Objective Clinicians interpret the stroboscopic examination by systematically rating several parameters or “signs.” This can be time consuming and experience dependent. The significance of each of these signs is unknown. Some signs may be redundant, whereas others may be more independent, thus reflecting a unique aspect of the exam assessment. We wanted to determine which stroboscopic signs are more independent and clinically relevant. This may lead to a more efficient and reliable method of stroboscopic exam evaluation. Study Design Retrospective. Method One hundred and eighty one consecutive adult patients with dysphonia of various pathologies were studied. Severity of dysphonia was judged, and a set of seven stroboscopic signs for each stroboscopic exam was rated by our voice team. A principal component factor analysis was performed, and the two factors that accounted for the most variance in the original rating data were determined. These two independent factors were then investigated for clinical usefulness. Results Several individual stroboscopic signs of vocal fold vibration correlated with the “Vibration Factor” (VF) (mucosal wave, amplitude, vibratory behavior, and periodicity) and the vocal fold edge correlated with the “Edge Factor” (EF). Scores for VF and EF were used to differentiate between general categories of vocal fold pathology and related to the severity of dysphonia. Severity of dysphonia correlated with the VF to a greater degree than the EF. Furthermore, these two factor scores could be accurately estimated using only three stroboscopic signs (amplitude, vibratory behavior, and edge). Conclusion The results of the study support the concept that a small set of stroboscopic ratings is an adequate representation of the information derived from the original, more comprehensive sign rating protocol. A focused rating system may provide an efficient method for stroboscopic evaluation, contributing to the differentiation of various vocal fold pathologies and correlating to clinician ratings of severity of dysphonia.

Many acoustic measures have been used to assess and track the voices of patients with voice problems. Some of these measures rely on the accurate measurement of fundamental frequency to produce reliable results. Patients with voice disorders often produce voices with considerable quasiperiodicity or aperiodicity. There are other measurements that do not depend on the accurate tracking of fundamental frequency by computing the spectrum of the sound and comparing different parts of the spectrum. The moments of the spectral distribution may also be important measurements to use in patients with voice problems. Several studies have reported good results using these measures to track treatment progress. In this study, spectral moments were used to assess the effectiveness of two treatment approaches in patients with unilateral vocal fold paralysis (UVFP). Twenty-six patients with UVFP and dysphonia (16 female and 10 male patients) were studied. Thirteen underwent surgery to improve their voice, whereas the other 13 received voice therapy. The patients were recorded at three time intervals: before the start of treatment, about 1 month after treatment has been completed, and at 3 months after treatment. They produced three types of speech material, vowels /ah/ and /oo/ and a simple sentence. The first four spectral moments (mean, standard deviation, skewness, and kurtosis) were computed from the long-term average spectrum. Severity of voice dysphonia was rated on a 11-point scale ranging from 0 (normal) to 10 (aphonic). There were no statistical differences between males and females for any of the four moments. There was also no difference between the two treatment types. There were differences among the three types of speech material for moments 1 and 3. There were also differences for moments 1, 2, and 3 for the three treatment conditions with most of the differences occurring between the pretreatment and first posttreatment condition. Severity of dysphonia decreased significantly from the pretreatment to either of the two posttreatment conditions. Spectral moments appear to be viable acoustic measurements to use to assess the effects of treatment on the voice of patients with UVFP.

