Auditory-vocal integration impairment: New challenges and opportunities for voice assessment and therapy

This reflection paper addresses the importance of the interaction between voice perception and voice production, emphasizing the processes of auditory-vocal integration that are not yet widely reported in the context of voice clinicians. Given the above, this article seeks to 1) highlight the important link between voice production and voice perception and 2) consider whether this relationship might be exploited clinically for diagnostic purposes and therapeutic benefit. Existing theories on speech production and its interaction with auditory perception provide context for discussing why the evaluation of auditory-vocal processes could help identify associated origins of dysphonia and inform the clinician around appropriate management strategies. Incorporating auditory-vocal integration assessment through sensorimotor adaptation paradigm testing could prove to be an important addition to voice assessment protocols at the clinical level. Further, if future studies can specify the means to manipulate and enhance a person’s auditory-vocal integration, the efficiency of voice therapy could be increased, leading to improved quality of life for people with voice disorders.

Unilateral Vocal Fold Paralysis: The “Trifecta”—Dysphonia, Dysphagia, and Dyspnea

Purpose: A clinical case of unilateral vocal fold paralysis is presented with case history, auditory-perceptual analysis and accompanying audio files and ratings, videostroboscopic files and ratings, and acoustic analysis, as well as impressions and plan for treatment. Method: A single clinical case of unilateral vocal fold paralysis is presented for learning purposes. Results: Clinical keys are provided for learning. Conclusion: Learners will be able to follow a clinical case to aid in perceptual, videostroboscopic, acoustic, and voice assessment and goal and treatment planning. Supplemental Material https://doi.org/10.23641/asha.16799563

Clinical Case Study: Muscle Tension Dysphonia

Purpose: The purpose of this problem-based learning case study is to review and interact with a clinical case involving a patient diagnosed with muscle tension dysphonia. Included in the case study is a case history, a voice sample, and a laryngeal exam. Conclusions: The case study provides an opportunity to practice conducting an auditory-perceptual assessment and acoustic voice assessment on the provided voice sample. The case study also provides the opportunity to rate endoscopic and stroboscopic parameters on the laryngeal exam. Supplemental Material https://doi.org/10.23641/asha.16799641

Multiple laser puncture for Reinke’s edema: surgical outcome and voice assessment

<p class="abstract"><strong>Background: </strong>The two important principles in Reinke’s edema treatment are minimal intervention and superficial resection with evacuation the edema and preservation the medial edge of the vocal fold to improve the voice quality. The aim of this study was to evaluate a novel surgical technique in treatment of Reinke’s edema and its effect on subjective and quantitative voice characteristics. The study design was a prospective clinical series.</p><p class="abstract"><strong>Methods: </strong>We evaluated 67 patients from 19 to 73 years (mean, 47.7 years) with Reinke’s edema. The patients were divided into 3 types, mild, moderate and sever. Clinical voice assessment was composed of stroboscopy, subjective voice evaluation (GRBAS hoarseness scale) and quantitative voice evaluation were evaluated pre- and postoperatively. All patients underwent endolaryngeal CO2 laser puncturing for treatment of Reinke’s edema.</p><p class="abstract"><strong>Results: </strong>67 patients diagnosed as Reinke’s edema were classified by H. Yonekawa classification into three types. Type I 25 (37.3%) patients, type II 30 (44.8%), type III 12 (17.9%). Out of 67 patients, fifty two (77.6%) were smoker. In all the patients, the laryngostrobscopic findings showed an improvement of mucosal wave patterns with little vocal fold scaring. Significant vocal improvement was also noted in subjective and objective voice assessments.</p><p class="abstract"><strong>Conclusions: </strong>The laser puncture technique is safe, effective and less invasive to treat Reinke’s edema with significant improvement in vocal performance after surgery.</p>

Can preoperative results predict the need for future reintervention following injection laryngoplasty for unilateral vocal fold paralysis?

Purpose The objective was to investigate whether a patient’s preoperative test results can predict the need for future reoperation in unilateral vocal fold paralysis (UVFP). Methods A single-centre retrospective study was performed. The study group consisted of 18 patients with UVFP who had been treated with injection laryngoplasty but who required further treatment and were augmentated again within 36 months. The control group consisted of 33 injected patients who had not required reintervention up to 36 months later. Results Only glottal gap was associated with a relative risk for reinjection. Glottal gap was found to be severe in 77.8% of the patients from the study group compared to 42.4% of the controls, and the difference was statistically significant. The kind of injected material (calcium hydroxylapatite or hyaluronic acid), age, and voice assessment (perceptual, objective, or subjective) did not seem to affect the likelihood of reoperation being needed. There were no between-group statistically significant differences in individual aspects of the GRBAS scale. The global score was slightly higher in the study group, but it did not reach statistical significance (U = 198.5; p = 0.09). A comparison of VHI scores did not yield statistically significant differences between the study and control groups. No significant differences in objective acoustic voice parameters were observed between the groups. Conclusion Only glottal gap occurred to be associated with a relative risk for reinjection. A kind of injected material (CaHA or HA), age, perceptual, objective and subjective voice assessment do not seem to impact the likelihood of reoperation in patients with UVFP.