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Veselinović M, Škrbić R, Mumović G, Dragičević D, Despić D, Milankov V. Voice Improvement after Voice Therapy in Female Patients with Unilateral Vocal Fold Paralysis after Thyroid Surgery. Folia Phoniatr Logop 2023; 75:265-272. [PMID: 36746136 DOI: 10.1159/000529573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Dysphonic voice is present in patients with unilateral vocal fold paralysis (UVFP). The aim of this study was to present outcomes following rehabilitation of patients with UVFP, performed according to a voice therapy protocol. METHODS This prospective study comprised 27 women with UVFP who underwent pre- and post-voice therapy assessment. The mean age of patients was 53.19 ± 10.06 years. The protocol included the following: (1) multidimensional assessment of voice quality before treatment; (2) digital laryngeal manipulation voice therapy; (3) voice therapy evaluation which implied repeated multidimensional assessment of voice. RESULTS The results showed improvement in voice quality following voice therapy with regard to the parameters of the objective voice analysis (maximum fundamental frequency of voice, minimum intensity of voice, jitter, shimmer, harmonics-to-noise ratio, and signal-to-noise ratio, p ˂ 0.05), maximum phonation time, subjective analysis of voice, as well as self-assessment of voice quality on all the subscales and overall score (p ˂ 0.001). CONCLUSION Implementing a protocol provides clear guidelines at each stage of the treatment. Voice therapy performed using digital laryngeal manipulation improves the majority of the acoustic and perceptual characteristics of the voice.
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Affiliation(s)
- Mila Veselinović
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- The Clinic for Otorhinolaryngology and Head and Neck Surgery, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Renata Škrbić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Gordana Mumović
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Danijela Dragičević
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- The Clinic for Otorhinolaryngology and Head and Neck Surgery, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Dajana Despić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Vesela Milankov
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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Revelli L, Gallucci P, Marchese MR, Voloudakis N, Di Lorenzo S, Montuori C, D'Alatri L, Pennestri F, De Crea C, Raffaelli M. Is There Any Reliable Predictor of Functional Recovery Following Post-thyroidectomy Vocal Fold Paralysis? World J Surg 2023; 47:429-436. [PMID: 36222871 DOI: 10.1007/s00268-022-06765-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Predicting definitive outcomes of post-thyroidectomy vocal fold paralysis (VFP) is challenging. We aimed to identify reliable predictors based on intraoperative neuromonitoring (IONM) and flexible fiberoptic laryngostroboscopy (FFL) findings. METHODS Among 1172 thyroid operations performed from April to December 2021, all patients who exhibited vocal fold paralysis (VFP) at post-operative laryngoscopy were included. IONM data, including type of loss of signal (LOS), were collected. Patients underwent FFL, with arytenoid motility assessment, at 15, 45 and 120 days post-operatively. Patients were divided into two groups: those who recovered vocal fold motility (VFM) by the 120th post-operative day (recovery group) and those who did not (non-recovery group). RESULTS Fifty-nine VFP cases (5.0% of total patients) met the inclusion criteria. Eight patients were lost at follow-up and were excluded. Overall, 9 patients were included in the non-recovery group (0.8% of total patients) and 42 in the recovery group. Among various predictive factors, only arytenoid fixation (AF) at the 15th post-operative day and Type I LOS were significant predictors for no VFM recovery (p = 0.007, RR = 9.739, CI:1.3-72.3 and p = 0.001, RR = 9.25, CI:2.2-39.3 for AF and Type I injury, respectively). The combination of type of LOS and arytenoid motility at the 15th post-op day yielded satisfactory predictive values for the progression of transient VFP to permanent. CONCLUSIONS Arytenoid motility at the 15th post-op day and type II LOS are associated with recovery of VFM. Type of LOS and FFL could be included in the follow-up protocols of patients with VFP to reliably predict clinical outcomes.
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Affiliation(s)
- Luca Revelli
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Pierpaolo Gallucci
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Maria Raffaella Marchese
- UOC Otorinolaringoiatria, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Nikolaos Voloudakis
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy.
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Sofia Di Lorenzo
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Claudio Montuori
- UOC Otorinolaringoiatria, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lucia D'Alatri
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Otorinolaringoiatria, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Pennestri
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Carmela De Crea
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Marco Raffaelli
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
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Kruse E, Döllinger M, Schützenberger A, Kist AM. GlottisNetV2: Temporal Glottal Midline Detection Using Deep Convolutional Neural Networks. IEEE J Transl Eng Health Med 2023; 11:137-144. [PMID: 36816097 PMCID: PMC9933989 DOI: 10.1109/jtehm.2023.3237859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/27/2022] [Accepted: 01/04/2023] [Indexed: 11/26/2023]
Abstract
High-speed videoendoscopy is a major tool for quantitative laryngology. Glottis segmentation and glottal midline detection are crucial for computing vocal fold-specific, quantitative parameters. However, fully automated solutions show limited clinical applicability. Especially unbiased glottal midline detection remains a challenging problem. We developed a multitask deep neural network for glottis segmentation and glottal midline detection. We used techniques from pose estimation to estimate the anterior and posterior points in endoscopy images. Neural networks were set up in TensorFlow/Keras and trained and evaluated with the BAGLS dataset. We found that a dual decoder deep neural network termed GlottisNetV2 outperforms the previously proposed GlottisNet in terms of MAPE on the test dataset (1.85% to 6.3%) while converging faster. Using various hyperparameter tunings, we allow fast and directed training. Using temporal variant data on an additional data set designed for this task, we can improve the median prediction accuracy from 2.1% to 1.76% when using 12 consecutive frames and additional temporal filtering. We found that temporal glottal midline detection using a dual decoder architecture together with keypoint estimation allows accurate midline prediction. We show that our proposed architecture allows stable and reliable glottal midline predictions ready for clinical use and analysis of symmetry measures.
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Affiliation(s)
- Elina Kruse
- Department Artificial Intelligence in Biomedical EngineeringFriedrich-Alexander-University Erlangen–Nürnberg (FAU)91052ErlangenGermany
| | - Michael Döllinger
- Division of Phoniatrics and Pediatric AudiologyDepartment of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital Erlangen, Friedrich-Alexander-University Erlangen–Nürnberg (FAU)91054ErlangenGermany
| | - Anne Schützenberger
- Division of Phoniatrics and Pediatric AudiologyDepartment of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital Erlangen, Friedrich-Alexander-University Erlangen–Nürnberg (FAU)91054ErlangenGermany
| | - Andreas M. Kist
- Department Artificial Intelligence in Biomedical EngineeringFriedrich-Alexander-University Erlangen–Nürnberg (FAU)91052ErlangenGermany
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104
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Kissel I, Van Lierde K, D'haeseleer E, Adriaansen A, Papeleu T, Tomassen P, Marie JP, Meerschman I. Longitudinal Vocal Outcomes and Voice-Related Quality of Life After Selective Bilateral Laryngeal Reinnervation: A Case Study. J Speech Lang Hear Res 2023; 66:1-15. [PMID: 36603545 DOI: 10.1044/2022_jslhr-22-00398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Bilateral vocal fold paralysis (BVFP) is a severe disorder that can result in respiratory, swallowing, and voice-related problems. Most surgical treatments do not restore laryngeal function and often need to compromise voice quality to preserve respiratory function. Laryngeal reinnervation (LR) may offer a solution to this problem, but literature on longitudinal outcomes of this procedure is scarce. This study aims to report the longitudinal vocal outcomes of BVFP after LR and subsequent voice therapy. METHOD The case of a 23-year-old man with BVFP after a traumatic dissection of both recurrent laryngeal nerves is described. Selective bilateral LR of both adductors and abductors was performed 5 months after the onset of BVFP. Voice therapy was provided after the LR procedure. Multidimensional voice assessments, including acoustic, perceptual, and patient-reported outcome measures (PROMs), were conducted 2, 5, 6.5, 8, and 31 months after LR. RESULTS An improvement of vocal capabilities and voice quality was noticed 6.5 months after LR, after 4.5 months of voice therapy, with normative values after 2.5 years. PROMs showed an improvement of voice-related quality of life, but some limitations to activities of daily living were still present. Inspiratory arytenoid abduction was not observed on laryngeal videostroboscopic findings in this patient, but tracheostomy was not required. CONCLUSIONS Voice therapy after LR helps establish healthy and efficient voice use without increasing compensatory hyperfunctional behavior. More research is needed to examine potential merits of voice therapy in the rehabilitation of vocal and respiratory functions after LR.
