This is the unspecified version of the paper.This version of the publication may differ from the final published version. Permanent repository link Abstract Objectives/HypothesesThe objectives of this study were to determine appropriate acoustic and outcome measures for the evaluation of a method of laryngeal manual therapy (LMT) used in the treatment of patients with muscle tension dysphonia (MTD). The effects of this technique was also investigated. The study was based on the hypotheses that the vertical position of the larynx in the vocal tract would lower, that the quality of the voice would normalize, and that a reduction in any vocal tract discomfort would occur following LMT. Study designThis was a small, prospective, repeated measures pilot study in which each member of the research team was 'blinded' to all other stages of the study and during which all data were anonymized until the final stage of data analysis. MethodsTen subjects presenting with MTD completed outcome measures and provided audiorecordings immediately before, immediately after and one week after LMT. The Kay CSL 4150 was used for acoustic and spectrographic measurements. A new perceptual, self-rating scale, the Vocal Tract Discomfort Scale, and a new proforma for use by the clinician for palpatory evaluation, were developed for the study. ResultsRelative average perturbation during connected speech was significantly reduced following LMT, indicating a reduction in abnormal vocal function. The severity and frequency of vocal tract discomfort was shown to have reduced following LMT. ConclusionsThis pilot study showed positive evidence for laryngeal manual therapy as a method of therapy in the treatment of hyperfunctional voice disorders. Its effects were shown to be measurable with both acoustical analysis and the Vocal Tract Discomfort scale.

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\s=b\The treatment of mucoceles by the Lynch-Howarth frontoethmoidectomy has been criticized because of a high rate of recurrence and postoperative complications. The long-term results in 60 patients treated by this method are examined to evaluate these criticisms. Compared with the osteoplastic flap\p=n-\obliterativeproce-dure, our results suggest a much lower recurrence rate (4%) and considerably better cosmesis with frontoethmoidectomy. This is achieved by the use of a fenestrated Silastic drainage tube left in place for five months and careful positioning of the scar. The criticisms would appear to be unjustified, and these results lend support to the continued use of the Lynch-Howarth procedure in the treatment of frontoethmoidal mucoceles.

Background The following position statement from the Union of the European Phoniatricians, updated on 25th May 2020 (superseding the previous statement issued on 21st April 2020), contains a series of recommendations for phoniatricians and ENT surgeons who provide and/or run voice, swallowing, speech and language, or paediatric audiology services. Objectives This material specifically aims to inform clinical practices in countries where clinics and operating theatres are reopening for elective work. It endeavours to present a current European view in relation to common procedures, many of which fall under the aegis of aerosol generating procedures. Conclusion As evidence continues to build, some of the recommended practices will undoubtedly evolve, but it is hoped that the updated position statement will offer clinicians precepts on safe clinical practice.

Caffeine is considered to be a dehydrating agent with detrimental effects on the quality of voice of persons ingesting it. This has led medical personnel dealing with voice disorders, especially in the case of professional voice users, to give advice against the use of caffeine. Yet this is an anecdotal truth as an extensive Medline literature search did not reveal any scientific evidence of caffeine being proven to have adverse effects on the vocal folds. We, therefore, initiated this pilot study to ascertain the connection between caffeine and voice quality on a laboratory basis. Two hundred and fifty mg of caffeine were provided to eight volunteers in tablet form, and blood levels along with laryngograph readings were recorded to document the changes produced. Analysing the irregularities of frequencies in a) free speech b) a reading passage and c) singing ‘Happy Birthday’, substantial changes were seen to authenticate the fact that caffeine does produce alterations in voice quality but these alterations have considerable intrasubject variability. A full study with wider parameters is to be performed on this subject as we consider it to be of importance in the management of voice disorders.

This article presents the authors' philosophy regarding the use of physical manipulation of the larynx and the neck in patients presenting with voice disorders from the context of the anatomy and physiology of the larynx. The biomechanics of the laryngeal structures are reviewed. Potential indications for manipulation are discussed. The examination of the larynx and perilaryngeal structures is presented from a mechanical standpoint. Some basic tenets in laryngeal manipulation, including potential risks and contraindications, are offered.

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