)

Suppa, A; Marsili, L; Giovannelli, F; Di Stasio, F; Rocchi, L; Upadhyay, N; Ruoppolo, G; Cincotta, M; Berardelli, A

2015-08-01

In healthy subjects (HS), transcranial magnetic stimulation (TMS) applied during 'linguistic' tasks discloses excitability changes in the dominant hemisphere primary motor cortex (M1). We investigated 'linguistic' task-related cortical excitability modulation in patients with adductor-type spasmodic dysphonia (ASD), a speech-related focal dystonia. We studied 10 ASD patients and 10 HS. Speech examination included voice cepstral analysis. We investigated the dominant/non-dominant M1 excitability at baseline, during 'linguistic' (reading aloud/silent reading/producing simple phonation) and 'non-linguistic' tasks (looking at non-letter strings/producing oral movements). Motor evoked potentials (MEPs) were recorded from the contralateral hand muscles. We measured the cortical silent period (CSP) length and tested MEPs in HS and patients performing the 'linguistic' tasks with different voice intensities. We also examined MEPs in HS and ASD during hand-related 'action-verb' observation. Patients were studied under and not-under botulinum neurotoxin-type A (BoNT-A). In HS, TMS over the dominant M1 elicited larger MEPs during 'reading aloud' than during the other 'linguistic'/'non-linguistic' tasks. Conversely, in ASD, TMS over the dominant M1 elicited increased-amplitude MEPs during 'reading aloud' and 'syllabic phonation' tasks. CSP length was shorter in ASD than in HS and remained unchanged in both groups performing 'linguistic'/'non-linguistic' tasks. In HS and ASD, 'linguistic' task-related excitability changes were present regardless of the different voice intensities. During hand-related 'action-verb' observation, MEPs decreased in HS, whereas in ASD they increased. In ASD, BoNT-A improved speech, as demonstrated by cepstral analysis and restored the TMS abnormalities. ASD reflects dominant hemisphere excitability changes related to 'linguistic' tasks; BoNT-A returns these excitability changes to normal. © 2015 Federation of European Neuroscience Societies and John

Scrub typhus causing neonatal hepatitis with acute liver failure-A case series.

Science.gov (United States)

Vajpayee, Shailja; Gupta, R K; Gupta, M L

2017-05-01

Neonatal hepatitis with acute liver failure due to varied etiology including various infections is reported in the past. Scrub typhus as a cause of neonatal hepatitis has rarely been reported in literature. A high index of clinical suspicion is required for early diagnosis and timely treatment. Severity and prognosis of the disease varies widely because several different strains of Orientia tsutsugamushi exist with different virulence. Delayed diagnosis can result in complication and significant morbidity and mortality. Here, we report three cases of neonatal hepatitis with acute liver failure caused by scrub typhus to increase awareness.

Rhinologic headache caused by mucosal contact with a surgical solution. A case report

Directory of Open Access Journals (Sweden)

Ignacio ALCALÁ-RUEDA

2016-03-01

Full Text Available Introduction and objective: Rhinologic headache caused by mucosal contact is a difficult definition condition with good response to surgical approach. Description: We present a case of a 31 year-old male with rhinologic headache criteria. We decided to offer a surgical approach, successfully. Discussion: Rhinologic headache is included in the group of “Headache caused by disorders of the nasal mucosa, turbinates or septum”. There is no agreement about its cause because the prevalence of mucosal nasal contact is similar in patients with and without facial pain. There is evidence in the resolution of facial pain with a surgical approach. Conclusions: Despite the evidence of success in the surgical approach, some doubts still persist about the causes of this entity.

Cause and motivation in cases of non-fatal drug overdoses in opiate addicts.

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Pfab, R; Eyer, F; Jetzinger, E; Zilker, Thomas

2006-01-01

Drug overdose (OD) is a frequent incident among opiate addicts. Survivors of ODs are at risk for additional and eventually fatal ODs. ODs may be classified as accidental (aOD) or deliberate (dOD). Investigations into the connection between OD and suicide attempts have led to insconsistent results. (1) to determine how many non-fatal ODs were dODs and how many were aODs; (2) to determine how many cases of dODs were motivated by explicit or by ambivalent suicidal intentions; (3) to determine how many cases of aODs had causes that might respond to preventative measures; (4) to compare the addiction histories of dODs and aODs; (5) to compare the drugs causing the ODs; and (6) to compare the severity of the ODs in both groups. Prospective study utilizing a standardized questionnaire to evaluate opiate-addicted patients admitted to our treatment unit for OD. All cases underwent standardized drug testing to identify drug use patterns. Seventy-four cases of OD underwent standardized interviews after awakening. Forty-three percent of the cases were dOD. Cases of dOD had significantly more OA in substitution programs, more previous ODs, and more often consumed methadone and cocaine. Among dODs, 22.5% had suicidal intention and 9.6% were ambivalent about committing suicide; background motivations were most often conflicts with spouses. Fifty-seven percent of the cases were aOD. Cases of aODs had significantly more potential lethal intoxications and had heroin detected more frequently. aODs happened with unexpected pure heroin (46%), in combination with alcohol (36%), as relapse after abstinence (40%) or after institutionalized treatment (19%). This group should be accessible for targeted education.

Validation of a telephone screening tool for spasmodic dysphonia and vocal fold tremor.

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Johnson, David M; Hapner, Edie R; Klein, Adam M; Pethan, Madeleine; Johns, Michael M

2014-11-01

The objective of this study was to ascertain whether clinicians can reliably distinguish between spasmodic dysphonia (SD)/vocal tremor and other voice disorders by telephone, despite this modality's limited frequency response. Randomized, single-blinded, and prospective study. Voice-disordered patients with (n = 22) and without (n = 17) SD and/or vocal tremor recorded standardized utterances via landline telephone. A laryngologist and two speech-language pathologists blinded to the diagnoses rated each recording as "yes" or "no" to "SD or tremor present?," and if "yes" categorized into adductor, abductor, tremor only, or adductor with tremor subtypes. Twenty-one recordings were presented twice at random so intrarater reliability could be assessed. All ratings were compared with gold standard diagnosis by a second laryngologist who performed a full examination, including videostroboscopy, on each patient. For the comparison "SD or tremor" yes versus no, sensitivity, specificity, positive predictive value, and negative predictive value are 90%, 95%, 96%, and 89%, respectively. Interrater reliability (Cohen kappa) compared with the gold standard ranged from 0.70 to 0.93 (substantial to almost perfect agreement). Cronbach alpha among three raters was 0.90 for this comparison. Intrarater reliability (number matched/number inspected) was very high, ranging from 0.97 to 1.0. Comparing gold standard and telephone rating of SD/tremor subtypes, kappa ranged from 0.48 to 0.60 (moderate agreement). Cronbach alpha among three raters was 0.88 for this comparison. Intrarater reliability ranged from 0.84 to 0.97. SD and tremor can be reliably distinguished from other voice disorders over the telephone. Copyright © 2014 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Quantifying the impact of selection bias caused by nonparticipation in a case-control study of mobile phone use

DEFF Research Database (Denmark)

Vrijheid, Martine; Richardson, Lesley; Armstrong, Bruce K

2009-01-01

To quantitatively assess the impact of selection bias caused by nonparticipation in a multinational case-control study of mobile phone use and brain tumor.......To quantitatively assess the impact of selection bias caused by nonparticipation in a multinational case-control study of mobile phone use and brain tumor....

First Cases of Cutaneous Leishmaniasis Caused by Leishmania (Viannia) naiffi Infection in Surinam

NARCIS (Netherlands)

van Thiel, Pieter-Paul A. M.; van Gool, Tom; Kager, Piet A.; Bart, Aldert

2010-01-01

Cutaneous leishmaniasis in Surinam is generally caused by infection by Leishmania guyanensis. We report three cases of infection with Leishmania (Viannia) naiffi, a Leishmania species not described from Surinam before. Treatment with pentamidine proved to be effective

A young man with myelosuppression caused by clindamycin: a case report

OpenAIRE

Morales, Manuel Polanco; Carvallo, Anna Paola Thome; Espinosa, Karla Adriana Bautista; Murillo, Edgar Enrique Meza

2014-01-01

Introduction Clindamycin is used to treat various bacterial infections, but its administration can cause anaphylaxis, liver reactions, pseudomembranous colitis, and peripheral blood cytopenias (anemia, neutropenia, and thrombocytopenia), alone or in combination. We report the case of a patient with a recurrent infection of the tonsils who received clindamycin. Pancytopenia, a previously unreported hematological disorder related to clindamycin use, was observed in conjunction with the infectio...

[Respiratory infections caused by respiratory syncytial virus in the adult population: description of 16 cases].

Science.gov (United States)

Reina, Jordi; López, Carla

2013-08-17

Respiratory infections of viral etiology are frequent in the adult population. Those caused by respiratory syncytial virus (RSV) are a little known entity. The aim of this study was to determine the clinical and epidemiological characteristics of adult patients with respiratory infection due to RSV. We performed a prospective study from October 2012 to March 2013 on respiratory infections caused by RSV. Viral detection was performed using a technique of reverse transcription polymerase chain reaction genomic amplification in real time. We diagnosed 16 patients, 12 (75%) requiring hospitalization. Patients were grouped into immunocompromised (7 [43.7%]) and immunocompetent cases (9 cases 56.3%]). The first group included 3 patients with HIV infection (42.8%) and 4 hematologic patients (57.2%). The second group included those who had a baseline disease, 5 cases (55.5%), and those who lacked it, 4 cases (44.4%), and did not require hospitalization. The main clinical manifestations of patients prompting them to attend the Emergency Department were cough (50%), dyspnea (43.5%), fever (25%), expectoration (25%) and flu symptoms (25%). The most frequent diagnoses at discharge were pneumonia (37.5%) and flu syndrome (31.2%). Respiratory infections caused by RSV represent a rare condition that mainly affects immunocompromised patients. The underlying pathology determines the evolution of the process, which is favorable except in cases of severe immunosuppression. Copyright © 2013 Elsevier España, S.L. All rights reserved.

A case of xerostomia caused by exposure to radioactive iodine

International Nuclear Information System (INIS)

Kusafuka, Yuji; Kamata, Takahiro; Nakanishi, Yoshitaka; Kurita, Hiroshi; Sakai, Hironori

2012-01-01

Oral radioiodine ( 131 I) therapy is known to be an effective treatment for differentiated thyroid carcinoma, but it can cause salivary gland impairment. We report a case of xerostomia caused by oral radioiodine therapy for thyroid cancer. A 47-year-old woman consulted our hospital because of tongue pain accompanied by xerostomia. The patient had a history of receiving radioiodine therapy for metastatic thyroid carcinoma 3 times (total 9,990 MBq). Clinical examination demonstrated oral dryness and reduced salivary gland function. On the gum test, the salivary flow was 2 ml in 6 minutes. It was hard to continue chewing for more than 6 minutes because of irritation. A computed tomographic scan showed atrophic changes of both parotid glands. On radioiodine whole-body imaging, uptake of radioiodine was evident in both the parotid and submandibular glands. Based on these findings, xerostomia caused by salivary gland injury due to radioiodine therapy was clinically diagnosed. The salivary gland injury was irreversible, and the patient received symptomatic therapy and pilocarpine hydrochoride. Early intervention to avoid salivary gland injury is important in patients who receive radioactive iodine therapy. (author)

Outcome Measurement in the Treatment of Spasmodic Dysphonia: A Systematic Review of the Literature.

Science.gov (United States)

Rumbach, Anna; Aiken, Patrick; Novakovic, Daniel

2018-04-11

The aim of this review was to systematically identify all available studies reporting outcomes measures to assess treatment outcomes for people with spasmodic dysphonia (SD). Full-text journal articles were identified through searches of PubMed, Embase, CINAHL, and Cochrane databases and hand searching of journals. A total of 4,714 articles were retrieved from searching databases; 1,165 were duplicates. Titles and abstracts of 3,549 were screened, with 171 being selected for full-text review. During full-text review, 101 articles were deemed suitable for inclusion. An additional 24 articles were identified as suitable for inclusion through a hand search of reference lists. Data were extracted from 125 studies. A total of 220 outcome measures were identified. Considered in reference to the World Health Organization International Classification of Functioning, Disability and Health (ICF), the majority of outcomes were measured at a Body Function level (n = 212, 96%). Outcomes that explored communication and participation in everyday life and attitudes toward communication (ie, activity and participation domains) were infrequent (n = 8; 4%). Quality of life, a construct not measured within the ICF, was also captured by four outcome measures. No instruments evaluating communication partners' perspectives or burden/disability were identified. The outcome measures used in SD treatment studies are many and varied. The outcome measures identified predominately measure constructs within the Body Functions component of the ICF. In order to facilitate data synthesis across trials, the development of a core outcome set is recommended. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.

Impact of muscle tension dysphonia on tonal pitch target implementation in vietnamese female teachers.

Science.gov (United States)

Nguyen, Duong Duy; Kenny, Dianna T

2009-11-01

Muscle tension dysphonia (MTD) is a voice disorder with deteriorated vocal quality, particularly pitch problems. Because pitch is mainly controlled by the laryngeal muscles, and because MTD is characterized by increased laryngeal muscle tension, we hypothesized that it may result in problems in pitch target implementation in tonal languages. We examined tonal samples of 42 Vietnamese female primary school teachers diagnosed with MTD and compared them with 30 vocally healthy female teachers who spoke the same dialect. Tonal data were analyzed using Computerized Speech Lab (CSL-4300B) for Windows. From tonal sampling bases, fundamental frequency (F0) was measured at target points specified by contour examination. Parameters representing pitch movement including time, size, and speed of movement were measured for the falling tone and rising tone. We found that F0 at target points in MTD group was lowered in most tones, especially tones with extensive F0 variation. In MTD group, target F0 of the broken tone in isolation was 37.5 Hz lower (P<0.01) and target F0 of rising tone in isolation was 46 Hz lower (P<0.01) than in control group. In MTD group, speed of pitch fall of the falling tone in isolation was faster than control group by 2.2 semitones/second (st/s) (P<0.05) and speed of pitch rise in the rising tone in isolation was slower than control group by 7.2 st/s (P<0.01). These results demonstrate that MTD is associated with problems in tonal pitch variation.

