Prevalence and risk factors for voice problems among telemarketers

OBJECTIVES: To investigate whether there is an increased prevalence of voice problems among telemarketers compared with the general population and if these voice problems affect productivity and are associated with the presence of known risk factors for voice problems. DESIGN: Cross-sectional survey study. SETTINGS: One outbound telemarketing firm, 3 reservations firms, 1 messaging firm, 1 survey research firm, and 1 community college. PARTICIPANTS: Random and cluster sampling identified 373 employees of the 6 firms; 304 employees completed the survey. A convenience sample of 187 community college students similar in age, sex, education level, and smoking prevalence served as a control group. MAIN OUTCOME MEASURES: Demographic, vocational, personality, and biological risk factors for voice problems; symptoms of vocal attrition; and effects of symptoms on work. RESULTS: Telemarketers were twice as likely to report 1 or more symptoms of vocal attrition compared with controls after adjusting for age, sex, and smoking status (P<.001). Of those surveyed, 31% reported that their work was affected by an average of 5.0 symptoms These respondents tended to be women (P<.001) and were more likely to smoke (P =.02); take drying medications (P<.001); have sinus problems (P =.04), frequent colds (P<.001), and dry mouth (P<.001); and be sedentary (P<.001). CONCLUSIONS: Telemarketers have a higher prevalence of voice problems than the control group. These problems affect productivity and are associated with modifiable risk factors. Evaluation of occupational voice disorders must encompass all of the determinants of health status, and treatment must focus on modifiable risk factors, not just the reduction of occupational vocal load.     

Evaluation of laryngopharyngeal reflux in patients with suspected laryngopharyngeal reflux, chronic otitis media and laryngeal disorders

We investigated the prevalence of laryngopharyngeal reflux in patients with signs and symptoms of reflux, chronic otitis media and benign and malignant vocal cord lesions. Three groups of patients in Ankara Ataturk Education and Research Hospital ENT–Head and Neck Surgery Clinics were compared between 2005 and 2006. The first group had patients with signs and symptoms of reflux, the second group consisted of patients with chronic otitis media, and in the third group had patients with laryngeal pathology, i.e. vocal cord lesions. The results of pH monitoring of all the three groups of patients were analyzed for laryngopharyngeal reflux. In the evaluation, two different criteria, based on reflux number and time spent in reflux, were used. It was investigated whether there was a difference in terms of reflux among these three groups. Also, the effects of reflux in etiopathogenesis of chronic otitis media and vocal cord lesions are discussed. A total of 84 patients were studied, with 22 patients with signs and symptoms of reflux in Group 1, 42 patients with chronic otitis media in Group 2, and 20 patients with vocal cord lesions in Group 3. No statistical difference could be detected among the groups in terms of the two criteria mentioned above. The frequency of laryngopharyngeal reflux in patients with chronic otitis media and vocal cord lesions was found to be as high as than in the patients with signs and symptoms of reflux. During the treatment of chronic otitis media and laryngeal disorders, we advise reflux work-up, and in case if there is reflux, we recommend reflux treatment in addition to treatment of primary disease.     

Perzeptive und maschinelle Stimm- und Sprechanalyse bei chronischer Laryngitis und T1-Stimmlippenkarzinom

Background

Patients with chronic laryngitis and T1 vocal cord cancer were compared using perceptual and text-based objective voice and speech analyses in order to determine which group is more affected in its ability to communicate and whether a distinction between the two pathologies is possible.

Patients and methods

In all, 13 patients with histologically proven chronic laryngitis and 13 patients with T1 vocal cord cancer were compared perceptually by five speech therapists on the basis of seven criteria and objectively by a speech recognition system and prosodic analysis.

Results

Both, the data of the five speech therapists and the results of the automatic analysis revealed no significant differences between the two patient groups.

Conclusion

A distinction between chronic laryngitis and T1 vocal cord carcinoma by mere voice and speech analysis is not possible, because the patient groups do not show significant differences in their voice quality.     

