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Abstract
Objectives/HypothesesThe objectives of this study were to determine appropriate acoustic and outcome measures for the evaluation of a method of laryngeal manual therapy (LMT) used in the treatment of patients with muscle tension dysphonia (MTD). The effects of this technique was also investigated. The study was based on the hypotheses that the vertical position of the larynx in the vocal tract would lower, that the quality of the voice would normalize, and that a reduction in any vocal tract discomfort would occur following LMT.
Study designThis was a small, prospective, repeated measures pilot study in which each member of the research team was 'blinded' to all other stages of the study and during which all data were anonymized until the final stage of data analysis.
MethodsTen subjects presenting with MTD completed outcome measures and provided audiorecordings immediately before, immediately after and one week after LMT. The Kay CSL 4150 was used for acoustic and spectrographic measurements. A new perceptual, self-rating scale, the Vocal Tract Discomfort Scale, and a new proforma for use by the clinician for palpatory evaluation, were developed for the study.
ResultsRelative average perturbation during connected speech was significantly reduced following LMT, indicating a reduction in abnormal vocal function. The severity and frequency of vocal tract discomfort was shown to have reduced following LMT.
ConclusionsThis pilot study showed positive evidence for laryngeal manual therapy as a method of therapy in the treatment of hyperfunctional voice disorders. Its effects were shown to be measurable with both acoustical analysis and the Vocal Tract Discomfort scale.
\s=b\The treatment of mucoceles by the Lynch-Howarth frontoethmoidectomy has been criticized because of a high rate of recurrence and postoperative complications. The long-term results in 60 patients treated by this method are examined to evaluate these criticisms. Compared with the osteoplastic flap\p=n-\obliterativeproce-dure, our results suggest a much lower recurrence rate (4%) and considerably better cosmesis with frontoethmoidectomy. This is achieved by the use of a fenestrated Silastic drainage tube left in place for five months and careful positioning of the scar. The criticisms would appear to be unjustified, and these results lend support to the continued use of the Lynch-Howarth procedure in the treatment of frontoethmoidal mucoceles.
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 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.
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