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   2012| July-December  | Volume 2 | Issue 2  
    Online since February 5, 2013

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Treatment of laryngeal hyperfunction with flow phonation: A pilot study
Gary H McCullough, Richard I Zraick, Stamatela Balou, Hylan C Pickett, Balaji Rangarathnam, Ozlem E Tulunay-Ugur
July-December 2012, 2(2):64-69
Context: While clinical successes and descriptions have been reported in a few texts, no data exist to define the utility of flow phonation to improve voice quality in patients with laryngeal hyperfunction. Aims: To provide pilot data regarding the utility of three exercises (gargling, cup bubble blowing, and stretch-and-flow) to improve phonatory airflow during voicing in patients with laryngeal hyperfunction. Settings and Design: Outpatient Voice and Swallowing Center in a University Medical Center. Materials and Methods: Participants received five treatment sessions and were evaluated prior to treatment and after each session using a Phonatory Aerodynamic System to measure airflow during voicing tasks. Noise-to-harmonic ratio and perceptual voice measures were also obtained, as was self-perception of voice handicap. Statistical Analysis Used: Repeated All increased airflow and decreased laryngeal airway resistance over five sessions. Measures Analysis of Variance. Results: Six participants completed the protocol. All participants decreased self-perception of voice handicap and improved on noise-to-harmonic ratio and perceptual ratings of vocal quality. Conclusions: Data derived on a small sample of patients in an exploratory investigation suggest further research into the use of these three exercises to improve airflow with voicing and improve vocal quality in patients with laryngeal hyperfunction is warranted.
  12 18,750 543
Acoustic measurements of geriatric voice
Swapna Sebastian, Sonia Babu, Neethu E Oommen, Achamma Ballraj
July-December 2012, 2(2):81-84
Background: Aging larynx can cause changes in the voice. Knowledge about the normal changes in voice parameters is important in differentiating it from pathological voices. This study is a preliminary investigation on the age related changes in the parameters of voice in geriatric normal subjects, which has been scarcely reported in the Indian literature. Materials and Methods: Our study focused on the changing acoustic parameters of voice due to aging in normal geriatric subjects. The acoustic parameters of males and females with normal voice between the age groups of 60 to 80 were studied. 20 subjects in each category (male and female) were included in the study. All the subjects were taken after clearance from ENT to rule out any vocal pathology. The parameters taken were fundamental frequency, formants (f1, f2), jitter and shimmer. Results and Discussion: Our study shows that there are not any significant changes in the acoustic parameters either in males or in females across the age of 60 years to 80 years. However when compared to adult norms (18-25 yrs) the acoustic values are showing a difference both in males as well as in females in fundamental frequency. Comparison was also done between males and females between the age group of 60 to 80 years. Males differed from females significantly for the parameters of fundamental frequency and formant frequencies (f1 and f2 ) only and not for the parameters of jitter and shimmer.
  9 6,077 248
Clinical utility of 24 hour pharyngeal pH monitoring for hoarseness
Mary E Beaver, Colleen M Karow
July-December 2012, 2(2):60-63
Objective: To evaluate the contribution of 24 hour pharyngeal pH monitoring of patient presenting with symptoms of hoarseness, globus, throat clearing, and sore throat. Study Design: Retrospective case study. Setting: Tertiary laryngology practice. Materials and Methods: Results of 167 pharyngeal pH studies performed for complaints of hoarseness, globus, and throat clearing in an outpatient private practice setting from 5/09-12/09 were analyzed for pharyngeal reflux pattern and severity. Patient records were reviewed for chief complaint, symptom duration, ten item Voice Handicap Index (VHI-10) and Reflux Symptom Index (RSI) scores. Nonparametric testing was used to compare symptom duration, VHI-10 scores, and RSI scores between those patients with and without abnormal pharyngeal pH studies. Results: 71 studies (43%) were normal with zero events below pH 5.5. 32 studies (19%), or 33% of all positive studies showed supine pharyngeal reflux only. 46 studies or 48% of all positive studies showed combination upright daytime reflux events and supine reflux. 18 studies or 19% of all positive studies had only upright events. There was no significant difference in presenting symptoms, symptom duration, or severity scores in the patients that had negative vs. positive pharyngeal pH studies. Conclusion: 24 hour pharyngeal pH study eliminates the diagnosis of reflux in a significant percentage of patients with hoarseness. Severity or duration of symptoms of hoarseness, globus, or throat clearing does not reliably predict presence of reflux.
