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Voice therapy is a mainstay treatment modality in the management of phonotrauma in singers. However, the typical duration of therapy an injured singer undergoes is unknown. The primary aims of the study were to determine (1) the number of therapy sessions preceding a decision for surgery and (2) the number of sessions and length of time to achieve improvement in singers who did not undergo surgery. Whether specific singer factors were associated with the length of therapy was also investigated. Retrospective. Records of singers with phonotraumatic vocal fold lesions seen over a 9-year period at a tertiary care voice center were reviewed. Sixty singers who underwent surgery and 183 singers who did not undergo surgery were included in the final analysis. In nearly ¾ of the surgical patients, five or fewer voice therapy sessions were completed prior to the decision for surgery. Singers who did not undergo surgery required on average 3-4 sessions before noting improvement. Over 60% of the non-surgical singers improved within 3 months and 84% were judged to be improved by 6 months. Lesion type, professional/amateur status, formal voice training, and having a current voice teacher/coach were not associated with the length of voice therapy. The length of voice therapy prior to decision for surgery was limited, and so was the length of therapy leading to initial improvement in singers who did not require surgery. These findings provide a framework for voice therapy expectations and could be reassuring for this unique population. [ABSTRACT FROM AUTHOR]

(1) To describe a combination voice rest and steroid regimen to clarify ambiguous diagnoses in singers who present with phonotraumatic lesions and (2) to determine which videostroboscopic parameters show the most consistent response to this regimen. Chart review. Singers with phonotraumatic vocal fold lesions seen at a tertiary care voice center over a 10-year period were identified. Those who had uncertain diagnoses on initial presentation, completed a combination regimen including voice rest and steroids, and had follow-up examinations were included in the analysis. The effect of this combination regimen was assessed by ratings of pre- and postregimen videostroboscopy examinations and by auditory perceptual ratings. Whether the combination regimen clarified the diagnosis was noted. Twenty-nine singers were prescribed the combination regimen with the intent to clarify the diagnosis. In 79% (23/29) of these singers, the regimen helped clarify diagnosis, for example, ruling in or ruling out specific lesions, confirming areas of scar, or distinguishing acute from chronic phonotraumatic injury. Stroboscopic exams were improved in 86% (25/29). The most common stroboscopic finding was a reduction in the lesion size (66%). Auditory perceptual ratings improved in 48% (14/29) of patients. A "cool down" combination of voice rest and steroids can improve diagnostic clarity in a subset of singers with phonotraumatic lesions. This combination regimen can be considered, with both the side effect profile of steroids and possible financial ramifications of strict voice rest in mind, when the initial diagnosis is unclear. [ABSTRACT FROM AUTHOR]

Gel-based injectable biomaterials have significant potential for treating vocal fold defects such as scarring. An ideal injectable for vocal fold lamina propria restoration should mimic the microenvironment of the lamina propria to induce scarless wound healing and functional tissue regeneration. Most current synthetic or natural injectable biomaterials do not possess the same level of complex, tissue-specific constituents as the natural vocal fold lamina propria. In this study we present a newly-developed injectable gel fabricated from decellularized bovine vocal fold lamina propria. Blyscan assay and mass spectrometry indicated that the vocal fold-specific gel contained a large amount of sulfated glycosaminoglycans and over 250 proteins. Gene Ontology overrepresentation analysis revealed that the proteins in the gel dominantly promote antifibrotic biological process. In vivo study using a rabbit vocal fold injury model showed that the injectable gel significantly reduced collagen density and decreased tissue contraction of the lamina propria in vocal folds with chronic scarring. Furthermore, this acellular gel only elicited minimal humoral immune response after injection. Our findings suggested that the tissue-specific, injectable extracellular matrix gel could be a promising biomaterial for treating vocal fold scarring, even after the formation of mature scar. Vocal fold lamina propria scarring remains among the foremost therapeutic challenges in the management of patients with voice disorders. Surgical excision of scar may cause secondary scarring and yield inconsistent results. The present study reports an extracellular matrix-derived biomaterial that demonstrated antifibrotic effect on chronic scarring in vocal fold lamina propria. Its injectability minimizes the invasiveness of the delivery procedure and the degree of mucosal violation. In this work we also describe a new methodology which can more accurately identify proteins from the complex mixture of an acellular extracellular matrix gel by excluding interfering peptides produced during the enzymatic digestion in gel fabrication. [ABSTRACT FROM AUTHOR]