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Affiliation(s)
- Imke Kissel
- Centre for Speech and Language Sciences, Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Kristiane Van Lierde
- Centre for Speech and Language Sciences, Department of Rehabilitation Sciences, Ghent University, Belgium
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, South Africa
| | - Evelien D'haeseleer
- Centre for Speech and Language Sciences, Department of Rehabilitation Sciences, Ghent University, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Belgium
- Musical Department, Royal Conservatory of Brussels, Belgium
| | - Anke Adriaansen
- Centre for Speech and Language Sciences, Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Tine Papeleu
- Centre for Speech and Language Sciences, Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Peter Tomassen
- Department of Head and Neck Surgery, Ghent University Hospital, Belgium
| | - Jean-Paul Marie
- Department of Otorhinolaryngology-Head and Neck Surgery, Rouen University Hospital, France
| | - Iris Meerschman
- Centre for Speech and Language Sciences, Department of Rehabilitation Sciences, Ghent University, Belgium
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105
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Ikuma T, McWhorter AJ, Adkins L, Kunduk M. Investigation of Vocal Bifurcations and Voice Patterns Induced by Asymmetry of Pathological Vocal Folds. J Speech Lang Hear Res 2023; 66:48-60. [PMID: 36472934 DOI: 10.1044/2022_jslhr-21-00499] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Vocal fold asymmetry creates irregular entrainments and modulations in voice, which may lead to rough perceptual quality. The presence of asymmetry can also cause mid-phonation bifurcations where a small change in the phonatory system causes a drastic change in vibration pattern, resulting in transitions in and out of rough voice. This study surveys sustained phonation recordings of speakers with the diagnoses of vocal fold polyp or unilateral vocal fold paralysis to investigate the resulting voice patterns. METHOD This retrospective study observed 71 sustained phonation recordings from 48 patients. Segments with distinctive signal patterns were identified within each recording with narrowband spectrogram and computer-assisted analysis of spectral peaks. RESULTS Phonation segmentation yielded 240 segments across all the recordings. Five voice patterns were recognized: (regularly or irregularly) entrained, modulated, uncoupled, unstable, and pulsed. Thirty-six patients (75%) exhibited irregular patterns. No single irregular pattern lasted for the entire phonation and was always accompanied by at least one mid-phonation bifurcation. Durations of the irregular segments (M = 0.4 s) were significantly shorter than the segments with the regular pattern (M = 1.4 s). CONCLUSIONS The results suggest that vocal fold pathology frequently introduces dynamic vibratory patterns that affect both the acoustic signals and perceptions. Due to these abnormalities, it is important for clinical voice assessment protocols, both perceptual and acoustic, to account for these possible bifurcations, irregular signal patterns, and their tendencies.
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Affiliation(s)
- Takeshi Ikuma
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans
- Voice Center, The Our Lady of the Lake Regional Medical Center, Baton Rouge, LA
| | - Andrew J McWhorter
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans
- Voice Center, The Our Lady of the Lake Regional Medical Center, Baton Rouge, LA
| | - Lacey Adkins
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans
- Voice Center, The Our Lady of the Lake Regional Medical Center, Baton Rouge, LA
| | - Melda Kunduk
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans
- Voice Center, The Our Lady of the Lake Regional Medical Center, Baton Rouge, LA
- Department of Communication Sciences & Disorders, Louisiana State University, Baton Rouge
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106
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Motie-Shirazi M, Zañartu M, Peterson SD, Mehta DD, Hillman RE, Erath BD. Effect of nodule size and stiffness on phonation threshold and collision pressures in a synthetic hemilaryngeal vocal fold model. J Acoust Soc Am 2023; 153:654. [PMID: 36732229 PMCID: PMC9884154 DOI: 10.1121/10.0016997] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 12/19/2022] [Accepted: 01/06/2023] [Indexed: 06/18/2023]
Abstract
Synthetic vocal fold (VF) replicas were used to explore the role of nodule size and stiffness on kinematic, aerodynamic, and acoustic measures of voiced speech production. Emphasis was placed on determining how changes in collision pressure may contribute to the development of phonotrauma. This was performed by adding spherical beads with different sizes and moduli of elasticity at the middle of the medial surface of synthetic silicone VF models, representing nodules of varying size and stiffness. The VF models were incorporated into a hemilaryngeal flow facility. For each case, self-sustained oscillations were investigated at the phonation threshold pressure. It was found that increasing the nodule diameter increased the open quotient, phonation threshold pressure, and phonation threshold flow rate. However, these values did not change considerably as a function of the modulus of elasticity of the nodule. Nevertheless, the ratio of collision pressure to subglottal pressure increased significantly for both increasing nodule size and stiffness. This suggests that over time, both growth in size and fibrosis of nodules will lead to an increasing cycle of compensatory vocal hyperfunction that accelerates phonotrauma.
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Affiliation(s)
- Mohsen Motie-Shirazi
- Department of Mechanical and Aerospace Engineering, Clarkson University, Potsdam, New York 13699, USA
| | - Matías Zañartu
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso, Chile
| | - Sean D Peterson
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Daryush D Mehta
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Robert E Hillman
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Byron D Erath
- Department of Mechanical and Aerospace Engineering, Clarkson University, Potsdam, New York 13699, USA
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107
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Koh JH, Ruane LE, Phyland D, Hamza K, Fukusho R, Leahy E, Avram A, Yap G, Lau KK, MacDonald MI, Leong P, Baxter M, Bardin PG. Computed Tomography Imaging of the Larynx for Diagnosis of Vocal Cord Dysfunction. NEJM Evid 2023; 2:EVIDoa2200183. [PMID: 38320086 DOI: 10.1056/evidoa2200183] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Larynx CT for Vocal Cord Dysfunction DiagnosisThis study compared VCD diagnosis using CT imaging of the larynx with laryngoscopy (diagnostic standard). In one, CT imaging and laryngoscopy were performed on the same day; in the other, diagnostic studies were 4 to 6 weeks apart. A negative CT imaging result had a negative predictive value for VCD greater than 80% when positive population prevalence was 30%.
