Linda Rammage

Singapore General Hospital, Tumasik, Singapore

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Publications (13)13.69 Total impact

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    ABSTRACT: The objective was to determine if particle size affects durability of medialization in patients undergoing injection laryngoplasty (IL) with hyaluronic acid (HA) for unilateral vocal cord paralysis (UVCP). We hypothesized that large particle-size HA (LPHA) persists longer after injection to produce a more durable vocal result. The study design used was a prospective randomized controlled single-blind trial. Patients underwent IL with Restylane (small particle-size HA, SPHA) or Perlane (LPHA) (Q-Med AB, Uppsala, Sweden). Injections were performed transcutaneously in the outpatient clinic. The Voice Handicap Index (VHI) at 6 months postinjection was the primary outcome measure. Secondary outcomes included videostroboscopic findings, and objective acoustic and aerodynamic measures. Seventeen patients (eight SPHA, nine LPHA) were available for follow-up at 6 months. Normalized VHI scores at 6 months after IL were significantly lower in the LPHA group compared to the SPHA group when not adjusted for age and sex (P=0.027). After adjustment, the difference was not significant (P=0.053) but the LPHA group trended toward lower normalized VHI scores. The findings support the hypothesis that the larger particle-size of LPHA makes this material more durable than SPHA for IL. This material may be considered for temporary medialization in patients with UVCP in whom medium-term improvement of at least 6 months is desirable. The transcutaneous route can be used safely in the office setting in non-anticoagulated patients.
    No preview · Article · Jul 2009 · Journal of voice: official journal of the Voice Foundation
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives To determine if particle size affects durability of medialisation in patients undergoing injection laryngoplasty (IL) with hyaluronic acid (HA) for unilateral vocal cord paralysis (UVCP). Hypothesis: Larger particle-size HA persists longer after injection to produce a more durable vocal result.
    No preview · Article · Aug 2008 · Otolaryngology Head and Neck Surgery
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    ABSTRACT: The objective of this study was to evaluate the efficacy of a new surgical procedure for adductor spasmodic dysphonia (AddSD). This surgery involves the bilateral selective division of the adductor branches of the recurrent laryngeal nerves with immediate reinnervation of the distal nerve trunks with branches of the ansa cervicalis (selective denervation-reinnervation). Our first six patients to undergo this procedure were enrolled in the study. All patients suffered from AddSD and had previously received botulinum toxin A (Botox, Allergen, Markham, ON) therapy. Patients were recorded preoperatively and all underwent the same surgical procedure performed by the same lead surgeon. All patients were surveyed postoperatively and then re-recorded. Expert and untrained judges undertook perceptual evaluation of voice quality. Voice samples were also objectively evaluated for aphonic voice breaks. No major surgical complications were noted. Patient satisfaction was excellent, and five of the six patients no longer require botulinum toxin therapy. In five of the six patients, the majority of untrained and expert listeners perceived the postoperative voice to be superior. Objectively, the rate of aphonic voice breaks was also reduced in five of the six patients.
    No preview · Article · Jul 2003 · The Journal of otolaryngology
  • Linda Rammage

    No preview · Article · Jan 2000 · International Journal of Speech-Language Pathology
  • A.J. Emami · Murray Morrison · Linda Rammage · Douglas Bosch
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    ABSTRACT: Multiple etiological factors including gastroesophageal reflux, hyperfunctional voice use, and endotracheal intubation have been implicated in the development of posterior laryngeal ulcers and granulomas. The optimal approach to treatment of these lesions remains controversial. The mainstay of treatment at Vancouver General Hospital has been aggressive medical management of gastroesophageal reflux, with complimentary voice therapy offered to patients suspected of having significant hyperfunctional phonation. The authors reserve Botulinum toxin injection or surgical excision for patients who fail initial therapy. They conducted a retrospective analysis of their voice clinic records from 1985-1997 to examine the efficacy of this approach. They identified 76 patients with the diagnosis of contact ulcer or granuloma. Fifty-two patients had follow-up data available for review. Ninety-four percent of patients were treated nonsurgically: 35 patients were treated solely by dietary and medical therapy to control gastroesophageal reflux, 10 patients were treated by a combination of medical gastroesophageal reflux control and voice therapy, 3 patients had Botox injections, 2 patients had surgical excision of granuloma, 1 patient had a Kenalog injection, and 1 patient underwent laparoscopic fundoplication. Overall, 77% of patients had complete resolution, whereas 11% had partial resolution and another 11% had no significant improvement. The data supports control of gastroesophageal reflux as a central component in treatment of posterior laryngeal ulcers and granulomas.
    No preview · Article · Jan 2000 · Journal of Voice
  • Murray Morrison · Linda Rammage · A.J. Emami
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    ABSTRACT: Muscular tension dysphonia, episodic laryngospasm, globus, and cough may be considered to be hyperfunctional laryngeal symptoms. Suggested etiological factors for these symptoms include gastroesophageal reflux, psychological problems, and/or dystonia. We propose a unifying hypothesis that involves neural plastic change to brainstem laryngeal control networks through which each of the above etiologies, plus central nervous system viral illness, can play a role. We suggest that controlling neurons are held in a "spasm-ready" state and that symptoms may be triggered by various stimuli. Inclusion criteria for the irritable larynx syndrome are episodic laryngospasm and/or dysphonia with or without globus or chronic cough; visible or palpable evidence of tension or tenderness in laryngeal muscles; and a definite symptom-triggering stimulus. thirty-nine patients with irritable larynx syndrome were studied. Gastroesophageal reflux was felt or proven to play a major role in a large number of the group (>90%), and about one third were deemed to have psychological causative factors. Viral illness seemed quite prevalent, with one third of patients able to relate the onset of symptoms to a viral illness that we feel might lead to central nervous system changes. Our proposed hypothesis includes a mechanism whereby acquired plastic change to central brainstem nuclei may lead to this form of hyperkinetic laryngeal dysfunction. It gives structure and reason to an array of therapy measures and suggests direction for basic research.
    No preview · Article · Oct 1999 · Journal of Voice
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    ABSTRACT: Voice disorders in children differ from those in adults in several special aspects.
    No preview · Chapter · Jan 1994

