Results of the study of conservative treatment of laryngeal manifestations of laryngopharyngeal reflux

Gastroesophageal reflux disease (GERD) is a disease of the gastrointestinal tract caused by the discharge of stomach contents into the esophagus. In GERD, both esophageal and extraesophageal manifestations are widespread, but, unfortunately, the latter are less well known. About one third of GERD patients have extraesophageal symptoms, which can occur even in the absence of the usual esophageal symptoms of GERD, which makes diagnosis difficult. The most common of these is laryngitis. In addition to reflux laryngitis, laryngopharyngeal reflux (LFR) can cause the development of contact granulomas, laryngeal stenosis, functional dysphonia, vocal fold nodules, Reinecke's edema, and laryngeal neoplasms. These symptoms disappear after taking antireflux therapy, but there is still no consensus on its duration.Aim. To evaluate the results of treatment of laryngeal manifestations of LFR with omeprasole 20 mg 30 minutes before meals in the morning.Methods. The study involved 531 patients with complaints of hoarseness, of which women 337 - 63.5%, men 194 - 36.5%. We prescribed omeprasole 20 mg 30 minutes before meals in the morning for 6 weeks. Patients were questioned using the Reflux Symptom Index (RSI) questionnaire and indirect laryngoscopy with an assessment of laryngeal changes according to the Reflux Signs Scale (RSS).Results. There was a statistically significant decrease in hoarseness 1 week after treatment, which continues to decrease 6 weeks after the initiation of treatment when evaluating the data on the RSI questionnaire. There was no statistically significant difference in the laryngoscopic picture before the start of treatment and after 1 week of treatment according to RSS; a statistically significant decrease in the quantitative assessment of RSS was revealed 6 weeks after the initiation of treatment.Conclusions. Omeprasole at a dose of 20 mg in 30 minutes reduces the symptoms of LFR already after 1 week, the decrease in the severity of symptoms continues by 6 weeks of its use. Improvement of the laryngoscopic picture with the appointment of omeprazole 20 mg 30 minutes before meals occurs by the 6th week of its use. A positive correlation was found between the severity of LFR symptoms, including hoarseness, and the severity of changes in the laryngoscopic picture.

Presbylarynx, Functional Voice Disorders, Muscle Tension Dysphonia

Presbylarynx refers to age-related structural changes of the vocal folds that include muscle atrophy, reduced neuromuscular control, loss of superficial lamina propria layer, and reduced pliability. The changes result in thin and bowed vocal folds, increased vocal effort requirements, breathy voice, change in habitual pitch, and strain. The primary treatment options are voice therapy focused on strengthening breath support and the intrinsic muscles of the larynx, and optimization of resonance; injection augmentation of the vocal folds; and type I thyroplasty. Functional dysphonia is defined as change in voice quality in the absence of structural or neurological abnormalities of the larynx. Muscle tension dysphonia (MTD) is a subtype of functional voice disorders and involves laryngeal muscle tension imbalance due to excessive or dysregulated activation resulting often in strained or breathy voice. MTD can be divided into primary (psychological etiology or vocal misuse) and secondary (compensatory for organic laryngeal pathology). The mainstay of treatment for MTD is voice therapy, along with medical or surgical treatment of the underlying vocal pathology in secondary MTD. Mutational falsetto, or puberphonia, is a functional voice disorder where a high-pitched, pre-adolescent voice fails to transition to the lower pitch of adulthood. This review contains 5 figures, 7 tables, 4 videos and 10 references Key Words: Presbylarynx, Injection augmentation, Type I thyroplasty, Primary muscle tension dysphonia, Secondary muscle tension dysphonia, Muscle tension patterns, Manual circumlaryngeal therapy, Functional dysphonia, Mutational falsetto

