Independence of Vocal Load From Vocal Pathology Across Singing Genres.

Objective: To investigate the extent to which vocal load is associated with previous diagnosis of a vocal pathology among four major genres of singers (primarily classical, primarily musical theatre (MT), classical and MT combined, and contemporary commercial music only).

Study Design: Cross sectional survey.

Methods/design: An anonymous online survey was sent out to about 1000 professional singers through convenience sampling to touring companies, opera companies, MT companies, agents, directors and musical directors.

Associations of Education and Training with Perceived Singing Voice Function Among Professional Singers.

Background: The educational backgrounds of professional singers vary greatly and span from no formal training to advanced degrees in music or theater. Consequently, professional singers have a wide range of knowledge regarding basic voice care. The objective of this study was to examine associations between singers' educational backgrounds, specifically their knowledge of vocal pedagogy and awareness of vocal health, and their perceptions of their current vocal function associated with singing.

Prevalence of Vocal Fold Pathologies Among First-Year Singing Students Across Genres.

Objectives/hypothesis: The purpose of the study was to compare the prevalence of vocal fold pathologies among first-year singing students from the classical, musical theatre, and contemporary commercial music (CCM) genres.

Study Design: Prospective cohort study.

Methods: Videostroboscopic examinations were rated by blinded expert raters.

Heterogeneous perivascular cell coverage affects breast cancer metastasis and response to chemotherapy.

Angiogenesis and co-optive vascular remodeling are prerequisites of solid tumor growth. Vascular heterogeneity, notably perivascular composition, may play a critical role in determining the rate of cancer progression. The contribution of vascular pericyte heterogeneity to cancer progression and therapy response is unknown.

Factors influencing botulinum toxin dose instability in spasmodic dysphonia patients.

Objective: 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.

Study Design: Retrospective review.

Changing trends of speech outcomes after total laryngectomy in the 21st century: a single-center study.

Objectives/hypothesis: To describe the speech rehabilitation outcomes of patients undergoing total laryngectomy (TL) in the 21st century.

Study Design: Retrospective chart review.

Setting: Tertiary academic center

Subjects And Methods: Retrospective review of 167 patients who underwent TL from June 2000 to February 2012.

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

Objectives: 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.

Effects of enhanced bolus flavors on oropharyngeal swallow in patients treated for head and neck cancer.

Background: Treatment for head and neck cancer can reduce peripheral sensory input and impair oropharyngeal swallow. This study examined the effect of enhanced bolus flavor on liquid swallows in these patients.

Methods: Fifty-one patients treated for head and neck cancer with chemoradiation or surgery and 64 healthy adult control subjects served as subjects.

Longitudinal tracheoesophageal puncture size stability.

Objective: The purpose of this study is to investigate prosthesis size stability over time and determine which factors influence need for change in size.

Study Design: Retrospective chart review.

Setting: Teaching hospital.

Relation of mucous membrane alterations to oral intake during the first year after treatment for head and neck cancer.

Background: Acute oral mucositis is associated with pain and impaired swallowing. Little information is available on the effects of chronic mucositis on swallowing.

Methods: Sixty patients treated for cancer of the head and neck were examined during the first year after their cancer treatment.

Comparison of trained clinician ratings with expert ratings of aspiration on videofluoroscopic images from a randomized clinical trial.

Accurate detection and classification of aspiration is a critical component of videofluoroscopic swallowing evaluation, the most commonly utilized instrumental method for dysphagia diagnosis and treatment. Currently published literature indicates that interjudge reliability for the identification of aspiration ranges from poor to fairly good depending on the amount of training provided to clinicians. The majority of extant studies compared judgments among clinicians.

What information do clinicians use in recommending oral versus nonoral feeding in oropharyngeal dysphagic patients?

There is little evidence regarding the type(s) of information clinicians use to make the recommendation for oral or nonoral feeding in patients with oropharyngeal dysphagia. This study represents a first step toward identifying data used by clinicians to make this recommendation and how clinical experience may affect the recommendation. Thirteen variables were considered critical in making the oral vs.

Comparison of 2 interventions for liquid aspiration on pneumonia incidence: a randomized trial.

Background: Aspiration pneumonia is common among frail elderly persons with dysphagia. Although interventions to prevent aspiration are routinely used in these patients, little is known about the effectiveness of those interventions.

Objective: To compare the effectiveness of chin-down posture and 2 consistencies (nectar or honey) of thickened liquids on the 3-month cumulative incidence of pneumonia in patients with dementia or Parkinson disease.

Voice restoration following total laryngectomy by tracheoesophageal prosthesis: effect on patients' quality of life and voice handicap in Jordan.

Background: Little has been reported about the impact of tracheoesophageal (TE) speech on individuals in the Middle East where the procedure has been gaining in popularity. After total laryngectomy, individuals in Europe and North America have rated their quality of life as being lower than non-laryngectomized individuals. The purpose of this study was to evaluate changes in quality of life and degree of voice handicap reported by laryngectomized speakers from Jordan before and after establishment of TE speech.