Prevalence of Self-reported Allergic and Non-allergic Rhinitis Symptoms in Stockholm: Relation to Age,Gender, Olfactory Sense and Smoking

Objective--To estimate the prevalence of isolated self-reported allergic and non-allergic rhinitis symptoms in an adult population and to explore the relations to age, gender, olfaction and smoking habits. Material and methods--Self-judged health and environmental exposures were investigated by means of a questionnaire survey administered to a stratified random sample of 15,000 adults in Stockholm County. Results--A total of 10,670 individuals were included in the analysis, corresponding to a response rate of 73%. The results revealed a high prevalence of self-reported non-allergic rhinitis, 19%, almost as high as the prevalence of self-reported allergic rhinoconjunctivitis, 24%. In contrast to current clinical opinion, we did not find a significant increase in the prevalence of non-allergic symptoms with increased age. There were no statistically significant gender differences in the prevalence of either allergic or non-allergic symptoms. A reduced sense of smell was twice as common in the non-allergic group, 23%, as in the healthy population. The prevalence of rhinitis symptoms differed according to smoking habits. Conclusion--Both self-reported allergic rhinitis symptoms and non-allergic nasal symptoms are frequent in the population sample. Self-reported non-allergic nasal symptoms seem to occur independent of age and reduced olfactory sense is a common complaint among these subjects. The prevalence of self-reported allergic and non-allergic nasal symptoms did not differ much between men and women or between individuals with different smoking habits.     

The effect of snoring on voice: a controlled study of 30 subjects

We conducted a study to determine the prevalence of vocal symptoms in snorers. A total of 30 patients with a history of snoring were investigated for the presence or absence of three vocal symptoms immediately after they awoke from sleep: hoarseness, voice weakness, and other changes in voice quality. All patients were also asked to complete a voice-related quality-of-life (V-RQOL) questionnaire. Findings were compared with those of an age- and sex-matched control group of 30 nonsnorers. The most common vocal symptom in the snoring group was hoarseness, which occurred in 11 patients (36.7%); voice weakness and other voice quality changes were present in 8 snorers each (26.7%). In the control group, the most common vocal symptom was voice weakness, which was present in 7 subjects (23.3%); 5 controls (16.7%) experienced other changes in voice quality, and 3 controls (10.0%) experienced hoarseness. The difference between the prevalence of hoarseness in the two groups was statistically significant (p = 0.030), and the differences in voice weakness and other voice quality changes were not. The mean V-RQOL score was 87.50 ± 26.89 in the snoring group and 96.00 ± 5.82 in the control group-again, not a statistically significant difference. Finally, we found no association between any of the three vocal symptoms and the prevalence of mouth breathing, the level of snoring loudness, and the mean number of snores per minute. We conclude that snorers are more likely to experience hoarseness than are nonsnorers.     

Prevalence of self-reported allergic and non-allergic rhinitis symptoms in Stockholm: relation to age,gender, olfactory sense and smoking

OBJECTIVE: To estimate the prevalence of isolated self-reported allergic and non-allergic rhinitis symptoms in an adult population and to explore the relations to age, gender, olfaction and smoking habits. MATERIAL AND METHODS: Self-judged health and environmental exposures were investigated by means of a questionnaire survey administered to a stratified random sample of 15,000 adults in Stockholm County. RESULTS: A total of 10,670 individuals were included in the analysis, corresponding to a response rate of 73%. The results revealed a high prevalence of self-reported non-allergic rhinitis, 19%, almost as high as the prevalence of self-reported allergic rhinoconjunctivitis, 24%. In contrast to current clinical opinion, we did not find a significant increase in the prevalence of non-allergic symptoms with increased age. There were no statistically significant gender differences in the prevalence of either allergic or non-allergic symptoms. A reduced sense of smell was twice as common in the non-allergic group, 23%, as in the healthy population. The prevalence of rhinitis symptoms differed according to smoking habits. CONCLUSION: Both self-reported allergic rhinitis symptoms and non-allergic nasal symptoms are frequent in the population sample. Self-reported non-allergic nasal symptoms seem to occur independent of age and reduced olfactory sense is a common complaint among these subjects. The prevalence of self-reported allergic and non-allergic nasal symptoms did not differ much between men and women or between individuals with different smoking habits.     

Selective attention in a vocal abuse population

The speech discrimination abilities in noise of 25 female vocal abusers and 25 female subjects without a history of vocal abuse were compared, employing the Goldman-Fristoe-Woodcock Test of Selective Attention. The vocal abuse group was found to be significantly poorer in discrimination ability than the control group. A post hoc analysis of the three background noises (fan noise, cafeteria noise, male speaker) yielded significant differences for both groups with the fan and cafeteria noise versus the one speaker noise. A possible relationship between listening in the presence of noise and vocal misuse while speaking in the presence of noise is offered.     