  • No preview · Chapter · Jan 1994
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    ABSTRACT: While elderly patients may develop voice disorders from those etiological factors that affect all age groups, such as upper respiratory tract infections, they are also susceptible to changes that are related to getting or being old. Certain voice changes are a normal part of the aging process and should not be considered disordered, but it is important for the otolaryngologist and speech pathologist to recognize and understand these, in order to be in a position to help out when problems develop.
    No preview · Chapter · Jan 1994
  • Hamish Nichol · Murray D. Morrison · Linda A. Rammage
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    ABSTRACT: A review is given of the experience obtained over 6 years of having a psychiatric consultant available as part of the staff of the Voice Clinic, to which more than a thousand patients have been referred. The presenting features in a case that should alert the otolaryngologist to the need for psychiatric consultation and possible treatment are noted. Suggestions are made as to how to prepare the patient for the referral to a psychiatrist with the appropriate interests and willingness to collaborate closely with the otolaryngologist and the speech pathologist.
    No preview · Article · Jul 1993 · Otolaryngology Head and Neck Surgery
  • Murray D. Morrison · Linda A. Rammage
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    ABSTRACT: It is apparent that voice disorders frequently labelled "functional" are associated with laryngeal muscle misuse. This use of the word "functional" is, however, intrinsically ambiguous, and so we propose an alternative term based on descriptive features of dysfunction: "muscle misuse voice disorders". Persistent phonation with an abnormal laryngeal posture can lead to organic changes such as nodules or polyps, particularly in females with posterior glottic chink. We hypothesized that the chink was related to an overall increase in laryngeal muscle tension, and more directly due to inadequate relaxation of the posterior crico-arytenoid muscle during phonation. We employed the term "muscular tension dysphonia" (MTD) to note this condition, but it may be that the term "laryngeal isometric" is superior since there are other misuses of the larynx that obviously are manifestations of abnormalities of muscular tension. With this in mind we have evolved a new classification based on the laryngeal isometric, glottic and supraglottic lateral contraction states, antero-posterior contraction states, conversion aphonia, psychogenic bowing, and adolescent transitional dysphonia.
    No preview · Article · Jun 1993 · Acta Oto-Laryngologica
  • Linda A. Rammage · Robert C. Peppard · Diane M. Bless
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    ABSTRACT: The relationships of posterior glottal chink magnitude and nodule size with phonatory flow rate, resistance, and breathiness were investigated in 70 women in a retrospective study. Results demonstrated a strong relationship between chink size airflow, but no relationship between nodule size and airflow. Resistance and nodule size were moderately correlated. Breathiness was not explained by airflow, nodule size, or chink magnitude. Subjects in therapy demonstrated concurrent reductions in airflow and chink size. For the laryngeal magnitude measures, visual-perceptual ratings were compared with computer-based measurements. The discussion includes a critical analysis of measurement methods and directions for future research.
    No preview · Article · Mar 1992 · Journal of Voice
  • Murray D. Morrison · Hamish Nichol · Linda A. Rammage
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    ABSTRACT: One thousand consecutive patients seen in a multidisciplinary voice clinic are reviewed. The incidence and relative severity of diagnostic features in each of five assessment areas are calculated and compared. The five areas include: 1. history, 2. laryngoscopic examination, 3. perceptual-acoustic assessment, 4. voice related musculoskeletal, and 5. psychological evaluations. Feature prevalence is presented for patients we have classified as having muscular tension dysphonia, which can be primary, or associated with vocal nodules, chronic laryngitis, or polypoidal degeneration; or as having a psychogenic "functional" dysphonia. Following review of the data, we present a suggested list of diagnostic criteria that should be present before using a specific diagnostic label. These criteria have been further broken down into those that will be present to make a diagnosis, and those that may be present.
    No preview · Article · Feb 1986 · The Laryngoscope

Publication Stats

461 Citations
13.69 Total Impact Points


  • 2009
    • Singapore General Hospital
      • Department of Otolaryngology
      Tumasik, Singapore
  • 1986-2003
    • University of British Columbia - Vancouver
      • • Department of Surgery
      • • Faculty of Medicine
      Vancouver, British Columbia, Canada
  • 1993-1999
    • Vancouver General Hospital
      Vancouver, British Columbia, Canada
  • 1992
    • Northeastern University
      Boston, Massachusetts, United States