IntroductionTo update the European guidelines for the assessment of voice quality (VQ) in clinical practice.MethodsNineteen laryngologists–phoniatricians of the European Laryngological Society (ELS... Show moreIntroductionTo update the European guidelines for the assessment of voice quality (VQ) in clinical practice.MethodsNineteen laryngologists–phoniatricians of the European Laryngological Society (ELS) and the Union of the European Phoniatricians (UEP) participated to a modified Delphi process to propose statements about subjective and objective VQ assessments. Two anonymized voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 3/4. The statements with ≥ 3/4 score by 60–80% of experts were improved and resubmitted to voting until they were validated or rejected.ResultsOf the 90 initial statements, 51 were validated after two voting rounds. A multidimensional set of minimal VQ evaluations was proposed and included: baseline VQ anamnesis (e.g., allergy, medical and surgical history, medication, addiction, singing practice, job, and posture), videolaryngostroboscopy (mucosal wave symmetry, amplitude, morphology, and movements), patient-reported VQ assessment (30- or 10-voice handicap index), perception (Grade, Roughness, Breathiness, Asthenia, and Strain), aerodynamics (maximum phonation time), acoustics (Mean F0, Jitter, Shimmer, and noise-to-harmonic ratio), and clinical instruments associated with voice comorbidities (reflux symptom score, reflux sign assessment, eating-assessment tool-10, and dysphagia handicap index). For perception, aerodynamics and acoustics, experts provided guidelines for the methods of measurement. Some additional VQ evaluations are proposed for voice professionals or patients with some laryngeal diseases.ConclusionThe ELS-UEP consensus for VQ assessment provides clinical statements for the baseline and pre- to post-treatment evaluations of VQ and to improve collaborative research by adopting common and validated VQ evaluation approach. Show less
Hendriksma, M.; Heijnen, B.J.; Verbist, B.M.; Jong, M.A. de; Langeveld, A.P.M.; Benthem, P.P.G. van; Sjogren, E.V. 2022
Objective: To evaluate the long-term functional outcomes in patients who received primary radiotherapy for tumour-node stage T2N0 glottic carcinoma, stratified for tumour extension. Methods: A... Show moreObjective: To evaluate the long-term functional outcomes in patients who received primary radiotherapy for tumour-node stage T2N0 glottic carcinoma, stratified for tumour extension. Methods: A cross-sectional study was performed on patients who were treated with radiotherapy for T2N0 glottic carcinoma. Four questionnaires were used to measure different aspects of functional outcome. In addition, objective evaluation and perceptual analysis were performed. Results: Fourteen patients were included in this study. The median time between the start of radiotherapy and assessment was 42 months (range, 26-143 months). Patients reported high-level functioning, with low symptom scores and good swallowing function, and showed a median dysphonia grade of 1.5. The median Voice Handicap Index-30 score was 17.5. Conclusion: Patients with T2N0 glottic carcinoma treated with radiotherapy had good long-term quality of life, with low symptom scores, good swallowing functioning and slightly elevated voice outcome parameters. Show less
Hendriksma, M.; Heijnen, B.J.; Verbist, B.M.; Jong, M.A. de; Langeveld, A.P.M.; Benthem, P.P.G. van; Sjgren, E.V. 2022
ObjectiveTo evaluate the long-term functional outcomes in patients who received primary radiotherapy for tumour–node stage T2N0 glottic carcinoma, stratified for tumour extension.MethodsA cross... Show moreObjectiveTo evaluate the long-term functional outcomes in patients who received primary radiotherapy for tumour–node stage T2N0 glottic carcinoma, stratified for tumour extension.MethodsA cross-sectional study was performed on patients who were treated with radiotherapy for T2N0 glottic carcinoma. Four questionnaires were used to measure different aspects of functional outcome. In addition, objective evaluation and perceptual analysis were performed.ResultsFourteen patients were included in this study. The median time between the start of radiotherapy and assessment was 42 months (range, 26–143 months). Patients reported high-level functioning, with low symptom scores and good swallowing function, and showed a median dysphonia grade of 1.5. The median Voice Handicap Index-30 score was 17.5.ConclusionPatients with T2N0 glottic carcinoma treated with radiotherapy had good long-term quality of life, with low symptom scores, good swallowing functioning and slightly elevated voice outcome parameters. Show less
This article addresses some issues related to Voice and little v. It does so by discussing and analyzing the variation that exists in the Chinese language family with respect to object placement ... Show moreThis article addresses some issues related to Voice and little v. It does so by discussing and analyzing the variation that exists in the Chinese language family with respect to object placement (VO versus OV). It turns out that this variation can be accounted for straightforwardly as long as we assume, first, that Voice and v are sometimes split and sometimes bundled, even within one language, and, second, that Voice does not always select vP; it can also select VP. Show less