Functional speech outcomes after laryngectomy and pharyngolaryngectomy

OBJECTIVE: To compare and contrast functional speech outcomes of patients having undergone total laryngectomy and pharyngolaryngectomy who use tracheoesophageal speech as their primary mode of communication. DESIGN: Group comparison design. SETTING: Adult acute tertiary care hospital. PATIENTS: Thirty patients who underwent total laryngectomy and 13 who underwent pharyngolaryngectomy with free jejunal interposition reconstruction. All patients used tracheoesophageal speech. INTERVENTION: Group comparisons across measures of speech intelligibility, voice quality, tracheoesophageal speech use, voice satisfaction and levels of perceived voice disability, handicap, and well-being/distress. MAIN OUTCOME MEASURE: The existence of any significant differences between the 2 groups on measures of intelligibility, voice quality, tracheoesophageal speech use, and voice satisfaction and levels of voice disability, handicap, and well-being/distress. RESULTS: Statistical comparisons confirmed reduced functional intelligibility (P<.05), reduced vocal quality (P<.01), and higher levels of disability (P<.05) in the pharyngolaryngectomy group. However, no significant difference was observed between the proportion of patients classified as "successful" tracheoesophageal speech users in either group. Low levels of handicap and high levels of patient well-being were recorded in both groups. CONCLUSION: Despite the perceptual differences in voice quality and intelligibility observed between the 2 groups, tracheoesophageal speech that is functional, effective, and perceived by the patients as satisfactory can be achieved after total laryngectomy and pharyngolaryngectomy with free jejunal interposition reconstruction.     

Vocal symptoms and acoustic changes in relation to the expanded disability status scale,duration and stage of disease in patients with multiple sclerosis

Vocal symptoms and acoustic measures of patients with multiple sclerosis (MS) are investigated in relation to the duration of the disease, stage of the disease and the degree of disability. Eighty-two patients were enrolled in this study (40 MS, 42 controls). In the MS group, the most common vocal symptoms were vocal breaks and vocal fatigue present in 10. None of the patients in the control group had voice breaks. In the male group, there was a significant decrease in the fundamental frequency, habitual pitch and maximum phonation time with a significant increase in Shimmer. In the female group, there was a significant decrease in the maximum phonation time only. There was no correlation between vocal symptoms and acoustic measures versus duration of the disease and extent of disability except for vocal fatigue which significantly associated with EDSS (expanded disability status scale) score. Patients with MS may develop vocal symptoms irrespective of the EDSS score, duration and stage of the disease. Vocal fatigue and vocal breaks are more common than hoarseness.     

Is an occupation with vocal load a risk factor for laryngopharyngeal reflux: a prospective,multicentre, multivariate comparative study

Clin. Otolaryngol. 2012, 37 , 362–368 Objectives: To compare the prevalence of laryngopharyngeal reflux in choristers, teachers and control subjects without vocal load at work and to determine the risk factors for laryngopharyngeal reflux. Design: A prospective, multicentre, multivariate comparative study. Participants: One hundred and nineteen singers from four professional choirs, seventy teachers from four schools and 111 control subjects with an occupation without vocal load. Main outcome measures: All participants completed a questionnaire about their dietary habits, height and weight, presence of stress, smoking and allergies, including the nine‐item Reflux Symptom Index. The groups of choristers, teachers and the controls were compared with each other with regard to their sex, age, dietary habits, body‐mass index, Reflux Symptom Index score and other factors affecting voice quality. The subjects from all three groups with suspected laryngopharyngeal reflux were compared with the subjects without it. The relationship between the Reflux Symptom Index score and the possible risk factors for reflux was estimated. Results: The results showed significantly higher Reflux Symptom Index scores in the choristers than in the teachers and the controls (mean scores, 7.86 versus 6.33, P = 0.044; 7.86 versus 4.80, P = 0.000, respectively), but the number of subjects with suspected laryngopharyngeal reflux (Reflux Symptom Index score >13) did not differ significantly between the groups. The choristers were significantly more often treated for laryngopharyngeal reflux than the teachers and the controls (41%, 17% and 28%, respectively). The occupation chorister and frequently experiencing stress were the only factors that influenced the total Reflux Symptom Index score. Conclusions: Laryngopharyngeal reflux affects the choristers more often than the teachers or the control subjects without vocal load at work. These results suggest that singing as the main professional activity can notably contribute to the development of the reflux. Vocal load without singing is probably not an important aetiological factor for laryngopharyngeal reflux. The extraoesophageal symptoms affecting voice require treatment for laryngopharyngeal reflux and proper dietary habits especially in the group with high voice quality demands.     

