Impacto en la calidad de vida del tratamiento de disfonía espasmódica aductora con toxina botulínica A

Introducción. La distonía laríngea o disfonía espasmódica se caracteriza por contracciones involuntarias de los músculos laríngeos internos que se desencadenan al hablar, siendo la forma aductora la más frecuente. La inyección de toxina botulínica es el manejo de elección. Para evaluar la respuesta a la terapia existen varios instrumentos validados, uno de ellos es el cuestionario Voice Handicap Index-10 (VHI-10). El objetivo de este estudio es caracterizar a los pacientes con disfonía espasmódica aductora y evaluar el impacto de la toxina en su calidad de vida. Método. Éste se centró en un estudio retrospectivo descriptivo en pacientes adultos con diagnóstico de disfonía espasmódica aductora tratados con toxina botulínica A, en el Hospital Clínico Universidad de Chile (HCUC), en el periodo comprendido entre 2013 y 2021. El mismo permitió la obtención de los datos epidemiológicos de los pacientes, a quienes se les solicitó responder la encuesta VHI-10 previo y posterior a un mes de cada inyección de la toxina. Resultados. Se incluyeron 55 pacientes (218 procedimientos). La dosis promedio utilizada fue de 9,18 UI con un intervalo promedio de 7,4 meses. El puntaje VHI-10 promedio en la evaluación inicial fue de 29,4 y posinfiltración de 14,96, siendo esta diferencia significativa (p < 0,000001). En nuestra serie casi un tercio tiene asociada alguna patología neurológica, y se reportó un 3,67% de complicaciones leves y transitorias. Conclusión. La disfonía espasmódica aductora tiene un gran impacto en la calidad de vida de los pacientes, que se reduce significativamente mediante la inyección de toxina botulínica A, procedimiento que ha demostrado ser seguro y eficaz.

Monitoring Adult Subglottic Stenosis With Spirometry and Dyspnea Index: A Novel Approach

Objective The aim was to examine the correlations among the anatomic Cotton-Myer classification, pulmonary function tests (PFTs), and patient-perceived dyspnea or dysphonia in patients with subglottic stenosis and identify measurements accurately reflecting treatment effects. Study Design Prospective cohort study. Setting Tertiary referral center. Method Fifty-two adults receiving endoscopic treatment for isolated subglottic stenosis were consecutively included. Correlations were calculated among the preoperative Cotton-Myer scale, PFTs, the Dyspnea Index (DI), and the Voice Handicap Index. Receiver operating characteristic curves were determined for PFT, DI, and Voice Handicap Index pre- and postoperative measurements. Results The Cotton-Myer classification correlated weakly with peak expiratory flow ( r = −0.35, P = .012), expiratory disproportion index ( r = 0.32, P = .022), peak inspiratory flow ( r = −0.32, P = .022), and total peak flow ( r = −0.36, P = .01). The DI showed an excellent area under the curve (0.99, P < .001), and among PFTs, the expiratory disproportion index demonstrated the best area under the curve (0.89, P < .001), followed by total peak flow (0.88, P < .001), peak expiratory flow (0.87, P < .001), and peak inspiratory flow (0.84, P < .001). Patients treated endoscopically with balloon dilatation showed a 53% decrease in expiratory disproportion index (95% CI, 41%-66%; P < .001) and a 37% improvement in peak expiratory flow (95% CI, 31%-43%; P < .001). Conclusion Expiratory disproportion index or peak expiratory flow combined with DI was a feasible measurement for the monitoring of adult subglottic stenosis. The percentage deterioration of peak expiratory flow and increase in expiratory disproportion index correlated significantly with a proportional percentage increase in DI.

Development, Validation, and Reliability of the Teacher-Reported Pediatric Voice Handicap Index

Purpose: The purpose of this study was to develop a novel teacher-reported pediatric voice outcome measure and to investigate its psychometric properties. Method: In the first stage, a new instrument, the Teacher-Reported Pediatric Voice Handicap Index (TRPVHI), was developed. After item generation, a panel of experts evaluated the items to assess the content validity. Subsequently, the final version of the preliminary instrument was applied to teachers of 306 children (57 dysphonic and 249 vocally healthy) between the ages of 4 and 11 years. Eventually, the construct validity, criterion-related validity, test–retest reliability, and internal consistency of the developed instrument were examined. Results: The items with a content validity ratio less than .8 were modified or removed, and accordingly, the preliminary version of the index was finalized. After the application of the preliminary version, item reduction was made based on the factor analysis. The index is composed of 27 questions and three subscales: Functional, Physical, and Emotional. A significant difference was observed between the dysphonic and vocally healthy children for the TRPVHI scores ( p < .001). A positive moderate correlation was determined between the Pediatric Voice Handicap Index and TRPVHI scores. Correlation coefficients between the test and retest scores of the TRPVHI were in the range of .92–.98. Cronbach's alpha values computed to assess the internal consistency were in the range of .94–.98. Conclusions: The TRPVHI is the only valid and reliable teacher-reported outcome measure of the effects of voice disorders on children. It is anticipated that the deployment of the TRPVHI in conjunction with other subjective tools, both in the initial evaluation and the follow-up of the treatment results, will allow a better understanding of the physical, functional, and emotional effects of voice disorders on children. Furthermore, it can potentially lead further research to enable the use of the TRPVHI for screening purposes.

Effect of Medialization on Dyspnea Index in Unilateral Vocal Fold Paralysis

Objective Patients with unilateral vocal fold paralysis commonly report dysphonia and dysphagia. Dyspnea also occurs, with studies on treatment-related change producing mixed results. Studies including patient-reported outcomes have focused on single-question global scales. The Dyspnea Index (DI) includes 10 questions, is specific to upper airway–related dyspnea, and may better capture these patients’ symptoms. We evaluated change in DI after treatment. Study Design Retrospective review. Setting Academic medical center. Methods Forty-three patients with unilateral vocal fold paralysis underwent injection augmentation (n = 25) or framework surgery (n = 18). DI was recorded preprocedure, 2 to 4 weeks afterward, and at approximately 3 months afterward in 19 patients. Voice Handicap Index–10, Glottal Function Index, Cough Severity Index, and Eating Assessment Tool–10 were also recorded. Change in parameters and correlations were assessed. Obesity, cardiac disease, pulmonary disease, and procedure (injection vs framework surgery) were evaluated for effect on DI. Results Twenty-four patients had an abnormal baseline DI (>10). DI decreased from 14.9 ± 13.8 to 6.5 ± 9.3 after treatment ( P < .001; 95% CI, 4.7-12.1). Twenty-eight scores decreased, 9 remained unchanged, and 6 increased. Change in DI was influenced by the presence of cardiac disease. Decreased DI persisted at 3-month follow-up. Voice Handicap Index–10, Glottal Function Index, Cough Severity Index, and Eating Assessment Tool–10 scores decreased and were correlated with change in DI. Conclusion Upper airway–related dyspnea is common in unilateral vocal fold paralysis, occurring in half of this cohort. Correcting glottic insufficiency may alleviate symptoms. Treatment decision making should consider postprocedural change in dyspnea, especially in patients for whom dyspnea is a motivating factor for seeking treatment.