Hoarseness in an older adult: Ortner syndrome

A detailed examination in an older adult presenting with chronic hoarseness is mandatory to exclude an upper aerodigestive tract malignancy. We describe a 71-year-old chronic smoker with essential hypertension who presented with hoarseness and vocal fatigue for 5 months. Laryngoscopic examination showed left vocal fold paralysis with phonation gap. No growth was seen at all laryngeal and hypopharyngeal subsites. The rest of the head and neck, chest, upper limbs and neurovascular examination were unremarkable. A plain chest radiograph demonstrated a cause for the left recurrent laryngeal nerve palsy. The diagnosis, complications and definitive management of the underlying cause and resultant voice problem will be discussed.

Prevalence of Dysphagia in Dysphonic Patients with Non-Neoplastic Vocal Fold Lesions

Background Dysphagia is the swallowing difficulties and trouble to move liquids, solids, medications and may be saliva from the mouth down to the stomach and is considered a serious red flag or alarm symptom. Aim of the Work to examine the prevalence of dysphagia on basis of subjective and objective measures in patients with the presenting symptom of dysphonia and diagnosed with non-neoplastic vocal fold lesions to consider the potential benefit of swallowing therapy hand in hand with the chosen management line of voice problem in the treatment of these patients if proved to have high prevalence of dysphagia. Subjects and Methods This study was applied on 50 patients with age ranging from 15-50 years diagnosed as being dysphonic secondary to non-neoplastic vocal fold lesions on objective and clinical measures, attending at the Phoniatric outpatient clinic at El-Demerdash hospital and Ain Shams University Specialized hospital. Results After the application of the A-EAT-10 questionnaire on 50 dysphonic patients who were selected to participate in this study, 12 cases (about 24%) were considered dysphagic with score above 3 and underwent VFSS. Within these 12 patients, Zero percent were found complaining of dysphagia according to VFSS. So there is No Correlation between frequencies of dysphagia by A-EAT-10 and by VFSS. Conclusion The present study showed that non-neoplastic vocal fold lesions are not an etiological factor for dysphagia despite the intricacy in the neuromuscular supply of pharynx and larynx. Diagnosis of Dysphagia can’t be confirmed depending only on subjective screening tools like A-EAT-10.

Voice problem in a patient with chronic renal failure

Background Chronic kidney failure is an irreversible medical condition that impairs the kidney’s ability to function. When CRF reaches a sophisticated stage, dangerous levels of fluid, electrolytes, and wastes can accumulate within the body. Dysphonia detected within the CRF patients was due to affection of the chronic kidney failure on the system and phonatory system. Patients with CRF treated by hemodialysis are exposed to continuous pulmonary insults of multifactorial origin: Fluid retention predisposes them to pulmonary edema which occurs more frequently within the presence of concomitant cardiovascular disease. Also, the spirit of the kidney failure patients can induce psychogenic dysphonia. The aim of this work is to see and analyzed voice problems in patients with chronic kidney failure to ascertain baseline data about the scale and distribution of the probable voice disorder in these patients for early detection and proper management. Results The results obtained from this study showed that there have been statistically significant differences between chronic kidney failure patients G1 and control G2 regarding first harmonic, jitter %, shimmer dB and noise harmonic ratio dB, presence of dysphonia, and also the total score of VHI. The results of the study revealed statistical correlation between the quantity of years of hemodialysis and total acoustic measures. Conclusion The results of our study revealed that subjects with chronic failure exhibit a clinical evidence of voice disorders and proving that there is interplay of different body systems and the larynx. The voice problems can vary between CRF patients depending on duration of hemodialysis and leading causes of chronic kidney failure.

Prevalence and Risk Factors for Occupational Voice problems in Teachers

A number of teachers are teaching all over Pakistan among private and public institutes. Voice problem is specified to be one of the major occupational risks of teachers actually the teachers frequently use theirvoice with high-intensity in noisy environment for a long time and without voice rest.

Preliminary Findings on Self-Reported Voice Disorders in Urban Ghana: A Qualitative Description Study

This preliminary qualitative description study explored knowledge from urban Ghanaians about the nature and impact of their self-reported voice problem. Ten Ghanaians were screened for a self-reported voice disorder using the Voice Handicap Index–10 (VHI-10), and they also completed a structured interview with a speech-language therapist. Content analysis was completed from interview responses using quantification of data. Four out of 10 adult Ghanaians demonstrated high VHI-10 scores that indicated a self-reported voice disorder. Themes that emerged included a recurring problem with voice, multiple vocal impairments, limitations with participating in vocal activities, and other health problems. Lack of financial resources and little knowledge about voice disorders were barriers to accessing care. In summary, four adult Ghanaians with a self-reported voice disorder described multiple problems with their voice, limiting their participation in vocal activities. Implications of these preliminary findings include early identification and improving voice care access to avoid handicapping voice problems.

Multi-institutional Study of Voice Disorders and Voice Therapy Referral

Objectives To assess perspectives of patients with voice problems and identify factors associated with the likelihood of referral to voice therapy via the CHEER (Creating Healthcare Excellence through Education and Research) practice-based research network infrastructure. Study Design Prospectively enrolled cross-sectional study of CHEER patients seen for a voice problem (dysphonia). Setting The CHEER network of community and academic sites. Methods Patient-reported demographic information, nature and severity of voice problems, clinical diagnoses, and proposed treatment plans were collected. The relationship between patient factors and voice therapy referral was investigated. Results Patients (N = 249) were identified over 12 months from 10 sites comprising 30 otolaryngology physicians. The majority were women (68%) and white (82%). Most patients reported a recurrent voice problem (72%) and symptom duration >4 weeks (89%). The most commonly reported voice-related diagnoses were vocal strain, reflux, and benign vocal fold lesions. Sixty-seven percent of enrolled patients reported receiving a recommendation for voice therapy. After adjusting for sociodemographic and other factors, diagnoses including vocal strain/excessive tension and vocal fold paralysis and academic practice type were associated with increased likelihood of reporting a referral for voice therapy. Conclusions The CHEER network successfully enrolled a representative sample of patients with dysphonia. Common diagnoses were vocal strain, reflux, and benign vocal fold lesions; commonly reported treatment recommendations included speech/voice therapy and antireflux medication. Recommendation for speech/voice therapy was associated with academic practice type.