Unilateral Vocal Fold Paralysis in Parkinson Disease: Case Report and Review of the Literature.

Science.gov (United States)

Hamdan, Abdul-Latif; Khalifee, Elie; Tabet, Georges

2017-10-24

The objective of this study was to report the first case of unilateral vocal fold paralysis in a patient with Parkinson disease (PD) and to review the literature. This is a case report and literature review following PubMed search using the keywords "Parkinson," "vocal fold paralysis," "vocal fold palsy," "vocal fold immobility," "vocal fold adductor palsy," "airway obstruction," and "stridor." A total of 18 subjects diagnosed with PD and vocal fold paralysis were described. In all cases, the vocal fold paralysis was bilateral and the main presenting symptoms were stridor and shortness of breath necessitating intubation and tracheostomy. This article describes the first case of PD presenting with dysphonia secondary to unilateral vocal fold paralysis (left). The management consisted of injection laryngoplasty for medialization of the paralyzed vocal fold. Patients with PD can present with unilateral vocal fold paralysis. Early treatment is advocated in view of the advent of injection laryngoplasty as a safe office procedure. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

[The combined treatment of dysphonia in the subjects engaged in the voice and speech professions].

Science.gov (United States)

Stepanova, Yu E; Gotovyakhina, T V; Korneenkov, A A; Koren', E E

The objective of the present study was to evaluate the effectiveness of the application of homeovox for the combined treatment of small vocal cord nodules and acute laryngitis in the professional voice users. A total of 40 subjects presenting with dysphonia were examined after they were divided into two study groups and two groups of comparison depending on the nosological form of the pathological condition. The subjects comprising the study groups were given traditional therapy in the combination with the intake of homeovox whereas the patients included in the two groups of comparison received the traditional treatment alone. The outcome of the treatment was evaluated on days 1, 5, and 10 after the initiation of therapy based on the analysis of the changes in the videoendostroboscopic picture of the larynx and the acoustic characteristics obtained by the computer-assisted analysis of the voice. The analysis of the results of the combined treatment has demonstrated the statistically significant differences in some acoustic parameters of the voice between the subjects with small vocal cord nodules and acute laryngitis belonging to the study groups and the groups of comparison. It is concluded that the introduction of homeovox in the combined treatment of the patients presenting with the small nodules in the vocal cords and acute catarrhal laryngitis accelerates the recovery of the acoustic characteristics of the voice within various periods after the onset of the treatment in comparison with the patients treated with the use of traditional therapy alone.

Randomized controlled trial of vocal function exercises on muscle tension dysphonia in Vietnamese female teachers.

Science.gov (United States)

Nguyen, Duong Duy; Kenny, Dianna T

2009-04-01

This study evaluated the treatment effects of vocal function exercises on muscle tension dysphonia (MTD) in tonal language speakers. Single-blinded, randomized, controlled, clinical trial. Forty female primary school teachers from Northern Vietnam, diagnosed with MTD, were randomly allocated into a treatment group (n = 22), which used a full vocal exercise protocol (FE) (modified for use with Vietnamese speakers), and a control group (n = 18) which was treated with a partial vocal exercise protocol (PE). The treatment duration was 4 weeks for both groups. Acoustic and perceptual data were used as primary outcome measures. Acoustic parameters included frequency and amplitude perturbation, harmonics-to-noise ratio (HNR), mean fundamental frequency of the broken and rising tones, and parameters representing pitch movement in the rising tone. Perceptual analyses were performed on pre- and posttreatment samples of the sustained /a/ sound using anchor vocal samples. Self-report data, collected via a posttreatment questionnaire, comprised the secondary outcome measure. Significant changes in perturbation, HNR, and perceptual data were observed in the FE group but not in the PE group. The FE group showed increased size and speed of pitch change. Participants from both groups showed positive changes in some tonal parameters after treatment. However, the magnitude of change and the number of participants with positive changes were larger in the FE group. The data showed that vocal function exercises may be a cost-effective treatment for MTD.

Remote transient Lactobacillus animalis bacteremia causing prosthetic hip joint infection: a case report.

Science.gov (United States)

Somayaji, R; Lynch, T; Powell, J N; Gregson, D

2016-11-04

Lactobacillus spp. are uncommon pathogens in immunocompetent hosts, and even rarer causes of prosthetic device infections. A case of chronic hip prosthetic joint infection (PJI) caused by L. animalis is described. This occurred 5 years after a transient bacteremia with the same organism. Whole genome sequencing of both isolates proved this PJI infection resulted from this remote bacteremia. We document that prosthetic joint infections may be a consequence of bacteremia as much as 3 years before the onset of symptoms.

Middle ear osteoma causing progressive facial nerve weakness: a case report.

Science.gov (United States)

Curtis, Kate; Bance, Manohar; Carter, Michael; Hong, Paul

2014-09-18

Facial nerve weakness is most commonly due to Bell's palsy or cerebrovascular accidents. Rarely, middle ear tumor presents with facial nerve dysfunction. We report a very unusual case of middle ear osteoma in a 49-year-old Caucasian woman causing progressive facial nerve deficit. A subtle middle ear lesion was observed on otoscopy and computed tomographic images demonstrated an osseous middle ear tumor. Complete surgical excision resulted in the partial recovery of facial nerve function. Facial nerve dysfunction is rarely caused by middle ear tumors. The weakness is typically due to a compressive effect on the middle ear portion of the facial nerve. Early recognition is crucial since removal of these lesions may lead to the recuperation of facial nerve function.

Ethylene Glycol Poisoning; an Unusual Cause of Hyperglycemia: A Case Report

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Abdul Raoof Kunnummal Madathodi

2015-03-01

Full Text Available Background:Poisoning with ethylene glycol (EG can be fatal even if appropriate treatments are delivered. EG poisoning usually causes central nervous system depression, cardiovascular dysfunction, metabolic acidosis and acute renal failure (ARF. Case Report:A 33-year-old man was referred to the emergency department with reduced consciousness and dyspnea of four-hour duration due to unknown reason. The patient had no history of diabetes, hypertension, cardiac disease or asthma. He was tachycardic, tachypneic and hypertensive. Laboratory investigations revealed hyperglycemia, high serum creatinine, hyponatremia, hyperkalemia, leukocytosis and high anion gap metabolic acidosis (HAGMA. He was initially managed as diabetic ketoacidosis (DKA. Alternative diagnoses of toxic alcohols poisoning was considered as there was no improvement. EG ingestion was confirmed when the relatives found an empty bottle of automotive brake oil, a poly glycol-based product, in the patient’s room. Although he was treated with ethanol and hemodialysis, renal failure worsened and finally he succumbed to death due to severe sepsis on the seventh day of EG ingestion. Discussion: This case illustrates the difficulties posed by high toxicity as well as unraveled and delayed diagnosis of EG poisoning. High anion gap and high osmolal gap are characteristics of EG poisoning. Transient pancreatitis caused by EG and insulin resistance due to ARF are the possible explanations for hyperglycemia secondary to EG poisoning. Conclusion:EG poisoning may manifest with hyperglycemia and HAGMA resembling DKA. It is important for the clinician to have high degree of suspicion for EG poisoning in case of HAGMA and ARF refractory to common treatments.

A Rare Case of Pneumonia Caused by Shewanella putrefaciens

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Rajshree Patel

2012-01-01

Full Text Available Shewanella putrefaciens is a gram-negative, nonfermentative, oxidase positive, motile bacillus that produces hydrogen sulphide. It is found widely in the nature especially in marine environments. In some very rare cases Shewanella putrefaciens can be a human pathogen. It can produce a wide variety of clinical syndromes including bacteremia as well as skin and soft tissue infections. However, pneumonia due to S. putrefaciens is rare; there are a total of 4 reported cases in the literature. We present a case of 63-year-old male who was presented to emergency room status after cardiac arrest, fell into sea water face down. On the second day of hospitalization, he was diagnosed to have pneumonia based on the clinical, radiological, and laboratory findings. Empirical antibiotic treatment with vancomycin and piperacillin/tazobactam combination was initiated. Gram-stained smear of endotracheal aspirate yielded gram-negative bacteria, and the isolate grown from endotracheal aspirate culture was identified as S. putrefaciens by Biomerieux API 20 NE technique. On review of the literature and according to culture and sensitivity results, therapy in our patient was changed to cefepime. Patient’s pneumonia improved with treatment with cefepime. We believe that our patient developed pneumonia evidently caused by S. putrefaciens, after near drowning in sea water. The pneumonia resolved after treatment with cefepime.

An unusual ulcer: A case of cutaneous mucormycosis caused by Rhizopus oryzae

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Bradley J. Gardiner

2015-03-01

Full Text Available Mucormycoses are high-mortality infections feared by clinicians worldwide. They predominantly affect immunocompromised hosts and are associated with a spectrum of disease. We describe a case of cutaneous mucormycosis caused by Rhizopus oryzae in a patient with multiple risk factors cured with complete surgical excision and a short course of antifungal therapy.

Lawn mower injuries as a cause of serious visual acuity impairment - Case reports.

Science.gov (United States)

Jasielska, Monika; Winiarczyk, Mateusz; Bieliński, Paweł; Mackiewicz, Jerzy

2017-05-11

[b]Abstract Objective.[/b] The aim of the study is to present four cases of lawn mowers injuries as a cause of serious visual acuity impairment. [b]Materials and Method[/b]. A retrospective study of four patients admitted in 2013-2015 to the Department of Vitreoretinal Surgery in Lublin with severe open or closed globe injury, one with an intraocular foreign body (IOFB). The presence of eye protective equipment was assessed, as well as visual acuity, eye tissue condition before and after treatment, and applied therapy. In all cases an improvement was achieved in local conditions. The intraocular foreign body was removed, wounds sutured and damaged tissues placed in position. All eyeballs were saved. In three cases, visual acuity was improved to a usable level. Three patients underwent pars plana vitrectomy, one with IOFB removal from the vitreous cavity. [b]Conclusions[/b]. Lawn mower induced eye injuries are a significant cause of serious visual acuity impairment or blindness. The presented study shows that lawn mower eye injuries are still a therapeutic, social and economic problem, yet are very preventable with proper eye protection and patients' education. Current prevention strategies are inadequate, and therefore should be updated.

Internal Carotid Artery Blister-Like Aneurysm Caused by Aspergillus – Case Report

International Nuclear Information System (INIS)

Ogawa, Masaki; Sakurai, Keita; Kawaguchi, Takatsune; Naiki-Ito, Aya; Nakagawa, Motoo; Okita, Kenji; Matsukawa, Noriyuki; Shibamoto, Yuta

2015-01-01

Blister-like aneurysm of the supraclinoid internal carotid artery (ICA) is a well-documented cause of subarachnoid hemorrhage. Generally, this type of aneurysm is associated with various conditions such as hypertension, arteriosclerosis, and ICA dissection. Although Aspergillus is the most common organism causing intracranial fungal aneurysmal formation, there is no report of a blister-like aneurysm caused by Aspergillus infection. An 83-year-old man received corticosteroid pulse therapy followed by oral steroid therapy for an inflammatory pseudotumor of the clivus. Two months later, the patient was transported to an emergency department due to the diffuse subarachnoid hemorrhage, classified as Fisher group 4. Subsequent 3D computed tomography angiogram revealed a blister-like aneurysm at the superior wall of the left ICA. Six days later, the patient died of subarachnoid hemorrhage caused by the left ICA aneurysm rerupture. Autopsy revealed proliferation of Aspergillus hyphae in the wall of the aneurysm. Notably, that change was present more densely in the inner membrane than in the outer one. Thus, it was considered that Aspergillus hyphae caused infectious aneurysm formation in the left ICA via hematogenous seeding rather than direct invasion. The blister-like aneurysm is a rare but important cause of subarachnoid hemorrhage. This case report documents another cause of blister-like aneurysms, that is an infectious aneurysm associated with Aspergillus infection

Suppressed without a Cause: A Case of Idiopathic Immune Deficiency.

Science.gov (United States)

Ayub, Muhammad Talha; Jafar, Munnam S; Khalid, Muhammad; Baig, Muhammad A; Mba, Benjamin

2018-01-01

We report a case of a 45-year-old male who presented with a headache, fever, vomiting, somnolence, and difficulty walking for 10 days. His cerebrospinal fluid studies revealed cryptococcal meningitis. Chest and abdominal computed tomography (CT) scans showed splenomegaly along with mediastinal, retroperitoneal and inguinal lymphadenopathy. CD4 count turned out to be 208 μL -1 . Human immunodeficiency virus (HIV) testing, serum protein electrophoresis, serum light chains and quantitative immunoglobulins were non-diagnostic and CD4 lymphopenia was attributed to acute infection. However, a persistent CD4 lymphopenia was seen in subsequent outpatient testing, which prompted a detailed workup for secondary causes of immunodeficiency. Repeated lymph node biopsies with analytic cytometric immunophenotypic analysis were normal, as was the bone marrow biopsy with detailed immunophenotypic and cytogenetic studies. The patient was hence being treated as a case of idiopathic CD4 lymphocytopenia.

Two cases of scalp white piedra caused by Trichosporon ovoides.

