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Mark S Courey - One of the best experts on this subject based on the ideXlab platform.
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measuring the impact of Dysphonia on quality of life using health state preferences
Laryngoscope, 2020Co-Authors: Leanne Goldberg, Matthew R Naunheim, Jennifer B Dai, Benjamin J Rubinstein, Mark S CoureyAbstract:OBJECTIVES Formal evaluation of health states related to Dysphonia have not been rigorously evaluated in affected patients. The objective of this project was to evaluate the health states of mild, moderate, and severe Dysphonia using formal health state preference evaluation, and to compare these outcomes with the degree of voice handicap. DESIGN Prospective health state preference assessment. METHODS A convenience sample of patients presenting with voice complaints were enrolled from an academic voice center. Demographic and voice handicap index (VHI-10) data were obtained, and an assessment of preference for five health states (monocular blindness, binocular blindness, mild Dysphonia, moderate Dysphonia, and severe Dysphonia) was performed. Utility scores were calculated on a scale from 0 (death) to 1 (perfect health). Analysis was performed with ANOVA testing with post-hoc comparisons and correlation statistics. RESULTS Of 209 assessments, 149 (75.6%) met quality criteria. Relative to monocular blindness (score 0.61 [CI 0.57-0.64]), moderate Dysphonia (0.58 [0.54-0.62]) was rated equivalently, with severe Dysphonia (0.33 [0.29-0.37]) ranking significantly worse and mild Dysphonia (0.96 [0.95-0.98]) significantly better. Binocular blindness (0.18 [0.15-0.21]) was the worst-ranked health state. There was a weak inverse correlation of VHI-10 with Dysphonia-related preference scores; with worsening reported voice handicap, scores decreased. CONCLUSION This study demonstrated that Dysphonia had a significant impact of quality of life, with moderate Dysphonia ranking equivalently with monocular blindness. These numerical estimates may be used for ongoing research into the value and cost-effectiveness of medical, therapeutic, and surgical interventions for voice disorders. LEVEL OF EVIDENCE 2c (outcomes research) Laryngoscope, 130:E177-E182, 2020.
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prevalence and causes of Dysphonia in a large treatment seeking population
Laryngoscope, 2012Co-Authors: Seth M Cohen, Nelson Roy, Jaewhan Kim, Carl V Asche, Mark S CoureyAbstract:Objectives/Hypothesis: To determine the prevalence and common causes of Dysphonia as diagnosed by primary care physicians (PCPs) and otolaryngologists and to evaluate differences in etiologies offered by these providers. Study Design: Retrospective analysis of data from a large, nationally representative administrative U.S. claims database. Methods: Patients were identified as dysphonic based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004, to December 31, 2008. Data regarding age, sex, geographic location, and type of physician providing the Dysphonia diagnosis were collected. Overall and age-related prevalence rates, as well as frequency of specific etiologies by provider type, were calculated. Results: Of the almost 55 million individuals in the database, 536,943 patients (ages 0 to >65 years) were given a Dysphonia diagnosis (point prevalence rate of 0.98%). The prevalence rate was higher among females as compared to males (1.2% vs. 0.7%) and among those >70 years of age (2.5%). The most frequent diagnoses overall were acute laryngitis, nonspecific Dysphonia, benign vocal fold lesions, and chronic laryngitis. PCPs more commonly diagnosed acute laryngitis, whereas otolaryngologists more commonly diagnosed nonspecific Dysphonia and laryngeal pathology. Gastroesophageal reflux was more commonly diagnosed as a comorbid condition by otolaryngologists than by PCPs. Overall laryngeal cancer prevalence in this treatment-seeking population was 2.2% and was greatest among males >70 years of age. Conclusions: This analysis of insurance claims data from a nationally representative database represents the largest study of its kind. Important differences in Dysphonia prevalence related to age, sex, diagnosis, and physician type were identified. Laryngoscope, 122:343–348, 2012
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risk factors and demographics in patients with spasmodic Dysphonia
