Professional Voice Care May Reduce Vocal Disorders in Children

The vocal training and regular examinations by otolaryngologists that children who sing in choirs receive may pay off beyond voice training to benefit their overall vocal health, according to data from a recently published study that showed voice disorders were less common in a cohort of children singing in a choir compared to children who did not (JAMA Otolaryngol Head Neck Surg [published online ahead of print March 14, 2019]. doi: 10.1001/jamaoto.2019.0066).

“These findings suggest that there is a negative association between singing in a children’s choir and the presence of voice disorders,” said lead author of the study, Pedro Clarós, MD, PhD, who is with the Clarós Otorhinolaryngology Clinic in Barcelona, Spain.

The prospective cohort study was conducted to more fully examine whether an association exists between the development of vocal disorders and children who sing in a choir. According to the study authors, examination of this association in prepubescent children is lacking. To fill that gap, investigators enrolled 1,495 children (aged 8 to 14 years) from four local schools in Barcelona, Spain between October 2016 and April 2018. Of the children enrolled, 752 sang in a children’s choir and 743 children did not. Children in the choirs sang for a mean time of 7.5 hours per week for 2.5 years.

All children underwent videolaryngoscopy followed by videostroboscopy to assess the effect of singing or not singing in a choir on voice disorders (primary outcome). The study also looked at voice symptom complaints using surveys and the GRBAS (grade, roughness, breathiness, asthenia, strain) scale measurements (secondary outcomes).

The study found 12 voice disorders that were more common among the children who did not sing compared to those who did (32.4% vs 15.6%), with both functional voice disorders and organic voice disorders occurring more frequently in the non-singing children than the singing children (20.2% vs. 9.4% and 12.2% and 6.1%, respectively). Voice complaints or dysphonia were also higher in the children who did not sing in choirs compared to those who did (28.9% vs 21.0%) as reported by both the children and their parents, teachers, and choir directors. Muscle tension dysphonia (MTD) accounted for the largest difference between the two groups overall (17.2% vs. 8.4%) followed by psychogenic dysphonia (3.0% vs. 1.1%) and vocal fold nodules (7.9% vs. 4.0%).

These findings suggest that professional voice care that includes speech therapists and frequent otorhinolaryngologic examinations may be an important intervention to prevent or reduce voice disorders in children who sing in choirs, according to Dr. Clarós.

He also underscored that similar interventions to promote good voice care are important for all children, including non-singing children, particularly given the influence of good voice care over the long term on both the personal and professional lives of people. “The importance of voice care is particularly salient in children because they do not control their behavior or voice as well as adults and therefore are more vulnerable to possible voice trauma,” he said. “We believe it is crucial to introduce the same solicitude for voice in non-singing children.”

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Nimodipine May Improve Vocal Fold or Facial Motion After Injury

Is nimodipine effective for neuroprotection following cranial nerve injury?

Bottom line: Nimodipine significantly increased the odds of vocal fold motion and facial recovery after injury.

Background: Nimodipine is a calcium channel blocker that has been used to treat hypertension and vasospasm. Various otolaryngology studies suggest that nimodipine exerts a neuroprotective effect on injured neurons, but the exact mechanism remains unknown and no large, multi-institutional clinical trials exist to investigate its efficacy for treatment of various cranial nerve injuries.

Study design: Literature review of nine studies ranging in date from January 1, 1987, to October 11, 2017.

Setting: PubMed, Embase, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials, Clinical Trials.gov, WHO International Clinical Trials Registry Platform, and EU Clinical Trials Register databases.

Synopsis: Overall, nimodipine-treated patients had significantly higher odds of recovering vocal fold or facial motion compared with controls. Nimodipine efficacy on vocal fold motion recovery following recurrent laryngeal nerve (RLN) injury was assessed in three studies; nimodipine treatment was associated with a statistically significant increase in odds of vocal fold motion recovery at three to six months after RLN injury. Nimodipine efficacy on facial motion recovery following facial nerve injury was assessed in three studies; nimodipine treatment was associated with a statistically significant moderate increase in odds of facial motion recovery at six to 12 months after vestibular schwannoma surgery. The effect of nimodipine on symptoms relating to the cochleovestibular nerve was investigated in three trials, which showed general improvement of patient-reported symptoms of subjective tinnitus and vertigo; study methodology and outcome measures were too heterogeneous to be combined for meta-analysis, however. Of the nine studies, five reported on adverse events associated with nimodipine treatment, with the most common being drowsiness and dizziness, likely secondary to hypotension. Limitations included heterogeneity of some of the studies related to the cochleovestibular nerve.

Citation: Lin RJ, Klein-Fedyshin M, Rosen CA. Nimodipine improves vocal fold and facial motion recovery after injury: a systematic review and meta-analysis.
Laryngoscope. 2019;129:943–951.

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