Hostname: page-component-89b8bd64d-7zcd7 Total loading time: 0 Render date: 2026-05-09T06:33:22.119Z Has data issue: false hasContentIssue false
  • English
  • Français

Perceived vocal morbidity in a problem asthma clinic

Published online by Cambridge University Press:  22 July 2008

A E Stanton ,
C Sellars ,
K MacKenzie ,
A McConnachie  and
C E Bucknall
A E Stanton*
Affiliation:
Department of Respiratory Medicine, Glasgow Royal Infirmary, Scotland, UK
C Sellars
Affiliation:
Department of Speech and Language Therapy, Glasgow Royal Infirmary, Scotland, UK
K MacKenzie
Affiliation:
Department of Otolaryngology, Glasgow Royal Infirmary, Scotland, UK
A McConnachie
Affiliation:
Robertson Centre for Biostatistics, University of Glasgow, Scotland, UK
C E Bucknall
Affiliation:
Department of Respiratory Medicine, Glasgow Royal Infirmary, Scotland, UK
*
Address for correspondence: Dr Andrew Stanton, Osler Chest Unit, Churchill Hospital, Headington, Oxford OX3 7LJ, UK. Fax:  +44 1865 225221 E-mail: andrewestanton@hotmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims:

Asthma treatment has the potential to affect patients' voices. We undertook detailed characterisation of voice morbidity in patients attending a problem asthma clinic, and we determined how patients' perceptions related to objective assessment by an experienced observer.

Methods:

Forty-three patients took part in the study. Subjects completed the self-administered voice symptom score (VoiSS) questionnaire and underwent digital voice recording. These voice recordings were scored using the grade–roughness–breathiness–asthenicity–strain system (GRBAS). Laryngoscopy was also performed.

Results:

The median VoiSS was 26 (range three to 83). VoiSS were significantly lower in the 17 patients with normal laryngeal structure and function (range four to 46; median 22), compared with the 26 patients with functional or structural laryngeal abnormality (range three to 83; median 33) (95 per cent confidence intervals for difference 0.0–21.0; p = 0.044). The overall grade score for the GRBAS scale did not differ between these two groups, and only 13 patients had a GRBAS score of one or more, recognised as indicating a voice problem. There were positive correlations between related GRBAS score and voice symptom score subscales. Although voice symptom scores were significantly more abnormal in patients with structural and functional abnormalities, this score performed only moderately well as a predictive tool (sensitivity 54 per cent; specificity 71 per cent). Nevertheless, the voice symptom score performed as well as the more labour-intensive GRBAS score (sensitivity 57 per cent; specificity 60 per cent). Patients' inhaled corticosteroid dose (median dose 1000 µg beclomethasone dipropionate or equivalent) had a statistically significant relationship with their overall grade score for the GRBAS scale (r = 0.56; p < 0.001), but not with their VoiSS. Only one patient had evidence of laryngeal candidiasis, and only two had any evidence of abnormality suggesting steroid-induced myopathy.

Conclusions:

Vocal morbidity is common in patients with asthma, and should not be immediately attributed to steroid-related candidiasis. The VoiSS merits further, prospective validation as a screening tool for ENT and/or speech and language therapy referral in patients with asthma.

Keywords

AsthmaVoiceVocal QualityLaryngoscopy

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 1 , January 2009 , pp. 96 - 102
Copyright
Copyright © JLO (1984) Limited 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

Presented in abstract form to the European Respiratory Society meeting, 7 September 2004, Glasgow, Scotland, UK, and published previously as Stanton et al. Perceived vocal morbidity in a problem asthma clinic. Eur Resp J 2004;24(suppl 48):A2887.

