Elsevier

Journal of Voice

Volume 26, Issue 5, September 2012, Pages 577-583
Journal of Voice

Prevalence of Abnormal Laryngeal Findings in Healthy Singing Teachers

https://doi.org/10.1016/j.jvoice.2012.01.002Get rights and content

Summary

Objective

To determine the prevalence of abnormal laryngeal findings during strobovideolaryngoscopy and objective voice measurement in healthy singers without significant voice complaints.

Study Design

Prospective evaluation of professional singing teachers.

Setting

A quiet room in a hotel during a convention of the National Association of Teachers of Singing.

Subjects

Seventy-two volunteers (60 females and 12 males), all of whom were trained singers without significant voice complaints.

Main Outcome Measure

Abnormalities observed on strobovideolaryngoscopy.

Secondary Outcome Measure

Abnormalities identified during acoustic analysis.

Results

Abnormalities were found during strobovideolaryngoscopy in 86.1% (62 of 72 of subjects, many of whom had more than one abnormality. For the purpose of this study, the authors defined “normal” as having no structural pathology (masses, cysts, ectasias, and so on) and a reflux finding score (RFS) of less than 7. Subjects’ evaluations were considered “abnormal” if they had at least one documented laryngeal pathology and/or an RFS  7. The most common findings were signs associated with laryngopharyngeal reflux (LPR). Subjects were also identified with prominent varicosities or ectasias, incomplete glottic closure, and structural abnormalities. LPR was observed in 72% of patients using the physical findings (arytenoid erythema and/or edema) relied on typically to establish the clinical diagnosis as well as using the RFS (16.7% in women and 25% in men). Posterior laryngeal mucosal hypertrophy was also demonstrated in 64% of the participants. Acoustic analysis of female subjects showed that shimmer, relative average perturbation, and maximum fundamental frequency differed significantly from widely used norms.

Conclusion

Laryngeal abnormalities occur commonly in asymptomatic patients. Physicians must exercise caution in establishing a causal relationship between an observed abnormality and a patient’s voice complaint. Baseline examinations of voice patients when they are healthy and asymptomatic should be encouraged to establish each individual’s “normal” condition.

Introduction

Strobovideolaryngoscopy and objective voice measures are critical in the diagnosis and management of any patient with voice complaints. Strobovideolaryngoscopy provides valuable information regarding the anatomy and function of the vocal folds, as well as supraglottic and subglottic structures. This slow-motion evaluation of the mucosal layer of the leading edge of the vocal folds helps detecting asymmetries of vibration, structural abnormalities (including vascular abnormalities), small masses, submucosal scars, and many other aberrations that cannot be seen under ordinary light. However, expert interpretation of findings is required. Some individuals without voice complaints have vocal fold abnormalities that cause no symptoms. If these are discovered during examination of a voice complaint, it is easy to conclude erroneously that they are responsible for the patient’s problem. This study was carried out to determine the prevalence of abnormal findings in a select group of vocally healthy singing teachers with no significant voice complaints.

Similarly, objective acoustic voice measures are used commonly in clinical practice. However, the normative values referenced routinely were not established on trained singers. This study evaluated acoustic measures in healthy singing teachers to determine whether their results were consistent with the normative values used in most clinical voice laboratories.

In the present study, the authors examined strobovideolaryngoscopic findings and objective voice measurement findings in 72 healthy singing teachers in an effort to help determine the prevalence and variability of occult vocal fold pathology.

Section snippets

Methods

At the 2008 Convention of the National Association of Teachers of Singing in Nashville, TN, volunteers were recruited for participation in this study after institutional review board approval had been obtained. Seventy-six healthy singing teacher participants (13 males and 63 females) completed a brief questionnaire, underwent strobovideolaryngoscopy, and provided a digital recording of speech and nonspeech utterances. All participants had no voice complaints and reported no major systemic

Results

Participants included in this study reported no voice problems that they considered significant or that the investigators could hear during speech or singing. Three participants were excluded owing to their inability to complete strobovideolaryngoscopy. Two of these were disqualified because of hyperactive gag reflex, one because the vocal folds could not be viewed clearly as a result of a prominent ω-shaped epiglottis. One participant’s data were missing from the recorded sample and not

Discussion

Abnormal findings on strobovideolaryngoscopy may be causally related to a patient’s voice complaint. However, abnormal occult laryngeal findings occur in healthy (nontreatment seeking) individuals without voice complaints. Lundy et al4 reported the incidence of laryngeal abnormalities that they found in 65 singing students at a local school of music. They reported a high incidence (73.4%) of findings suggestive of LPR in this group and 8.3% (5 students) were found to have benign vocal fold

Conclusion

Strobovideolaryngoscopy is invaluable in the diagnosis and treatment of voice disorders. However, abnormal findings are common in asymptomatic subjects. Great care must be exercised in determining whether an abnormality identified during examination is related causally to the patient’s voice complaint. Abnormal acoustic measures also are common in asymptomatic subjects. Baseline testing of healthy, asymptomatic patients can be invaluable in establishing a “normal” condition of each individual,

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