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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This document is a position statement on the formal perceptual evaluation of voice quality in the United Kingdom (UK). It addresses a number of clinical issues pertaining to the complexity of voice quality analysis. There is also a brief description of the three formal perceptual protocols most commonly used in the UK: The Vocal Profile Analysis (VPA), GRBAS and The Buffalo III Voice Profile. Potential clinical problems with perceptual voice quality evaluation are highlighted. Problems associated with the lack of defined terminology, limitless variety of voice quality, general lack of reliability data and difficulties in determining specificity and sensitivity are discussed. A practical guide for selecting an evaluation scheme is described. The conclusion is that the GRBAS scheme should be recommended as the absolute minimum standard for practising UK voice clinicians. However, there is a clear need to develop a more satisfactory perceptual rating scheme that is clinically realistic, theoretically sound, internationally acceptable and has proven reliability.

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We reviewed the results and side-effect profile of the Dysport preparation of botulinum toxin A (BTA) in the management of the adductor spasmodic dysphonia. We performed 272 injection episodes in 68 patients, 42 (62%) female, 26 (38%) male. A total of 116 of these injections were unilateral, and 156 were bilateral; 94% of the injections were considered to have been successful with a voice score of 2 or higher. The mean duration of effect (injection intervals) was 128.8 days in the unilateral cohort and 118.7 days in the bilateral (P > 0.05). We injected a relatively lower dose of BTA for unilateral injection episodes in our institution compared to those reported by others to produce comparable results and side-effect profiles.

ObjectivesIn this preliminary prospective study, we compared unilateral and bilateral thyroarytenoid muscle injections of Botulinum toxin (Dysport) in 31 patients with adductor spasmodic dysphonia, who had undergone more than 5 consecutive Dysport injections (either unilateral or bilateral) and had completed 5 concomitant self-rated efficacy and complication scores questionnaires related to the previous injections. We also developed a Neurophysiological Scoring (NPS) system which has utility in the treatment administration.Method and materialsData were gathered prospectively on voice improvement (self-rated 6 point scale), length of response and duration of complications (breathiness, cough, dysphagia and total voice loss). Injections were performed under electromyography (EMG) guidance. NPS scale was used to describe the EMG response. Dose and unilateral/bilateral injections were determined by clinical judgment based on previous response. Time intervals between injections were patient driven.ResultsLow dose unilateral Dysport injection was associated with no significant difference in the patient's outcome in terms of duration of action, voice score (VS) and complication rate when compared to bilateral injections. Unilateral injections were not associated with any post treatment total voice loss unlike the bilateral injections.ConclusionUnilateral low dose Dysport injections are recommended in the treatment of adductor spasmodic dysphonia.

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