Background The following position statement from the Union of the European Phoniatricians, updated on 25th May 2020 (superseding the previous statement issued on 21st April 2020), contains a series... Show moreBackground The following position statement from the Union of the European Phoniatricians, updated on 25th May 2020 (superseding the previous statement issued on 21st April 2020), contains a series of recommendations for phoniatricians and ENT surgeons who provide and/or run voice, swallowing, speech and language, or paediatric audiology services. Objectives This material specifically aims to inform clinical practices in countries where clinics and operating theatres are reopening for elective work. It endeavours to present a current European view in relation to common procedures, many of which fall under the aegis of aerosol generating procedures. Conclusion As evidence continues to build, some of the recommended practices will undoubtedly evolve, but it is hoped that the updated position statement will offer clinicians precepts on safe clinical practice. Show less
Desuter, G.; Cartiaux, O.; Pierard, J.; Henrard, S.; Lith-Bijl, J. van; Benthem, P.P. van; Sjogren, E. 2020
Introduction. Accuracy of thyroid cartilage fenestration during Montgomery thyroplasty (MTIS) is considered a key success factor. The primary aim of the study was to retrospectively evaluate the... Show moreIntroduction. Accuracy of thyroid cartilage fenestration during Montgomery thyroplasty (MTIS) is considered a key success factor. The primary aim of the study was to retrospectively evaluate the accuracy of fenestration. Furthermore, recent publications indicate a possible discrepancy in MTIS voice outcomes related to gender. The secondary aim of the study was to investigate whether the fenestration accuracy could explain this discrepancy.Material and Method. Study was performed by virtually drawing the fenestration on a 3D CT scan as proposed by the MTIS's instructions for use (the "expected window" (EW)), and comparing it to the actually realized fenestration (the "realized window "(RW)). Four position variables, (a) surface overlap (%), (b) the distances between RW and EW centers (mm), (c) the angle between RW and EW (), and (d) the orientation of RW's center, were studied and compared to MPT (seconds) and VHI-30 scores outcomes. A descriptive statistical analysis and comparison between males and females were performed using a Mann-Whitney U test. Linear regression and multivariate analysis were also performed.Results. The median overlapping surface was 58.8 % [34.6; 75.4]. The median radius was 3.2 mm [1.7; 4.1]. The median angle was 16 [6.8; 21.2]. Results show no significant differences of overlapping surface percentage, distance, or angle by gender. Data show no correlation between voice outcome and percentage overlap, distance, or angle. However, data show better outcomes when fenestration was located in the infero-anterior orientation. All patients of this orientation were males.Conclusions. Data provided by this study advocate a maximal infero-anterior positioning of the window during MTIS. This position is more difficult to obtain in female patients. Show less
Speyer, R.; Kim, J.H.; Doma, K.; Chen, Y.W.; Denman, D.; Phyland, D.; ... ; Cordier, R. 2019
PurposeThe current review was conducted to identify all self-report questionnaires on functional health status (FHS) and/or health-related quality-of-life (HR-QoL) in adult populations with... Show morePurposeThe current review was conducted to identify all self-report questionnaires on functional health status (FHS) and/or health-related quality-of-life (HR-QoL) in adult populations with dysphonia (voice problems), and to evaluate the psychometric properties of the retrieved questionnaires.MethodsA systematic review was performed in the electronic literature databases PubMed and Embase. The psychometric properties of the questionnaires were determined using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) taxonomy and checklist. Responsiveness was outside the scope of this review and as no agreed gold standard' measures are available in the field of FHS and HR-QoL in dysphonia, criterion validity was not assessed. Only questionnaires developed and published in English were included.ResultsForty-eight studies reported on the psychometric properties of 15 identified questionnaires. As many psychometric data were missing or resulted from biased study designs or statistical analyses, only preliminary conclusions can be drawn. Based on the current available psychometric evidence in the literature, the Voice Handicap Index seems to be the most promising questionnaire, followed by the Vocal Performance Questionnaire.ConclusionsMore research is needed to complete missing data on psychometric properties of existing questionnaires in FHS and/or HR-QoL. Further, when developing new questionnaires, the use of item response theory is preferred above classical testing theory, as well as international consensus-based psychometric definitions and criteria to avoid bias in outcome data on measurement properties. Show less