Longitudinal formant analysis after cochlear implantation in school-aged children

INTRODUCTION: The purpose of this investigation was to describe the correlation between vocal and hearing development by longitudinal analysis of sound spectrograms, as a basic system for evaluating progress in vocal development. SUBJECTS AND METHODS: Two school-aged children with prelingual deafness were evaluated diachronically to assess speech perception and speech intelligibility after cochlear implantation. One child had non-syndromic hearing impairment without any known neurological deficit except for hearing loss, while the other had hearing impairment accompanied by mild mental retardation and attention deficit disorder. Their voices were recorded for monthly follow-up after cochlear implantation; these were used for formant analysis and compared with their mother's voice, and alteration of the formant data was also compared with monosyllable speech perception. RESULTS: Formant analysis demonstrated high concordance was observed between monosyllable speech perception and speech intelligibility. F1-F2 forms of the patients more closely resembled those of their mothers after 1 year's follow-up. The time point at which speech development altered was very similar in both cases although the final outcomes were different. CONCLUSION: Fair improvement of articulation after cochlear implant was demonstrated by the F1-F2 gram analysis. This procedure can be used for data sharing and cooperation between medical and educational specialists.     

Features of muscle tension dysphonia before and after correction of unilateral vocal cord paralysis

OBJECTIVES: We performed a retrospective, longitudinal study to compare the prevalence of hyperkinetic laryngeal features before and after successful correction in patients with unilateral vocal cord paralysis (UVCP). METHODS: Eighty-six patients with UVCP who had a successful surgical correction were enrolled. Preoperative and post-operative videolaryngostroboscopy images were analyzed, and the muscle tension patterns (MTPs) were rated according to the Morrison-Rammage classification. A 4-item glottal closure index was used for each patient on study entry and for 40 normal subjects as the control group. RESULTS: There was no significant difference in MTP prevalence before (57%) and after (55%) surgical correction for UVCP. Although the glottal closure symptoms were tremendously improved through surgical medialization for UVCP, they persisted and were more prevalent than those in normal individuals. CONCLUSIONS: Persistence of MTPs after correction of UVCP may be due to intractable vocal habits or psychogenic factors.     

Oral breathing challenge in participants with vocal attrition.

Vocal folds undergo osmotic challenge by mouth breathing during singing, exercising, and loud speaking. Just 15 min of obligatory oral breathing, to dry the vocal folds, increases phonation threshold pressure (Pth) and expiratory vocal effort in healthy speakers (M. Sivasankar & K. Fisher, 2002). We questioned whether oral breathing is more detrimental to phonation in healthy participants with a history of temporary vocal attrition. The effects of a 15-min oral or nasal breathing challenge on Pth and perceived expiratory vocal effort were compared for participants reporting symptoms of vocal attrition (N = 18, ages 19-38 years) and normal controls (N = 20, ages 19-33 years). Post-challenge-prechallenge differences in Pth (deltaPth) and effort (deltaEffort) revealed that oral breathing, but not nasal breathing, increased Pth (p < .001 ) and effort (p < .001) at low, comfortable, and high pitch. deltaPth was significantly greater in participants with vocal attrition than in normal controls (p < .001). Nasal breathing reduced Pth for all controls but not for all participants reporting vocal attrition. deltaPth was significantly and linearly correlated with deltaEffort (rvocal attrition = .81, p < .001; rcontrol = .84, p < .001). We speculate that the greater increases in Pth in participants reporting vocal attrition may result from delayed or inadequate compensatory response to superficial laryngeal dehydration. Obligatory oral breathing may place voice users at risk for exacerbating vocal attrition. That sol layer depletion by obligatory oral breathing increased Pth and vocal effort provides support for the role of superficial hydration in maintaining ease of phonation.     