Science.gov (United States)

Tambe, Swagata A; Dhurat, S Rachita; Kumar, Chaya A; Thakare, Preeti; Lade, Nitin; Jerajani, Hemangi; Mathur, Meenakshi

2009-01-01

White piedra is a superficial fungal infection of the hair shaft, caused by Trichosporon beigelii . We report two cases of white piedra presenting as brown palpable nodules along the hair shaft with a fragility of scalp hairs. T. beigelii was demonstrated in hair culture of both the patients and T. ovoides as a species was confirmed on carbohydrate assimilation test. The first patient responded to oral itraconazole and topical ketoconazole, with a decrease in the palpability of nodules and fragility of scalp hairs at the end of two months.

Two cases of scalp white piedra caused by Trichosporon ovoides

Directory of Open Access Journals (Sweden)

Tambe Swagata

2009-01-01

Full Text Available White piedra is a superficial fungal infection of the hair shaft, caused by Trichosporon beigelii . We report two cases of white piedra presenting as brown palpable nodules along the hair shaft with a fragility of scalp hairs. T. beigelii was demonstrated in hair culture of both the patients and T. ovoides as a species was confirmed on carbohydrate assimilation test. The first patient responded to oral itraconazole and topical ketoconazole, with a decrease in the palpability of nodules and fragility of scalp hairs at the end of two months.

Reinke Edema: Watch For Vocal Fold Cysts.

Science.gov (United States)

Tüzüner, Arzu; Demirci, Sule; Yavanoglu, Ahmet; Kurkcuoglu, Melih; Arslan, Necmi

2015-06-01

Reinke edema is one of the common cause of dysphonia middle-aged population, and severe thickening of vocal folds require surgical treatment. Smoking plays a major role on etiology. Vocal fold cysts are also benign lesions and vocal trauma blamed for acquired cysts. We would like to present 3 cases with vocal fold cyst related with Reinke edema. First case had a subepidermal epidermoid cyst with Reinke edema, which could be easily observed before surgery during laryngostroboscopy. Second case had a mucous retention cyst into the edematous Reinke tissue, which was detected during surgical intervention, and third case had a epidermoid cyst that occurred 2 months after before microlaryngeal operation regarding Reinke edema reduction. These 3 cases revealed that surgical management of Reinke edema needs a careful dissection and close follow-up after surgery for presence of vocal fold cysts.

High-speed Imaging of Vocal Fold Vibration Onset Delay: Normal Versus Abnormal.

Science.gov (United States)

Woo, Peak

2017-05-01

Vocal fold vibration onset delay (VFVOD) is heard frequently in spasmodic dysphonia and in muscle tension dysphonia. VFVOD changes due to other vocal pathologies have not been investigated. VFVOD during sustained vowel production was estimated with high-speed video in 10 normal and 40 pathologic subjects (scars, vocal fold paralysis, vocal fold nodules, and polyps). Analysis of high-speed video was done using digital kymography. VFVOD can be divided into two portions. Pre-phonation delay (PPD) is the duration when the vocal folds are nearly approximated to the time of first observed oscillation. Steady state delay (SSD) is the time when vocal folds are observed to come into oscillation until steady state of oscillation is observed. Normal subjects have almost zero PPD with vocal fold oscillation observed before full vocal fold adduction. Pathologic cases showed prolonged PPD because of (1) false cord adduction, (2) prolonged true vocal fold adduction, and (3) delay to onset of vocal fold vibration. Normal subjects have SSD of three to five cycles before steady state. Pathologic states result in increased SSD. Causes for increased SSD include (1) slow ramping up to steady state, (2) partial vibration of vocal folds, and (3) diplophonia with alternating beats before achieving steady state. There are significant differences between normal and pathology groups in both PPD and SSD. VFVOD is elevated in pathologic states. This can be due to increase in PPD or SSD. VFVOD is an under-recognized phenomenon that may contribute to complaints of vocal fatigue and dysphonia. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Hyperthyroidism--cause of depression and psychosis: a case report.

Science.gov (United States)

Marian, G; Nica, E A; Ionescu, B E; Ghinea, D

2009-01-01

Psychiatric symptoms have been reported quite frequently in certain thyroid diseases, but more frequently in association with hypothyroidism. Thyrotoxicosis can be associated with various psychiatric symptoms, such as emotional lability, anxiety, restlessness and rarely frank psychosis. Psychotic symptoms in the context of hyperthyroidism typically present as an affective psychosis. The link between psychosis and hyperthyroidism is poorly understood. Because of this association of psychiatric symptoms is important to exclude a somatic cause, when assessing a patient first. We present the case of young woman who was followed over 2 years and who initially presented to psychiatric consultation for depressive symptoms, after being diagnosed with hyperthyroidism and specific therapy instituted, but who developed psychotic symptoms.

Hyperthyroidism–cause of depression and psychosis: a case report

Science.gov (United States)

Marian, G; Ionescu, BE; Ghinea, D

2009-01-01

Psychiatric symptoms have been reported quite frequently in certain thyroid diseases, but more frequently in association with hypothyroidism. Thyrotoxicosis can be associated with various psychiatric symptoms, such as emotional lability, anxiety, restlessness and rarely frank psychosis. Psychotic symptoms in the context of hyperthyroidism typically present as an affective psychosis. The link between psychosis and hyperthyroidism is poorly understood. Because of this association of psychiatric symptoms is important to exclude a somatic cause, when assessing a patient first. We present the case of young woman who was followed over 2 years and who initially presented to psychiatric consultation for depressive symptoms, after being diagnosed with hyperthyroidism and specific therapy instituted, but who developed psychotic symptoms. PMID:20108759

Localization fibrosing mediastinitis causing pulmonary infraction: A case report

Energy Technology Data Exchange (ETDEWEB)

Sur, Young Keun; Kim, Eun Young; Kang, Doo Kyoung; Park, Kyung Joo; Koh, Young Wha; Sun, Joo Sung [Ajou University School of Medicine, Suwon (Korea, Republic of)

2016-06-15

A 44-year-old female patient visited our emergency room for hemoptysis and refractory chest wall pain of 2 months duration. She had no history of smoking or other medical conditions. Chest CT scan showed homogenously enhancing soft tissue mass without calcification at the left pulmonary hilum. Encasing and compression of the left lower pulmonary artery by the mass had resulted in pulmonary infarction in the left lower lobe. Laboratory tests for tuberculosis, fungus, and vasculitis were all negative. The patient underwent surgical biopsy and resection of infarcted left lower lobe that was histopathologically confirmed as fibrosing mediastinitis. Herein, we reported a rare case of surgically confirmed and treated localized fibrosing mediastinitis causing pulmonary infarction.

A Case of Ventilator-Associated Pneumonia Caused by Ewingella americana : First Report from Turkey

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Kenan Ecemiş

2014-09-01

Full Text Available Ewingella americana is a very rare cause of serious infections, especially in immunocompromised patients. We report a case of ventilator-associated pneumonia (VAP in an intensive care unit patient, who was treated successfully with ceftriaxone. To the best of our knowledge, this is the first case of VAP due to Ewingella americana in the English literature.J Microbiol Infect Dis 2014; 4(3: 118-120

Hemosuccus pancreaticus as a rare cause of gastrointestinal bleeding: a report of two cases.

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Ghodratollah Maddah

2015-05-01

Full Text Available Pancreatic diseases are known to be associated with complications such as pseudocyst and abscess. A pseudoaneurysm associated with pancreatitis may develop as well. The pseudoaneurysm may rupture into various parts of the gastrointestinal tract; the peritoneal cavity, or the retroperitoneum. We report two cases of Hemosuccus pancreaticus admitted to our center in the past five years. One case was associated with acute pancreatitis, and another case was associated with chronic pancreatitis. A pseudocyst was found in two cases. Both were successfully managed by emergency surgery. So, Hemosuccus pancreaticus is a rare cause of gastrointestinal bleeding with difficult diagnosis, and surgery is the effective treatment for the patient with severe bleeding. However in cases with no life-threatening bleeding angiography and embolization can be performed.

Case of double cancer of the liver (hepatoma and cholangioma) caused by accumulation of thorotrast

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Masai, K; Watanabe, T [Yanai-Byoin National Sanatorium, (Japan)

1977-03-01

Fairly many cases of delayed disorders caused by thorotrast have been reported. The authors experienced a case of a 65 year old male who had received an infusion of thorotrast solution at the old army hospital 38 years ago and died from liver cirrhosis and hepatic cancer (double cancer of hepatoma and cholangiocarcinoma). By the biopsy after his death, alpha rays were demonstrated in granules of foreign body in hepatic tissues, and in corporation with its contrast, it was certified that a chain of abnormal shadows mainly seen in the liver and the spleen, on the scout film of the abdomen before death, was caused by thorotrast. From pathological findings in hepatic cancers, hepatoma was recognized in the right lobe and cholangioma, in the left lobe, and there was no pathological relationship between the two cancers. Namely, it was double cancer within the same organ. Case of double cancer in the liver such as this case were thought to be very rare in Japan, and a few literature considerations were also reported.

Static winging of the scapula caused by osteochondroma in adults: a case series

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Orth Patrick

2012-10-01

Full Text Available Abstract Introduction Although palsy of the long thoracic nerve is the classical pathogenesis of winging scapula, it may also be caused by osteochondroma. This rare etiopathology has previously been described in pediatric patients, but it is seldom observed in adults. Case presentation We describe three cases of static scapular winging with pain on movement. Case 1 is a Caucasian woman aged 35 years with a wing-like prominence of the medial margin of her right scapula due to an osteochondroma originating from the ventral omoplate. Histopathological evaluation after surgical resection confirmed the diagnosis. The postoperative course was unremarkable without signs of recurrence on examination at 2 years. Case 2 is a Caucasian woman aged 39 years with painful scapula alata and neuralgic pain projected along the left ribcage caused by an osteochondroma of the left scapula with contact to the 2nd and 3rd rib. Following surgical resection, the neuropathic pain continued, demanding neurolysis of the 3rd and 4th intercostal nerve after 8 months. The patient was free of symptoms 2 years after neurolysis. Case 3 is a Caucasian woman aged 48 years with scapular winging due to a large exostosis of the left ventral scapular surface with a broad cartilaginous cap and a large pseudobursa. Following exclusion of malignancy by an incisional biopsy, exostosis and pseudobursa were resected. The patient had an unremarkable postoperative course without signs of recurrence 1 year postoperatively. Based on these cases, we developed an algorithm for the diagnostic evaluation and therapeutic management of scapula alata due to osteochondroma. Conclusions Orthopedic surgeons should be aware of this uncommon condition in the differential diagnosis of winged scapula not only in children, but also in adult patients.

A rare cause of chronic mesenteric ischemia from fibromuscular dysplasia: a case report

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Senadhi Viplove

2010-11-01

Full Text Available Abstract Introduction Chronic mesenteric ischemia is a condition that is classically associated with significant atherosclerosis of the abdominal arteries, causing postprandial abdominal pain out of proportion to physical examination. The abdominal pain is exacerbated after meals due to the shunting of blood away from the intestines to the stomach, causing relative ischemia. More than 95% of chronic mesenteric ischemia cases are due to atherosclerosis. We report the first known case of chronic mesenteric ischemia from fibromuscular dysplasia. To the best of our knowledge, this is also the first known case in the literature where postprandial abdominal pain was the presenting symptom of fibromuscular dysplasia. Case presentation A 44-year-old Caucasian woman with a history of hypertension and preeclampsia, who had taken oral contraceptive pills for 15 years, presented with an intractable, colicky abdominal pain of two weeks duration. This abdominal pain worsened with oral intake. It was also associated with diarrhea and vomiting. Physical examination revealed stage III hypertension out of proportion to her risk factors and diffuse abdominal pain without peritoneal signs. An abdominal computed tomography scan, completed in the emergency room, revealed nonspecific colitis. Laboratory work revealed leukocytosis with a left shift, an erythrocyte sedimentation rate of 79 and a C-reactive protein level of 100. She was started on intravenous flagyl and intravenous ciprofloxacin. However, all microbial cultures were negative including three cultures for clostridium difficile. Urine analysis revealed nephritic range proteinuria. The laboratory profile was within normal limits for perinuclear-anti-neutrophil cytoplasmic antibody, cytoplasmic-anti-neutrophil cytoplasmic antibody, anti-saccharomyces cerevisiae antibody, antinuclear antibody test, celiac profile, lactate, carbohydrate antigen-125 and thyroid stimulating hormone. A colonoscopy was completed

Can a giant cervical osteophyte cause dysphagia and airway obstruction? A case report.

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Kapetanakis, Stylianos; Vasileiadis, Ioannis; Papanas, Nikolaos; Goulimari, Reggina; Maltezos, Eustratios

2011-05-01

Cervical spondylosis is a common disorder mainly affecting elderly people. It frequently presents with excessive bone formation (osteophytes). These may lead to pain and neurological deficits due to root compression. Dysphagia and airway obstruction due to a giant anterior osteophyte of the cervical spine are extremely rare. We present the case of an 81-year-old patient suffering from dysphagia and slight dyspnoea due to a giant cervical osteophyte. Osteophyte resection was performed and the patient was relieved from symptoms. This case highlights that a large cervical osteophyte may, albeit rarely, be the cause of simultaneously presenting dysphagia and dyspnoea, and should, therefore, be included in the diagnostic workup in such cases.

Encouragement to Increase the Use of Psychosocial Skills in the Diagnosis and Therapy of Patients With Functional Dysphonia.

