There is an increasing need for studies of efficacy of behavior readjustment therapy procedures in human communicative disorders. Legal, social, scientific and professional considerations point up the need for more careful documentation of the effects of treatment techniques used by phoniatricians and speech-language pathologists. This study is conducted in order to evaluate the efficacy of the accent method of voice therapy (AM). The AM is one of the holistic approaches for behavior readjustment voice therapy. It tackles collectively and simultaneously the various parameters of voice such as pitch, loudness and timbre. The results of intervention utilizing the AM in this clinical trial are assessed in a relatively controlled setup. Patients with voice problems resulting from various etiologic vocal pathologies are distributed randomly into two groups. Group 1 (G1) is given the full aspect of the AM, that is, voice hygiene advice plus the accent exercises to correct the faulty vocal technique (habit). Group 2 (G2) receives only voice hygiene advice. The AM is administered in individual sessions 20 min each, twice a week, while the voice hygiene advice counseling is given once a week. The assessment of the vocal pathology is done following a diagnostic protocol utilizing subjective as well as quasi-objective measures of evaluation. The initial assessment presents the baseline (pretest) data for both groups. The follow-up evaluations are done at mid intervention (mid-test), that is, 10 sessions for G1 and 5 sessions for G2, and at the termination of intervention/therapy (post-test). The difference in improvement between G1 and G2 at the end of the observation was generally significant in favor of G1. There were significant improvements in G1 in certain items specific for the various etiologic categories. The improvement from pretest to mid-test to post-test values followed a linear tendency. The significance of the results is discussed and the conclusions are outlined and criticized.

Background: The aim of this study was to evaluate the clinical reliability of ultrasound (US) examination using relative laryngeal movement of 40% as a cutoff point to diagnose pharyngeal abnormalities of swallowing using ultrasonographic examination in dysphagic cerebral palsy (CP) patients and comparing its results with a flexible fiberoptic endoscope. Methods: Twenty-five cerebral palsy children suffering from clinical dysphagia were included in this study. The rest distance between the thyroid cartilage and the hyoid bone and the shortest distance between them during swallowing were measured by ultrasound, then the approximation distance and the percentage of relative laryngeal movement were calculated. All children also have been submitted for flexible fiberoptic endoscopy (FEES). Results: The mean value of the percentage of relative laryngeal movement was significantly less in the CP children with pharyngeal phase abnormality diagnosed by the flexible fiberoptic endoscope (p < 0.001). The mean of relative laryngeal movement in CP patients with and without pharyngeal abnormality diagnosed by the flexible fiberoptic endoscope was 20.10 ± 13.73 and 66.19% ± 3.42 respectively. Conclusion: Ultrasound can efficiently measure the relative laryngeal movement, and as it gives a numerical value, it can be used as a follow-up bedside test in children suffering from dysphagia.

Introduction Thyroidectomy is a common procedure. Certain swallowing problems could happen after this surgery and affect the quality of life of the patient. Objective To evaluate swallowing after thyroidectomy in the early and late postoperative periods and to correlate subjective and objective parameters. Methods A prospective study with100 patients who underwent total thyroidectomy at our institution from April 2018 to September 2019. Each patient was assessed by the Arabic version of the Eating Assessment Tool (EAT-10) questionnaire and the fiberoptic endoscopic evaluation of swallowing (FEES) preoperatively, and in the early postoperative (EPO) and late postoperative (LPO) periods. Results The rate of dysphagia was of 82% in the EPO period, and of 36% in the LPO period. Two groups were compared regarding vocal fold mobility using the FEES. Group I included 89 patients with normal vocal fold mobility, 42% of whom had early dysphagia, and only 22% had late dysphagia. Regarding swallowing, we found that in the EPO period, the rates of delayed triggering, aspiration, penetration and residue were of 12.4%, 0%, 0%, and 42.7% respectively. Group II (unilateral immobile vocal fold) included 11 patients in the EPO evaluation, and all of them had early dysphagia. Conclusion Swallowing problems can occur in patients after thyroidectomy regardless of alterations in larynx mobility, and they are characterized by delayed triggering and stasis of food, which are also noticed in the LPO period, though more frequently in the EPO period. Moreover, there is a highly significant correlation between the subjective and objective parameters of swallowing in both EPO and LPO periods.

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Background: The accent method (AM) is one of the holistic approaches for behavior readjustment technique (BRAT). Anatomic physiologic explanation for the accent method is the rhythmic pairing of timing with respiration and phonation may promote motor learning of new phonatory behaviors that will enhance the Bernoulli's effect to restore the glottic wave with better adjustment and symmetry of the vibrator (vocal fold mucosa). Aim of the work: To evaluate the role of applying the accent method of voice therapy on patients with different benign vocal fold lesions post-operatively in order to emphasize the importance of postoperative Accent Method in improving the vocal performance. Patients and Methods: This study was conducted on 100 patients: 50 adult patients of both sexes received "accent exercises" of voice therapy 1week after microlaryngeal phonosurgery which was the study group (G1) and other 50 adult patients of both sexes as a control group (G2) received only voice hygienic advice. Three assessments were done, the first was before the microlaryngeal phonosurgery, the second was one week after surgery and the third was after the course of the voice therapy which compared subjective and objective voice evaluation parameters investigating the therapeutic effect of voice therapy. Results: For the second assessment (after microlaryngeal phonosurgery), there were no statistically significant differences between the 2 groups in all voice evaluation parameters. For the third assessment (after the "accent exercises" given to G1 only and voice hygienic advice given to both groups), there were statistically significant/highly significant differences in favor of G1 as regard auditory perceptual assessment (APA), high-speed video-kymography parameters, acoustic analysis and aerodynamic measures. Conclusion: Since the minimal associated pathological lesions (MAPLs) represent 10% of dysphonia in vocology which likely a result of phonotrauma (abuse and misuse of voice), voice therapy after doing microlaryngeal phonosurgery is almost always a good idea in order to make the person aware of circumstances and habits of voice use that may lead to recurrence of the lesion in the first place.