Summary
Objectives
To explore the characteristics of functional dysphonia (FD) using multimodal methods.
Methods
A total of 47 FD patients and a group of 22 normal controls were enrolled. Subjective
auditory-perceptual assessment of the voice, Voice Handicap Index (VHI) 30, acoustic
analysis, psychological scales assessment, surface electromyography (sEMG), nasal
airflow and thoracoabdominal studies were performed.
Results
FD was mostly triggered by mood changes. Patient self-evaluation was more serious
than auditory-perceptual evaluation and objective acoustic analysis. There was no
obvious organic disorder observed under laryngoscope in patients with FD, but there
were cases of glottic insufficiency and supraglottic compensation. With regards to
sEMG, nasal airflow, chest, and abdomen examination results: (1) sEMG in the normal
control group was symmetrical and stable on both sides during rest and phonation,
and nasal airflow as well as the chest and abdomen were symmetrical and regular; (2)
sEMG in the FD group showed increased recruitment of the sternocleidomastoid muscles,
the infra- and suprahyoid muscles, and the cricothyroid muscle, accompanied by prephonation
recruitment and postphonation persistence, mainly involving the infra- and suprahyoid
muscles; (3) In the FD group, there was shortened inspiratory time, increased chest
breathing amplitude, and reduced abdominal breathing, with predominantly chest breathing,
and a “breath-holding” phenomenon was observed in some patients, with a significant
increase in the number of breaths during the short text task.
Conclusions
FD occurs mainly in middle-aged women, and there are many triggers. The Hamilton Anxiety/Depression
Rating Scale scores were higher, and subjective symptoms were more serious than objective
evaluation. No obvious organic changes were seen under laryngoscope, and features
such as supraglottic compensation and glottic insufficiency were observed; muscle
tension was significantly higher than that of the normal control group, and prephonation
recruitment and postphonatory persistence were seen in some patients; the breathing
pattern was mainly chest breathing, and the times of breaths during the short text
task significantly increased. With identification of the characteristics of FD, the
therapy could be focused them.
Key Words
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REFERENCES
- Validity and reliability of surface electromyography in the assessment of primary muscle tension dysphonia.J Voice. 2017; 31: 386.e9-386.e17
- Functional dysphonia.Curr Opin Otolaryngol Head Neck Surg. 2003; 11: 144-148
- Emerging techniques in assessment and treatment of muscle tension dysphonia.Curr Opin Otolaryngol Head Neck Surg. 2017; 25: 447-452
- Effectiveness of voice therapy in functional dysphonia: where are we now?.Curr Opin Otolaryngol Head Neck Surg. 2011; 19: 160-164
- A taxonomy of voice therapy.Am J Speech Lang Pathol. 2015; 24: 101-125
- The treatment of muscle tension dysphonia: a comparison of two treatment techniques by means of an objective multiparameter approach.J Voice. 2010; 24: 294-301
- Functional dysphonia: strategies to improve patient outcomes.Patient Relat Outcome Meas. 2015; 6: 243-253
- Do standard instrumental acoustic, perceptual, and subjective voice outcomes indicate therapy success in patients with functional dysphonia?.J Voice. 2019; 33: 317-324
- Surface EMG and related measures in normal and vocally hyperfunctional speakers.J Speech Hear Disord. 1989; 54: 68-73
- EMG study of hyperkinetic phonation using surface electrodes.Folia Phoniatr (Basel). 1988; 40: 21-30
- Role of surface EMG in diagnostics and treatment of muscle tension dysphonia.Acta Otolaryngol. 1998; 118: 739-743
- Aerodynamic patterns in patients with voice disorders: a retrospective study.J Voice. 2017; 31: 545-549
- Current and emerging concepts in muscle tension dysphonia: a 30-month review.J Voice. 2005; 19: 261-267
- Emerging techniques in assessment and treatment of muscle tension dysphonia.Curr Opin Otolaryngol Head Neck Surg. 2017; 25: 447-452
- The relationship between VHI scores and specific acoustic measures of mildly disordered voice production.J Voice. 2006; 20: 308
- An examination of surface EMG for the assessment of muscle tension dysphonia.J Voice. 2013; 27: 177-186
- Randomized controlled trial of vocal function exercises on muscle tension dysphonia in Vietnamese female teachers.J Otolaryngol Head Neck Surg. 2009; 38: 261-278
- Relationship between fatigue, perfectionism, and functional dysphonia.Otolaryngol Head Neck Surg. 2011; 144: 921-926
- Personality and voice disorders: a multitrait-multidisorder analysis.J Voice. 2000; 14: 521-548
- Encouragement to increase the use of psychosocial skills in the diagnosis and therapy of patients with functional dysphonia.J Voice. 2017; 31: 132.e1-132.e7
- Electrical activity of extrinsic laryngeal muscles in subjects with and without dysphonia.J Voice. 2015; 29 (129.e9-17)
- Airway reactivity induced reversible voice dysfunction in singers.Allergy Asthma Proc. 1997; 18: 1-5
- Phonatory symptoms and acoustic findings in patients with asthma: a cross-sectional controlled study.Indian J Otolaryngol Head Neck Surg. 2017; 69: 42-46
Article info
Publication history
Published online: January 23, 2021
Accepted:
December 15,
2020
Footnotes
Funding: Beijing Municipal Administration of Hospital Clinical Medicine Development of Special Funding Support (Code. XMLX201848).
Conflict of interest: None.
Identification
Copyright
© 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