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Affiliation(s)
- Joo H Koh
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, Victoria, Australia
- Ear, Nose, and Throat Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Laurence E Ruane
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, Victoria, Australia
- Hudson Institute and School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Debra Phyland
- Ear, Nose, and Throat Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Kais Hamza
- School of Mathematical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Risa Fukusho
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, Victoria, Australia
| | - Elizabeth Leahy
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, Victoria, Australia
| | - Adriana Avram
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, Victoria, Australia
| | - Grace Yap
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, Victoria, Australia
| | - Kenneth K Lau
- Diagnostic Imaging, Monash Health and University, Melbourne, Victoria, Australia
| | - Martin I MacDonald
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, Victoria, Australia
- Hudson Institute and School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Paul Leong
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, Victoria, Australia
- Hudson Institute and School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Malcolm Baxter
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, Victoria, Australia
- Ear, Nose, and Throat Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Philip G Bardin
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, Victoria, Australia
- Hudson Institute and School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
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108
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Dehqan A. Outcomes of Cricothyroid Visor Maneuver (CVM) for Treatment of Vocal Polyp: A Case Report. J Voice 2023; 37:144.e1-144.e7. [PMID: 33199079 DOI: 10.1016/j.jvoice.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of the study is the clinical investigation of a patient with a vocal fold polyp, and the visual, acoustical, perceptual, and self-report changes before and after using the cricothyroid visor manoeuvre (CVM). DESIGN A 48-year-old female university professor, gynecologist, and obstetrician with a history of laryngopharyngeal reflux and a left vocal polyp participated. Treatment was provided in 10 sessions. Pre- and post-treatment audio recordings of sustained vowels, selected sentences, and connected speech samples were submitted to auditory-perceptual and acoustical analysis to assess the effects of the two-treatment program. Also, laryngoscopic images, perceptions by the patient about her voice quality and quality of life before and after therapy were assessed. RESULTS Improvements in acoustic parameters were obtained especially in perturbation and CCPS parameters. The overall voice quality scores on the CAPE-V were moderate before therapy and became mild after therapy. Laryngoscopy images demonstrated improvement in the glottis closure configuration in two phases (open and close) in pre- and post- CVM therapy and a decrease in polyp size. The patient had improvement in VAS, IVQLP, and VRQOL scores. CONCLUSION The CVM therapy used in the study resulted in positive changes in acoustic and perceptual-auditory aspects of voice production, self-report, and QOL for the patient. The CVM approach appears to have been effective for this case in decreasing the polyp size or its regression or for vocal adaptation.
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Affiliation(s)
- Ali Dehqan
- Cellular and Molecular Research Center, Zahedan University of Medical Sciences, Zahedan, Iran; Department of Speech therapy, School of Rehabilitation, Zahedan University of Medical Sciences, Zahedan, Iran.
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Yousef AM, Deliyski DD, Zacharias SRC, de Alarcon A, Orlikoff RF, Naghibolhosseini M. Spatial Segmentation for Laryngeal High-Speed Videoendoscopy in Connected Speech. J Voice 2023; 37:26-36. [PMID: 33257208 PMCID: PMC8411982 DOI: 10.1016/j.jvoice.2020.10.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/11/2020] [Accepted: 10/23/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study proposes a new computational framework for automated spatial segmentation of the vocal fold edges in high-speed videoendoscopy (HSV) data during connected speech. This spatio-temporal analytic representation of the vocal folds enables the HSV-based measurement of the glottal area waveform and other vibratory characteristics in the context of running speech. METHODS HSV data were obtained from a vocally normal adult during production of the "Rainbow Passage." An algorithm based on an active contour modeling approach was developed for the analysis of HSV data. The algorithm was applied on a series of HSV kymograms at different intersections of the vocal folds to detect the edges of the vibrating vocal folds across the frames. This edge detection method follows a set of deformation rules for the active contours to capture the edges of the vocal folds through an energy optimization procedure. The detected edges in the kymograms were then registered back to the HSV frames. Subsequently, the glottal area waveform was calculated based on the area of the glottis enclosed by the vocal fold edges in each frame. RESULTS The developed algorithm successfully captured the edges of the vocal folds in the HSV kymograms. This method led to an automated measurement of the glottal area waveform from the HSV frames during vocalizations in connected speech. CONCLUSION The proposed algorithm serves as an automated method for spatial segmentation of the vocal folds in HSV data in connected speech. This study is one of the initial steps toward developing HSV-based measures to study vocal fold vibratory characteristics and voice production mechanisms in norm and disorder in the context of connected speech.
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Affiliation(s)
- Ahmed M Yousef
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
| | - Dimitar D Deliyski
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
| | - Stephanie R C Zacharias
- Head and Neck Regenerative Medicine Program, Center for Regenerative Medicine, Mayo Clinic, Scottsdale, Arizona; Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Otolaryngology Head and Neck Surgery, University of Cincinnati, Ohio
| | - Robert F Orlikoff
- College of Allied Health Sciences, East Carolina University, Greenville, North Carolina
| | - Maryam Naghibolhosseini
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan.
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110
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Basar G, Kaleoglu Aslan O, Surmeli M. Relationship between dysphonia and anxiety in fibromyalgia syndrome. Eur Arch Otorhinolaryngol 2023; 280:285-288. [PMID: 35943596 DOI: 10.1007/s00405-022-07555-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/11/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Our aim in conducting this study is to determine the relationship dysphonia and anxiety in patients with fibromyalgia syndrome (FS). METHODS Between April 2021 and June 2021, 25 FS diagnosed patients (22 females, 3 males; mean age: 45.36 ± 7.68 years; range 27-65 years), and, for the control group, 25 healthy volunteers (20 females, 5 males; mean age: 42.60 ± 9.98 years; range 29-62 years) with similar demographic features were included in the study. Visual Analog Scale (VAS), Beck Anxiety Questionary (BAQ), and voice analyses were evaluated for all the participants. Acoustic parameters (AP), such as F0 (Hz), jitter (%), shimmer (%), and Maximum Phonation Time (MPT), were measured for dysphonia. The correlation between MPT and BAQ was evaluated. RESULTS The demographic characteristics of the groups did not differ statistically significantly (p > 0.05). VAS and BAQ scores were statistically significantly higher in the FS group than healthy individuals. In the assessment of sound, there was no significant difference between F0 and jitteriness between the two groups. While shimmer scores were significantly higher in the FS group, MPT scores were statistically significantly higher in healthy individuals. CONCLUSIONS In our study, we observed that FS patients had statistically significantly higher BAQ, VAS scores compared to the control group. The shimmer of voice was increased and MPT values were decreased statistically significantly in FS patients. This says that there may be weakness in the laryngeal muscles affecting the vocal cord and thus voice quality. In addition to this, increased anxiety in FS patients may be associated with dysphonia. There is need for more controlled studies with increased number of patients to investigate the dysphonia in FS patients.
