leo meulenbroek 1

1 Hogeschool van Arnhem/Nijmegen, education, Arnhem

OBJECTIVE: The purpose was to investigate the relation between laryngeal pathology, voice handicap and voice complaints in student teachers.
METHODS: A cross sectional survey was performed among 214 female future teachers using a general questionnaire and the Voice Handicap Index. By laryngostroboscopy the vocal fold mucosal wave and glottal closure were observed at the start of the education.
RESULTS: It was observed that there were significant higher scores of the student teachers with voice complaints at the moment and/or in the past year on the VHI total (p< 0.001), the subtest VHIE (p= 0.017) and VHIP (p< 0.001) compared to the students with no voice complaints. The study showed that the majority of the students with a vocal fold lesion (82%) showed more voice complaints at the moment and/or during the past year than students with no vocal fold lesions (53%)(p=0.010). Students with vocal fold lesions had 4x higher risk of voice complaints (OR 3.9). More student teachers (19%) with a deviant glottal closure had vocal fold lesions compared to students (6%) with a normal glottal closure (p=0.003, OR 3.6). Of the students with both vocal fold lesions and glottal insufficiency 91% reported voice complaints compared to students with no fold lesions and no deviant glottal closure (56%) (p=0.039). Students with a deviant glottal closure did not have a higher VHI score compared to students with normal glottal closure (p= 0.422). Students with a vocal fold lesion did show a higher VHI score compared to student teachers with no vocal fold lesion (p=0.414).
CONCLUSION. The stroboscopic results were reflected in reporting voice complaints, but  surprisingly not in the students expression of voice handicap. It is in a way alarming to see that students with a deviant glottal closure did not apprehend a voice handicap and tended to be unaware. It is of great concern to increase the students awareness in order to prepare these future teachers properly for the vocally demanding profession.
   Key words:  student teachers, vocal folds, laryngeal pathology, voice problems, voice handicap,
 

Annerose Keilmann 1,2 , Esther Schiffer 1,2 , Michael Beck 1,2,3 , Gudrun Schulze Frenking 1,2,3 , Katrin Degenhardt 1,2,3

1 Mainz Medical School, Communication Disorders, Mainz

2 Mainz Medical School, , Mainz

3 , ,

Background: Patients with mucopolysaccharidosis (MPS) type II typically develop narrowing of the upper airways. In many patients these changes lead to voice disorders, a higher resistance of the airways, and in severe cases to dyspnoea. Intubation can be problematic. To date, there is no universally accepted examination protocol for assessing these alterations.
Objective: To develop a standardized classification for assessing the alterations of larynx and hypo pharynx in MPS patients. Standardization could provide information that would allow assessment of the efficacy of enzyme replacement therapy (ERT).
Methods: We developed a classification protocol in which the alterations of the epiglottis (VO, V1, V2), the false (T0–T4) and the true vocal folds (S0–S2) and the mucosa in the posterior region of the larynx (A0–A4), are described by rigid or flexible endoscopy of the upper airways. Voice quality was quantified using the Göttingen hoarseness diagram. The diadochokinetic rate was determined using Motor speech Profile (Kay). We used this classification in six patients with MPS II before the start of treatment and during ERT.
Results: Quantification of the alterations was possible using videoendoscopy with both rigid and flexible endoscopy, depending on the patient’s needs. Most patients demonstrated a slight hoarseness, but alterations to the vocal folds were not visible in any of the patients. In some patients, there were clinically relevant alterations of the posterior region of the larynx and in the region of the false vocal folds.
Conclusion: Regular monitoring of the above mentioned parameters could provide information about the natural progression of MPS and allow assessment of the efficacy of ERT.

Monique Verguts 1 , Anita Eggermont 1 , Peter Hellings 1 , Felix de Jong 1

1 UZ Leuven, ENT-HN, Leuven

The aim of the study was to assess the effect of nasal provocation with grass pollen in singers with an allergy to grass pollen on subjective and objective voice parameters, as well as the effect on voice appearance.

An observational study in 14 volunteers was conducted. 8 singers with a known allergy to grass pollen, but who were not treated for any allergy at the time of the experiments, were included, as well as 6 singers without an allergy to grass pollen. All subjects completed a questionnaire, underwent a skin prick allergy test, a voice evaluation involving videolaryngostroboscopy, voice range profile and acoustical analysis followed by a nasal provocation with allergen. Subjective nasal symptoms and nasal resistance were assessed to check the effectiveness of the provocation. After 1 hour and after 24 hours, subjective symptoms were re-assessed and all subjects underwent a second and third voice evaluation involving videolaryngostroboscopy, voice range profile and acoustical analysis to see the effect of provocation.

No striking difference in objective voice parameters or voice appearance was found before and after provocation. Regarding the subjective voice parameters, a significant increase of symptoms was found after nasal provocation in allergic subjects. All 8 allergic subjects reported nasal symptoms during and after the provocation, 6 of them reported an increase of laryngeal symptoms during and after the provocation. Of the 6 subject that were not allergic, no one reported an increase of nasal or laryngeal symptoms during or after the provocation. 