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Kollbrunner, Jürg; Seifert, Eberhard

2017-01-01

Clinicians believe that psychosocial factors play a causal role in the etiology of many forms of functional dysphonia (FD). But for decades, all attempts to confirm such causation have failed. This paper aims to show the logic of this failure, to discuss the possibilities of employing psychology in therapy nonetheless, and to encourage clinicians to use their psychosocial knowledge and skills. The failure to confirm psychic and social factors as causal in the etiology of FD is basically a consequence of a principal shortcoming of evidence-based medicine (EBM). As the gold standard for validity, reliability, and objectivity in medical research, EBM is based on calculability and hence the processing of quantitative data. But life paths and life situations are best or sometimes only expressible in qualitative, experiential, and idiographic terms. Thus EBM-guided evaluation undervalues most psychosocial studies. This report of an experienced multidisciplinary voice team proposes alternative pathways for integrating psychosocial knowledge into the diagnosis and the treatment of FD. The difference between the fields of activity of psychotherapists and speech-language pathologists is discussed, and the latter group is shown the potential benefits of using more of their psychosocial knowledge and skills. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Percutaneous treatment of a bronchobiliary fistula caused by cholelithiasis: case report

International Nuclear Information System (INIS)

Kim, Jae Soo; You, Jin Jong

2004-01-01

Bronchobiliary fistulae are rare disorders, with inflammatory diseases of the liver, trauma, previous surgery and biliary obstruction being frequent causative factors. Endoscopic or transhepatic biliary drainage has been used successfully to avoid surgical treatment. We describe a case of a bronchobiliary fistula a 78-year-old man with biliary obstruction caused by impacted calculi. Without surgical or endoscopic intervention, fistulae were treated by percutaneous transhepatic biliary drainage and removal of calculi, in conjunction with balloon sphincteroplasty

Contact urticaria caused by the Apple Watch – A case report

OpenAIRE

Spencer D. Hawkins; Steven R. Feldman

2017-01-01

Smart watches are an upcoming trend that provide quick access to smartphone notifications on the wearer’s wrist. Metal portions of the Apple Watch contain small amounts of nickel, however, the interchangeable bands can be made of a variety of different materials including methacrylate polymers and fluoroelastomer synthetic rubber. There are multiple reports in non-peer reviewed literature such as social media and blogs of the Apple Watch causing skin irritation. Here we present a case report ...

Axial torsion of meckel's diverticulum causing small bowel obstruction in adult: A case report

Energy Technology Data Exchange (ETDEWEB)

Youn, In Kyung; Lee, Su Lim; Ku, Young Mi [Dept. of Radiology, Uijeongbu St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu (Korea, Republic of)

2016-02-15

Meckel's diverticulum (MD) is the most common congenital abnormality of the gastrointestinal tract that is prevalent in 2–3% of the population. The lifetime risk of complications is estimated at 4%. Small bowel obstruction is the second most common complication of MD. Among the causes of bowel obstruction, axial torsion of MD is the rarest complication. Urgent surgical treatment is needed in cases of small bowel obstruction associated with torsion of MD. Pre-operative diagnosis of MD as a cause of small bowel obstruction is difficult, because the diagnosis can be made only if the diverticulum is delineated at the site of obstruction. We reported a case of axial torsion of MD with necrosis that caused proximal small bowel perforation in a 21 year old male.

[A case of rhabdomyolysis caused by saw palmetto of healthy foods].

Science.gov (United States)

Hanaka, Minako; Yoshii, Chiharu; Yatera, Kazuhiro; Ito, Chiyo; Chojin, Yasuo; Nagata, Shuya; Yamasaki, Kei; Nishida, Chinatsu; Kawanami, Toshinori; Kawanami, Yukiko; Ishimoto, Hiroshi; Mukae, Hiroshi

2012-06-01

An 82-year-old man visited our hospital when he developed a fever of over 38 degrees C after having consumed 5 types of health foods. He had previously been treated for chronic obstructive pulmonary disease, hypertension and hyperuricemia. Blood examination on admission revealed renal dysfunction, marked elevation of C-reactive protein, and an elevated level of serum creatine kinase. According to the laboratory data and his clinical history, rhabdomyolysis complicated by acute renal failure was suspected, but his condition improved and his fever was reduced with fluid infusion. As a drug lymphocyte stimulation test was positive for only saw palmetto in the 5 health foods, we diagnosed the case as rhabdomyolysis induced by saw palmetto. We believe that this is the first case of a health food being the cause of rhabdomyolysis.

Combining Voice Therapy and Physical Therapy: A Novel Approach to Treating Muscle Tension Dysphonia

Science.gov (United States)

Craig, Jennifer; Tomlinson, Carey; Stevens, Kristin; Kotagal, Kiran; Fornadley, Judith; Jacobson, Barbara; Garrett, C. Gaelyn; Francis, David O.

2015-01-01

Objective This study investigated the role of a specialized physical therapy program for muscle tension dysphonia patients as an adjunct to standard of care voice therapy. Study Design Retrospective Cohort Study Methods Adult MTD patients seen between 2007 and 2012 were identified from the clinical database. They were prescribed voice therapy and, if concomitant neck pain, adjunctive physical therapy. In a pragmatic observational cohort design, patients underwent one of four potential treatment approaches: voice therapy alone (VT), voice therapy and physical therapy (VT+PT), physical therapy alone (PT), or incomplete/no treatment. Voice handicap outcomes were compared between treatment approaches. Results Of 153 patients meeting criteria (Median age 48 years, 68% female, and 30% had fibromyalgia, chronic pain, chronic fatigue, depression, and/or anxiety), there was a similar distribution of patients with moderate or severe pre-treatment VHI scores across treatment groups (VT 45.5%, VT+PT 43.8%, PT 50%, no treatment 59.1%; p=0.45). Patients treated with VT alone had significantly greater median improvement in VHI than those not treated: 10-point vs. 2-point (p=0.02). Interestingly, median VHI improvement in patients with baseline moderate-severe VHI scores was no different between VT (10), VT+PT (8) and PT alone (10; p=0.99). Conclusions Findings show voice therapy to be an effective approach to treating MTD. Importantly, other treatment modalities incorporating physical therapy had a similar, albeit not significant, improvement in VHI. This preliminary study suggests that physical therapy techniques may have a role in the treatment of a subset of MTD patients. Larger, comparative studies are needed to better characterize the role of physical therapy in this population. PMID:26012419

A randomized controlled trial of stretch-and-flow voice therapy for muscle tension dysphonia.

Science.gov (United States)

Watts, Christopher R; Hamilton, Amy; Toles, Laura; Childs, Lesley; Mau, Ted

2015-06-01

To investigate the effect of stretch-and-flow voice therapy on vocal function and handicap. Randomized controlled trial. Participants with primary muscle tension dysphonia were randomly assigned to experimental or control groups. Experimental participants received vocal hygiene education followed by 6 weeks of stretch-and-flow voice therapy. Control participants received vocal hygiene education only. Outcome variables consisted of a measure of vocal handicap (Voice Handicap Index [VHI]), maximum phonation time, s/z ratio, and acoustic measures. All measures were obtained at baseline prior to treatment and within 2 weeks posttreatment or at the end of the control period. The pre- to posttreatment measurement change (delta Δ) was applied to statistical analyses. A multivariate analysis of variance revealed significant group differences in pre-to-post changes on measures of VHI, maximum phonation time, and cepstral peak prominence (CPP) in connected speech and vowels (P = 0.003, 0.013, 0.025, and 0.017 respectively), with a significant reduction of VHI (Cohen's d = 1.6), increase in maximum phonation time (Cohen's d = 1.2), increase of CPP in connected speech (Cohen's d = 1.2), and increase of CPP in vowels (Cohen's d = 1.1) in the experimental group compared to the control group. This preliminary small sample randomized controlled trial found significantly greater improvement in vocal handicap, maximum phonation time, and acoustic measures of vocal function after participants received stretch-and-flow voice therapy compared to participants receiving vocal hygiene education alone. Additional research incorporating larger samples will be needed to confirm and further investigate these findings. 1b. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Influence of consonant voicing characteristics on sentence production in abductor versus adductor spasmodic dysphonia.

Science.gov (United States)

Cannito, Michael P; Chorna, Lesya B; Kahane, Joel C; Dworkin, James P

2014-05-01

This study evaluated the hypotheses that sentence production by speakers with adductor (AD) and abductor (AB) spasmodic dysphonia (SD) may be differentially influenced by consonant voicing and manner features, in comparison with healthy, matched, nondysphonic controls. This was a prospective, single blind study, using a between-groups, repeated measures design for the independent variables of perceived voice quality and sentence duration. Sixteen subjects with ADSD and 10 subjects with ABSD, as well as 26 matched healthy controls produced four short, simple sentences that were systematically loaded with voiced or voiceless consonants of either obstruant or continuant manner categories. Experienced voice clinicians, who were "blind" as to speakers' group affixations, used visual analog scaling to judge the overall voice quality of each sentence. Acoustic sentence durations were also measured. Speakers with ABSD or ADSD demonstrated significantly poorer than normal voice quality on all sentences. Speakers with ABSD exhibited longer than normal duration for voiceless consonant sentences. Speakers with ADSD had poorer voice quality for voiced than for voiceless consonant sentences. Speakers with ABSD had longer durations for voiceless than for voiced consonant sentences. The two subtypes of SD exhibit differential performance on the basis of consonant voicing in short, simple sentences; however, each subgroup manifested voicing-related differences on a different variable (voice quality vs sentence duration). Findings suggest different underlying pathophysiological mechanisms for ABSD and ADSD. Findings also support inclusion of short, simple sentences containing voiced or voiceless consonants as part of the diagnostic protocol for SD, with measurement of sentence duration in addition to judments of voice quality severity. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Longitudinal variations of laryngeal overpressure and voice-related quality of life in spasmodic dysphonia.

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Yeung, Jeffrey C; Fung, Kevin; Davis, Eric; Rai, Sunita K; Day, Adam M B; Dzioba, Agnieszka; Bornbaum, Catherine; Doyle, Philip C

2015-03-01

Adductor spasmodic dysphonia (AdSD) is a voice disorder characterized by variable symptom severity and voice disability. Those with the disorder experience a wide spectrum of symptom severity over time, resulting in varied degrees of perceived voice disability. This study investigated the longitudinal variability of AdSD, with a focus on auditory-perceptual judgments of a dimension termed laryngeal overpressure (LO) and patient self-assessments of voice-related quality of life (V-RQOL). Longitudinal, correlational study. Ten adults with AdSD were followed over three time periods. At each, both voice samples and self-ratings of V-RQOL were gathered prior to their scheduled Botox injection. Voice recordings subsequently were perceptually evaluated by eight listeners for LO using a visual analog scale. LO ratings for all-voiced and Rainbow Passage sentence stimuli were found to be highly correlated. However, only the LO ratings obtained from judgments of AV stimuli were found to correlate moderately with self-ratings of voice disability for both the physical functioning and social-emotional subscores, as well as the total V-RQOL score. Based on perceptual judgments, LO appears to provide a reliable means of quantifying the severity of voice abnormalities in AdSD. Variability in self-ratings of the V-RQOL suggest that perceived disability related to AdSD should be actively monitored. Further, auditory-perceptual judgments may provide an accurate index of the potential impact of the disorder on the speaker. Similarly, LO was supported as a simple clinical measure that serves as a reliable index of voice change over time. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

A Probable Case of Burn-out NASH Caused by Panhypopituitarism

Science.gov (United States)

Terawaki, Yuichi; Murase, Kunitaka; Motonaga, Ryoko; Tanabe, Makito; Nomiyama, Takashi; Shakado, Satoshi; Mizoguchi, Mikiro; Sakisaka, Shotaro; Yanase, Toshihiko

2016-03-01

A 38-year-old man diagnosed with craniopharyngioma at 8 years old underwent repeated surgery and radiation therapy. Complications included panhypopituitarism including growth hormone deficiency and hypogonadism at 13 years old. At 26 years of age, a slight fatty liver was found, which finally developed into liver cirrhosis (LC) at 35 years old. Viral infection or other etiologies causing LC were negative on serum examinations. Liver biopsy suggested a possibility of burn-out non-alcoholic steatohepatitis. This case indicates that a long-standing growth hormone deficiency and hypogonadism may lead to LC as a type of burn-out non-alcoholic steatohepatitis.

A Case of Fatal Bacterial Meningitis Caused by Enterococcus Faecalis: Postmortem Diagnosis

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Gülhan Yağmur

2015-10-01

Full Text Available Enterococcus species rarely cause bacterial meningitis without predisposing factors such as trauma, brain surgery, etc. In this study, we present a bacterial meningitis case caused by Enterococcus faecalis (E. faecalis in a 13-year-old male who was found dead at home. One hundred and forty two cm tall, 37 kg weight male had admitted to hospital two days after the beginning of complaints such as weakness, headache, swelling of left eye, nausea and vomiting. Body temperature was 37.3 oC, leucocyte count 22100/ mm3, and CRP 71 g/dl at the hospital admission. Antibiotic treatment with amoxicillin/clavulanic acid (625 mg was given to the patient but he was found dead in his house the day after. In autopsy; yellow-green purulant liquid in left frontoparietal zone, fullness of meningeal vessels and oedema was seen in brain. Isolated bacteria in cerebrospinal fluid (CSF was identificated as E. faecalis by mini API 32 Strep®. Postmortem microbiological sampling in autopsy and defining etiologic agents is important for rare meningitis cases in which antemortem identification could not be done before death.

Trigger wrist and carpal tunnel syndrome caused by hand intramuscular intrasynovial angiofibrolipoma: A rare case report

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Turan C Dulgeroglu

2016-08-01

Full Text Available Trigger wrist is a clinical entity characterized by triggering or the crackling of the wrist. Here, a case is reported of intrasynovial angiofibrolipoma that caused trigger wrist and carpal tunnel syndrome. This is the only case report where trigger wrist and carpal tunnel syndrome caused by the intrasynovial angiofibrolipoma were developed simultaneously. it is believed that that adhesive tenosynovitis developing in the tendons may have contributed to the triggering and carpal tunnel syndrome in the wrist as a result of inflammation occuring as a consequence of intrasynovial angiofibrolipoma. [Hand Microsurg 2016; 5(2.000: 107-109

l'amylose laryngée à propos d'un cas laryngeal location of amylosis

African Journals Online (AJOL)

maxillofac. 1992 ; 93 : 54-57. 5-Vicente Villagomez, Felicitos Santos, Ramiro Santos and al. Amyloidosis: Uncommon cause of dysphonia. Head and Neck Surgery 2004, 13: 1275-276. 6- Quinquenel ML, Le Coza, Desrues B et ...