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Affiliation(s)
- Gokhan Basar
- Physical Medicine and Rehabilitation Department, Health Science University, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Ozlem Kaleoglu Aslan
- Physical Medicine and Rehabilitation Department, Health Science University, Umraniye Training and Research Hospital, Istanbul, Turkey.
| | - Mehmet Surmeli
- Department of Otolaryngology, Head and Neck Surgery Department, Health Science University, Umraniye Training and Research Hospital, Istanbul, Turkey
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111
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Martinez JD, Easwaran M, Ramirez D, Erickson-DiRenzo E. Effects of Electronic (E)-cigarette Vapor and Cigarette Smoke in Cultured Vocal Fold Fibroblasts. Laryngoscope 2023; 133:139-146. [PMID: 35213064 DOI: 10.1002/lary.30073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/14/2022] [Accepted: 02/14/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The public use of electronic-cigarettes (e-cigs) is rapidly growing. When heated, e-cigs produce a vapor that is inhaled. The vocal folds are among the first tissues exposed to this insult. However, the impact of e-cigs on vocal fold health is almost entirely unknown. Our objective was to evaluate the effects of e-cig vapor on cultured human vocal fold fibroblasts (hVFFs), the primary cell type of the lamina propria. We compared the cellular effects of e-cig vapor without and with nicotine and conventional cigarette smoke. STUDY DESIGN In vitro. METHODS E-cig vapor extract (EVE) and cigarette smoke extract (CSE) were created by bubbling vapor and smoke, respectively, into the cell culture medium. hVFFs were exposed to EVE without or with nicotine or CSE for 24 hours. Untreated cells were used as a control group. Cells were harvested, and cytotoxicity, extracellular matrix and inflammatory gene expression, and DNA damage were assessed. RESULTS Undiluted EVE without and with nicotine reduced the viability of hVFFs to a cytotoxic level. CSE reduced hVFFs viability to a greater extent than EVE and induced DNA damage as measured by DNA double-strand breaks. No changes in gene expression were observed following EVE or CSE exposure. CONCLUSION EVE induces cytotoxicity in hVFFs. However, cellular responses were greater following exposure to CSE, suggesting cigarette smoke may induce more harm, at least in the short term. Findings from this investigation improve our understanding of responses of hVFFs to e-cigs and form the basis for an in vitro methodology to study the vocal fold responses to these products. LEVEL OF EVIDENCE NA Laryngoscope, 133:139-146, 2023.
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Affiliation(s)
- Joshua D Martinez
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Meena Easwaran
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Daniel Ramirez
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Elizabeth Erickson-DiRenzo
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
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112
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Komina EI, Alkhasov AB, Rusetsky YY, Latysheva EN. [Surgical treatment of postintubation stenosis of the larynx in children]. Vestn Otorinolaringol 2023; 88:50-55. [PMID: 37450391 DOI: 10.17116/otorino20228803150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Post-intubation laryngeal stenosis is the most common cause of upper respiratory obstruction in children. According to published data, the incidence of post-intubation stenosis ranges from 0.1 to 20%. Treatment of children with chronic laryngeal stenosis is a special branch of respiratory surgery. It remains one of the most complex and urgent problems in pediatrics, pediatric otorhinolaryngology, and pediatric surgery. Although numerous studies have described various methods for treating stenosis of the infraglottic space, there is no standard management approach. Currently, there are two main treatment methods: endoscopic interventions and open reconstructive surgery. Each method has its benefits and drawbacks. Despite the use of various techniques, the effectiveness of cicatricial laryngeal stenosis repair and decannulation in children is 63-64%, according to published data. With combined lesions of infraglottic and vocal cord parts of the larynx, especially with their cicatricial obliteration, reconstructive surgery is successful only in 50% of cases. Thus, treating children with post-intubation respiratory stenosis remains a complex problem and is a relevant direction for further research.
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Affiliation(s)
- E I Komina
- National Medical Research Center for Children's Health, Moscow, Russia
| | - A B Alkhasov
- National Medical Research Center for Children's Health, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Yu Yu Rusetsky
- National Medical Research Center for Children's Health, Moscow, Russia
- Central State Medical Academy of the Department of Presidential Affairs of the Russian Federation, Moscow, Russia
| | - E N Latysheva
- National Medical Research Center for Children's Health, Moscow, Russia
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113
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Melhorn J, Thomas J, Pavord ID. Take a Deep Breath - Time to Plunge into Inducible Laryngeal Obstruction. NEJM Evid 2023; 2:EVIDe2200299. [PMID: 38320096 DOI: 10.1056/evide2200299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Inducible laryngeal obstruction (ILO)/vocal cord dysfunction is frequently encountered in the specialist asthma clinic, where it is often misdiagnosed as asthma or is coexistent with asthma. It causes recurrent distressing episodes of acute dyspnea that can lead to hospital admissions, endotracheal intubation, and fruitless asthma treatment escalation, often including oral glucocorticoids.1-4 Early diagnosis and treatment of ILO offers the prospect of connecting patients with an effective speech- and language-based intervention earlier and avoiding these unnecessary and potentially harmful interventions.
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Affiliation(s)
- James Melhorn
- Respiratory Medicine Unit and Oxford Respiratory National Institute for Health and Care Research Biomedical Research Centre, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Jordan Thomas
- Respiratory Medicine Unit and Oxford Respiratory National Institute for Health and Care Research Biomedical Research Centre, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Ian D Pavord
- Respiratory Medicine Unit and Oxford Respiratory National Institute for Health and Care Research Biomedical Research Centre, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
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114
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Leong P, Vertigan AE, Hew M, Baxter M, Phyland D, Hull JH, Carroll TL, Gibson PG, McDonald VM, Bardin PG. Diagnosis of vocal cord dysfunction / inducible laryngeal obstruction-A Delphi study protocol. PLoS One 2022; 17:e0279338. [PMID: 36580467 PMCID: PMC9799289 DOI: 10.1371/journal.pone.0279338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 12/05/2022] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Currently there is no consistent and widely accepted approach to the diagnosis of vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO). Harmonised diagnostic methods are vital to enable optimal diagnosis, advance management and enable research. We aim to obtain consensus on how expert clinicians recognise and diagnose VCD/ILO. METHODS AND ANALYSIS Two-round modified Delphi, with workshop validation. ETHICS AND DISSEMINATION Institutional Board Review was obtained from the Monash Health Human Research Ethics Committee. The dissemination plan is for presentation and publication. REGISTRATION DETAILS Registered at Australia and New Zealand Clinical Trials Registry ACTRN12621001520820p.
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Affiliation(s)
- Paul Leong
- Monash Health, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
- * E-mail:
| | - Anne E. Vertigan
- John Hunter Hospital, Newcastle, Australia
- Centre of Excellence in Treatable Traits, University of Newcastle, Newcastle, Australia
| | - Mark Hew
- Monash University, Melbourne, Victoria, Australia
- Alfred Hospital, Melbourne, Victoria, Australia
| | - Malcolm Baxter
- Monash Health, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Debra Phyland
- Monash Health, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | | | - Thomas L. Carroll
- Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Peter G. Gibson
- John Hunter Hospital, Newcastle, Australia
- Centre of Excellence in Treatable Traits, University of Newcastle, Newcastle, Australia
| | - Vanessa M. McDonald
- John Hunter Hospital, Newcastle, Australia
- Centre of Excellence in Treatable Traits, University of Newcastle, Newcastle, Australia
| | - Philip G. Bardin
- Monash Health, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
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Lauridsen UM, Schultz JDJH, Nyhus CH, Sørensen JR. [Not Available]. Ugeskr Laeger 2022; 184:V05220332. [PMID: 36426831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Injection augmentation of the vocal cords is a recognized treatment modality in patients with glottal closure deficiency caused by paresis or paralysis of the vocal cord. The treatment can improve voice quality and also quality of life. It is preferable to minimize waiting time for the procedure for patients with lung cancer and mediastinal involvement, because the one-year mortality is above 40%, as argued in this review.