  7 5,716 226
Contact Endoscopy - A promising tool for evaluation of laryngeal mucosal lesions
Awadhesh Mishra, Ajith Nilakantan, Rakesh Datta, Kavita Sahai, Satwinder P Singh, Ashwani Sethi
July-December 2012, 2(2):53-59
Early diagnosis of laryngeal cancer is important for favourable treatment outcome. Due to morbidity and difficulties associated with surgical biopsy, a need has always been felt for an easy, non invasive yet accurate tool for knowing histopathological nature of mucosal lesions. Contact Endoscopy (CE) is one such technique which is capable of providing real time and magnified images of cellular structure of superficial layers of various mucosal surfaces with obvious advantages and potential for wide clinical application. In this review, a summary of role and efficacy of CE in diagnosis, treatment and follow up of various laryngeal mucosal lesions is presented. We searched Pubmed, Medline, Cochrane and Google scholar for articles on CE for mucosal lesions of larynx. For better understanding of the technique, articles on CE of other non-laryngeal sites of head and neck were also reviewed. Article selection was limited to human studies without restriction to language and year of publication. Reference lists from identified articles were also searched. Six prospective original articles, three descriptive studies and one review article on CE of laryngeal lesions are included in this review and their findings summarized. Common findings on examination of cellular architecture and vascular patterns described by various authors are also tabulated. The literature revealed high sensitivity (90-94.7%), specificity (81-100%) and accuracy (88-94%) of CE in diagnosis of laryngeal lesions across the published studies. CE is a promising non invasive tool for evaluation of laryngeal mucosal lesions. However, further prospective, randomized, double blinded studies as well as research to improve the technique to overcome the existing limitations are required before defining its precise role in clinical practice.
  3 10,228 305
Recurrent laryngeal leiomyoma
Shruthi P Suresh, Kalyani Raju, Gayathri B Nagaraju, SM Azeem Mohiyuddin, Merchant Shuaib
July-December 2012, 2(2):95-97
Leiomyoma-a benign smooth muscle tumor which is most commonly reported in uterus and gastrointestinal tract is rare in the upper aero-digestive tract due to the paucity of smooth muscle in the area. To the best of our knowledge, only 40 cases of leiomyoma occurring in larynx have been reported since 1966 in English literature. We report a case in a 18-year-old lady who presented with recurrent laryngeal leiomyoma which was confirmed by immunohistochemistry. The post-operative course was uneventful.
  2 6,192 179
Synergy between speech language pathologists and ENT surgeons to promote patient care
Prakash Boominathan, Vrushali Desai
July-December 2012, 2(2):51-52
  1 5,540 244
The effects of ILFN-exposure on voice acoustic parameters of commercial cabin crewmembers
Ana Mendes, Andreia Graça, Ana Jorge, Mariana Alves-Pereira, Nuno A. A. Castelo Branco, Adriana Freitas, Mara Laranjeira, Íris Bonança
July-December 2012, 2(2):70-80
Background: Long-term exposure to infrasound and low frequency noise (ILFN <500 Hz, including infrasound) can lead to the development of vibroacoustic disease (VAD). VAD is a systemic pathology characterized by the abnormal growth of extracellular matrices in the absence of inflammatory processes, namely of collagen and elastin, both of which are abundant in the basement membrane zone of the vocal folds. ILFN-exposed workers include pilots, cabin crewmembers, restaurant workers, ship machinists and, in previous studies, even though they did not present vocal symptoms, ILFN-exposed workers had significant different voice acoustic patterns (perturbation and temporal measures) when compared with normative population. Study Aims: The present study investigates the effects of age and years of occupational ILFN-exposure on voice acoustic parameters of 37 cabin crewmembers: 12 males and 25 females. Specifically, the goals of this study are to: 1) Verify if acoustic parameters change over the age and years of ILFN-exposure and 2) Determine if there is any interaction between age and years of ILFN-exposure on voice acoustic parameters of crewmembers. Materials and Methods: Spoken phonatory tasks were recorded with a C420 III PP AKG head-worn microphone and a DA-P1 Tascam DAT. Acoustic analyses were performed using KayPENTAX Computer Speech Lab and Multi-Dimensional Voice Program. Acoustic parameters included speaking fundamental frequency, perturbation measures (jitter, shimmer and harmonic-to-noise ratio), temporal measures (maximum phonation time and s/z ratio) and voice tremor frequency. Results: One-way ANOVA analysis revealed that as the number of ILFN-exposure years increased male cabin crewmembers presented significant different shimmer values of /i/ as well as tremor frequency of /u/. Females presented significantly different jitter % of /i, a, ɔ/ (p <0.05). Lastly, Two-way ANOVA analysis revealed that for females, there was a significant interaction between age and occupational ILFN-exposure for voice acoustic parameters, namely for jitter's mean for /a, ɔ/ and shimmer's (%) mean for /a, i/ (p <0.05). Discussion and Conclusion: These perturbation measure patterns may be indicative of histological changes within the vocal folds as a result of ILFN-exposure. The results of this study suggest that voice acoustic analysis may be an important tool for confirming ILFN-induced health effects.