Onabotulinum toxin A dosage trends over time for adductor spasmodic dysphonia: A 15-year experience.

Science.gov (United States)

Tang, Christopher G; Novakovic, Daniel; Mor, Niv; Blitzer, Andrew

2016-03-01

Although onabotulinum neurotoxin A (BoNTA) has been used for over three decades for the treatment of adductor spasmodic dysphonia, no study has been performed to look at the trend of BoNTA dosages across time. The goal of this study is to evaluate the dosage trends to determine if the dosage necessary for voice improvement in patients increases over time. Charts were reviewed for patients with 15 years or more of experience. Linear regression analysis was performed to determine correlation coefficients and trends. Fifty-five patients receiving BoNTA injections by the senior author (a.b.) for over 15 years were evaluated. Thirty-nine patients (82% female) met inclusion criteria. Patients received injections over an average of 18.6 years ± 1.36 years, with the longest follow-up of 21.5 years. Of 39 patients, 16 (41%) had a negative correlation coefficient (Pearson's r) suggesting a decrease over time, whereas 23 (59%) had a positive correlation coefficient suggesting an increase over time. The mean correlation coefficient was 0.139 ± 0.534 and P  0.05 in 20 patients. R(2) for all patients were less than 0.75. Onabotulinum neurotoxin A injection dosage trends vary depending on the individual over time. Overall, the dose range appears to be stable in the majority of patients, suggesting that tolerance does not play a significant part in dose variation over time. 4. Laryngoscope, 126:678-681, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

The Causes of Churn in the Telecommunication Industry: A Single, Exploratory Case Study on Kenyan Carriers

Science.gov (United States)

Halim, Joseph

2015-01-01

This single explorative case study investigated the causes of churn in the telecommunication industry in Kenya, narrowed down to include only the capital city of Nairobi. The question of this dissertation was split into three sub-questions. The first sub-question investigated the behavioral patterns of customers causing churn. The second…

Effects of muscle tension dysphonia on tone phonation: acoustic and perceptual studies in Vietnamese female teachers.

Science.gov (United States)

Nguyen, Duong Duy; Kenny, Dianna T

2009-07-01

Muscle tension dysphonia (MTD) is a hyperfunctional voice disorder commonly seen in professional voice users. To date, published acoustic studies of this disorder have mainly focused on nontonal language speakers, and no publication has documented its impact on lexical tone characteristics. In this study, we examined whether and how this voice disorder affected acoustically and perceptually the characteristics of tones in Vietnamese teachers. Voice data were obtained from 42 Vietnamese female primary school teachers diagnosed with MTD and 30 vocally healthy teachers. Tonal data were analyzed using Computerized Speech Lab (CSL-4300B) and Speech Analyzer. Parameters analyzed included the two most important acoustic cues in Vietnamese tones, that is, tonal fundamental frequency (F(0)) and laryngealization. Tonal F(0) was assessed using a factorial analysis of variance with group and career durations as independent variables. Tonal samples were also perceptually assessed by a panel of native speakers of the same dialect. The results showed that MTD lowered tonal F(0) in high tones and tones with extensive fundamental frequency variation. There was also a significant main effect for career duration; in MTD group, tonal F(0) was lower in teachers with longer career duration. The teachers with MTD showed different patterns of laryngealization compared with the control group. Tone perception was poorer for tones with extensive fundamental frequency variation and without a typical phonation type. The results in this group of teachers supported our hypothesis that MTD impairs lexical tone phonation.

Voice tuning with new instruments for type II thyroplasty in the treatment of adductor spasmodic dysphonia.

Science.gov (United States)

Sanuki, Tetsuji; Yumoto, Eiji; Toya, Yutaka; Kumai, Yoshihiko

2016-10-01

Adductor spasmodic dysphonia is a rare voice disorder characterized by strained and strangled voice quality with intermittent phonatory breaks and adductory vocal fold spasms. Type II thyroplasty differs from previous treatments in that this surgery does not involve any surgical intervention into the laryngeal muscle, nerve or vocal folds. Type II thyroplasty intervenes in the thyroid cartilage, which is unrelated to the lesion. This procedure, conducted with the aim of achieving lateralization of the vocal folds, requires utmost surgical caution due to the extreme delicacy of the surgical site, critically sensitive adjustment, and difficult procedures to maintain the incised cartilages at a correct position. During surgery, the correct separation of the incised cartilage edges with voice monitoring is the most important factor determining surgical success and patient satisfaction. We designed new surgical instruments: a thyroid cartilage elevator for undermining the thyroid cartilage, and spacer devices to gauge width while performing voice monitoring. These devices were designed to prevent surgical complications, and to aid in selecting the optimal size of titanium bridges while temporally maintaining a separation during voice monitoring. We designed new surgical instruments, including a thyroid cartilage elevator and spacer devices. Precise surgical procedures and performing voice tuning during surgery with the optimal separation width of the thyroid cartilage are key points for surgical success. We introduce the technique of voice tuning using these surgical tools in order to achieve a better outcome with minimal surgical complications. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Long-term voice handicap index after type II thyroplasty using titanium bridges for adductor spasmodic dysphonia.

Science.gov (United States)

Sanuki, Tetsuji; Yumoto, Eiji; Kodama, Narihiro; Minoda, Ryosei; Kumai, Yoshihiko

2014-06-01

To determine the long-term functional outcomes of type II thyroplasty using titanium bridges for adductor spasmodic dysphonia (AdSD) by perceptual analysis using the Voice Handicap Index-10 (VHI-10) and by acoustic analysis. Fifteen patients with AdSD underwent type II thyroplasty using titanium brides between August 2006 and February 2011. VHI-10 scores, a patient-based survey that quantifies a patient's perception of his or her vocal handicap, were determined before and at least 2 years after surgery. Concurrent with the VHI-10 evaluation, acoustic parameters were assessed, including jitter, shimmer, harmonic-to-noise ratio (HNR), standard deviation of F0 (SDF0), and degree of voice breaks (DVB). The average follow-up interval was 30.1 months. No patient had strangulation of the voice, and all were satisfied with the voice postoperatively. In the perceptual analysis, the mean VHI-10 score improved significantly, from 26.7 to 4.1 two years after surgery. All patients had significantly improved each score of three different aspects of VHI-10, representing improved functional, physical, and emotional well-being. All acoustic parameters improved significantly 2 years after surgery. The treatment of AdSD with type II thyroplasty significantly improved the voice-related quality of life and acoustic parameters 2 years after surgery. The results of the study suggest that type II thyroplasty using titanium bridges provides long-term relief of vocal symptoms in patients with AdSD. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

A rare case of prostatic abscess caused by Brucella organisms: First report in Saudi Arabia

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Anwar Hamdi Alenazi

2018-01-01

Full Text Available Brucellosis is a zoonotic infectious disease that is known endemic infection in Saudi Arabia. Yet, this infection has not been reported as evident cause of prostatic abscess. we present a new case of prostatic abscess caused by brucella organism proven using pus culture and serology. These organisms should be suspected in patients presenting with clinical picture of prostatic abscess especially in endemic areas.

Investigation of Stress Concentration and Casing Strength Degradation Caused by Corrosion Pits

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Wei Yan

2016-01-01

Full Text Available Downhole casing and tubing are subjected to corrosion in many cases because of the exposure to corrosive environment. A more serious problem is that pitting corrosion occurs in the casing inner surface. Meanwhile, downhole strings are subjected to various forms of mechanical loads, for example, internal pressure load, external collapse load, or both. These loads acting on the corrosion pits will cause stress concentration and degrade the casing strength. Thus, it is essential to evaluate the stress concentration degree reasonably. The SCF (stress concentration factor is usually used to characterize the degree of stress concentration induced by corrosion pits. This paper presented a comparison on the SCFs regarding the analytical method for a single pit and experimental method for double pits. The results show that the SCF of a single pit depends mainly on the depth of the corrosion pit; however, the SCF of the double pits strongly depends on the pits distance. A correction factor of 1.3 was recommended in the double pits SCF prediction model.

[A case of lipoma of the stomach prolapsing into the duodenal bulb and causing a duodenal ulcer].

Science.gov (United States)

Yamane, Tateki; Uchiyama, Kan; Furuya, Toru; Ishii, Takayuki; Omura, Nobuo; Nakano, Masataka; Fukamachi, Shinsuke; Suwa, Tatsushi; Okusa, Toshifumi

2009-11-01

We report a case of lipoma in the antrum of the stomach which prolapsed into the duodenal bulb and caused a duodenal ulcer, which was speculated to have been induced by the friction of its tip against the duodenal mucosa. Although the duodenal ulcer healed after the administration of a proton pump inhibitor, the symptoms of epigastric discomfort continued, which was suggested to be due to the prolapse. Therefore, a laparoscopic operation was conducted. The incidence of lipoma of the stomach is rare, and cases of its prolapse into the duodenum are few. Furthermore, it is extremely rare for it to cause a duodenal ulcer. Because these features made this case clinically interesting, we report it here.

Fusarium sacchari, a cause of mycotic keratitis among sugarcane farmers - a series of four cases from North India

NARCIS (Netherlands)

Bansal, Yashik; Chander, Jagdish; Kaistha, Neelam; Singla, Nidhi; Sood, Sunandan; van Diepeningen, Anne D

2016-01-01

The two most common filamentous fungi causing mycotic keratitis are Aspergillus and Fusarium spp. Around 70 Fusarium spp. are involved in causing human infections. In this study, four cases of keratitis in sugarcane farmers in India are being reported, caused by the sugar cane pathogen Fusarium

Intractable nausea caused by zolpidem withdrawal: a case report.

Science.gov (United States)

Baruch, Edward; Vernon, Leonard F; Hasbun, Rafael J

2007-03-01

First launched in France in 1988, zolpidem (Ambien®) is a short-acting hypnotic agent. Early studies reported that that the development of physical dependence and tolerance to sedative-hypnotic drugs, such as the depressant and anticonvulsant effects evidenced with benzodiazepines, is not found with zolpidem. Direct to consumer advertising by the manufacturer continues to state that the risk for dependency is low; however, recent publications seem to contradict this. Additionally, adverse drug reactions affecting the central nervous system, gastrointestinal tract, and respiratory system have been reported. Other studies have examined the interactions of selective serotonin reuptake inhibitors and zolpidem as a possible cause of hallucinations. With continued physician marketing efforts touting the safety and efficacy of zolpidem, there is a high likelihood to overlook the risk of dependency and the symptoms related to zolpidem withdrawal. We report a case of a 41-year-old female who developed a dependency to zolpidem, who on her own decided to decrease her dosage, resulting in intractable nausea requiring hospitalization. Reported cases of zolpidem withdrawal have occurred with doses in excess of 160 mg per day, none of these have reported with intractable nausea as the sole symptom. In our reported case, although exceeding recommended dosage withdrawal phenomenon seemed to be severe after withdrawal from a comparatively low dose of zolpidem. Before zolpidem is prescribed, patient education should include warnings about the potential problems associated with dependency and abrupt discontinuation. Education about this common and likely underrecognized clinical phenomenon will help prevent future episodes and minimize the risk of misdiagnosis.

Hemolytic disease of the newborn caused by anti-Wright (anti-Wra): case report and review of literature.

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Squires, Amanda; Nasef, Nehad; Lin, Yulia; Callum, Jeannie; Khadawardi, Emad M; Drolet, Christine; Core, David; Simmons, Brian

2012-01-01

Antibodies to red cell antigens that are found at low frequency in the general population are rare causes of hemolytic disease of the newborn. To understand how to detect these cases, we provide a basic review of routine antenatal maternal antibody testing and report a case of a neonate with severe HDN caused by anti-Wright (anti-Wra), successfully managed with transfusion, phototherapy, and high-dose intravenous immunoglobulin. When hemolysis in a newborn is suspected in the absence of major blood group incompatibility or commonly detected maternal red cell antibodies, a direct antiglobulin test should be performed. A positive DAT should alert the clinician to the presence of maternal antibodies against low-incidence antigens. Antibodies to the Wra antigen are one such rare cause of HDN.

Otomastoiditis caused by Sphingomonas paucimobilis: case report and literature review.

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Benevides, Gabriel Nuncio; Hein, Noely; Lo, Denise Swei; Ferronato, Angela Esposito; Ragazzi, Selma Lopes Betta; Yoshioka, Cristina Ryoka Miyao; Hirose, Maki; Cardoso, Debora Morais; Regina Dos Santos, Silvia; Gilio, Alfredo Elias

2014-01-01

Sphingomonas paucimobilis is an aerobic Gram-negative bacillus that, although rare in humans, most commonly infects immunocompromised and hospitalized patients. Among the 59 pediatric cases of S. paucimobilis infection reported in the literature, the most common diagnosis involves isolated bacteremia. These cases are related to sporadic or epidemic infections. Death related to this infection occurred in only one case. The authors report a case of an 11-year-old boy with the diagnosis of Sphingomonas paucimobilis otomastoiditis and a thorough review of the literature on this infection in pediatrics. The patient presented a 20-day history of fever, otalgia, otorrhea, and progressive retroauricular swelling with protrusion of the left ear; despite 15 days of amoxicillin regimen. His past medical history included chronic bilateral otitis media, but no cause of immunosuppression was found. A brain computed tomography scan showed left otomastoiditis associated with a large circumscribed fluid collection with deep involvement of the soft tissues of the temporal region, including the subperiosteal space. Blood tests showed neutrophilia and elevated C-reactive protein. Surgical manipulation of the cited collection drained a large amount of a fetid purulent secretion. Ceftazidime and clindamycin were empirically initiated. The outcome was favorable, with fever defervescence and resolution of the scalp deformation. Culture of the drained secretion was positive for S. paucimobilis . Ciprofloxacin was scheduled for a further 10 days after discharge. The follow-up showed complete recovery. As far as we know, this is the first case of S. paucimobilis otomastoiditis, complicated with subperiosteal abscess in an immunocompetent child. The authors call attention to the increasing number of reports on S. paucimobilis infection over the years, and therefore to the importance of this pathogen, which was previously underestimated.

