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  • 1.
    Hägglund, Patricia
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Sandström, Linda
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Blomstedt, Patric
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Karlsson, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Voice Tremor in Patients With Essential Tremor: Effects of Deep Brain Stimulation of Caudal Zona Incerta2016In: Journal of Voice, ISSN 0892-1997, E-ISSN 1873-4588, Vol. 30, no 2, p. 228-233Article in journal (Refereed)
    Abstract [en]

    Objectives. The present study aimed at evaluating the effect of deep brain stimulation (DBS) of the caudal zona incerta (cZi) on voice tremor in patients with essential tremor (ET). Study Design. This is a prospective nonrandomized design with consecutive patients.

    Methods. Twenty-six patients operated with cZi DBS were evaluated under two conditions: without stimulation (Stim OFF) and with stimulation (Stim ON). Voice tremor was assessed on the basis of recordings of sustained vowel productions using a four-point rating scale in a blinded and randomized procedure. Averaged values of multiple assessments for each stimulus were used in statistical testing. The group of patients with voice tremor in Stim OFF was analyzed separately from the group of patients without voice tremor.

    Results. Voice tremor was significantly reduced on stimulation compared with off for the subgroup with initial voice tremor. Voice tremor prevalence was found to be 50% (13 patients). Individual differences in voice tremor outcome were noticeable. Six of the patients with voice tremor at baseline improved substantially by cZi DBS treatment.

    Conclusions. On the group level, voice tremor in patients with ET was found to reduce when stimulating the cZi. Bilateral stimulation was indicated to be more effective in reducing voice tremor than unilateral stimulation. However, individual voice tremor outcomes suggest that not all patients benefit from cZi DBS. Severity of voice tremor at baseline may not be a good predictor of voice tremor outcome after cZi DBS. Patients should be informed before surgery regarding individual differences in response to DBS treatment.

  • 2.
    Karlsson, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Doorn, Jan van
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Letter to the Editor2012In: Journal of Voice, ISSN 0892-1997, E-ISSN 1873-4588, Vol. 26, no 5, article id 676.e1Article in journal (Other academic)
  • 3.
    Karlsson, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Malinova, Elin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Olofsson, Katarina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Blomstedt, Patric
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Linder, Jan
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Nordh, Erik
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Voice Tremor Outcomes of Subthalamic Nucleus and Zona Incerta Deep Brain Stimulation in Patients With Parkinson Disease2019In: Journal of Voice, ISSN 0892-1997, E-ISSN 1873-4588, Vol. 33, no 4, p. 545-549Article in journal (Refereed)
    Abstract [en]

    Objectives: We aimed to study the effect of deep brain stimulation (DBS) in the subthalamic nucleus (STN) and caudal zona incerta (cZi) on level of perceived voice tremor in patients with Parkinson disease (PD).

    Study Design: This is a prospective nonrandomized design with consecutive patients.

    Methods: Perceived voice tremor was assessed in patients with PD having received either STN-DBS (8 patients, 5 bilateral and 3 unilateral, aged 43.1-73.6 years; median = 61.2 years) or cZi-DBS (14 bilateral patients, aged 39.0-71.9 years; median = 56.6 years) 12 months before the assessment. Sustained vowels that were produced OFF and ON stimulation (with simultaneous L-DOPA medication) were assessed perceptually in terms of voice tremor by two raters on a four-point rating scale. The assessments were repeated five times per sample and rated in a blinded and randomized procedure.

    Results: Three out of the 22 patients (13%) were concluded to have voice tremor OFF stimulation. Patients with PD with STN-DBS showed mild levels of perceived voice tremor OFF stimulation and a group level improvement. Patients with moderate/severe perceived voice tremor and cZi-DBS showed marked improvements, but there was no overall group effect. Six patients with cZi-DBS showed small increases in perceived voice tremor severity.

    Conclusions: STN-DBS decreased perceived voice tremor on a group level. cZi-DBS decreased perceived voice tremor in patients with PD with moderate to severe preoperative levels of the symptom.

  • 4.
    Nygren, Mariana
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Tyboni, Mikaela
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Lindstrom, Fredric
    McAllister, Anita
    van Doorn, Janis
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Gender Differences in Children's Voice Use in a Day Care Environment2012In: Journal of Voice, ISSN 0892-1997, E-ISSN 1873-4588, Vol. 26, no 6, p. 817.e15-817 e18Article in journal (Refereed)
    Abstract [en]

    Background. The prevalence of dysphonia is higher in boys than in girls before puberty. This could be because of the differences in boys' and girls' voice use. Previous research on gender differences in prepubescent children's voice parameters has been contradictory. Most studies have focused on examining fundamental frequency. Objectives. The purpose of this study was to investigate voice use in boys and girls in a day care environment based on the voice parameters fundamental frequency (Hz), vocal intensity (dB SPL), and phonation time (%) and to ascertain whether there were any significant gender differences. Study Design. Prospective comparative design. Method. The study was conducted in a day care environment where 30 children (17 boys and 13 girls aged 4-5 years) participated. The participants' voices were measured continuously for 4 hours with a voice accumulator that registered fundamental frequency, vocal intensity level, phonation time, and background noise. Results. Mean (standard deviation) fundamental frequency was 310 (22) and 321 (16) Hz, vocal intensity was 93 (4) and 91 (3) dB SPL, and phonation time was 7.7 (2.0)% and 7.6 (2.5)% for boys and girls, respectively. No differences between genders were statistically significant. Conclusion. The finding of no statistically significant gender differences for measurements of voice parameters in a group of children aged 4-5 years in a day care environment is an important finding that contributes to increased knowledge about young boys' and girls' voice use.

  • 5. Opheim, Leif Runar
    et al.
    Hellman, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Engström-Laurent, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Laurent, Claude
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology. Department of Speech/Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa.
    Hyaluronan in Human Vocal Folds in Smokers and Nonsmokers: A Histochemical Study2016In: Journal of Voice, ISSN 0892-1997, E-ISSN 1873-4588, Vol. 30, no 3, p. 255-262Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES/HYPOTHESIS: To study the hyaluronan occurrence in human vocal folds, with special regards to gender and smoking and to discuss the implications of findings.

    STUDY DESIGN: This is a descriptive/morphologic study.

    METHODS: Sixteen cadaveric vocal folds from eight individuals between 58 and 90 years old (six women and two men) were removed and studied morphologically. Three of the individuals had been cigarette smokers. A direct method for hyaluronan histochemistry using a hyaluronan-binding protein probe (HABP) was used to visualize the polysaccharide. Five examiners performed an analysis of the intensities of hyaluronan staining, independently.

    RESULTS: We observed intense hyaluronan staining of the vocal folds of which those from women stained considerably stronger than those from men. Stratified squamous epithelium stained for hyaluronan in all sections, whereas respiratory epithelium only stained weakly or not at all. The highest accumulation of hyaluronan occurred subepithelially in the lamina propria, corresponding to Reinke's space. It was observed that vocal folds from smokers were more intensively stained than those from nonsmokers.

    CONCLUSIONS: Hyaluronan is found in all layers of the human vocal fold. Contradictory to earlier studies, hyaluronan was visualized in squamous epithelium, where it may function as an impact protector. The occurrence of hyaluronan in smokers may have implications in the development of vocal fold inflammation and tumor initiation as hyaluronan is an important molecule in these processes.

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