Laryngoscope, 2002Co-Authors: John M Schweinfurth, Mark J Billante, Mark S CoureyAbstract:Objectives: Spasmodic Dysphonia has been characterized as a functional, psychogenic, or movement disorder with no known etiology or cure. In the present study, risk factors associated with other movement disorders were evaluated in patients with spasmodic Dysphonia. Study Design: Retrospective patient survey of 168 patients with a known diagnosis of spasmodic Dysphonia who completed questionnaires at the time of interval botulinum toxin injection. Methods: Patients completed questionnaires on demographics, education level, work history, significant life events, medical, social, and family history. The results were compared with those of first-degree relatives as a control group with similar demographics. Data were analyzed using percentages calculated on the total number of responses and distribution of frequency of each. Statistical significance was estimated on t tests of X 2 values. Results: In the series of 168 patients, there was a female predominance of 79%. Age range at onset was 13 to 71 years with an average of age of 45 years. Sixty-five percent of patients had previously had the measles or mumps compared with the national average of 15% in a similar age group (P =.0001). Thirty percent of patients directly associated onset of spasmodic Dysphonia symptoms to an upper respiratory tract infection, and 21% to a major life stress. There was no significant incidence of any other medical or neurological condition or symptomatology. There was no family history of spasmodic Dysphonia. Twenty-six percent of patients had an essential tremor compared with 4% of first-degree relatives (P =.0001), and 11% had associated writer's cramp compared with 2% of relatives (P =.02). Less than 1% of patients described a history of toxic exposure or electrical injury. Conclusions: The majority of patients with spasmodic Dysphonia are girls and women. A significantly higher incidence of childhood viral illness was found in the patients with spasmodic Dysphonia. Patients with spasmodic Dysphonia had a significant incidence of both essential tremor and writer's cramp but no history of major illness or other neurological disorder. There appear to be no significant environmental or hereditary patterns in the etiology of spasmodic Dysphonia. Stress or viral infection may induce the onset of symptoms of spasmodic Dysphonia. Many features of the disorder are common to other movement disorders, and this knowledge may direct future research efforts.
Seth M Cohen - One of the best experts on this subject based on the ideXlab platform.
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prevalence and causes of Dysphonia in a large treatment seeking population
Laryngoscope, 2012Co-Authors: Seth M Cohen, Nelson Roy, Jaewhan Kim, Carl V Asche, Mark S CoureyAbstract:Objectives/Hypothesis: To determine the prevalence and common causes of Dysphonia as diagnosed by primary care physicians (PCPs) and otolaryngologists and to evaluate differences in etiologies offered by these providers. Study Design: Retrospective analysis of data from a large, nationally representative administrative U.S. claims database. Methods: Patients were identified as dysphonic based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004, to December 31, 2008. Data regarding age, sex, geographic location, and type of physician providing the Dysphonia diagnosis were collected. Overall and age-related prevalence rates, as well as frequency of specific etiologies by provider type, were calculated. Results: Of the almost 55 million individuals in the database, 536,943 patients (ages 0 to >65 years) were given a Dysphonia diagnosis (point prevalence rate of 0.98%). The prevalence rate was higher among females as compared to males (1.2% vs. 0.7%) and among those >70 years of age (2.5%). The most frequent diagnoses overall were acute laryngitis, nonspecific Dysphonia, benign vocal fold lesions, and chronic laryngitis. PCPs more commonly diagnosed acute laryngitis, whereas otolaryngologists more commonly diagnosed nonspecific Dysphonia and laryngeal pathology. Gastroesophageal reflux was more commonly diagnosed as a comorbid condition by otolaryngologists than by PCPs. Overall laryngeal cancer prevalence in this treatment-seeking population was 2.2% and was greatest among males >70 years of age. Conclusions: This analysis of insurance claims data from a nationally representative database represents the largest study of its kind. Important differences in Dysphonia prevalence related to age, sex, diagnosis, and physician type were identified. Laryngoscope, 122:343–348, 2012
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self reported impact of Dysphonia in a primary care population an epidemiological study