Complications of type I thyroplasty and arytenoid adduction

OBJECTIVES/HYPOTHESIS: Unilateral vocal fold paralysis resulting in glottal incompetence can cause significant morbidity attributable to impaired speech, swallowing, and ability to protect the airway. Type I thyroplasty in combination with arytenoid adduction is a proven technique for medialization of the paralyzed vocal fold but must be evaluated in light of potential complications following laryngeal framework surgery. STUDY DESIGN AND METHODS: The charts of 237 patients who underwent unilateral vocal fold medialization surgery between July 1, 1991, and August 30, 1999, at a tertiary care cancer referral center were retrospectively reviewed. RESULTS: There were 98 cases of type I thyroplasty alone and 96 cases of type I thyroplasty with arytenoid adduction. The two groups had similar patient characteristics. Mean time of surgery (45 vs. 73 min, P <.0001) and length of hospital stay (1.1 vs. 1.8 d, P <.0001) were increased when arytenoid adduction was performed. Overall improvement of symptoms was similar in both groups (93%-94%), but posterior glottic closure appeared subjectively improved when arytenoid adduction was used (P =.0054). Overall complication rates were slightly higher in the arytenoid adduction group (14% vs. 19%), primarily because of transient vocal fold edema and wound complications (9 vs. 19 cases), but the increase was not statistically significant (P =.1401). Complications warranting medical or surgical intervention occurred in 8% of cases. Two patients who underwent type I thyroplasty with arytenoid adduction required tracheotomy as a consequence of postoperative complications. The three patients who had extrusion of the implant underwent type I thyroplasty alone. CONCLUSION: Using the appropriate technique, the potential benefits of improved glottic function following type I thyroplasty with arytenoid adduction outweigh the small risk of significant complications observed.     

嗓音训练在单侧声带息肉术后嗓音恢复中的应用

目的　探讨单侧大、小声带息肉术后发声功能恢复规律和嗓音训练最佳时机。方法 选取68例武汉市第三医院耳鼻咽喉科行单侧声带息肉手术患者,根据与声带平行的息肉最大直径占同侧声带膜部1/3以下称为小声带息肉,1/3及以上为大声带息肉,分成大声带息肉组30例,小声带息肉组38例,每组随机分成嗓音训练组和禁声组;分别于术前1 d,术后3 d、7 d、2 w行嗓音障碍指数量表、嗓音声学客观参数检测。结果 大、小声带息肉嗓音训练组术后2 w总体评价低于禁声组（P <0.05）,总体评价高于对照组（P >0.05）。大声带息肉嗓音训练组患者术后3 d基频微扰、振幅微扰、嗓音障碍严重指数、最长发声时间与禁声组无统计学差异（P >0.05）,术后7 d、2 w上述指标与禁声组有统计学差异（P <0.05）。小声带息肉组嗓音训练组患者术后3 d、7 d、2 w基频微扰、振幅微扰、嗓音障碍严重指数、最长发声时间与禁声组有统计学差异（P <0.05）,术后2 w大、小声带息肉嗓音训练组与对照组差异均无统计学差异（P >0.05）。结论 单侧小声带息肉患者术后应尽早嗓音训练,单侧大声带息肉患者术后第4天开始嗓音训练更有利于嗓音功能恢复。     

Childhood apraxia of speech and multiple phonological disorders in Cairo-Egyptian Arabic speaking children: Language, speech, and oro-motor differences

Childhood apraxia of speech is a neurological childhood speech-sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits. Children with childhood apraxia of speech and those with multiple phonological disorder share some common phonological errors that can be misleading in diagnosis. This study posed a question about a possible significant difference in language, speech and non-speech oral performances between children with childhood apraxia of speech, multiple phonological disorder and normal children that can be used for a differential diagnostic purpose. 30 pre-school children between the ages of 4 and 6 years served as participants. Each of these children represented one of 3 possible subject-groups: Group 1: multiple phonological disorder; Group 2: suspected cases of childhood apraxia of speech; Group 3: control group with no communication disorder. Assessment procedures included: parent interviews; testing of non-speech oral motor skills and testing of speech skills. Data showed that children with suspected childhood apraxia of speech showed significantly lower language score only in their expressive abilities. Non-speech tasks did not identify significant differences between childhood apraxia of speech and multiple phonological disorder groups except for those which required two sequential motor performances. In speech tasks, both consonant and vowel accuracy were significantly lower and inconsistent in childhood apraxia of speech group than in the multiple phonological disorder group. Syllable number, shape and sequence accuracy differed significantly in the childhood apraxia of speech group than the other two groups. In addition, children with childhood apraxia of speech showed greater difficulty in processing prosodic features indicating a clear need to address these variables for differential diagnosis and treatment of children with childhood apraxia of speech.     

Electromyographic biofeedback training with patients exhibiting a hyperfunctional voice disorder

Baseline EMG measures of general laryngeal area muscle tension while speaking and during silence were taken from a group of 21 normal subjects and 7 subjects diagnosed through indirect laryngoscopy as having vocal nodules. In an attempt to reduce their baseline scores, the vocal nodule patients underwent 8 EMG biofeedback training sessions followed by a 2-week follow-up session. Sophisticated listeners then judged the qualities of the voices produced during the baseline and follow-up sessions. Measures of sound pressure levels for the speech samples were also taken to determine their effects on EMG scores. Results of the statistical analyses revealed that significant differences in general laryngeal area muscle tension while speaking and in silence exist between normal and pathological subjects; and that subjects with vocal nodules could significantly reduce these tension levels with EMG biofeedback training. A positive correlation was then found between the EMG measures and the judgments of voice qualities. No correlations were found between EMG measures and sound pressure levels.     