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116
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Abstract
PURPOSE Voice therapy is the primary treatment for children presenting with benign morphological vocal fold changes. This study examined the number of voice therapy sessions required to meet treatment goals and identified factors that predicted treatment length for pediatric voice patients. METHOD An observational cohort design was employed. Data were extracted from the University of Wisconsin-Madison Voice and Swallow Outcome Database. This study examined 62 children who completed a course of voice therapy with a speech-language pathologist (SLP) addressing dysphonia caused by benign vocal fold lesions. Extracted data included patient demographics, auditory-perceptual assessments, acoustic and aerodynamic voice measures, videostroboscopy ratings, and medical comorbidities. Linear regression was used to identify predictors of number of therapy sessions. RESULTS Patients received an average of 7.5 sessions of voice therapy prior to discharge. Baseline auditory-perceptual assessment of dysphonia (p = .032), phonation threshold pressure (PTP, p = .005), Glottal Function Index (GFI) score (p = .006), and glottic closure pattern (p = .023) were significant predictors of number of voice therapy sessions. These measures, as well as hourglass glottic closure, predicted longer intervention duration. The regression model had an overall r 2 of .62. CONCLUSIONS Pediatric voice therapy addressing benign vocal fold lesions and/or laryngeal edema required an average of 7.54 sessions before voice outcomes were sufficiently improved for discharge. More severe overall SLP ratings of dysphonia, GFI scores, PTP, or hourglass glottic closure pattern significantly predicted increased number of therapy sessions prior to discharge. Future work should determine what other factors affect treatment duration and how the efficiency of pediatric voice therapy can be maximized.
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117
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Yoshinaga T, Zhang Z, Iida A. Comparison of one-dimensional and three-dimensional glottal flow models in left-right asymmetric vocal fold conditions. J Acoust Soc Am 2022; 152:2557. [PMID: 36456298 PMCID: PMC9629867 DOI: 10.1121/10.0014949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 06/17/2023]
Abstract
While the glottal flow is often simplified as one-dimensional (1D) in computational models of phonation to reduce computational costs, the 1D flow model has not been validated in left-right asymmetric vocal fold conditions, as often occur in both normal and pathological voice production. In this study, we performed three-dimensional (3D) and 1D flow simulations coupled to a two-mass model of adult male vocal folds and compared voice production at different degrees of left-right stiffness asymmetry. The flow and acoustic fields in 3D were obtained by solving the compressible Navier-Stokes equations using the volume penalization method with the moving vocal fold wall as an immersed boundary. Despite differences in the predicted flow pressure on vocal fold surface between the 1D and 3D flow models, the results showed reasonable agreement in vocal fold vibration patterns and selected voice outcome measures between the 1D and 3D models for the range of left-right asymmetric conditions investigated. This indicates that vocal fold properties play a larger role than the glottal flow in determining the overall pattern of vocal fold vibration and the produced voice, and the 1D flow simplification is sufficient in modeling phonation, at least for the simplified glottal geometry of this study.
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Affiliation(s)
- Tsukasa Yoshinaga
- Department of Mechanical Engineering, Toyohashi University of Technology, 1-1 Hibarigaoka, Tenpaku, Toyohashi 441-8580, Japan
| | - Zhaoyan Zhang
- Department of Head and Neck Surgery, University of California, Los Angeles, 31-24 Rehabilitation Center, 1000 Veteran Avenue, Los Angeles, California 90095-1794, USA
| | - Akiyoshi Iida
- Department of Mechanical Engineering, Toyohashi University of Technology, 1-1 Hibarigaoka, Tenpaku, Toyohashi 441-8580, Japan
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118
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Kanaya M, Matsumoto T, Uemura T, Kawabata R, Nishimura T, Tokuda IT. Physical modeling of the vocal membranes and their influence on animal voice production. JASA Express Lett 2022; 2:111201. [PMID: 36456367 DOI: 10.1121/10.0015071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The vocal membrane, i.e., an extended part of the vocal fold, is observed in a wide range of species including bats and primates. A theoretical study [Mergell, Fitch, and Herzel (1999). J. Acoust. Soc. Am. 105(3), 2020-2028] predicted that the vocal membranes can make the animal vocalizations more efficient by lowering the phonation threshold pressure. To examine this prediction, a synthetic model of the vocal membrane was developed, and its oscillation properties were examined. The experiments revealed that the phonation threshold pressure was lower in the vocal membrane model compared to that in a model with no vocal membrane. Chaotic oscillations were observed as well.
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Affiliation(s)
- Mayuka Kanaya
- Graduate School of Science and Engineering, Ritsumeikan University, Noji-higashi, Kusatsu, Shiga 525-8577, Japan
| | - Takuma Matsumoto
- Graduate School of Science and Engineering, Ritsumeikan University, Noji-higashi, Kusatsu, Shiga 525-8577, Japan
| | - Taisuke Uemura
- Graduate School of Science and Engineering, Ritsumeikan University, Noji-higashi, Kusatsu, Shiga 525-8577, Japan
| | - Rei Kawabata
- College of Science and Engineering, Ritsumeikan University, Noji-higashi, Kusatsu, Shiga 525-8577, Japan
| | - Takeshi Nishimura
- Center for the Evolutionary Origins of Human Behavior, Kyoto University, Inuyama, Aichi 484-8506, Japan , , , , ,
| | - Isao T Tokuda
- Graduate School of Science and Engineering, Ritsumeikan University, Noji-higashi, Kusatsu, Shiga 525-8577, Japan
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Adriaansen A, Meerschman I, Van Lierde K, D'haeseleer E. Effects of voice therapy in children with vocal fold nodules: A systematic review. Int J Lang Commun Disord 2022; 57:1160-1193. [PMID: 35758272 DOI: 10.1111/1460-6984.12754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Vocal fold nodules (VFNs) are the main cause of paediatric dysphonia. Voice therapy is recommended as the preferable treatment option for VFNs in children. AIM The aim of this systematic review is to provide an overview of the existing literature concerning the effects of voice therapy in children with VFNs. METHODS & PROCEDURES This systematic literature review was developed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via PubMed) and Embase were searched and the grey literature was checked. The search strategy was based on three concepts: VFNs, voice therapy and children. Two examiners independently determined article eligibility and extracted all relevant data from the included studies. The methodological quality of the included study was assessed using the QualSyst tool. MAIN CONTRIBUTIONS By identifying, evaluating and summarizing the results of all relevant studies about voice therapy in paediatric VFNs, this systematic review makes the available evidence more accessible to voice therapists, otolaryngologists and other relevant stakeholders. CONCLUSIONS & IMPLICATIONS 24 studies were included in this systematic review. Eight studies (8/24) reported a significant improvement for at least one outcome parameter after voice therapy. However, five papers (5/24) could not demonstrate significant changes after voice therapy. All studies that did not test for significance (11/24) found improvements for one or more outcome parameters. The overall quality of the included studies is adequate (55%). In sum, there is some evidence that voice therapy is effective in children with VFNs, but further well-designed research, especially randomized controlled trials, is necessary to confirm these results. WHAT THIS PAPER ADDS What is already known on the subject Voice therapy is preferable in children with VFNs because of the phonotraumatic nature of the nodules and the associated high recurrence rate after phonosurgery. Most voice therapists in clinical practice offer an eclectic voice therapy programme, consisting of direct and indirect voice therapy techniques. What this study adds to existing knowledge This systematic review provides a clear overview of the available evidence concerning the effects of voice therapy in paediatric VFNs. There is some evidence that voice therapy is an effective treatment option in children with VFNs, but well-designed research is scarce on this subject. What are the potential or actual clinical implications of this work? This review shows that effectiveness studies with strong designs are very scarce in children with VFNs. Clinicians should be aware that few therapy techniques have been thoroughly investigated in this population. However, this review may guide voice therapists when creating a treatment plan for a child with VFNs because it identifies, evaluates and summarizes the results of all relevant individual studies about voice therapy in paediatric VFNs. Voice therapy seems to be effective in treating paediatric patients with VFNs, given the fact that a considerable number of included studies report significant improvements after voice therapy. Both direct and indirect therapy approaches appear to have a positive effect on the phonation of children with VFNs.