Janina K. Casper, Ph.D., CCC-SLP passed away on May 15, 2008, after a lengthy battle with lung cancer. She leaves behind a legacy that few can match. In 1937, she and her family moved to the United States from Poland. She did not speak a word of English, but through hard work and determination, she mastered the language, along with every other challenge that was put before her. Janina married Max Casper, and they had two children, Michele and Jeff, both of whom have gone on to distinguish themselves in their chosen fields. She also treasured her time with her four grandchildren. Janina loved to travel with her husband Max and children, spent a year in Holland on sabbatical and traveled extensively in Europe.As a professional, Janina demanded the highest level of professionalism, knowledge, and skill both of herself and others. Over the course of many years, she continually impressed others with her dedication as a professional, her intelligence, and her work ethic. Her primary concern and goal was to provide the best possible care to her patients. Although she is most often associated with the field of voice, she also worked for many years with individuals with cleft lip & palate, as well as laryngectomy patients. She was instrumental in establishing the first multidisciplinary clinic for children and adults with cleft lip & palate and also organized the first laryngectomy treatment group in Syracuse. In the middle 1970s, Janina began her work in the field of voice, and continued to devote her intellect, clinical expertise, and research in this area for over 30 years. She was a founding member of the Syracuse Voice Center and worked with allied medical professionals throughout her career. Her thirst for knowledge resulted in her collaboration with many others on programs of research dealing with all aspects of voice. She expected the best of herself, and of others in the field to uphold the standards of excellence that she maintained. Most notably, she demanded proof and applied scientific rigor to the evaluation of new research.Janina performed evidence-based practice long before that phase became fashionable. Her skill and dedication was recognized in 2006 when she was awarded the Frank R. Kleffner Lifetime Clinical Achievement Award by the ASHA Foundation. In 2003, she retired as a Professor Emeritus. I met Janina in 1969 and for the first few years had mostly social contact with her. In the late 1970s, we began a professional relationship, working together on the voice team, research, and presentations at state and national meetings. This collaboration led to the development of the first edition of our book on voice disorders, which is now in its third edition. During the writing of this book, I came to know Janina's dedication to the pursuit of knowledge and her skills in working with patients and obtaining the best possible result. She had very definite ideas about how to diagnose and treat voice problems and never hesitated to say so. She always questioned her own knowledge and skills and developed new ideas for research projects on treatment, treatment efficacy, and long-term results. She sought solutions to the problems facing patients and professionals dealing with the voice and worked with many others in the field to advance our knowledge about the voice. She became very excited when she heard a new idea or was presented with new ways of looking at the voice. Most of all, she demanded evidence and applied scientific rigor to the evaluation of new research. Janina was very interested in the training of future Speech Language Pathologists. She taught the course in Voice Disorders at Syracuse University for many years. She mentored students in the Clinical Fellowship Year program at the Communication Disorder Unit and did her best to interest these students in voice. Those who showed an interest in the voice were taken under her wing and provided with an excellent education and experience with patients. One person who received such mentoring is Ashley Paseman, who has developed her skills with voice patients and has been involved with many research projects with Janina. She took over Janina's caseload when Janina retired from Upstate. Here are Ashley's comments.“When I relocated to Syracuse, NY it certainly wasn't the weather that drew me, but the prospect of working under the tutelage of Janina Casper. My keen interest in voice gave me the courage to approach this giant force in our field, and ask her to consider mentoring me. Although she agreed, she certainly made sure I was holding up my end of the bargain. She would consistently test, challenge, push, and encourage me until I had it ‘right.’ My experience with Janina was perhaps quite unique, as I spent several years working side-by-side with her. Once I succeeded in garnering her approval, our relationship also grew into a very special, close and familial friendship. Over the years her humor and quick wit always surfaced in the face of any clinical mishap, and would often make me laugh until my stomach hurt. Janina became a key figure in my life that guided me, and stood firmly by me through some of my biggest personal and professional challenges. Her influence has profoundly shaped me both clinically and personally, and I know that her memory and spirit will continue to live on in those of us who were privileged to have known her.” Janina K. Casper, Ph.D., CCC-SLP passed away on May 15, 2008, after a lengthy battle with lung cancer. She leaves behind a legacy that few can match. In 1937, she and her family moved to the United States from Poland. She did not speak a word of English, but through hard work and determination, she mastered the language, along with every other challenge that was put before her. Janina married Max Casper, and they had two children, Michele and Jeff, both of whom have gone on to distinguish themselves in their chosen fields. She also treasured her time with her four grandchildren. Janina loved to travel with her husband Max and children, spent