Otomastoiditis caused by Sphingomonas paucimobilis: case report and literature review

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Gabriel Nuncio Benevides

2014-09-01

Full Text Available Sphingomonas paucimobilis is an aerobic Gram-negative bacillus that, although rare in humans, most commonly infects immunocompromised and hospitalized patients. Among the 59 pediatric cases of S. paucimobilis infection reported in the literature, the most common diagnosis involves isolated bacteremia. These cases are related to sporadic or epidemic infections. Death related to this infection occurred in only one case. The authors report a case of an 11-year-old boy with the diagnosis of Sphingomonas paucimobilis otomastoiditis and a thorough review of the literature on this infection in pediatrics. The patient presented a 20-day history of fever, otalgia, otorrhea, and progressive retroauricular swelling with protrusion of the left ear; despite 15 days of amoxicillin regimen. His past medical history included chronic bilateral otitis media, but no cause of immunosuppression was found. A brain computed tomography scan showed left otomastoiditisassociated with a large circumscribed fluid collection with deep involvement of the soft tissues of the temporal region, including the subperiosteal space. Blood tests showed neutrophilia and elevated C-reactive protein. Surgical manipulation of the cited collection drained a large amount of a fetid purulent secretion. Ceftazidime and clindamycin were empirically initiated. The outcome was favorable, with fever defervescence and resolution of the scalp deformation. Culture of the drained secretion was positive for S. paucimobilis. Ciprofloxacin was scheduled for a further 10 days after discharge. The follow-up showed complete recovery. As far as we know, this is the first case of S. paucimobilis otomastoiditis, complicated with subperiosteal abscess in an immunocompetent child. The authors call attention to the increasing number of reports on S. paucimobilis infection over the years, and therefore to the importance of this pathogen, which was previously underestimated.

A Case of Frequent Arousal Following Nocturnal Dyspnea Caused by Gastroesophageal Reflux Disease

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Dae Wui Yoon

2013-06-01

Full Text Available Gastroesophageal reflux disease (GERD is a common disorder that is associated with many esophageal syndromes and complications. Most cases of reflux event occur during the day, but reflux during sleep can cause not only esophageal problems, but also sleep problems, such as arousal and poor sleep quality. We report the case of a 17-year-old man who had been referred to us with frequent arousal following sudden dyspnea. On polysomnography, no respiratory disturbances and periodic limb movements were found during the sleep study, but frequent events of arousal were reported (arousal index: 12.3/h. On a 24-hr esophageal pH monitoring test, his DeMeester score was 176.43 and the total reflux time was 1120.9 min (76.9%, indicating the presence of significant acid reflux. After treatment with a proton-pump inhibitor, the arousals following nocturnal dyspnea and fatigue in the morning disappeared in the patient. GERD should be considered as a cause of spontaneous arousal or awakening not accompanying respiratory disturbances.

Identification of the cause of severe skin infection by Fournier transform infrared spectroscopy: a case of Fournier's gangrene caused by fish bone.

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Shimizu, Takae; Harada, Kazutoshi; Akazawa, Satoshi; Yamaguchi, Miyuki; Inozume, Takashi; Kawamura, Tatsuyoshi; Shibagaki, Naotaka; Momosawa, Akira; Shimada, Shinji

2014-06-01

Fournier's gangrene (FG) is an infrequent but highly lethal infection. Here we report a 74-year-old man who presented with genital swelling and severe malaise. Based on the physical and imaging examination results, the diagnosis of FG was confirmed. Intraoperative findings showed dirty necrosis of soft tissue, and a splinter-shaped foreign body was found in the perirectal region. The foreign body was thought to be the cause of the condition, and it was analyzed using Fourier transform infrared spectroscopy. We found that the foreign body was a mixture of calcium phosphate and protein, suggesting that the splinter was a bone. Moreover, during the medical interview, the patient mentioned about intake of fish around the time of onset of symptoms. Therefore, to confirm the results of the analysis, DNA was extracted from the foreign body, and genomic PCR with subsequent sequence analysis was performed. The DNA sequence was identical to that of Oncorhynchus kisutch, a salmon that is a very popular food in Japan. On the basis of these findings, we concluded that FG in this case was caused by the penetration into the rectum of an accidentally ingested fish bone. Although some cases of intra-abdominal abscess due to accidental ingestion of fish bone have been reported, FG caused by fish bone is extremely rare. © 2014 Japanese Dermatological Association.

Treatment of 9 cases of pulmonary atelectasis caused by endobronchial tuberculosis with intraluminal stent implantation

International Nuclear Information System (INIS)

Ji Hongjiang; Li Qiang; Liu Zhongling; Bai Chong; Yao Xiaopeng; Zhao Lijun; Xu Hao; Dong Yuchao; Huang Haidong; Wang Qin

2007-01-01

Objective: To evaluate the effect and safety of intraluminal stent implantation in the treatment of complete airway obstruction with unilateral pulmonary atelectasis caused by endobronchial tuberculosis (EBTB). Methods: 9 cases of pulmonary atelectasis caused by EBTB were treated with high- frequency electricity/microwave, balloon dilation and endobronchial stent implantation. At the time of 1 week and 4-6 months after stenting ,the diameters of stenotic segment were measured. Results: All 9 cases with atelectasis of EBTB showed complete re-expansion within 3 days after the stent implantation. The mean diameter of the stenotic segments of 9 EBTB patients increased to 9.17 ± 1.24 mm at 7th day after stent implantation; 3 of 9 EBTB patients occured mild restenosis after implantation of tracheobronchial stents. However, combination therapy of cryotherapy and balloon dilation can effectively prevent the aggravation of restenosis. Conclusion: Comparing with traditional surgical treatment, the intraluminal stent implantation for atelectasis caused by EBTB is a new, effective, safe and microtraumatic method with reliable preservation of pulmonary function. (authors)

A case of double cancer of the liver (hepatoma and cholangioma) caused by accumulation of thorotrast

International Nuclear Information System (INIS)

Masai, Kenji; Watanabe, Tadashi

1977-01-01

Fairly many cases of delayed disorders caused by thorotrast have been reported. The authors experienced a case of 65 year old male who had received an infusion of thorotrast solution at the old army hospital 38 years ago and died for liver cirrhosis and hepatic cancer (double cancer of hepatoma and cholangiocarcinoma). By the biopsy after his death, alpha ray was proved in granules of foreign body in hepatic tissues, and in corporation with its contrast, it was certified that a chain of abnormal shadows mainly seen in the liver and the spleen, on the scout film of the abdomen before death, was caused by thorotrast. From pathological findings in hepatic cancers, hepatoma was recognized in the right lobe and cholangioma, in the left lobe, and there was no pathological relationship between two cancers. Namely, it was double cancer within the same organ. Case of double cancer in the liver such as this case was thought to be very rare in Japan, and a few literature considerations were also reported. (Tsunoda, M.)

Lateral Cricoarytenoid Release: Development of a Novel Surgical Treatment Option for Adductor Spasmodic Dysphonia in a Canine Laryngeal Model.

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Park, Andrea M; Paniello, Randal C

2016-09-01

To investigate the efficacy of a novel adductor muscle-releasing technique designed to decrease the force of vocal fold adduction, as a potential surgical therapy for patients with adductor spasmodic dysphonia (ADSD). Experimental animal study. A canine laryngeal model was used to assess the acute and sustained efficacy of a lateral cricoarytenoid (LCA) muscle release. A total of 34 canine hemilaryngeal preparations were divided among 7 experimental groups. The LCA muscle was separated from its cricoid cartilage origin via an open, anterior, submucosal approach. The laryngeal adductory pressures (LAP) were assessed pre- and post-muscle release via direct recurrent laryngeal nerve stimulation. Measurements were repeated at 1.5, 3, or 6 months postoperatively. Another study evaluated release of the thyroarytenoid (TA) muscle from its thyroid cartilage origin. Releasing the LCA muscle demonstrated a significant decrease in LAP acutely and was maintained at all 3 time points with the aid of a barrier (P < .05). Without the barrier, the LCA muscle reattached to the cricoid. Acute release of the TA muscle did not significantly decrease the LAP. The proposed LCA release procedure may provide patients with a permanent treatment option for ADSD. However, longer-term studies and human trials are needed. © The Author(s) 2016.

Hemothorax caused by spontaneous rupture of hepatocellular carcinoma in the pleural cavity: A case report

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Seo, Hin Hee; Ohm, Joon Young [Dept. of Radiology, Chungnam National University Hospital, Daejeon (Korea, Republic of); Kim, Song Soo; Kim, Jin Hwan [Dept. of Radiology, Chungnam National University School of Medicine, Daejeon(Korea, Republic of)

2017-07-15

Hemothorax resulting from ruptured hepatocellular carcinoma (HCC) is extremely rare and is generally caused by ruptured intrathoracic metastatic lesions. However, we report a rare case of hemothorax resulting from intrathoracic rupture of primary HCC.

A Rare Case of Cranial Osteomyelitis Caused by Proteus Vulgaris

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Hakan Uslu

2011-03-01

Full Text Available Osteomyelitis of the calvarial bones can cause serious complications such as brain abscess, due to the close proximity to adjacent brain structures. Development of the purulent secretion in surgery and traumatic scalp injuries must be considered as a possibility of osteomyelitis possibility. Generally gram positive, rarely gram negative bacteria and mix agents, can be isolated in infection. Especially chronic pyogenic osteomyelitis agents can be isolated from chronic infections such as tuberculosis. In cranial osteomyelitis diagnosis, radiological diagnosis has a very important place together with the clinical diagnosis. However, infection can usually show late findings radiologically. In treatment, antibiotic treatment is absolutely essential as well as removal of the infected part of the bone. Due to antibiotic treatment lasting between 6-12 weeks, organizing the antibiotic protocols according to the results of culture-antibiograms, which were provided from purulent secretions, has the most important role in the success of surgical treatment. In Proteus sp. infections, for choice of suitable treatment, determination of the type of bacteria is important. For exact diagnosis, histopathological examination of the bone tissue must be carried out. In this report, a case with cranial osteomyelitis caused by Proteus vulgaris which is a gram negative bacteria causing anaerobic infections and classified in the Enterobacteriaceae family is presented. The patient was treated with surgery and appropriate antibiotics. Early recognition of this condition, planning the best treatment strategy and taking precautions to prevent complications, is mandatory for a better outcome.

The emerging trend of self-circumcision and the need to define cause: Case report of a 21 year-old male

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Ronald Kintu-Luwaga

2016-01-01

Conclusion: Cases of self-circumcision continue to emerge. There is need to report all cases, explore and manage the possible causes. The stigma uncircumcised males face among circumcised peers may be an important cause. Public health education and improved access to voluntary medical male circumcision services may help to prevent this practice.

A pediatric case of life-threatening airway obstruction caused by a cervicomediastinal thymic cyst

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Komura, Makoto; Kanamori, Yutaka; Sugiyama, Masahiko; Iwanaka, Tadashi [University of Tokyo Hospital, Department of Pediatric Surgery, Tokyo (Japan); Fukushima, Noriyoshi [University of Tokyo Hospital, Department of Pathology, Tokyo (Japan)

2010-09-15

Most patients with thymic cysts complain of a slowly enlarging, asymptomatic cervical mass. Only 6-10% suffer dysphagia, dyspnoea, stridor, cervical pain or vocal paralysis. In some rare cases sudden onset of severe dyspnoea or asphyxia is the first symptom, especially in neonates and small infants. We report a unique case of a 20-month-old child, who required emergency tracheal intubation due to asphyxia. Cervicomediastinal thymic cyst might need to be included in causes of life-threatening airway obstruction in young children. (orig.)

Validity and Reliability of Surface Electromyography in the Assessment of Primary Muscle Tension Dysphonia.