Laryngoscope, 2010Co-Authors: Seth M CohenAbstract:Objectives/Hypothesis: This study's objectives are to 1) to assess the prevalence of Dysphonia in the primary care community, 2) evaluate the severity of Dysphonia, 3) explore potential risk factors for Dysphonia, 4) examine the treatment of dysphonic patients, and 5) assess treatment-related barriers. The hypotheses are that 1) Dysphonia is common in the primary care community, 2) it adversely impacts patients' quality of life (QOL), and 3) patients are underevaluated and experience obstacles with respect to seeking treatment. Study Design: Cross-sectional, practice-based study in the primary care population. Methods: English-speaking patients 18 years of age and older were recruited from a primary care research network. Patients presenting to their primary care practices were given a packet of questionnaires to complete that documented demographic information, risk factors, presence of Dysphonia, prior treatment, and reasons for not seeking treatment. The Voice-Related Quality of Life (VRQOL) and Center for Epidemiological Studies-Depression Scale (CES-D) served as quality-of-life outcome measures. A priori sample size calculations were performed indicating a sample size of 780. Univariate analyses, descriptive statistics, odds ratios and 95% confidence intervals, and multivariate analyses were performed. Results: A total of 789 patients with a mean age of 49.9 years and range of 18 to 94 years participated. Lifetime prevalence of Dysphonia was 29.1%, point prevalence of Dysphonia 7.5%, and 4.3% had had Dysphonia for >4 weeks. Of those with current Dysphonia, only 46% had not missed work. Of those with current Dysphonia, 73.3% had had Dysphonia more than once. Patients with Dysphonia had lower VRQOL scores and higher CES-D scores (t test, P ≤.001). Risk factors for Dysphonia and impaired VRQOL on multivariate analysis included neurologic disease, dry mouth, family history of Dysphonia, college or postgraduate level education, allergies or sinus problems, neck pain, medication for depression/anxiety, more than three upper respiratory infections per year, gastroesophageal reflux at least monthly, and asthma or lung disease. Of the patients who had ever had Dysphonia, 22.1% received treatment. Common treatment modalities included antireflux treatment, antiallergy treatment, and antibiotics. Speech-language pathology evaluation was rare. Compared to those not interested in treatment, patients wanting treatment were more likely to have chronic Dysphonia >4 weeks (30.6% vs. 8.1%; χ2, P ≤.001), more likely to have Dysphonia more than once (85.1% vs. 58.0%; χ2, P ≤.001), and lower VRQOL scores (median 67.5 vs. 97.5; rank sum test, P <.001). Reasons for not seeking treatment included thinking the Dysphonia would go away, physicians did not ask about voice problems, and being unaware of treatment options. Conclusions: At the time one in 13 primary care patients had Dysphonia resulting in significant functional impairment with reduced voice-specific QOL and greater depression scores. Risk factors for Dysphonia and voice-specific QOL impairment were identified and might be useful for identifying patients at risk for Dysphonia. Barriers exist that prevent dysphonic patients from receiving evaluation and treatment. Whether improved methods of Dysphonia screening leads to better outcomes and reduced societal impact needs investigation. Laryngoscope, 2010
Shaheen N Awan - One of the best experts on this subject based on the ideXlab platform.
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automated acoustic analysis of task dependency in adductor spasmodic Dysphonia versus muscle tension Dysphonia
Laryngoscope, 2014Co-Authors: Alqhazo Mazin, Shaheen N AwanAbstract:Objectives/Hypothesis Distinguishing muscle tension Dysphonia (MTD) from adductor spasmodic Dysphonia (ADSD) can be difficult. Unlike MTD, ADSD is described as “task-dependent,” implying that Dysphonia severity varies depending upon the demands of the vocal task, with connected speech thought to be more symptomatic than sustained vowels. This study used an acoustic index of Dysphonia severity (i.e., the Cepstral Spectral Index of Dysphonia [CSID]) to: 1) assess the value of “task dependency” to distinguish ADSD from MTD, and to 2) examine associations between the CSID and listener ratings. Study Design Case-Control Study. Methods CSID estimates of Dysphonia severity for connected speech and sustained vowels of patients with ADSD (n = 36) and MTD (n = 45) were compared. The diagnostic precision of task dependency (as evidenced by differences in CSID-estimated Dysphonia severity between connected speech and sustained vowels) was examined. Results In ADSD, CSID-estimated severity for connected speech (M = 39. 2, SD = 22.0) was significantly worse than for sustained vowels (M = 29.3, SD = 21.9), [P = .020]. Whereas in MTD, no significant difference in CSID-estimated severity was observed between connected speech (M = 55.1, SD = 23.8) and sustained vowels (M = 50.0, SD = 27.4), [P = .177]. CSID evidence of task dependency correctly identified 66.7% of ADSD cases (sensitivity) and 64.4% of MTD cases (specificity). CSID and listener ratings were significantly correlated. Conclusion Task dependency in ADSD, as revealed by differences in acoustically-derived estimates of Dysphonia severity between connected speech and sustained vowel production, is a potentially valuable diagnostic marker. Level of Evidence 3b. Laryngoscope, 124:718–724, 2014
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toward validation of the cepstral spectral index of Dysphonia csid as an objective treatment outcomes measure