a year in Holland on sabbatical and traveled extensively in Europe. As a professional, Janina demanded the highest level of professionalism, knowledge, and skill both of herself and others. Over the course of many years, she continually impressed others with her dedication as a professional, her intelligence, and her work ethic. Her primary concern and goal was to provide the best possible care to her patients. Although she is most often associated with the field of voice, she also worked for many years with individuals with cleft lip & palate, as well as laryngectomy patients. She was instrumental in establishing the first multidisciplinary clinic for children and adults with cleft lip & palate and also organized the first laryngectomy treatment group in Syracuse. In the middle 1970s, Janina began her work in the field of voice, and continued to devote her intellect, clinical expertise, and research in this area for over 30 years. She was a founding member of the Syracuse Voice Center and worked with allied medical professionals throughout her career. Her thirst for knowledge resulted in her collaboration with many others on programs of research dealing with all aspects of voice. She expected the best of herself, and of others in the field to uphold the standards of excellence that she maintained. Most notably, she demanded proof and applied scientific rigor to the evaluation of new research. Janina performed evidence-based practice long before that phase became fashionable. Her skill and dedication was recognized in 2006 when she was awarded the Frank R. Kleffner Lifetime Clinical Achievement Award by the ASHA Foundation. In 2003, she retired as a Professor Emeritus. I met Janina in 1969 and for the first few years had mostly social contact with her. In the late 1970s, we began a professional relationship, working together on the voice team, research, and presentations at state and national meetings. This collaboration led to the development of the first edition of our book on voice disorders, which is now in its third edition. During the writing of this book, I came to know Janina's dedication to the pursuit of knowledge and her skills in working with patients and obtaining the best possible result. She had very definite ideas about how to diagnose and treat voice problems and never hesitated to say so. She always questioned her own knowledge and skills and developed new ideas for research projects on treatment, treatment efficacy, and long-term results. She sought solutions to the problems facing patients and professionals dealing with the voice and worked with many others in the field to advance our knowledge about the voice. She became very excited when she heard a new idea or was presented with new ways of looking at the voice. Most of all, she demanded evidence and applied scientific rigor to the evaluation of new research. Janina was very interested in the training of future Speech Language Pathologists. She taught the course in Voice Disorders at Syracuse University for many years. She mentored students in the Clinical Fellowship Year program at the Communication Disorder Unit and did her best to interest these students in voice. Those who showed an interest in the voice were taken under her wing and provided with an excellent education and experience with patients. One person who received such mentoring is Ashley Paseman, who has developed her skills with voice patients and has been involved with many research projects with Janina. She took over Janina's caseload when Janina retired from Upstate. Here are Ashley's comments. “When I relocated to Syracuse, NY it certainly wasn't the weather that drew me, but the prospect of working under the tutelage of Janina Casper. My keen interest in voice gave me the courage to approach this giant force in our field, and ask her to consider mentoring me. Although she agreed, she certainly made sure I was holding up my end of the bargain. She would consistently test, challenge, push, and encourage me until I had it ‘right.’ My experience with Janina was perhaps quite unique, as I spent several years working side-by-side with her. Once I succeeded in garnering her approval, our relationship also grew into a very special, close and familial friendship. Over the years her humor and quick wit always surfaced in the face of any clinical mishap, and would often make me laugh until my stomach hurt. Janina became a key figure in my life that guided me, and stood firmly by me through some of my biggest personal and professional challenges. Her influence has profoundly shaped me both clinically and personally, and I know that her memory and spirit will continue to live on in those of us who were privileged to have known her.”

The present study was designed to assess the effect of head position on glottic closure as reflected in airflow rates (open quotient and maximum flow declination rate), in patients with unilateral vocal fold paralysis. Ten patients, 2 males and 8 females ranging in age from 40 to 75, with a mean age of 57.3, served as subjects. Airflow measures were taken during sustained phonation of two vowels (/i/ and /a/) in 3 head positions (center, right, left). Vowels /i/ and /a/ were produced at subject's comfortable pitch and loudness, with random ordering of both vowel order and head orientation. Subjects were trained to focus eye gaze on right and left markers (70-degree angle) and a central marker at eye level directly in front of the subject. Theoretically, if turning the head during phonation alters the laryngeal anatomic relationship by bringing the vocal folds in closer proximity to one another, then airflow rate should lessen. Our results indicate that head position does not improve glottic closure in these patients, which is in contrast to previously published research.(1) Our results question the utility and underlying theoretical construct for the use of head turning as a therapeutic technique for improvement of voice in patients with unilateral vocal fold paralysis.