Professional singers often present a difficult diagnostic dilemma concerning their medication use. Most drugs are never formally evaluated for effects on the voice and finding details of rare side effects can be time consuming for the practitioner. Common use of over-the-counter medication and herbal remedies, combined with the interaction of prescription medications used to treat other medical conditions, can cause many physical and psychologic interactions in patients that may not intuitively relate to medication use. Some side effects and interactions may be managed easily, whereas others may be much more severe. An open communication with the patient and knowledge of these issues can be helpful in the management of professional voice users.
[Show abstract][Hide abstract] ABSTRACT: This guideline provides evidence-based recommendations on managing hoarseness (dysphonia), defined as a disorder characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life (QOL). Hoarseness affects nearly one-third of the population at some point in their lives. This guideline applies to all age groups evaluated in a setting where hoarseness would be identified or managed. It is intended for all clinicians who are likely to diagnose and manage patients with hoarseness.
The primary purpose of this guideline is to improve diagnostic accuracy for hoarseness (dysphonia), reduce inappropriate antibiotic use, reduce inappropriate steroid use, reduce inappropriate use of anti-reflux medications, reduce inappropriate use of radiographic imaging, and promote appropriate use of laryngoscopy, voice therapy, and surgery. In creating this guideline the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of neurology, speech-language pathology, professional voice teaching, family medicine, pulmonology, geriatric medicine, nursing, internal medicine, otolaryngology-head and neck surgery, pediatrics, and consumers.
The panel made strong recommendations that 1) the clinician should not routinely prescribe antibiotics to treat hoarseness and 2) the clinician should advocate voice therapy for patients diagnosed with hoarseness that reduces voice-related QOL. The panel made recommendations that 1) the clinician should diagnose hoarseness (dysphonia) in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related QOL; 2) the clinician should assess the patient with hoarseness by history and/or physical examination for factors that modify management, such as one or more of the following: recent surgical procedures involving the neck or affecting the recurrent laryngeal nerve, recent endotracheal intubation, radiation treatment to the neck, a history of tobacco abuse, and occupation as a singer or vocal performer; 3) the clinician should visualize the patient's larynx, or refer the patient to a clinician who can visualize the larynx, when hoarseness fails to resolve by a maximum of three months after onset, or irrespective of duration if a serious underlying cause is suspected; 4) the clinician should not obtain computed tomography or magnetic resonance imaging of the patient with a primary complaint of hoarseness prior to visualizing the larynx; 5) the clinician should not prescribe anti-reflux medications for patients with hoarseness without signs or symptoms of gastroesophageal reflux disease; 6) the clinician should not routinely prescribe oral corticosteroids to treat hoarseness; 7) the clinician should visualize the larynx before prescribing voice therapy and document/communicate the results to the speech-language pathologist; and 8) the clinician should prescribe, or refer the patient to a clinician who can prescribe, botulinum toxin injections for the treatment of hoarseness caused by adductor spasmodic dysphonia. The panel offered as options that 1) the clinician may perform laryngoscopy at any time in a patient with hoarseness, or may refer the patient to a clinician who can visualize the larynx; 2) the clinician may prescribe anti-reflux medication for patients with hoarseness and signs of chronic laryngitis; and 3) the clinician may educate/counsel patients with hoarseness about control/preventive measures. DISCLAIMER: This clinical practice guideline is not intended as a sole source of guidance in managing hoarseness (dysphonia). Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.
Otolaryngology Head and Neck Surgery 09/2009; 141(3 Suppl 2):S1-S31. DOI:10.1016/j.otohns.2009.06.744 · 2.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Singing voice is a special subgroup within the field of voice. In addition to the differences in physiology between singing and speaking voice, singer patients are often regarded as a challenge for the otolaryngologist.The reason for this is probably that the field of voice has not received as much attention as others in our speciality.Moreover, in the case of singers, empathy is vital in the doctor-patient relationship, and, as in many other cases, it forms part of the therapeutic effect. In order to achieve this, the physician has to know what singers are and which are the main pathologies they suffer, how they are formed and how they are expressed.This review offers an overlook of the pathological-physiology of singing voice from a double point of view, scientific and artistic, which in the case of singing are inevitably linked.
Acta Otorrinolaringológica Española 11/2010; 61(6). DOI:10.1016/j.otorri.2009.12.006
[Show abstract][Hide abstract] ABSTRACT: Despite the prevalence of voice disorders, as well as the physiological and functional changes of the aging larynx, there is a lack of data analyzing dysphonia in the geriatric population. The goal of this study was to investigate dysphonia in this cohort.
Retrospective chart review.
This study analyzes the histories, demographics, Voice Handicap Index (VHI) questionnaires, and objective voice measures (OVMs) for 175 patients with voice complaints, age ranging from 65 to 89 years. Diagnoses of any vocal fold pathology were made via strobovideolaryngoscopy and laryngeal electromyography (LEMG) at the time of presentation.
Strobovideolaryngoscopy revealed that laryngeal laryngopharyngeal reflux in 91% (N=159) was the most common diagnosis associated with the voice complaints, followed by muscle tension dysphonia in 73% (N=127) and paresis in 72% (N=126). Of the 175 patients in this study, 27% (N=48) of patients had a history of antecedent event, which might have contributed to their current dysphonia, most commonly upper respiratory tract infection in 27% (N=13) and endotracheal intubation in 21% (N=10). Ninety-three percent (N=153) of patients who underwent LEMG had weakness in the distribution of at least one nerve. VHI scores varied greatly, ranging from 4 to 104, with an average score of 43.9. When VHI scores were correlated with OVMs, correlations were found with mean jitter (%), jitter (abs.), maximum phonation time (s), and shimmer (%). When OVM scores were compared with KayPENTAX normative thresholds, 69.7% of subjects were found to be above the threshold for soft phonation index.
Our studies identified at least one pathologic factor contributing to dysphonia in all elderly patients presenting with voice complaints. The high average VHI score indicated that these geriatric patients experienced significant dissatisfaction because of their dysphonia. The problem was of sufficient magnitude to result in a high percentage of patients proceeding with treatment. Additional research is needed to determine normative values for OVMs and other assessments in the elderly population and establish whether normative values in common use are appropriate for this population.
Journal of voice: official journal of the Voice Foundation 04/2011; 26(2):254-8. DOI:10.1016/j.jvoice.2010.10.024 · 0.94 Impact Factor
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