Jitka Vydrova 1 , Jan Svec 1,2 , Frantisek Sram 1,2,3

1 Medical healthcom, otolaryngology and phoniatry, Prague 2

2 Palacky University Olomouc, Laboratory of Biophysicd, Olomouc

3 Medical healthcom, Otolaryngology and phoniatry, Prague 2

Introduction: Different styles of singing expose the singers to different types of vocal loading and as such present different demands on the vocal folds. The present study addresses the hypothesis that different singing styles lead to different pathological findings on the vocal folds and their singers suffer from different types of voice disorders.

Material and methods: Over and period of sixteen months, a total of 1333 professional singers of different artistic styles, who visited the Voice Centre in Prague to seek help with their singing problems, were examined. The singers were divided into classical (971) and non-classical (362). The vocal folds were examined using strobolaryngoscopy and the upper laryngeal airways, including epipharynx, maxillary and frontal sinuses, were examined nasoepipharyngoscopically and ultrasonically. Their records were analyzed retrospectively.

Results: The findings in classical singers were less serious and of acute nature. They consisted mainly from: A) inflammation in the upper respiratory tract and sinuses in an initial stage and B) acute vocal fold injuries (hemorrhage in submucosa). In non-classical singers the findings were rather of chronic nature and often irreversible. They included: A) inflammation in the upper respiratory tract in a progressed stage, B) vocal fold lesions (edema, nodules etc.) and C) incomplete glottal closure.

Discussion and conclusion:  Whereas the exact role of the vocal loading in classical versus non-classical singing could not be specified, the findings suggest that classical professional singers are more perceptive towards their voice problems, detect the problems earlier and are more cautious in taking care of their voice so that their treatment can be done conservatively with medications.  Non-classical professional singers, on the other hand, were more tolerant towards their voice problems and postponed the clinician’s visit until the problems were of chronic nature, irreversible, and often required surgical intervention. The results indicate that singers of non-classical styles are at greater risk for serious voice disorders than classical singers.  

 

Correspondence address:

Jitka Vydrova, MDVoice Centre PragueSpanelska 4120 00 Prague 2, the Czech Republic tel/fax: 420 222 519 016e-mail: vydrova@medico.cz

Susanna Simberg 1 , Pekka Santtila 1 , Anna Soveri 1 , Markus Varjonen 1 , Eeva Sala 2 , N. Kenneth Sandnabba 1

1 Åbo Akademi University, Logopedics, Turku

2 University Central Hospital, Department of Otorhinolaryngology, Turku

The purpose of the study was to explore the existence of genetic effects and the interaction between possible genetic effects and a voice-demanding occupation on dysphonia.

One thousand seven hundred and twenty-eight Finnish twins (555 male, 1173 female) born between years 1961 and 1989 completed a questionnaire concerning vocal symptoms and occupation. The zygosity determination resulted in 125 monozygotic and 108 dizygotic full twin pairs.  A composite variable called dysphonia was formed by summing six vocal symptoms based on the results of a factor analysis. Twin model fitting was used to explore the contribution of genetic and environmental effects on the dysphonia variable.

Individual differences in dysphonia were explained by genetic effects (35%) and nonshared environmental effects (65%). For the participants who worked in voice demanding occupations the causes of dysphonia were more environmental while the etiology of the symptoms was more strongly affected by genes in the participants with less voice demanding occupations.

 

The result of this study show that both genetic and environmental factors have an impact on the etiology of voice problems. Environmental factors, either independently or interacting with genetic factors, seem to play the key role, especially if the person has a voice demanding occupation.

Berit Schneider-Stickler 1 , Antonia Breiter 1 , Christian Mittermaier 2 , Matthias Leonhard 1 , Wolfgang Gruther 2 , Gobert Skrbensky 3 , Wolfgang Bigenzahn 1

1 Medizinische Universität, Universitätsklinik für Hals-, Nasen- und Ohrenkrankheiten, klinische Abteilung für Phoniatrie-Logopädie, Wien

2 Medizinische Universität, Universitätsklinik für Physikalische Medizin und Rehabilitation, Wien

3 Medizinische Universität, Universitätsklinik für Orthopädie, Wien

Background: Several studies highlighted the importance of posture and balance in classical singers. Hyperfunctional voice production seems to have a negative impact on both parameters.

Goal of this interdisciplinary study was the examination of postural mechanism, balance control and body position in classical singers with functional voice disorders (±secondary vocal fold alterations) in comparison to classical singers without voice problems.

 

Methods: Eighteen female singers (aged between 21-49 years) with functional voice problems have been selected from our outpatients department (group 1). As a control group 24 female classical singers (aged between 20 and 55 years) took part in this study (group 2).

All subjects underwent comprehensive examinations: voice range profile measurements, acoustic voice analyses, laryngostroboscopy, posturography, raster stereography, and pedobarography. The posturography was repeated while singing. Balance and posture were retested after customization of correctional insoles.

 

Results: In voice range measurements, group 1 revealed a significant lower range of singing voice as well as increased sound pressure level of speaking voice. The posturography showed in both group a destabilizing effect of singing on body balance; the equilibrium scores of several subtests were even higher in group 1 than in group 2.

The pedobarography indicated functional foot arch impairment in both groups; after insole customization an improvement could be reached only in group 2. It was interesting to note, that muscular tension disorders and backache occurred more often in group 1.

 

Conclusion: The results of the study confirm the negative impact of hyperfunctional phonation on the musculoskeletal system, and thus, on body balance and posture. In the treatment of functional voice disorders in classical singers an interdisciplinary approach is necessary.