Summary Objectives To investigate the efficacy of stretch-and-flow voice therapy as a primary physiological treatment for patients with hyperfunctional voice disorders. Study Design Prospective case series. Methods Participants with a diagnosis of primary muscle tension dysphonia or phonotraumatic lesions due to hyperfunctional vocal behaviors were included. Participants received stretch-and-flow voice therapy structured once weekly for 6 weeks. Outcome variables consisted of two physiologic measures (s/z ratio and maximum phonation time), an acoustic measure (cepstral peak prominence [CPP]), and a measure of vocal handicap (voice handicap index [VHI]). All measures were obtained at baseline before treatment and within 2 weeks posttreatment. Results The s/z ratio, maximum phonation time, sentence CPP, and VHI showed statistically significant ( P < 0.05) improvement through therapy. Effect sizes reflecting the magnitude of change were large for s/z ratio and VHI ( d = 1.25 and 1.96 respectively), and moderate for maximum phonation time and sentence CPP ( d = 0.79 and 0.74, respectively). Conclusions This study provides supporting evidence for preliminary efficacy of stretch-and-flow voice therapy in a small sample of patients. The treatment effect was large or moderate for multiple outcome measures. The data provide justification for larger, controlled clinical trials on the application of stretch-and-flow voice therapy in the treatment of hyperfunctional voice disorders. [ABSTRACT FROM AUTHOR]

Summary: Objectives: To create a high-resolution three-dimensional (3D) reconstruction of a case of cricoarytenoid subluxation and perform quantitative analysis to understand its anatomy and functional consequence. Study Design: Computational, with image processing and analysis. Methods: High-resolution axial computed tomography images of the larynx of a patient with an anteriorly subluxed arytenoid were processed with custom MATLAB routines to create a versatile 3D reconstruction. The geometries of the subluxed and nonsubluxed arytenoids were quantitatively compared. Results: The anteriorly subluxed arytenoid has an inferoposteriorly displaced vocal process (VP), resulting in an elongated and inferiorly positioned vocal fold. The paradoxical posterior displacement of the VP with elongation of the vocal fold has not been described previously. Quantitative analysis reveals significant rotational components and a unidirectional translational component in anterior arytenoid subluxation. Conclusions: Quantitative 3D analysis yielded insight into the biomechanics of anterior arytenoid subluxation. Subluxation in this case appeared to involve more pure rotational than translational motion. Overrocking of the subluxed arytenoid can produce paradoxical elongation of the involved vocal fold. [ABSTRACT FROM AUTHOR]

Summary: Objectives: To create a high-resolution three-dimensional (3D) reconstruction of a case of cricoarytenoid subluxation and perform quantitative analysis to understand its anatomy and functional consequence. Study Design: Computational, with image processing and analysis. Methods: High-resolution axial computed tomography images of the larynx of a patient with an anteriorly subluxed arytenoid were processed with custom MATLAB routines to create a versatile 3D reconstruction. The geometries of the subluxed and nonsubluxed arytenoids were quantitatively compared. Results: The anteriorly subluxed arytenoid has an inferoposteriorly displaced vocal process (VP), resulting in an elongated and inferiorly positioned vocal fold. The paradoxical posterior displacement of the VP with elongation of the vocal fold has not been described previously. Quantitative analysis reveals significant rotational components and a unidirectional translational component in anterior arytenoid subluxation. Conclusions: Quantitative 3D analysis yielded insight into the biomechanics of anterior arytenoid subluxation. Subluxation in this case appeared to involve more pure rotational than translational motion. Overrocking of the subluxed arytenoid can produce paradoxical elongation of the involved vocal fold. [Copyright &y& Elsevier]

Summary Objectives (1) To develop an automated algorithm to analyze electroglottographic (EGG) signal in continuous dysphonic speech, and (2) to identify EGG waveform parameters that correlate with the auditory-perceptual quality of strain in the speech of patients with adductor spasmodic dysphonia (ADSD). Study Design Software development with application in a prospective controlled study. Methods EGG was recorded from 12 normal speakers and 12 subjects with ADSD reading excerpts from the Rainbow Passage. Data were processed by a new algorithm developed with the specific goal of analyzing continuous dysphonic speech. The contact quotient, pulse width, a new parameter peak skew, and various contact closing slope quotient and contact opening slope quotient measures were extracted. EGG parameters were compared between normal and ADSD speech. Within the ADSD group, intra-subject comparison was also made between perceptually strained syllables and unstrained syllables. Results The opening slope quotient SO7525 distinguished strained syllables from unstrained syllables in continuous speech within individual subjects with ADSD. The standard deviations, but not the means, of contact quotient, EGGW50, peak skew, and SO7525 were different between normal and ADSD speakers. The strain-stress pattern in continuous speech can be visualized as color gradients based on the variation of EGG parameter values. Conclusions EGG parameters may provide a within-subject measure of vocal strain and serve as a marker for treatment response. The addition of EGG to multidimensional assessment may lead to improved characterization of the voice disturbance in ADSD. [ABSTRACT FROM AUTHOR]