Journal of Voice, 2013Co-Authors: Elizabeth A Peterson, Shaheen N Awan, Nelson Roy, Ray M Merrill, Russell Banks, Kristine TannerAbstract:Summary Objectives To examine the validity of the Cepstral Spectral Index of Dysphonia (CSID) as an objective treatment outcomes measure of Dysphonia severity. Method Pre- and posttreatment samples of sustained vowel and connected speech productions were elicited from 112 patients across six diagnostic categories: unilateral vocal fold paralysis, adductor spasmodic Dysphonia, primary muscle tension Dysphonia, benign vocal fold lesions, presbylaryngis, and mutational falsetto. Listener ratings of severity in connected speech were compared with a three-factor CSID model consisting of the cepstral peak prominence (CPP), the low-to-high spectral energy ratio, and its standard deviation. Two additional variables, the CPP standard deviation and gender, were included in the five-factor CSID model to estimate severity of vowels. Results CSID-estimated severity for sustained vowels and connected speech was strongly associated with listener ratings pretreatment, posttreatment, and change observed pre- to posttreatment. Spectrum effects were examined, and severity of Dysphonia did not influence the relationship between listener perceived severity and CSID-estimated severity. Conclusions The results confirm a robust relationship between listener perceived and CSID-derived Dysphonia severity estimates in sustained vowels and connected speech across diverse diagnoses and severity levels and support the clinical utility of the CSID as an objective treatment outcomes measure.
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nonlinear dynamic analysis of disordered voice the relationship between the correlation dimension d2 and pre post treatment change in perceived Dysphonia severity
Journal of Voice, 2010Co-Authors: Shaheen N Awan, Nelson Roy, Jack J JiangAbstract:Summary The purpose of this study was to evaluate the clinical utility of nonlinear dynamic analysis methods, including phase space portraits and measures of the correlation dimension ( D 2 ) to predict pre- versus post-treatment change in perceived Dysphonia severity in a group of 88 patients with muscle tension Dysphonia (MTD). Pre- and posttreatment vowel samples from 88 women with primary MTD (mean age=46.2 years; standard deviation=13.1) were selected for analysis (176 voice samples in total). Phase space reconstructions and correlation dimensions were computed to describe the nonlinear dynamic characteristics of all voice samples. Ten blinded listeners were asked to rate the vowel samples for severity of Dysphonia using a 100-point visual analog scale (VAS). In the computation of D 2 results, 22 severely dysphonic pretreatment voice samples were not analyzed, as a finite value for the correlation dimension could not be computed. For the remaining pre-/post-treatment voice samples, a significant difference in the correlation dimension ( D 2 ) between the pre- versus post-treatment voice samples was observed; however, D 2 was poorly correlated with changes in perceived Dysphonia severity ratings after treatment ( r =0.244, P =0.056). Thus, the utility of the correlation dimension ( D 2 ) as a treatment-outcome measure and as a measure of Dysphonia that may strongly relate to perceived Dysphonia severity does not appear to be supported, particularly for pretreatment voices that may have increased levels of Dysphonia severity. Instead, the strength of nonlinear dynamic methods may potentially reside in providing some insight into the theoretical rules or initial conditions that may result in different modes of normal or disordered phonation.
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toward the development of an objective index of Dysphonia severity a four factor acoustic model
Clinical Linguistics & Phonetics, 2006Co-Authors: Shaheen N Awan, Nelson RoyAbstract:During assessment and management of individuals with voice disorders, clinicians routinely attempt to describe or quantify the severity of a patient's Dysphonia. This investigation used acoustic measures derived from sustained vowel samples to predict Dysphonia severity (as determined by auditory‐perceptual ratings), for a diverse set of voice samples obtained from 134 adult females, with and without voice disorders. Stepwise multiple regression analysis on all voice samples, followed by randomized and repeated cross‐validation (random selection of 75% of the original 134 voice sample corpus; 100 iterations) indicated that a four‐variable model comprised of time and spectral‐based acoustic measures was able to strongly predict perceived severity of Dysphonia (mean R = .880; mean R2 = .775). A cepstral‐based measure (CPP/EXP ratio) was determined to be the most significant contributor to the prediction of Dysphonia severity, though it is clear that the addition of other acoustic measures (pitch sigma; shim...