43例人工耳蜗植入患者基因检测及术后康复效果分析

目的总结川南地区43例人工耳蜗植入患者的基因突变类型，分析其人工耳蜗术后康复效果，了解两者的相关性。方法对43例耳聋患者行GJB2、SLC26A4、mtDNA 12S rRNA基因检测，有基因位点发生致病突变者为耳聋基因检测阳性，归为A组；其余为基因检测阴性，归为B组。两组患者均行单侧人工耳蜗植入术，于术前、术后3、6、12个月行听觉行为分级（categories of auditory performance,CAP）、言语可懂度分级（speech intelligibility rating,SIR）评估。结果43例患者中基因位点发生致病突变者14例（A组）；耳聋基因筛查阴性29例（B组）。A组中9例患者GJB2检测阳性，6例患者SLC26A4检测阳性，其中1例患者GJB2、SLC26A4检测结果均为阳性，两组患者术后1年内不同时间点 CAP 和SIR 评分均较术前明显提高，且评分随着术后时间的延长逐渐提高(P<0.05)，但两组患者术前及术后不同时间点CAP和SIR评分比较均无差异(P>0.05)。结论43例患者中常见致病耳聋基因为GJB2、SLC26A4，人工耳蜗植入术能有效提高患者听力及言语能力，但耳聋基因突变与人工耳蜗植入术后康复效果无明显相关性。     

The clinical features of functional dysphonia

OBJECTIVE: This report aims to study the prevalence of features of laryngeal muscle tension in a population of patients with functional dysphonia (FD) and nondysphonic control subjects. STUDY DESIGN: Prospective control-blinded, cross-sectional study. METHODS: We reported on a prospective control-blinded, cross-sectional study of the prevalence of the six features described by Van Lawrence and the six features incorporated in the Morrison-Rammage classification. A senior laryngologist and senior speech pathologist independently rated sound-free, random-sequence video laryngoscopies of 51 patients with FD and 52 nondysphonic control subjects. Assessments were made of the presence or absence of the 12 laryngoscopic features of laryngeal dysfunction, and an overall rating made of the vocal technique as "normal" or "abnormal." RESULTS: More than 60% of the control population demonstrated 1 or more of the 12 features of hyperfunction. There was no significant difference in the prevalence of the six Van Lawrence features, the six Morrison-Rammage features, or the total number of abnormal features between patients with FD and control subjects. On overall assessment, both assessors noted a high prevalence (50% and 36%, respectively) of abnormal vocal technique in the control population. There was no statistical difference in the total number of abnormal features observed between patients with FD and control subjects. Positive predictive value calculations showed that the presence of a clinical feature, at best, presented a 75% chance of correctly identifying a patient with FD and, at worst, a 50% chance. CONCLUSION: The laryngoscopy features commonly associated with FD are frequently prevalent in the nondysphonic population and fail to distinguish patients with FD from normal subjects.     

Effects of exposure to sulfur mustard on speech aerodynamics

Sulfur mustard is an alkylating agent with highly cytotoxic properties even at low exposure. It was used widely against both military and civilian population by Iraqi forces in the Iraq-Iran war (1983-1988). Although various aspects of mustard gas effects on patients with chemical injury have been relatively well characterized, its effects on speech are still evolving. We evaluated aerodynamics of speech in male patients following sulfur mustard inhalation. In a case-control study patients with chemical injuries (n=19) along with age and sex-matched healthy control group (n=20) were selected. Aerodynamic analyses were performed by using the Glasgow Airflow Measurement System (known as ST1 dysphonia). Results indicated that except mean flow rate, there were statistically significant differences in vital capacity, phonation time, phonation volume, vocal velocity index, total expired volume and phonation quotient of patients between experimental and control groups (P<0.05). This study demonstrated mustard gas can impair different parameters of speech aerodynamics. Learning outcomes: As a result of this activity, the reader will be able to describe: (1) the evaluation of air flow in relation to speech system dysfunction and efficiency; (2) the effect of sulfur mustard known as mustard gas on respiratory physiology.