Science.gov (United States)

Khoddami, Seyyedeh Maryam; Talebian, Saeed; Izadi, Farzad; Ansari, Noureddin Nakhostin

2017-05-01

The study aims to evaluate the reliability and the discriminative validity of surface electromyography (sEMG) in the assessment of patients with primary muscle tension dysphonia (MTD). The study design is cross-sectional. Fifteen patients with primary MTD (mean age: 34.07 ± 10.99 years) and 15 healthy volunteers (mean age: 34.53 ± 10.63 years) were included. All participants underwent evaluation of sEMG to record the electrical activity of the thyrohyoid and cricothyroid muscles. The outcome measures were the root mean square (RMS), activity peak, duration, and time to the peak activity, which were obtained during /a/ and /i/ prolongation for test-retest reliability. The test-retest reliability was good to excellent for the RMS and peak activity measures (intraclass correlation coefficient [agreement] [ICC agreement ] = 0.49-0.98). The reliability for the activity duration was poor to excellent (ICC agreement  = 0.19-0.9). Poor test-retest reliability was found for the time to peak measure (ICC agreement  = 0.15-0.37). The standard error of measurement for all sEMG measures was between 0.41 and 2.05. The smallest detectable change (SDC) was calculated between 1.13 and 5.66. The highest SDC values were obtained for the peak and the lowest SDCs were documented for the duration (5.66 and 1.13, respectively). All sEMG measures were not able to discriminate between the MTD patients and healthy subjects (P > 0.05). The sEMG is a reliable tool to measure the RMS, the peak activity, and the activity duration in primary MTD. However, it is not able to discriminate the patients with primary MTD from healthy subjects. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Tumor-Induced Osteomalacia Caused by Primary Fibroblast Growth Factor 23 Secreting Neoplasm in Axial Skeleton: A Case Report

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Gunjan Y. Gandhi

2012-01-01

Full Text Available We report the case of a 66-year-old woman with tumor-induced osteomalacia (TIO caused by fibroblast growth factor 23 (FGF-23 secreting mesenchymal tumor localized in a lumbar vertebra and review other cases localized to the axial skeleton. She presented with nontraumatic low back pain and spontaneous bilateral femur fractures. Laboratory testing was remarkable for low serum phosphorus, phosphaturia, and significantly elevated serum FGF-23 level. Magnetic resonance imaging (MRI of the lumbar spine showed a focal lesion in the L-4 vertebra which was hypermetabolic on positron emission tomography (PET scan. A computed tomography (CT guided needle biopsy showed a low grade spindle cell neoplasm with positive FGF-23 mRNA expression by reverse transcriptase polymerase chain reaction (RT-PCR, confirming the diagnosis of a phosphaturic mesenchymal tumor mixed connective tissue variant (PMTMCT. The patient elected to have surgery involving anterior resection of L-4 vertebra with subsequent normalization of serum phosphorus. Including the present case, we identified 12 cases of neoplasms localized to spine causing TIO. To our knowledge, this paper represents the first documented case of lumbar vertebra PMT causing TIO. TIO is a rare metabolic bone disorder that carries a favorable prognosis. When a lesion is identifiable, surgical intervention is typically curative.

Late Ebola virus relapse causing meningoencephalitis: a case report.

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Jacobs, Michael; Rodger, Alison; Bell, David J; Bhagani, Sanjay; Cropley, Ian; Filipe, Ana; Gifford, Robert J; Hopkins, Susan; Hughes, Joseph; Jabeen, Farrah; Johannessen, Ingolfur; Karageorgopoulos, Drosos; Lackenby, Angie; Lester, Rebecca; Liu, Rebecca S N; MacConnachie, Alisdair; Mahungu, Tabitha; Martin, Daniel; Marshall, Neal; Mepham, Stephen; Orton, Richard; Palmarini, Massimo; Patel, Monika; Perry, Colin; Peters, S Erica; Porter, Duncan; Ritchie, David; Ritchie, Neil D; Seaton, R Andrew; Sreenu, Vattipally B; Templeton, Kate; Warren, Simon; Wilkie, Gavin S; Zambon, Maria; Gopal, Robin; Thomson, Emma C

2016-07-30

There are thousands of survivors of the 2014 Ebola outbreak in west Africa. Ebola virus can persist in survivors for months in immune-privileged sites; however, viral relapse causing life-threatening and potentially transmissible disease has not been described. We report a case of late relapse in a patient who had been treated for severe Ebola virus disease with high viral load (peak cycle threshold value 13.2). A 39-year-old female nurse from Scotland, who had assisted the humanitarian effort in Sierra Leone, had received intensive supportive treatment and experimental antiviral therapies, and had been discharged with undetectable Ebola virus RNA in peripheral blood. The patient was readmitted to hospital 9 months after discharge with symptoms of acute meningitis, and was found to have Ebola virus in cerebrospinal fluid (CSF). She was treated with supportive therapy and experimental antiviral drug GS-5734 (Gilead Sciences, San Francisco, Foster City, CA, USA). We monitored Ebola virus RNA in CSF and plasma, and sequenced the viral genome using an unbiased metagenomic approach. On admission, reverse transcriptase PCR identified Ebola virus RNA at a higher level in CSF (cycle threshold value 23.7) than plasma (31.3); infectious virus was only recovered from CSF. The patient developed progressive meningoencephalitis with cranial neuropathies and radiculopathy. Clinical recovery was associated with addition of high-dose corticosteroids during GS-5734 treatment. CSF Ebola virus RNA slowly declined and was undetectable following 14 days of treatment with GS-5734. Sequencing of plasma and CSF viral genome revealed only two non-coding changes compared with the original infecting virus. Our report shows that previously unanticipated, late, severe relapses of Ebola virus can occur, in this case in the CNS. This finding fundamentally redefines what is known about the natural history of Ebola virus infection. Vigilance should be maintained in the thousands of Ebola survivors

Metabolic and toxic causes of canine seizure disorders: A retrospective study of 96 cases.

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Brauer, Christina; Jambroszyk, Melanie; Tipold, Andrea

2011-02-01

A wide variety of intoxications and abnormal metabolic conditions can lead to reactive seizures in dogs. Patient records of dogs suffering from seizure disorders (n=877) were reviewed, and 96 cases were associated with an underlying metabolic or toxic aetiology. These included intoxications by various agents, hypoglycaemia, electrolyte disorders, hepatic encephalopathy, hypothyroidism, uraemic encephalopathy, hypoxia and hyperglycaemia. The incidence of the underlying diseases was determined. The most common causes of reactive seizures were intoxications (39%, 37 dogs) and hypoglycaemia (32%, 31 dogs). Hypocalcaemia was the most frequent electrolyte disorder causing reactive seizures (5%) and all five of these dogs had ionised calcium concentrations ≤0.69 mmol/L. Eleven per cent of dogs with seizures had metabolic or toxic disorders and this relatively high frequency emphasises the importance of a careful clinical work-up of cases presented with seizures in order to reach a correct diagnosis and select appropriate treatment options. Copyright © 2009 Elsevier Ltd. All rights reserved.

Small simple hepatic cysts causing obstructive jaundice: a case report of sclerotherapy

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Kim, Hyun Ji; Song, Soon Young; Koh, Byung Hee; Cho, On Koo [Hanyang University College of Medicine, Hanyang University Hospital, Seoul (Korea, Republic of); Kim, Yong Soo [Hanyang University Guri Hospital, Guri (Korea, Republic of)

2007-10-15

A 62-year-old man visited our hospital for a regular follow-up of a known liver cirrhosis. Laboratory tests revealed recently elevated total and direct bilirubin levels. Imaging studies showed two small hepatic cysts (2.7 and 2.9 cm in the largest diameter) compressing both central intrahepatic ducts, respectively. Obstructive jaundice caused by the cysts was diagnosed. Sclerotherapy of the cysts was performed with 100% ethanol after aspiration of the cyst contents. An follow-up CT obtained after 3 months showed decreased cyst size and improved bile duct dilatation. It is known that obstructive jaundice due to a hepatic cyst is rare, and the cysts were unusually large and centrally located. We report a case of obstructive jaundice caused by very small hepatic cysts that was successfully treated with sclerotherapy.

Small simple hepatic cysts causing obstructive jaundice: a case report of sclerotherapy

International Nuclear Information System (INIS)

Kim, Hyun Ji; Song, Soon Young; Koh, Byung Hee; Cho, On Koo; Kim, Yong Soo

2007-01-01

A 62-year-old man visited our hospital for a regular follow-up of a known liver cirrhosis. Laboratory tests revealed recently elevated total and direct bilirubin levels. Imaging studies showed two small hepatic cysts (2.7 and 2.9 cm in the largest diameter) compressing both central intrahepatic ducts, respectively. Obstructive jaundice caused by the cysts was diagnosed. Sclerotherapy of the cysts was performed with 100% ethanol after aspiration of the cyst contents. An follow-up CT obtained after 3 months showed decreased cyst size and improved bile duct dilatation. It is known that obstructive jaundice due to a hepatic cyst is rare, and the cysts were unusually large and centrally located. We report a case of obstructive jaundice caused by very small hepatic cysts that was successfully treated with sclerotherapy

Breakdown Cause and Effect Analysis. Case Study

Science.gov (United States)

Biały, Witold; Ružbarský, Juraj

2018-06-01

Every company must ensure that the production process proceeds without interferences. Within this article, the author uses the term "interferences" in reference to unplanned stoppages caused by breakdowns. Unfortunately, usually due to machine operators' mistakes, machines break, which causes stoppages thus generating additional costs for the company. This article shows a cause and effect analysis of a breakdown in a production process. The FMEA as well as quality management tools: the Ishikawa diagram and Pareto chart were used for the analysis. Correction measures were presented which allowed for a significant reduction in the number of stoppages caused by breakdowns.

Long-term Dose Stability of OnabotulinumtoxinA Injection for Adductor Spasmodic Dysphonia: A 19-Year Single Institution Experience

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Paul Paddle

2017-11-01

Full Text Available ObjectivesAdductor spasmodic dysphonia (AdSD is a focal dystonia predominantly involving the laryngeal adductor muscles. AdSD is reported to be a largely non-progressive neurological disorder, though fluctuations in symptom severity do occur. Repeated laryngeal onabotulinumtoxinA (BTX-A injections are the primary management for AdSD. A number of studies have demonstrated long-term dose stability as evidence of this long-term disease stability.MethodsA retrospective review was performed on all patients undergoing BTX-A injections for AdSD from April 1994 to September 2013 by a single laryngologist at a tertiary referral laryngology center. Patient demographics, injection doses, use of diazepam and/or lidocaine, and self-reported vocal function were recorded. Multiple linear regression analyses were performed.Results83 patients underwent a total of 1,168 injections over 19 years. The mean starting dose was 2.35 MU (0.79 SD. The mean long-term dose was 2.36 MU (0.79 SD. After adjusting for confounders, the change in the relative dose of BTX-A, with every year elapsed since initial dose was 0.13% (95% confidence interval −0.31 to 0.57%, p = 0.568.ConclusionBTX-A dose is stable over time in our large cohort of patients treated with bilateral thyroarytenoid injections for AdSD.

A Case Report of Penile Infection Caused by Fluconazole- and Terbinafine-Resistant Candida albicans.

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Hu, Yongxuan; Hu, Yanqing; Lu, Yan; Huang, Shiyun; Liu, Kangxing; Han, Xue; Mao, Zuhao; Wu, Zhong; Zhou, Xianyi

2017-04-01

Candida albicans is the most common pathogen that causes balanoposthitis. It often causes recurrence of symptoms probably due to its antifungal resistance. A significant number of balanitis Candida albicans isolates are resistant to azole and terbinafine antifungal agents in vitro. However, balanoposthitis caused by fluconazole- and terbinafine-resistant Candida albicans has rarely been reported. Here, we describe a case of a recurrent penile infection caused by fluconazole- and terbinafine-resistant Candida albicans, as well as the treatments administered to this patient. The isolate from the patient was tested for drug susceptibility in vitro. It was sensitive to itraconazole, voriconazole, clotrimazole and amphotericin B, but not to terbinafine and fluconazole. Thus, oral itraconazole was administrated to this patient with resistant Candida albicans penile infection. The symptoms were improved, and mycological examination result was negative. Follow-up treatment of this patient for 3 months showed no recurrence.

A Case of Hypogonadotropic Hypogonadism Caused by Opioid Treatment for Nonmalignant Chronic Pain

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Yukiko Tabuchi

2012-01-01

Full Text Available We report a case of 42-year-old male patient with hypogonadotropic hypogonadism. He suffered from general fatigue and erectile dysfunction after the treatment with transdermal fentanyl for chronic pain by traffic injury. Endocrine examinations and hormone stimulating tests showed that he had hypogonadotropic hypogonadism. Brain magnetic resonance imaging (MRI showed no abnormal findings, and he had no past history of accounting for acquired hypogonadotropic hypogonadism. Therefore, his hypogonadism was diagnosed to be caused by opioid treatment. Although opioid-induced endocrine dysfunctions are not widely recognized, this case suggests that we should consider the possibility of endocrine dysfunctions in patients with opioid treatment.

Workplace productivity and voice disorders: a cognitive interviewing study on presenteeism in individuals with spasmodic dysphonia.

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Isetti, Derek; Meyer, Tanya

2014-11-01

The objective of this study was to obtain initial reactions and suggested modifications to two existing presenteeism scales: the Stanford Presenteeism Scale 6 (SPS-6) and the Work Productivity and Activity Impairment Questionnaire-Specific Health Problem (WPAI-SHP) among a cohort of employed individuals with a focal laryngeal dystonia, spasmodic dysphonia (SD). The study design is a qualitative study. Nine speakers with SD underwent cognitive interviews, during which they were asked to evaluate the relevance of statements and clarity of wording on the SPS-6, the WPAI-SHP, and an additional set of voice-related statements designed by the researchers. Participants were asked to complete the scales, rank order statements in terms of perceived importance, and suggest additional statements of relevance. Although all participants noted that their SD did have an effect on their jobs, there were suggestions for modifying both the WPAI-SHP and the SPS-6. Participants regarded specific voice-related statements that were generated by the researchers to be of greater importance than the majority of the statements on the SPS-6. Minor changes in the wording of the instructions on the WPAI-SHP were recommended. Presenteeism is an important construct to measure in individuals with a chronic voice disorder such as SD. However, existing presenteeism scales might best be administered in conjunction with additional statements that are more voice related so that clinicians can be made aware of specific difficulties encountered in the workplace. Copyright © 2014 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Brown tumor of the patella caused by primary hyperparathyroidism: A case report

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Irie, Tomoko; Mawatari, Taro; Ikemura, Satoshi; Matsui, Gen; Iguchi, Takahiro; Mitsuyasu, Hiroaki [Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka (Japan)

2015-06-15

It has been reported that the common sites of brown tumors are the jaw, pelvis, ribs, femurs and clavicles. We report our experience in a case of brown tumor of the patella caused by primary hyperparathyroidism. An initial radiograph and CT showed an osteolytic lesion and MR images showed a mixed solid and multiloculated cystic tumor in the right patella. One month after the parathyroidectomy, rapid bone formation was observed on both radiographs and CT images.1.