Interdependencies between acoustic and high-speed videoendoscopy parameters

In voice research, uncovering relations between the oscillating vocal folds, being the sound source of phonation, and the resulting perceived acoustic signal are of great interest. This is especially the case in the context of voice disorders, such as functional dysphonia (FD). We investigated 250 high-speed videoendoscopy (HSV) recordings with simultaneously recorded acoustic signals (124 healthy females, 60 FD females, 44 healthy males, 22 FD males). 35 glottal area waveform (GAW) parameters and 14 acoustic parameters were calculated for each recording. Linear and non-linear relations between GAW and acoustic parameters were investigated using Pearson correlation coefficients (PCC) and distance correlation coefficients (DCC). Further, norm values for parameters obtained from 250 ms long sustained phonation data (vowel /i/) were provided. 26 PCCs in females (5.3%) and 8 in males (1.6%) were found to be statistically significant (|corr.| ≥ 0.3). Only minor differences were found between PCCs and DCCs, indicating presence of weak non-linear dependencies between parameters. Fundamental frequency was involved in the majority of all relevant PCCs between GAW and acoustic parameters (19 in females and 7 in males). The most distinct difference between correlations in females and males was found for the parameter Period Variability Index. The study shows only weak relations between investigated acoustic and GAW-parameters. This indicates that the reduction of the complex 3D glottal dynamics to the 1D-GAW may erase laryngeal dynamic characteristics that are reflected within the acoustic signal. Hence, other GAW parameters, 2D-, 3D-laryngeal dynamics and vocal tract parameters should be further investigated towards potential correlations to the acoustic signal.

Acoustic characteristics of voice in voice professionals with hypotonic dysphonia

The article presents the results of a study of the acoustic characteristics of the voice in voice professionals and non-voice professionals. We examined 80 people aged 23 to 45 years with functional dysphonia of the hypotonic type, who applied to the phoniatric office of the St. Petersburg Research Institute of ENT. Of these, 23 were professional vocalists, 12 were representatives of speech professions, and 45 were non-professional voices. First, the phoniatrist examined the larynx and assessed its condition with video endostroboscopy (K. Storz) or video pharyngolaryngoscopy (VIVIDEO, KayPentax). Objective acoustic analysis was performed using the Multi-Speech software and hardware complex and the MDVP software (KayPentax). The numerical and graphical expressions of the following parameters were evaluated: noise-to-harmonic ratio (NHR), voice turbulence index (VTI), and soft phonation index (SPI). The results of the study showed that the SPI index is the most informative in assessing hoarseness in patients with hypotonic functional dysphonia. The lower values of this indicator in vocalists can be explained by the presence of a sufficiently developed resonator system of the vocal apparatus, which is reflected in the amplification of the high-frequency components of the voice spectrum.

Modern approaches to the diagnosis and voice therapy of voice-leading disorders in vocalists

Diagnosis and treatment of laryngeal diseases in vocalists remains one of the most important tasks of otorhinolaryngology. One of the causes of vocal dysfunction in vocalists is functional dysphonia. Among the factors leading to the development of functional disorders of the larynx, a significant role is given to non-compliance with the vocal regime and vocal technique. The high frequency of voice function disorders among vocalists and the existing diagnostic difficulties determine the relevance of this problem and the need for further research. Objectives: Improvement of the effectiveness of diagnostics of laryngeal diseases and phonopedic rehabilitation in vocalists by identifying the features of the mechanism of voice-leading while the larynx is in a vocal position and the use of the individual vocal technique. Materials and methods: An examination of 10 vocalists with complaints of impaired vocal function was conducted. The age of the patients ranged from 18 to 43 years. The method includes performing video endolaryngoscopy and video stroboscopic endolaryngoscopy using a flexible video rhino-pharynx-laryngoscope during functional tests. Simultaneously with the endoscopy of the larynx, an audio recording of the voice followed by computer acoustic analysis was done. Conclusions: This method makes it possible to evaluate the patient’s phonation in a vocal position and when using various vocal techniques, as well as to determine objective acoustic indicators. The results obtained are necessary for the selection of phonopedic correction methods. The proposed method increases the effectiveness of the diagnosis of laryngeal diseases and phonopedic rehabilitation in vocalists.