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Affiliation(s)
- Anke Adriaansen
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Iris Meerschman
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Evelien D'haeseleer
- Department of Rehabilitation Sciences, Center for Speech and Language Sciences (CESLAS), Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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120
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Kim S, Kang M, Park JS, Seok HY. Letter to the Editor: Guillain-Barré Syndrome Needs to Be Considered as a Cause of Idiopathic Bilateral Vocal Fold Paralysis. J Korean Med Sci 2022; 37:e315. [PMID: 36281489 PMCID: PMC9592941 DOI: 10.3346/jkms.2022.37.e315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/29/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sohyeon Kim
- Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Minsung Kang
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Jin-Sung Park
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea.
| | - Hung Youl Seok
- Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
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Fang Y, Chen M, Li G, Yang Y, He P, Chen J, Cheng L, Wu H. Cancer-associated fibroblast-like fibroblasts in vocal fold leukoplakia suppress CD8 +T cell functions by inducing IL-6 autocrine loop and interacting with Th17 cells. Cancer Lett 2022; 546:215839. [PMID: 35961512 DOI: 10.1016/j.canlet.2022.215839] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/14/2022] [Accepted: 07/25/2022] [Indexed: 11/19/2022]
Abstract
The characteristics of fibroblast cells in head and neck precancerous lesion and its ability to secrete inflammatory cytokines and affect CD8+T cell functions remain unclear. Herein, we reported the existence of fibroblasts in human-derived vocal fold leukoplakia (VFL) with positive staining of fibroblast activation protein (FAP) and α-smooth muscle actin (α-SMA). The fibroblasts from VFL and cancer-associated fibroblasts (CAFs) from head and neck squamous cell carcinoma (HNSCC) displayed similar cellular functions and robust inflammatory cytokine secretions. The effects of fibroblasts from VFL in inducing the apoptosis, depletion of CD8+ T cells and recruitment of regulatory T cells (Treg cells) were observed. We further assessed the autocrine loop within VFL fibroblasts to self-stimulate by secreting IL-6, TGF-β through the IL-6/JAK2/STAT3 pathway. The synergistic stimulation of IL-6 and TGF-β promoted Th17 cell differentiation and IL-17A secretion, which could result in fibroblast activation in another positive loop. Tocilizumab (TOC), a monoclonal antibody targeting IL-6R, managed to suppress the overexpression of both IL-6 and TGF-β in VFL fibroblasts, and thus blocking IL-6 autocrine loop and CAF-Th17 loop in vitro. In a murine model of oral leukoplakia (OL), local injection of TOC inhibited the outgrowth of lesions and showed notable effect in control of OL progression in vivo. Our findings establish a novel rationale for blocking the IL-6/JAK2/STAT3 pathway to inhibit vocal fold (oral) leukoplakia progression and postpone HNSCC tumorigenesis.
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Affiliation(s)
- Yi Fang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China
| | - Min Chen
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China
| | - Guangfei Li
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China
| | - Yue Yang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China
| | - Peijie He
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China
| | - Jian Chen
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China.
| | - Lei Cheng
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China.
| | - Haitao Wu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China; Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, 200031, China.
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122
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Chi Y, Honda K, Wei J. Near-infrared photoglottography for measuring multiple glottal events. JASA Express Lett 2022; 2:105203. [PMID: 36319211 DOI: 10.1121/10.0014810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Near-infrared (NIR) photoglottography (PGG) is a non-invasive method for monitoring glottal activities which retains functionality of conventional PGG using visible light with more convenient accessibility. This paper is to investigate its performance in comparison with simultaneously recorded electroglottography (EGG) signals. Results showed that NIR PGG detects continuous transillumination for glottal aperture and vocal-fold contact. Glottal timing markers known as glottal closure and opening instants are detectable agreeing to the corresponding EGG-based instants. Further, it was inferred that variations of glottal waveforms based on NIR PGG reflect vertical vocal-fold edge motions.
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Affiliation(s)
- Yujie Chi
- College of Intelligence and Computing, Tianjin University, Tianjin, 300350, China , ,
| | - Kiyoshi Honda
- College of Intelligence and Computing, Tianjin University, Tianjin, 300350, China , ,
| | - Jianguo Wei
- College of Intelligence and Computing, Tianjin University, Tianjin, 300350, China , ,
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123
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Abstract
Self-sustained vocal fold vibration is possible with either or both of two mechanisms: (1) a mucosal wave propagating along the medial surface of the vocal folds and (2) a vocal tract that offers inertive reactance. A quantitative comparison shows the mucosal wave mechanism has a lower threshold pressure and a higher glottal efficiency, but the supraglottal inertance mechanism can assist in the oscillation and is effective in optimizing the two mechanisms. It is concluded that optimal parameters are a mucosal wave velocity on the order of 1 m/s and a diameter of the larynx canal (epilarynx tube) on the order of 0.8 cm.
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Affiliation(s)
- Ingo R Titze
- Utah Center for Vocology, University of Utah, Salt Lake City, Utah 84112, USA
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124
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Stager SV, Maryn Y. Glottal Stop Production in Controls and Patients With Unilateral Vocal Fold Paresis/Paralysis. J Speech Lang Hear Res 2022; 65:3392-3404. [PMID: 36044894 DOI: 10.1044/2022_jslhr-21-00599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSES The purposes of this study were to determine whether the acoustic measures from glottal stops distinguished between controls and patients with unilateral vocal fold paresis/paralysis (UVFP) at initial evaluation and posttreatment/observation, to explore the types of false vocal fold (FVF) movement during glottal stop production in UVFP, and to assess the agreement between normalization of various measures and reported voice normalization. METHOD Patients with UVFP and controls were recorded acoustically and laryngoscopically speaking two sets of five repeated /i/s, controls once and patients with UVFP initially and posttreatment/observation. Averaged intensity differences and slopes for offsets (maximum voicing intensity to minimum glottal stop intensity) and onsets (minimum glottal stop intensity to maximum voicing intensity) were measured. FVF movements were rated separately for paretic and nonparetic sides. Patients were asked to report voice normalization posttreatment/observation. Cohen's kappas were calculated for agreements between patient-reported voice normalization and normalization of Voice-Related Quality of Life (V-RQOL), translaryngeal flow, four acoustic measures of glottal stop production, and FVF movement. RESULTS Significant differences (analysis of variance [ANOVA]; p < .014) were found for all acoustic measures between controls and patients with UVFP and between patients with UVFP initially and posttreatment/observation (paired t tests; p < .05). In addition, 78% of UVFP patients had no FVF movement on the paretic side initially, and 42% had bilateral dynamic FVF movement posttreatment/observation. Cohen's kappa showed moderate agreement between voice normalization and V-RQOL, slight agreement with offset measures, and fair agreement with onset measures. CONCLUSION This study provided proof of concept for using acoustic measures of glottal stops to distinguish between controls and patients with UVFP, both initially and posttreatment/observation.