A Case of False-Positive Mycobacterium tuberculosis Caused by Mycobacterium celatum

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Edward Gildeh

2016-01-01

Full Text Available Mycobacterium celatum is a nontuberculous mycobacterium shown to cause symptoms similar to pulmonary M. tuberculosis. Certain strains have been shown to cross-react with the probes used to detect M. tuberculosis, making this a diagnostic challenge. We present a 56-year-old gentleman who developed signs and symptoms of lung infection with computed tomography scan of the chest showing right lung apex cavitation. Serial sputum samples were positive for acid-fast bacilli and nucleic acid amplification testing identified M. tuberculosis ribosomal RNA, resulting in treatment initiation. Further testing with high performance liquid chromatography showed a pattern consistent with M. celatum. This case illustrates the potential for M. celatum to mimic M. tuberculosis in both its clinical history and laboratory testing due to the identical oligonucleotide sequence contained in both. An increasing number of case reports suggest that early reliable differentiation could reduce unnecessary treatment and public health intervention associated with misdiagnosed tuberculosis.

Fluorouracil implants caused a diaphragmatic tumor to be misdiagnosed as liver metastasis: a case report

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Shen, Yang-Yang; Qin, Hong-Wei; Zhang, Jian-Bo; Wang, Zhen-Dan; Li, Pang; Pang, Kai; Zhang, Bo; Li, Sheng; Cui, Kai

2016-01-01

Fluorouracil implants are widely used in peritoneal interstitial chemotherapy. Curative effects have been obtained, but implants have also caused some complications. We performed an analysis of a 66-year-old male patient’s case history, as well as conventional pathological analysis and Raman spectroscopic detection of the diaphragmatic tumor. We also analyzed the underlying causes of this condition to prevent complications and reduce misdiagnoses in future cases. The patient had a history of peritoneal fluorouracil implantation. Pathological analysis of the diaphragmatic mass revealed foreign particles, and Raman detection showed that the mass contained fluorouracil. Fluorouracil implants may persist due to the high concentrations of this drug used in peritoneal chemotherapy. This finding should provide guidance and improve the application of peritoneal implants. In clinical trials, and the diagnosis of liver metastasis should be based on pathological results

Prosthetic joint infection caused by Granulicatella adiacens: a case series and review of literature.

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Quénard, Fanny; Seng, Piseth; Lagier, Jean-Christophe; Fenollar, Florence; Stein, Andreas

2017-06-23

Bone and joint infection involving Granulicatella adiacens is rare, and mainly involved in cases of bacteremia and infectious endocarditis. Here we report three cases of prosthetic joint infection involving G. adiacens that were successfully treated with surgery and prolonged antimicrobial treatment. We also review the two cases of prosthetic joint infection involving G. adiacens that are reported in the literature. Not all five cases of prosthetic joint infection caused by G. adiacens were associated with bacteremia or infectious endocarditis. Dental care before the onset of infection was observed in two cases. The median time delay between arthroplasty implantation and the onset of infection was of 4 years (ranging between 2 and 10 years). One of our cases was identified with 16srRNA gene sequencing, one case with MALDI-TOF mass spectrometry, and one case with both techniques. Two literature cases were diagnosed by 16srRNA gene sequencing. All five cases were cured after surgery including a two-stage prosthesis exchange in three cases, a one-stage prosthesis exchange in one case, and debridement, antibiotics, irrigation, and retention of the prosthesis in one case, and prolonged antimicrobial treatment. Prosthetic joint infection involving G. adiacens is probably often dismissed due to difficult culture or misdiagnosis, in particular in the cases of polymicrobial infection. Debridement, antibiotics, irrigation, and retention of the prosthesis associated with prolonged antimicrobial treatment (≥ 8 weeks) should be considered as a treatment strategy for prosthetic joint infection involving G. adiacens.

Hyperparathyroidism as a cause of recurrent acute pancreatitis: A case report

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Tešić-Rajković Snežana

2016-01-01

Full Text Available Introduction. One of the more uncommon etiological factors responsible for the development of acute pancreatitis (AP is hypercalcemia. Hyperparathyroidism (HPT, as a cause of hypercalcemia, is responsible for 1.5–13% of AP according to a number of studies. A mechanism of the development of AP in hyperparathyroidism is still unclear. Case report. We presented a 47-year-old female patient, who had five episodes of AP in total before the etiological factors were finally determined. The patient had certain comorbidities which were considered to be potential causes of AP. She had chronic renal insufficiency (she was on a regular hemodialysis program, systemic lupus erythematosus and mioma uteri. She used to regularly take an antiepileptic drug (combination of sodium valproate and valproic acid. During the fifth episode of AP, the serum calcium level was for the first time elevated to twice the normal value. Level of parathyroid hormone was several times higher. A static scintigraphy found hyperplasia or hyperfunctional adenoma of the right inferior and superior parathyroid glands. Abdominal multislice computed tomography (MSCT scan verified the enlargement of the entire pancreas, as well as the presence of heterogeneous structures with diffuse amorphous calcifications. The lytic lesions in the pelvic bones could be seen in both sides. Parathyroidectomy was being postponed by an endocrine surgeon because of the poor overall condition of the patient. In the next period the patient had five more episodes of AP. The condition was significantly contributed by increasingly more frequent and longer episodes of metrorrhagia. Despite all therapeutic measures that were taken, systemic inflammatory response syndrome (SIRS developed, and fatal outcome occurred. Conclusion. In case of recurrent pancreatitis, hyperparathyroidism is to be considered even if a significant elevation of serum calcium is not present. This is especially the case for patients with

[The accuracy of the causes of death and the estimated trend: the case of cervix uteri].

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Mancuso, Pamela; Sacchettini, Claudio; Vicentini, Massimo; Caroli, Stefania; Giorgi Rossi, Paolo

2016-01-01

reduction in cervical cancer mortality is the ultimate goal of the screening. Quality of death certificate reports has been improved over time, but they are still inaccurate, making it difficult to assess time trends in mortality. to evaluate the accuracy of the topographic coding of causes of death and to estimate the mortality time trend for cervical cancer through the method of incidence-based mortality (IBM) using cancer registry (CR) data. from the mortality registry (MR), we extracted data on deaths for cervix uteri cancer, corpus uteri cancer, and uterus cancer not otherwise specified (NOS) referred to residents in Reggio Emilia (Emilia-Romagna Region, Northern Italy) from 1997 to 2013. Deaths were checked with the CR to verify the topographical site of the primary tumour. Furthermore, by using CR data, we constructed a cohort of incident cervical cancer cases diagnosed between 1997 and 2009 with a 5-year follow-up. We calculated cause-specific IBM (excluding ovary) and IBM for all cause, crude and standardized, and annual percentage change (APC). out of 369 deaths for uterine cancer, 269 were reported in the RT: 32 for cervix uteri cancer, 76 for corpus uteri cancer, 161 for uterus cancer NOS. 28 of the 32 persons who died for cervical cancer were incidents for cervix uteri cancer. 63 of the 76 who died for corpus uteri cancer were incidents for corpus uteri cancer. Of the 161 who died of uterus cancer NOS, 80 were incidents for corpus uteri cancer, 45 for cervix uteri cancer, 28 for uterus cancer NOS, 5 for vagina cancer, and 3 for cancer of other non-specified organs. Applying these proportions of misclassification, we can estimate that the real number of cervical cancer deaths is 2.4 folds the number of cases reported in the MR as cervical cancer. IBM for all causes decreased significantly over the years (APC: -9.5; 95%CI -17.1;-1.1); cause-specific IBM decreases, but not significantly (APC: -5.1; 95%IC -16.1;+7.3). There is no improvement in survival (r

Case Report: Sciatic nerve schwannoma - a rare cause of sciatica [version 1; referees: 2 approved

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Sunil Munakomi

2017-03-01

Full Text Available Herein we report a rare case of a sciatic nerve schwannoma causing sciatica in a 69-year-old female. Sciatic nerve schwannoma is a rare entity. It should always be considered as a possible cause of sciatica in patients that present with symptoms of sciatica with no prolapsed disc in the lumbar spine and a negative crossed straight leg raise test. Timely diagnosis and complete excision of the lesion leads to complete resolution of the symptoms of such patients.

Level, causes, and risk factors of stillbirth: a population-based case control study from Chandigarh, India.

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Newtonraj, Ariarathinam; Kaur, Manmeet; Gupta, Madhu; Kumar, Rajesh

2017-11-13

Globally, India ranks first in the absolute number of stillbirths. Hence, the level, causes, and risk factors of stillbirths were estimated to facilitate designing of prevention strategy. Capture and recapture method was used to identify 301 stillbirths from 1st July 2013 to 31st August 2014 in Chandigarh Union Territory of India. Verbal autopsies (n = 181) were done at household level to identify causes of stillbirths. Risk factors were determined using case-control approach. Women who had a stillbirth in the past 3 months were enrolled as cases (n = 181) and those who had live-birth in same neighbourhood were included as controls (n = 181). Statistical differences in the distribution of characteristics of cases and controls were tested by t test and chi square test respectively for quantitative and categorical variables. In logistic regression models adjusted odds ratios (aOR) and 95% confidence intervals (CIs) were estimated for various risk factors. Stillbirth rate was estimated to be 16/1000 birth. Antepartum causes were more common (68%) than intrapartum causes (32%). Among maternal conditions, hypertension (18.2%) and chorio-amnionitis (13.8%), and among foetal conditions, growth restriction (19.9%) and congenital anomalies (18.8%) were the leading causes. In about half of the stillbirths foetal (48%) and maternal (44.7%) causes were unidentifiable. Risk factors of stillbirths were: higher maternal age (aOR 1.1, 95%CI 1.0-1.2), vaginal delivery (aOR 8.1, 95%CI 2.6-26), induced labour (aOR 2.6, 95%CI 1.5-4.5), green or light brown liquor (aOR 2.0, 95%CI 1.1-3.8), preterm delivery (aOR 6.4, 95%CI 3.7-11) and smaller household size (aOR 1.2, 95% CI 1.1-1.3). Stillbirth rate was high in Chandigarh Union Territory of India. Major causes and risk factors amenable to interventions were infections, hypertension, congenital malformations, foetal growth restriction, pre-maturity and household size. Therefore, better maternity ante-natal and intra-natal care is

Massive empyema caused by Mycoplasma pneumoniae in an adult: A case report

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Ron Merav

2006-02-01

Full Text Available Abstract Background Mycoplasma pneumoniae is responsible for more than 20% of community acquired pneumonia cases, and capable of causing upper respiratory illness as well. Complications of M.pneumoniae infections include CNS involvement but other as pericarditis were also reported. The lack of feasible culture methods and under appreciation of the pathogens ability to cause invasive disease leads to reduced number of diagnosed M.pneumoniae related complications. In contrast to many other respiratory pathogens causing pneumonia, M. pneumoniae related severe pleural complications were almost never reported. Case presentation We report a previously healthy 57 years old woman presented with indolent massive right pleural effusion, leukocytosis and elevated ESR. Extensive microbiological evaluation didn't reveal any pathogen in the pus even before antibiotic treatment was started. Surprisingly, M.pneumoniae DNA was detected in the pus from the empyema using PCR designed to detect M.pneumoniae. A serological assay (Serodia-Myco II using convalescent serum was indeterminate with a titer of 1:80. The patient responded well to a treatment that included right thoracotomy with pleural decortication and a combination of antibiotics and anti-inflammatory medications. Conclusion M.pneumoniae related empyema was never reported before in adult patients and was reported in only a few pediatric patients. In our patient there was no evidence to any common pathogens even before initiating antibiotic treatment. The only pathogen detected was M.pneumoniae. In this patient, serology was not helpful in establishing the diagnosis of M.pneumoniae related diseases, as was suggested before for older patients. We suggest that M.pneumoniae related empyema is probably under-diagnosed complication due to insensitivity of serology in older patients and under use of other diagnosis methods.

Infectious crystalline keratopathy caused by Cladosporium sp. after penetrating keratoplasty: a case report

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Stock RA

2016-08-01

Full Text Available Ricardo Alexandre Stock,1 Elcio Luiz Bonamigo,2 Emeline Cadore,3 Rafael Allan Oechsler4 1Corneal Transplant Section, Santa Terezinha University Hospital, 2Department of Ophthalmology and Bioethics, 3University of Western Santa Catarina, Joaçaba, 4Cornea Department, Oftalmo Center Blumenau, Blumenau, Santa Catarina, Brazil Background: Infectious crystalline keratopathy is a rare, progressive infection characterized by the insidious progression of branches and crystalline corneal opacities with minimal or no inflammation. This case report describes the evolution of an infectious crystalline keratopathy caused by Cladosporium sp., which developed after tectonic keratoplasty in a patient with a history of ocular trauma.Case presentation: A 40-year-old Brazilian male was the victim of firework-induced trauma to the left eye, which resulted in a corneal laceration that could not be sutured as well as a severe traumatic cataract. The patient underwent penetrating keratoplasty and phacoemulsification. During postoperative follow-up, another therapeutic keratoplasty was required because unresponsive infectious keratitis was observed. The infiltrate’s characteristics were suggestive of infectious crystalline keratopathy; in particular, the infiltrate was insidious and progressive, and grayish-white branches appeared in the anterior corneal stroma. As different therapies were administered, inflammatory reactions ranging from mild to severe were observed. The infection was unresponsive to typical antifungal drugs. This lack of response most likely occurred due to steroid treatment and the diffuse corneal spread of an atypical microorganism, which was subsequently identified in culture as Cladosporium sp. After the second therapeutic keratoplasty, the patient’s eye integrity was successfully reestablished.Conclusion: This study likely provides the first report describing a case of infectious crystalline keratopathy caused by Cladosporium sp. This case

Laryngeal manifestations of relapsing polychondritis and a novel treatment option.

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Childs, Lesley F; Rickert, Scott; Wengerman, Oscar C; Lebovics, Robert; Blitzer, Andrew

2012-09-01