References

1 Barnes, P. Corticosteroids. In: O'Byrne, PM, Thomson, NC, eds. Manual of Asthma Management. London: WB Saunders, 2001;173–96Google Scholar
2 Williamson, IJ, Matusiewicz, SP, Brown, PH, Greening, AP, Crompton, GK. Frequency of voice problems and cough in patients using pressurized aerosol inhaled steroid preparations. Eur Respir J 1995;8:590–2CrossRefGoogle ScholarPubMed
3 Crompton, GK, Sanderson, R, Dewar, MH, Matusiewicz, SP, Ning, AC, Jamieson, AH et al. Comparison of Pulmicort pMDI plus Nebuhaler and Pulmicort Turbuhaler in asthmatic patients with dysphonia. Respir Med 2000;94:448–53CrossRefGoogle ScholarPubMed
4 Lavy, JA, Wood, G, Rubin, JS, Harries, M. Dysphonia associated with inhaled steroids. J Voice 2000;14:581–8CrossRefGoogle ScholarPubMed
5 Wilson, JA, Deary, IJ, Millar, A, MacKenzie, K. The quality of life impact of dysphonia. Clin Otolaryngol 2002;27:179–82CrossRefGoogle ScholarPubMed
6 Baker, BM, Baker, CD, Le, HT Vocal quality, articulation and audiological characteristics of children and young adults with diagnosed allergies. Ann Otol Rhinol Laryngol 1982;91(suppl 48):277–80CrossRefGoogle Scholar
7 Carding, P. Voice pathology clinics in the UK. Clin Otolaryngol 2003;28:477–8CrossRefGoogle ScholarPubMed
8 Carding, P, Carlson, E, Epstein, R, Mathieson, L, Shewell, C. Formal perceptual evaluation of voice quality in the United Kingdom. Logoped Phoniatr Vocol 2000;25:133–8CrossRefGoogle ScholarPubMed
9 Hirano, M. Objective evaluation of the human voice: clinical aspects. Folia Phoniatr (Basel) 1989;41:89–144CrossRefGoogle ScholarPubMed
10 De Bodt, MS, Wuyts, FL, Van de Heyning, PH, Croux, C. Test-retest study of the GRBAS scale: influence of experience and professional background on perceptual rating of voice quality. J Voice 1997;11:74–80CrossRefGoogle ScholarPubMed
11 Dejonckere, PH, Obbens, C, de Moor, GM, Wieneke, GH. Perceptual evaluation of dysphonia: reliability and relevance. Folia Phoniatr (Basel) 1993;45:76–83CrossRefGoogle ScholarPubMed
12 Dejonckere, PH, Remacle, M, Fresnel-Elbaz, E, Woisard, V, Crevier, L, Millet, B. Reliability and clinical relevance of perceptual evaluation of pathological voices. Rev Laryngol Otol Rhinol (Bord) 1998;119:247–8Google ScholarPubMed
13 Webb, AL, Carding, PN, Deary, IJ, MacKenzie, K, Steen, N, Wilson, JA. The reliability of three perceptual evaluation scales for dysphonia. Eur Arch Otorhinolaryngol 2004;261:429–34CrossRefGoogle ScholarPubMed
14 Deary, IJ, Wilson, JA, Carding, PN, MacKenzie, K. VoiSS: a patient-derived voice symptom scale. J Psychosom Res 2003;54:483–9CrossRefGoogle ScholarPubMed
15 Wilson, JA, Webb, A, Carding, PN, Steen, IN, MacKenzie, K, Deary, IJ. The Voice Symptom Scale (VoiSS) and the Vocal Handicap Index (VHI): a comparison of structure and content. Clin Otolaryngol 2004;29:169–74CrossRefGoogle ScholarPubMed
16 Stanton, AE, Johnson, MK, MacKenzie, K, Carter, R, Bucknall, CE. Physiological evaluation of the upper airway in a problem asthma clinic. Eur Respir J 2004;24(suppl 48):P1712Google Scholar
17 Stanton, AE, MacKenzie, K, Carter, R, Bucknall, CE. The spectrum of upper airway problems in a problem asthma clinic – the role of the larynx. Eur Respir J 2004;24(suppl 48):P1711Google Scholar
18 Stanton, AE, McGarry, G, Carter, R, Bucknall, CE. The spectrum of upper airway problems in a problem asthma clinic – the role of the nose. Eur Respir J 2004;24(suppl 48):P1710Google Scholar
19 Fairbanks, G. Voice and Articulation Drillbook, 2nd edn. New York: Harper, 1960Google Scholar
20 De Bodt, MS, Van de Heyning, PH, Wuyts, FL, Lambrechts, L. The perceptual evaluation of voice disorders. Acta Otorhinolaryngologica Belg 1996;50:283–91Google ScholarPubMed
21 Altman, DG. Practical Statistics for Medical Research, 1st edn. London: Chapman & Hall, 1991Google Scholar
22 Ihre, E, Zetterstrom, O, Ihre, E, Hammarberg, B. Voice problems as side effects of inhaled corticosteroids in asthma patients – a prevalence study. J Voice 2004;18:403–14CrossRefGoogle ScholarPubMed
23 Millet, B, Dejonckere, PH. What determines the differences in perceptual rating of dysphonia between experienced raters? Folia Phoniatr Logop 1998;50:305–10CrossRefGoogle ScholarPubMed
24 Deary, IJ, Wilson, JA, Carding, PN, MacKenzie, K. The dysphonic voice heard by me, you and it: differential associations with personality and psychological distress. Clin Otolaryngol 2003;28:374–8CrossRefGoogle ScholarPubMed
25 Murry, T, Medrado, R, Hogikyan, ND, Aviv, JE. The relationship between ratings of voice quality and quality of life measures. J Voice 2004;18:183–92CrossRefGoogle ScholarPubMed