While there is no doubt that the middle perfect stem is a secondary addition to the verbal system of Ancient Greek, the reasons for its creation beside the older active perfect are rarely discussed... Show moreWhile there is no doubt that the middle perfect stem is a secondary addition to the verbal system of Ancient Greek, the reasons for its creation beside the older active perfect are rarely discussed. On the one hand, it has been claimed that the middle perfect stem was first introduced in the pluperfect for morpholog-ical reasons, in order to supply the active perfect with a past tense (Chantraine 1927); on the other hand, it has been argued that the difference lies in the role of the subject (Daues 2006). In this contribution, we propose that active and middle perfects fulfilled two different derivational functions. Originally, the active per-fect transformed certain types of dynamic events into a state (not necessarily a resulting state) of the subject; the middle perfect was introduced to indicate the resulting state of the object with transitive verbs. Subsequently, the middle per-fect gradually replaced the active perfect with deponent verbs, but the active per-fect was left untouched in large parts of its original domain. Finally, we argue that the perfect stem transformed a complex predicate into a simple one Show less
In this dissertation I examine the ‘Voice’ of the filmmaker from a political and aesthetic perspective. Within film practice the own ‘Voice’ refers mainly to the aesthetic style of a filmmaker.... Show moreIn this dissertation I examine the ‘Voice’ of the filmmaker from a political and aesthetic perspective. Within film practice the own ‘Voice’ refers mainly to the aesthetic style of a filmmaker. Within the field of postcolonial studies 'Voice' is related to the access that postcolonial subjects have to the production of discourse. Movies and other media can be seen in this context as a form of discourse. For Indigenous filmmakers both approaches to ‘Voice’ and having a ‘Voice’ are important. This study explores the way in which Indigenous filmmakers, particularly from Latin America, express their 'Voice' both politically and aesthetically in their films. Show less
In our culture, vocal harmonics fuction as independent musical elements since only a few decades. Thresholds of the audible explores the changing relationship between singers, listeners and... Show moreIn our culture, vocal harmonics fuction as independent musical elements since only a few decades. Thresholds of the audible explores the changing relationship between singers, listeners and harmonics. As a research method a series of compositions (Nulpunten/’Zeropoints’) has been developed, which attempt to make a fresh approach to overtone singing and to the sonic source material of the human body. They spark off further investigations of reality and illusion of our auditory world. Using his experiences with Tibetan monks and Sardinian brotherhoods and the ‘transverbal’ oeuvre of Michael Vetter, Mark van Tongeren develops his notion ‘multiphony of the body’. The last word, according to him, must be given to readers/listeners, who are challenged to shift their thresholds of the audible with the cd It starts here and the performance Incognito ergo sum. Show less
Turner syndrome (TS) is a disorder in females that is caused by the complete or partial absence of the second sex chromosome. The main characteristics are gonadal dysgenesis and short stature, with... Show moreTurner syndrome (TS) is a disorder in females that is caused by the complete or partial absence of the second sex chromosome. The main characteristics are gonadal dysgenesis and short stature, with adult patients being on average 20 cm shorter than healthy women. Growth hormone (GH) therapy increases adult height with 5 to 12 cm and the addition of the weak androgen oxandrolone (Ox) may further increase adult height. This thesis describes the results of the first randomized, double-blind, placebo-controlled study on the question whether GH-treated girls with Turner syndrome would profit from Ox therapy, and if so, which Ox dosage should be given. It was concluded that the conventional Ox dosage (0.06 mg/kg/day) should not be used because of its limited efficacy and virilizing capacity. In contrast, the addition of Ox at a dosage of 0.03 mg/kg/day starting between the age of 8 to 15 years increases height during therapy, modestly increases adult height gain and has a fairly good safety profile, except for a small deceleration in breast development. In patients considering this deceleration less important than the increment in height gain, we therefore suggest to add Ox 0.03 mg/kg/day to GH to increase height. Show less
The general aim of this thesis is to determine and compare disease and voice outcome for T1 glottic carcinoma treated with radiotherapy or laser surgery. The findings show similar oncological and... Show moreThe general aim of this thesis is to determine and compare disease and voice outcome for T1 glottic carcinoma treated with radiotherapy or laser surgery. The findings show similar oncological and functional results for radiotherapy and laser surgery in __superficial midcord T1a glottic carcinoma__. This outcome supports the Dutch national guideline __Treatment of Laryngeal Carcinoma__ which was published during the life-time of this thesis. In this guideline laser surgery is labeled treatment of choice in these lesions because of the shorter treatment duration, lower costs and the possibility for repeated treatments and/or additional radiotherapy. For larger T1 lesions, our literature review concludes that more comparative data, especially on functional results, are needed before definite conclusions can be drawn as to the role of laser surgery in these lesions. These studies are now being perform ed in a collaboration between the Leiden University Medical Center and the Eramus Medical Center, Rotterdam. Show less