Montesinos González, Juan Manuel - One of the best experts on this subject based on the ideXlab platform.
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Évaluation de l’efficacite de la toxine botulique dans la dysphonie spasmodique adducteur par analyse acoustique
'Servicio de Publicaciones de la Universidad de Cadiz', 2020Co-Authors: Riera Tur Laura, De Mier Morales Miguel, Ávalos Serrano Encarnación, Alonso Blanco Dolores, Pérez Ortega, Gumersindo Jesus, Montesinos González, Juan ManuelAbstract:Introducción: La disfonía espasmódica es una distonía focal caracterizada por contracciones involuntarias disrítmicas de la musculatura de la cuerda vocal, resultando una voz con contracciones espasmódicas que alteran el ritmo del habla y la capacidad de comunicación del paciente. Métodos: Presentamos una serie de 113 pacientes con diagnóstico de disfonía espasmódica aductora con edades comprendidas entre los 18 y 65 años. Realizaremos a todos ellos un análisis acústico de la voz antes y después del tratamiento con toxina botulínica. Resultados: Observamos una normalización de todos los parámetros en el análisis acústico tras el tratamiento con toxina botulínica. Conclusión: La infiltración de toxina botulínica en las cuerdas vocales es un tratamiento efectivo en la disfonía espasmódica aductora y el análisis acústico de la voz es un buen método para verificarlo.Introduction: Spasmodic Dysphonia is a focal dystonia characterized by involuntary dysrhythmic contractions of the musculature of the vocal cord, resulting in a voice with spasmodic contractions that alter the speech rhythm and the patient's communication capacity. Methods: We present a series of 113 patients diagnosed with adductor spasmodic Dysphonia with ages between 18 and 65 years. We will perform an acoustic analysis of the voice before and after the treatment with botulinum toxin. Results: We observed a normalization of all parameters in the acoustic analysis after treatment with botulinum toxin. Conclusion: The infiltration of botulinum toxin in the vocal cords is an effective treatment in adductor spasmodic Dysphonia and the acoustic analysis of the voice is a good method to verify it.Introducción: La dysphonie spasmodique est une dystonie focale caractérisée par des contractions involontaires dysrythmiques de la musculature de la corde vocale entraînant une voix avec des contractions spasmodiques qui modifient le rythme de la parole et la capacité de communication du patient. Méthodes : Nous présentons une série de 113 patients compris entre 18 et 65 ans pour lesquels nous réaliserons une analyse acoustique de la voix avant et après le traitement par toxine. Résultats : Suite au traitement par la toxine botulique de type A, nous observons une normalisation de l'ensemble des paramètres de l'analyse acoustique. Discussion/conclusion : L'infiltration de la toxine botulique dans les cordes vocales est un traitement efficace pour la dysphonie spasmodique en adduction qui permet d'obtenir une amélioration des paramètres
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Évaluation de l'efficacite de la toxine botulique dans la dysphonie spasmodique adducteur par analyse acoustique
'Servicio de Publicaciones de la Universidad de Cadiz', 2020Co-Authors: Riera Tur Laura, De Mier Morales Miguel, Ávalos Serrano Encarnación, Alonso Blanco Dolores, Pérez Ortega, Gumersindo Jesus, Montesinos González, Juan ManuelAbstract:Introduction: Spasmodic Dysphonia is a focal dystonia characterized by involuntary dysrhythmic contractions of the musculature of the vocal cord, resulting in a voice with spasmodic contractions that alter the speech rhythm and the patient's communication capacity. Methods: We present a series of 113 patients diagnosed with adductor spasmodic Dysphonia with ages between 18 and 65 years. We will perform an acoustic analysis of the voice before and after the treatment with