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Affiliation(s)
- Sheila V Stager
- Division of Otolaryngology, Department of Surgery, GW Medical Faculty Associates Voice Treatment Center, Washington, DC
| | - Youri Maryn
- ENT Department, European Institute for ORL-HNS, GZA Hospital Sint-Augustinus, Antwerp, Belgium
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Ghent, Belgium
- School of Speech Therapy, Faculty of Psychology and Educational Sciences, Université Catholique Louvain, Louvain-La-Neuve, Belgium
- Department of Speech-Language Therapy and Audiology, University College Ghent, Belgium
- Phonanium, Lokeren, Belgium
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125
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Schoder S, Kraxberger F, Falk S, Wurzinger A, Roppert K, Kniesburges S, Döllinger M, Kaltenbacher M. Error detection and filtering of incompressible flow simulations for aeroacoustic predictions of human voice. J Acoust Soc Am 2022; 152:1425. [PMID: 36182323 DOI: 10.1121/10.0013778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/09/2022] [Indexed: 06/16/2023]
Abstract
The presented filtering technique is proposed to detect errors and correct outliers inside the acoustic sources, respectively, the first time derivative of the incompressible pressure obtained from large eddy simulations with prescribed vocal fold motion using overlay mesh methods. Regarding the perturbed convective wave equation, the time derivative of the incompressible pressure is the primary sound source in the human phonation process. However, the incompressible pressure can be erroneous and have outliers when fulfilling the divergence-free constraint of the velocity field. This error is primarily occurring for non-conserving prescribed vocal fold motions. Therefore, the method based on a continuous stationary random process was designed to detect rare events in the time derivative of the pressure. The detected events are then localized and treated by a defined window function to increase their probability. As a consequence, the data quality of the non-linearly filtered data is enhanced significantly. Furthermore, the proposed method can also be used to assess convergence of the aeroacoustic source terms, and detect regions and time intervals, which show a non-converging behavior by an impulse-like structure.
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Affiliation(s)
- Stefan Schoder
- Institute of Fundamentals and Theory in Electrical Engineering (IGTE), Graz University of Technology, Inffeldgasse 18, 8010 Graz, Austria
| | - Florian Kraxberger
- Institute of Fundamentals and Theory in Electrical Engineering (IGTE), Graz University of Technology, Inffeldgasse 18, 8010 Graz, Austria
| | - Sebastian Falk
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstraße 1, 91054 Erlangen, Germany
| | - Andreas Wurzinger
- Institute of Fundamentals and Theory in Electrical Engineering (IGTE), Graz University of Technology, Inffeldgasse 18, 8010 Graz, Austria
| | - Klaus Roppert
- Institute of Fundamentals and Theory in Electrical Engineering (IGTE), Graz University of Technology, Inffeldgasse 18, 8010 Graz, Austria
| | - Stefan Kniesburges
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstraße 1, 91054 Erlangen, Germany
| | - Michael Döllinger
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstraße 1, 91054 Erlangen, Germany
| | - Manfred Kaltenbacher
- Institute of Fundamentals and Theory in Electrical Engineering (IGTE), Graz University of Technology, Inffeldgasse 18, 8010 Graz, Austria
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126
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Zhang Y, Jiang W, Sun L, Wang J, Zheng X, Xue Q. A Deep Learning-Based Generalized Empirical Flow Model of Glottal Flow During Normal Phonation. J Biomech Eng 2022; 144:091001. [PMID: 35171218 PMCID: PMC8990722 DOI: 10.1115/1.4053862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 02/10/2022] [Indexed: 11/08/2022]
Abstract
This paper proposes a deep learning-based generalized empirical flow model (EFM) that can provide a fast and accurate prediction of the glottal flow during normal phonation. The approach is based on the assumption that the vibration of the vocal folds can be represented by a universal kinematics equation (UKE), which is used to generate a glottal shape library. For each shape in the library, the ground truth values of the flow rate and pressure distribution are obtained from the high-fidelity Navier-Stokes (N-S) solution. A fully connected deep neural network (DNN) is then trained to build the empirical mapping between the shapes and the flow rate and pressure distributions. The obtained DNN-based EFM is coupled with a finite element method (FEM)-based solid dynamics solver for fluid-structure-interaction (FSI) simulation of phonation. The EFM is evaluated by comparing the N-S solutions in both static glottal shapes and FSI simulations. The results demonstrate a good prediction performance in accuracy and efficiency.
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Affiliation(s)
- Yang Zhang
- Department of Mechanical Engineering, University of Maine, Orono, ME 04469
| | - Weili Jiang
- Department of Mechanical Engineering, University of Maine, 204 Crosby Hall, Orono, ME 04473
| | - Luning Sun
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, IN 46556
| | - Jianxun Wang
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, IN 46556
| | - Xudong Zheng
- Department of Mechanical Engineering, University of Maine, Room 213 A, Boardman Hall, Orono, ME 04473
| | - Qian Xue
- Department of Mechanical Engineering, University of Maine, Room 213, Boardman Hall, Orono, ME 04473
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127
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Smulders Y. [A man with a low voice]. Ned Tijdschr Geneeskd 2022; 166:D6841. [PMID: 36300445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A 57-year old man with several non-specific complaints is found to have severe hypothyroidism. Only then he realizes that his voice may have changed. A recording of his voice during and after full recovery illustrates the profound effects that vocal cord myxedema may have of a patient's voice.
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Affiliation(s)
- Yvo Smulders
- Amsterdam UMC, afd. Interne Geneeskunde, Amsterdam
- Contact: Yvo Smulders
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128
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Thurner T, Esterer B, Furst D, Hollensteiner M, Sandriesser S, Augat P, Pruckner R, Wirthl D, Kaltenbrunner M, Muller A, Forster G, Pototschnig C, Schrempf A. Smart Artificial Soft Tissue - Application to a Hybrid Simulator for Training of Laryngeal Pacemaker Implantation. IEEE Trans Biomed Eng 2022; 70:735-746. [PMID: 36006884 DOI: 10.1109/tbme.2022.3201613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Surgical simulators are safe and evolving educational tools for developing surgical skills. In particular, virtual and hybrid simulators are preferred due to their detailedness, customization and evaluation capabilities. To accelerate the revolution of a novel class of hybrid simulators, a Smart Artificial Soft Tissue is presented here, that determines the relative position of conductive surgical instruments in artificial soft tissue by inverse resistance mappings without the need for a fixed reference point. This is particularly beneficial for highly deformable structures when specific target regions need to be reached or avoided. The carbon-black-silicone composite used can be shaped almost arbitrarily and its elasticity can be tuned by modifying the silicone base material. Thus, objective positional feedback for haptically correct artificial soft tissue can be ensured. This is demonstrated by the development of a laryngeal phantom to simulate the implantation of laryngeal pacemaker electrodes. Apart from the position-detecting larynx phantom, the simulator uses a tablet computer for the virtual representation of the vocal folds' movements, in accordance with the electrical stimulation by the inserted electrodes. The possibility of displaying additional information about target regions and anatomy is intended to optimize the learning progress and illustrates the extensibility of hybrid surgical simulators.