A randomized study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson's disease.

Purpose: This study was designed to identify which of 3 treatments for aspiration on thin liquids-chin-down posture, nectar-thickened liquids, or honey-thickened liquids-results in the most successful immediate elimination of aspiration on thin liquids during the videofluorographic swallow study in patients with dementia and/or Parkinson's disease.

Method: This randomized clinical trial included 711 patients ages 50 to 95 years who aspirated on thin liquids as assessed videofluorographically. All patients received all 3 interventions in a randomly assigned order during the videofluorographic swallow study.

The voice and laryngeal dysfunction in stroke: a report from the Neurolaryngology Subcommittee of the American Academy of Otolaryngology-Head and Neck Surgery.

Objective: Stroke is the third leading cause of death in the United States, behind heart disease and cancer. It affects as many as 5% of the population over 65 years old, and this number is growing annually due to the aging population. A significant portion of stroke patients that initially survive are faced with the risk of aspiration, as well as quality-of-life issues relating to impaired communication.

Complete hypopharyngeal obstruction by mucosal adhesions: a complication of intensive chemoradiation for advanced head and neck cancer.

Background: Severe swallowing dysfunction is the dominant long-term complication observed in patients treated for head and neck squamous cell carcinoma (HNSCC) with treatment protocols using intensive concurrent chemotherapy with radiation therapy (chemo/XRT). We identified a subset of these patients, who were seen with complete obstruction of the hypopharynx distal to the site of the primary cancer, and in whom we postulate that the obstruction was caused by separable mucosal adhesions rather than obliteration by a mature fibrous stricture.

Methods: Seven patients were referred to the senior author with a diagnosis of complete hypopharyngeal obstruction between 1992 and 2001.

Voice handicap index results for older patients with adductor spasmodic dysphonia.

Adductor spasmodic dysphonia (ADSD) adversely affects a speaker's ability to effectively communicate. For many individuals suffering with ADSD, botulinum toxin (Botox) is the chosen treatment to remediate the symptoms. Although Botox's effects on symptom remediation have been examined before, patient perception of improvement post-Botox has been examined less frequently.

Can maximum phonation time predict voice outcome after thyroplasty type I?

Background: Thyroplasty type I, as introduced by Isshiki and colleagues almost 30 years ago, has become the gold standard of improving glottal incompetence caused by unilateral vocal fold paralysis. Intraoperative assessment of the adequacy of glottal closure is subjective and based on the perceptual judgment of vocal quality and degree of improvement in glottal gap size.

Objective/hypotheses: The primary purpose of this study was to investigate whether the intraoperative measurement of maximum phonation time (MPT) is an adequate predictor of voice outcome after thyroplasty type I.

Spastic/spasmodic vs. tremulous vocal quality: motor speech profile analysis.

Strained, strangled, and tremulous vocal qualities that are typically seen in adductor spasmodic dysphonia (ADSD), voice tremor (Tremor), and the spastic dysarthria of amyotrophic lateral sclerosis (ALS) may sound similar and be difficult to differentiate. The purpose of this study was to determine if these vocal qualities of neurologic origin could be differentiated on the basis of acoustic and motor speech parameters. Three groups of subjects (ADSD, ALS, and Tremor) were analyzed by the Motor Speech Profile System (Kay Elemetrics, Lincoln Park, NJ) for fundamental frequency (Fo), standard deviation of Fo, diadochokinetic rate (ddk), standard deviation of ddk, mean intensity and standard deviation of ddk, frequency and amplitude variability in connected speech, and speaking rate in connected speech.

Prioritizing treatment outcomes: head and neck cancer patients versus nonpatients.

Background: Treatment decisions in head and neck cancer (HNC) might involve consideration of uncertain tradeoffs of one late effect against another or increasing toxicity or residual impairment for increased chance of survival. Understanding how patients prioritize potential outcomes, as well as whether these preferences are similar to those of nonpatients, is important to informed decision making and treatment planning.

Methods: Two hundred forty-seven newly diagnosed HNC patients from nine institutions and 131 nonpatients rank ordered a set of 12 potential treatment outcomes (eg, cure; being able to swallow; normal voice) from highest (1) to lowest (12).

Early results of transcutaneous injection laryngoplasty with micronized acellular dermis versus type-I thyroplasty for glottic incompetence dysphonia due to unilateral vocal fold paralysis.

Medialization thyroplasty (type I) has become the gold standard to improve glottic closure due to unilateral vocal fold paralysis. A newer injection method utilizing homologous collagen from cadaveric human tissue has been described as an attractive alternative as no donor site is required, there is a very low risk of hypersensitivity, and the intact, acellular collagen fibers may suffer a reduced long-term reabsorption rate. Preliminary results on eight patients comparing presurgical and postsurgical parameters (perceptual, stroboscopic, acoustic, and aerodynamic) revealed comparable results when compared with a control group of individuals, age- and sex-matched, that had undergone standard medialization thyroplasty (type I).