botulinum toxin. Results: We observed a normalization of all parameters in the acoustic analysis after treatment with botulinum toxin. Conclusion: The infiltration of botulinum toxin in the vocal cords is an effective treatment in adductor spasmodic Dysphonia and the acoustic analysis of the voice is a good method to verify it.La disfonía espasmódica es una distonía focal caracterizada por contracciones involuntarias disrítmicas de la musculatura de la cuerda vocal, resultando una voz con contracciones espasmódicas que alteran el ritmo del habla y la capacidad de comunicación del paciente. Estos movimientos involuntarios pueden dar lugar a un excesivo cierre glótico (DS aductora) o un cierre incompleto y/o una aproximación irregular de las cuerdas vocales (DS abductora). La DS aductora es la forma más común de aparición (90%) y se caracteriza por una tensión excesiva del músculo laríngeo (tiroaritenoideo), una calidad estrangulada y áspera de la voz con una frecuencia fundamental anormalmente baja. La prevalencia estimada se encuentra en 5.9 por 100.000.La infiltración de toxina botulínica en las cuerdas vocales es hoy en día el gold estándar para el tratamiento de la disfonía espasmódica.Introducción: La dysphonie spasmodique est une dystonie focale caractérisée par des contractions involontaires dysrythmiques de la musculature de la corde vocale entraînant une voix avec des contractions spasmodiques qui modifient le rythme de la parole et la capacité de communication du patient. Méthodes : Nous présentons une série de 113 patients compris entre 18 et 65 ans pour lesquels nous réaliserons une analyse acoustique de la voix avant et après le traitement par toxine. Résultats : Suite au traitement par la toxine botulique de type A, nous observons une normalisation de l'ensemble des paramètres de l'analyse acoustique. Discussion/conclusion : L'infiltration de la toxine botulique dans les cordes vocales est un traitement efficace pour la dysphonie spasmodique en adduction qui permet d'obtenir une amélioration des paramètre
Nelson Roy - One of the best experts on this subject based on the ideXlab platform.
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toward validation of the cepstral spectral index of Dysphonia csid as an objective treatment outcomes measure
Journal of Voice, 2013Co-Authors: Elizabeth A Peterson, Shaheen N Awan, Nelson Roy, Ray M Merrill, Russell Banks, Kristine TannerAbstract:Summary Objectives To examine the validity of the Cepstral Spectral Index of Dysphonia (CSID) as an objective treatment outcomes measure of Dysphonia severity. Method Pre- and posttreatment samples of sustained vowel and connected speech productions were elicited from 112 patients across six diagnostic categories: unilateral vocal fold paralysis, adductor spasmodic Dysphonia, primary muscle tension Dysphonia, benign vocal fold lesions, presbylaryngis, and mutational falsetto. Listener ratings of severity in connected speech were compared with a three-factor CSID model consisting of the cepstral peak prominence (CPP), the low-to-high spectral energy ratio, and its standard deviation. Two additional variables, the CPP standard deviation and gender, were included in the five-factor CSID model to estimate severity of vowels. Results CSID-estimated severity for sustained vowels and connected speech was strongly associated with listener ratings pretreatment, posttreatment, and change observed pre- to posttreatment. Spectrum effects were examined, and severity of Dysphonia did not influence the relationship between listener perceived severity and CSID-estimated severity. Conclusions The results confirm a robust relationship between listener perceived and CSID-derived Dysphonia severity estimates in sustained vowels and connected speech across diverse diagnoses and severity levels and support the clinical utility of the CSID as an objective treatment outcomes measure.
