We conducted a nationwide survey of spasmodic dysphonia (SD) in Japan with the aim of revealing the epidemiological and clinical features of SD. Questionnaires were sent to 655 major otolaryngological institutions with a data disc which included representative voice samples of SD. We identified 1,534 patients over a period of 2 years. Among them, 887 (0.77 patient/100,000 population) were new patients. Prevalence of the disease in Japan was estimated to be 3.5-7.0 patients/100,000 population. The patients were predominantly 20-39 years in age (59.0%) and female in gender (1: 4.1 male/female ratio). Adductor type accounted for 93.2% of the patients. Clinical symptoms were characterized by strangled or effortful speech in the adductor type, and whispered or breathy voice quality in the abductor type. The median interval between the onset of symptoms and the first hospital visit was 3.0 years. Treatments by botulinum toxin injection into the intrinsic laryngeal muscles or type 2 thyroplasty were aggregately performed at several hospitals. This study suggested that SD is not yet fully recognized even among otolaryngologists and that diagnostic criteria and a standard therapeutic guideline need to be established.
Stuttering may be related to developmental disability or mental diseases such as social anxiety disorder. However, there are few reports about these comorbid conditions in stuttering patients in Japan. In order to comprehend the relationship between stuttering and comorbid conditions, we conducted a chart review of 39 stuttering cases who sought consultation at Keio University Hospital in 2012 and 2013. Fifteen percent of the subjects had the following comorbid psychiatric conditions: mood disorder (depression and adjustment disorder), obsessive-compulsive disorder, epilepsy and tic disorder. Eighteen percent of the subjects had developmental disability, including definite or suspected developmental disability, and language development disorder. The age at which patients with developmental disability began stuttering was higher than that in patients without such disability. These findings suggest that clinical presentation of stuttering may be affected by comorbid developmental disability.
We investigated the effect of cognitive abilities related to development on spelling of Hangul. We tested 101 Korean-speaking children for their spelling, reading and cognitive abilities (phonological awareness, visual cognition, automatization and vocabulary). Results of multiple regression analysis revealed that vocabulary and phonological awareness were significant predictors of word dictation performance. For non-word dictation performance, non-word reading was a significant predictor. We used structural equation modeling (SEM) to investigate whether cognitive abilities affected spelling by mediated reading performance or not. The results showed that word dictation and non-word reading performance contributed to non-word dictation performance. These findings suggest that multiple cognitive abilities are related to spelling performance directly and indirectly through reading performance.
The "Overall Assessment of the Speaker's Experience of Stuttering" (OASES; Yaruss & Quesal, 2006) was designed to measure comprehensively the overall experiences and impacts of stuttering, in four sections. We translated the OASES into Japanese (OASES-J) and administered it to 27 clinical patients who had no other disorders. The results showed a moderate impact of stuttering in Section 3, "Communication in Daily Situations," and moderate/severe impacts in the other three sections and the total averages. The impact ratings in all sections were significantly higher than those of the self-help group members previously reported. A cluster analysis revealed that the patients could be subdivided into two groups. One group showed moderate/severe mean impact ratings in all sections and in the total average. The other group showed the same impact rating in Section 1, "General Information," as with the other group, but moderate impact in the remaining three sections and in total. The impact ratings and certain items in Sections 3 and 4 were significantly correlated with the 3-point impression scales of stuttering severity and psychological impacts used by speech therapists. These findings demonstrate that the OASES-J provides extra information about impact of stuttering beyond what speech therapists gather during a routine assessment, and that the OASES-J also could present useful perspectives towards clinical intervention.
Adolescent voice change is generally said to be completed by around the age of 14. Here we report two cases of patients examined at our hospital who became aware of an abnormally high pitch in their voice for the first time in their twenties when indicated by third parties. Both cases had already completed puberty and showed no organic laryngeal abnormality. Although they demonstrated higher than the average normal male pitch, they had only minimal consciousness of their abnormally high voice. On first examination, we employed the Kayser-Gutzmann method, clearing of the throat, and the siren method to guide the patients' voice to a lower pitch. We next performed voice training from vocalization, at the lower pitch, of a sustained vowel through a short sentence, and autofeedback of the voice was carried out. This training was performed at a frequency of once every one to two weeks. With both patients, it was possible to lower the vocal pitch during the first training session, but achieving a lower pitch in everyday conversation took some time. These results suggest that changes in the patients' social environment at school, e.g. respect for their individuality, had delayed their consciousness of their abnormality and, as a consequence, delayed their seeking a diagnosis of their condition.
We report the case of a male first-year junior high school student, aged 13, who was close to refusing to attend school because of his stuttering and who visited our hospital in the hope of being completely cured of his stuttering. We simultaneously implemented a dual approach consisting of direct speech training and cognitive behavioral therapy based on a multidimensional model. The direct speech training primarily consisted of training in soft vocal onset, light contact of the articulators, flexible utterance speed, and training to address associated symptoms. To correct the patient's cognition, we had him prepare and use a "stuttering notebook" into which he recorded his knowledge about stuttering, self-evaluation, his target, and his utterance experiences. After 11 treatments over a period of three months, the patient's stuttering eased and he was able to enjoy his life at school and put aside thoughts of refusing to attend. These findings suggest that using a dual approach of simultaneous direct speech training and cognitive behavioral therapy based on a multidimensional model can be effectively used on junior high school students who are on the verge of refusing to attend school because of their stuttering.
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