  1 9,563 218
Prenatal diagnosis of subglottic hemangioma
Sowmya Poojari, Sachin Gandhi, Girish Godbole, Aparna Kulkarni, Joshita Singh, Kaumudi Godbole
July-December 2012, 2(2):93-94
Hemangioma is by far the most common lesion of the subglottic airway in newborn and infants. It may cause severe, even life-threatening respiratory obstruction. A definitive diagnosis is based on direct endotracheal inspection of the subglottic airway. Plain radiograph of the neck may aid in establishing the diagnosis prior to endoscopy. This is a case report of prenatal diagnosis of subglottic hemangioma by fetal MRI and its management by planned delivery and tracheostomy.
  - 3,131 143
Trucut biopsy - An effective diagnostic tool in laryngeal and hypopharyngeal cancers: A preliminary study
Sachin Gandhi, Nilanjan P Bhowmick, Dhananjay S Kelkar, A Chandorkar
July-December 2012, 2(2):85-88
Background: Laryngeal and hypopharyngeal cancers are commonly diagnosed by histopathological examination of a punch biopsy specimen from the lesion. The histopathological report of the punch biopsy specimen in certain cases is inconclusive, most commonly in cases of endophytic growths. Objective: To evaluate the efficacy of trucut biopsy as a diagnostic procedure in such cases of laryngeal and hypopharyngeal growth which are clinically malignant but histopathology report by punch biopsy is inconclusive. Materials and Methods: Seven cases with clinical suspicion of laryngeal or hypopharyngeal malignancies but with inconclusive histopathological examination on punch biopsy were included. Trucut biopsy was performed in them. 6 out of the 7 trucut biopsies were found to be malignancies on histopathological examination. Conclusion: Trucut biopsy is promising diagnostic tool in laryngeal and hypopharyngeal malignancies especially in those cases where there is strong suspicion of malignancy and the punch biopsy does is inconclusive.
  - 4,673 127
Clinical application of the validated Hindi VHI in assessing subjective improvement following microlaryngeal surgeries for benign vocal fold lesions: A preliminary report
Ashwani Sethi, Rakesh Datta, Awadhesh K Mishra, Satwinder P Singh, Purnima Sangwan
July-December 2012, 2(2):89-92
Objective: To assess the clinical utility of a validated Hindi VHI in the assessment of patients treated microsurgically for benign vocal fold lesions. Design: Prospective study. Setting: Tertiary health care centre. Materials and Methods: The study population comprised 46 patients of either sex with benign vocal fold lesions, who underwent microlaryngeal surgery in our hospital between January, 2011 and May, 2012. An acoustic analysis of all the patients was done using Dr. Speech voice analysis software (Tiger electronics, USA) preoperatively and 6 weeks postoperatively. The parameters analyzed were in terms of perturbation (Jitter and shimmer), normalized noise energy (NNE), and fundamental frequency (F0). A validated Hindi version of VHI was filled by all the patients preoperatively and 6 weeks postoperatively. The results obtained were statistically correlated using SPSS 17 software. Results: There was a significant correlation between the parameters analyzed on Dr. Speech voice analysis software and VHI parameters obtained preoperatively and postoperatively as assessed using Pearson's correlation coefficient. There was a statistically significant improvement in objective voice parameters and VHI scores postoperatively as assessed using Pearson's correlation coefficient. Conclusion: The validated Hindi version of VHI correlates well with the widely used acoustic analysis software (Dr. Speech, Tiger electronics, USA). It also correlates well with voice improvement after surgeries for benign vocal fold lesions. It merits inclusion in the standard evaluation protocol both in the preoperative assessment and postoperative evaluation following surgical treatment for benign vocal fold lesions in Hindi speaking population.
  - 4,112 187
External laryngeal trauma: A management dilemma
Haris M Qadri, Poonam Goyal, Abhinav Bansal
July-December 2012, 2(2):98-100
External laryngeal trauma though uncommon but it is a life threatening ENT emergency. Early diagnosis, prompt establishment of a secure airway is the key for good outcome. Here we present a series of three cases of external laryngeal injury with significant trauma managed conservatively with good recovery to discuss the present concepts in management of external laryngeal trauma. The first case was presented with neck swelling and inability to speak after suicidal attempt. CT scan showed fracture of thyroid cartilage and hyoid bone. Second patient following trauma had change in voice and pain in neck with extensive injury clinically and on CT scan showed gross emphysema in soft tissue planes extending from skull base to mediastinum with comminuted fracture of anterior thyroid cartilage. The third patient presented with change in voice and respiratory distress. CT scan showed cricoid fracture at subglottic level. All these three patients were managed conservatively with systemic steroids, antibiotics and nebulization without any surgical intervention. All three patients showed complete recovery. Conclusion: External Laryngeal trauma can be managed conservatively without active surgical intervention with good voice airway.
  - 4,455 191