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prevalence and causes of Dysphonia in a large treatment seeking population
Laryngoscope, 2012Co-Authors: Seth M Cohen, Nelson Roy, Jaewhan Kim, Carl V Asche, Mark S CoureyAbstract:Objectives/Hypothesis: To determine the prevalence and common causes of Dysphonia as diagnosed by primary care physicians (PCPs) and otolaryngologists and to evaluate differences in etiologies offered by these providers. Study Design: Retrospective analysis of data from a large, nationally representative administrative U.S. claims database. Methods: Patients were identified as dysphonic based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004, to December 31, 2008. Data regarding age, sex, geographic location, and type of physician providing the Dysphonia diagnosis were collected. Overall and age-related prevalence rates, as well as frequency of specific etiologies by provider type, were calculated. Results: Of the almost 55 million individuals in the database, 536,943 patients (ages 0 to >65 years) were given a Dysphonia diagnosis (point prevalence rate of 0.98%). The prevalence rate was higher among females as compared to males (1.2% vs. 0.7%) and among those >70 years of age (2.5%). The most frequent diagnoses overall were acute laryngitis, nonspecific Dysphonia, benign vocal fold lesions, and chronic laryngitis. PCPs more commonly diagnosed acute laryngitis, whereas otolaryngologists more commonly diagnosed nonspecific Dysphonia and laryngeal pathology. Gastroesophageal reflux was more commonly diagnosed as a comorbid condition by otolaryngologists than by PCPs. Overall laryngeal cancer prevalence in this treatment-seeking population was 2.2% and was greatest among males >70 years of age. Conclusions: This analysis of insurance claims data from a nationally representative database represents the largest study of its kind. Important differences in Dysphonia prevalence related to age, sex, diagnosis, and physician type were identified. Laryngoscope, 122:343–348, 2012
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differential diagnosis of muscle tension Dysphonia and spasmodic Dysphonia
Current Opinion in Otolaryngology & Head and Neck Surgery, 2010Co-Authors: Nelson RoyAbstract:Purpose of reviewMuscle tension Dysphonia (MTD) can mimic the voice features of adductor spasmodic Dysphonia (ADSD) leading to diagnostic confusion. Researchers have begun to compare characteristics of MTD and ADSD to determine whether there are markers which reliably distinguish the two disorders a
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nonlinear dynamic analysis of disordered voice the relationship between the correlation dimension d2 and pre post treatment change in perceived Dysphonia severity
Journal of Voice, 2010Co-Authors: Shaheen N Awan, Nelson Roy, Jack J JiangAbstract:Summary The purpose of this study was to evaluate the clinical utility of nonlinear dynamic analysis methods, including phase space portraits and measures of the correlation dimension ( D 2 ) to predict pre- versus post-treatment change in perceived Dysphonia severity in a group of 88 patients with muscle tension Dysphonia (MTD). Pre- and posttreatment vowel samples from 88 women with primary MTD (mean age=46.2 years; standard deviation=13.1) were selected for analysis (176 voice samples in total). Phase space reconstructions and correlation dimensions were computed to describe the nonlinear dynamic characteristics of all voice samples. Ten blinded listeners were asked to rate the vowel samples for severity of Dysphonia using a 100-point visual analog scale (VAS). In the computation of D 2 results, 22 severely dysphonic pretreatment voice samples were not analyzed, as a finite value for the correlation dimension could not be computed. For the remaining pre-/post-treatment voice samples, a significant difference in the correlation dimension ( D 2 ) between the pre- versus post-treatment voice samples was observed; however, D 2 was poorly correlated with changes in perceived Dysphonia severity ratings after treatment ( r =0.244, P =0.056). Thus, the utility of the correlation dimension ( D 2 ) as a treatment-outcome measure and as a measure of Dysphonia that may strongly relate to perceived Dysphonia severity does not appear to be supported, particularly for pretreatment voices that may have increased levels of Dysphonia severity. Instead, the strength of nonlinear dynamic methods may potentially reside in providing some insight into the theoretical rules or initial conditions that may result in different modes of normal or disordered phonation.
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toward the development of an objective index of Dysphonia severity a four factor acoustic model
Clinical Linguistics & Phonetics, 2006Co-Authors: Shaheen N Awan, Nelson RoyAbstract:During assessment and management of individuals with voice disorders, clinicians routinely attempt to describe or quantify the severity of a patient's Dysphonia. This investigation used acoustic measures derived from sustained vowel samples to predict Dysphonia severity (as determined by auditory‐perceptual ratings), for a diverse set of voice samples obtained from 134 adult females, with and without voice disorders. Stepwise multiple regression analysis on all voice samples, followed by randomized and repeated cross‐validation (random selection of 75% of the original 134 voice sample corpus; 100 iterations) indicated that a four‐variable model comprised of time and spectral‐based acoustic measures was able to strongly predict perceived severity of Dysphonia (mean R = .880; mean R2 = .775). A cepstral‐based measure (CPP/EXP ratio) was determined to be the most significant contributor to the prediction of Dysphonia severity, though it is clear that the addition of other acoustic measures (pitch sigma; shim...