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129
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Castro C, Prado P, Espinoza VM, Testart A, Marfull D, Manriquez R, Stepp CE, Mehta DD, Hillman RE, Zañartu M. Lombard Effect in Individuals With Nonphonotraumatic Vocal Hyperfunction: Impact on Acoustic, Aerodynamic, and Vocal Fold Vibratory Parameters. J Speech Lang Hear Res 2022; 65:2881-2895. [PMID: 35930680 PMCID: PMC9913286 DOI: 10.1044/2022_jslhr-21-00508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/17/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE This exploratory study aims to investigate variations in voice production in the presence of background noise (Lombard effect) in individuals with nonphonotraumatic vocal hyperfunction (NPVH) and individuals with typical voices using acoustic, aerodynamic, and vocal fold vibratory measures of phonatory function. METHOD Nineteen participants with NPVH and 19 participants with typical voices produced simple vocal tasks in three sequential background conditions: baseline (in quiet), Lombard (in noise), and recovery (5 min after removing the noise). The Lombard condition consisted of speech-shaped noise at 80 dB SPL through audiometric headphones. Acoustic measures from a microphone, glottal aerodynamic parameters estimated from the oral airflow measured with a circumferentially vented pneumotachograph mask, and vocal fold vibratory parameters from high-speed videoendoscopy were analyzed. RESULTS During the Lombard condition, both groups exhibited a decrease in open quotient and increases in sound pressure level, peak-to-peak glottal airflow, maximum flow declination rate, and subglottal pressure. During the recovery condition, the acoustic and aerodynamic measures of individuals with typical voices returned to those of the baseline condition; however, recovery measures for individuals with NPVH did not return to baseline values. CONCLUSIONS As expected, individuals with NPVH and participants with typical voices exhibited a Lombard effect in the presence of elevated background noise levels. During the recovery condition, individuals with NPVH did not return to their baseline state, pointing to a persistence of the Lombard effect after noise removal. This behavior could be related to disruptions in laryngeal motor control and may play a role in the etiology of NPVH. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.20415600.
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Affiliation(s)
- Christian Castro
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso, Chile
- Department of Speech and Language Pathology, Universidad de Valparaíso, Chile
- Department of Speech and Language Pathology, Universidad de Chile, Santiago
| | - Pavel Prado
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
| | | | - Alba Testart
- Department of Speech and Language Pathology, Universidad de Playa Ancha, Valparaíso, Chile
| | - Daphne Marfull
- Department of Speech and Language Pathology, Universidad de Valparaíso, Chile
| | - Rodrigo Manriquez
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso, Chile
| | - Cara E. Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- Department of Biomedical Engineering, Boston University, MA
- Department of Otolaryngology-Head and Neck Surgery, Boston University, MA
| | - Daryush D. Mehta
- Center for Laryngeal Surgery & Voice Rehabilitation, Massachusetts General Hospital, Boston
- Department of Surgery, Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | - Robert E. Hillman
- Center for Laryngeal Surgery & Voice Rehabilitation, Massachusetts General Hospital, Boston
- Department of Surgery, Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | - Matías Zañartu
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso, Chile
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130
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Motie-Shirazi M, Zañartu M, Peterson SD, Mehta DD, Hillman RE, Erath BD. Collision Pressure and Dissipated Power Dose in a Self-Oscillating Silicone Vocal Fold Model With a Posterior Glottal Opening. J Speech Lang Hear Res 2022; 65:2829-2845. [PMID: 35914018 PMCID: PMC9911124 DOI: 10.1044/2022_jslhr-21-00471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/24/2022] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The goal of this study was to experimentally evaluate how compensating for the adverse acoustic effects of a posterior glottal opening (PGO) by increasing subglottal pressure and changing supraglottal compression, as have been associated with vocal hyperfunction, influences the risk of vocal fold (VF) trauma. METHOD A self-oscillating synthetic silicone model of the VFs with an airflow bypass that modeled a PGO was investigated in a hemilaryngeal flow facility. The influence of compensatory mechanisms on collision pressure and dissipated collision power was investigated for different PGO areas and supraglottal compression. Compensatory behaviors were mimicked by increasing the subglottal pressure to achieve a target sound pressure level (SPL). RESULTS Increasing the subglottal pressure to compensate for decreased SPL due to a PGO produced higher values for both collision pressure and dissipated collision power. Whereas a 10-mm2 PGO area produced a 12% increase in the peak collision pressure, the dissipated collision power increased by 122%, mainly due to an increase in the magnitude of the collision velocity. This suggests that the value of peak collision pressure may not fully capture the mechanisms by which phonotrauma occurs. It was also found that an optimal value of supraglottal compression exists that maximizes the radiated SPL, indicating the potential utility of supraglottal compression as a compensatory mechanism. CONCLUSIONS Larger PGO areas are expected to increase the risk of phonotrauma due to the concomitant increase in dissipated collision power associated with maintaining SPL. Furthermore, the risk of VF damage may not be fully characterized by only the peak collision pressure.
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Affiliation(s)
- Mohsen Motie-Shirazi
- Department of Mechanical and Aeronautical Engineering, Clarkson University, Potsdam, NY
| | - Matías Zañartu
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso, Chile
| | - Sean D. Peterson
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Ontario, Canada
| | - Daryush D. Mehta
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
| | - Robert E. Hillman
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
| | - Byron D. Erath
- Department of Mechanical and Aeronautical Engineering, Clarkson University, Potsdam, NY
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131
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Zhang Z. Oral vibratory sensations during voice production at different laryngeal and semi-occluded vocal tract configurations. J Acoust Soc Am 2022; 152:302. [PMID: 35931496 PMCID: PMC9270996 DOI: 10.1121/10.0012365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
Voice therapy often emphasizes vibratory sensations in the front part of the vocal tract during phonation to improve vocal efficiency. It remains unclear what laryngeal and vocal tract adjustments are elicited in speakers by this emphasis on oral vibratory sensations. Using a three-dimensional phonation model, this study aims to identify laryngeal and epilaryngeal adjustments that might produce maximal oral vibratory sensations during phonation, as quantified by the oral sound pressure level (SPL), and thus are likely to be elicited in voice therapy at different semi-occluded vocal tract configurations. Results show that maximum oral SPL occurs at intermediate vocal fold adduction configurations characterized by a trade-off between glottal gap and vocal fold vertical thickness. Epilaryngeal tube narrowing further increases the oral SPL in an open vocal tract, but has little effect on oral SPL in semi-occluded vocal tracts. Laryngeal and epilaryngeal configurations producing the maximum oral SPL generally have lower peak vocal fold contact pressure when producing a target output SPL. These favorable configurations are more easily identified in open vocal tracts than semi-occluded vocal tracts. However, semi-occlusion increases both the mean and dynamic oral pressure, which may familiarize speakers with oral vibratory sensations and facilitate adoption of favorable laryngeal configurations.
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Affiliation(s)
- Zhaoyan Zhang
- Department of Head and Neck Surgery, University of California, Los Angeles, 31-24 Rehabilitation Center, 1000 Veteran Ave., Los Angeles, California 90095-1794, USA
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132
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Abstract
Since severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was noted to cause coronavirus disease 2019 (COVID-19) in 2019, there have been many trials to develop vaccines against the virus. Messenger ribonucleic acid (mRNA) vaccine as a type of the vaccine has been developed and commercialized rapidly, but there was not enough time to verify the long-term safety. An 82-year-old female patient was admitted to the emergency room with dyspnea accompanied by stridor three days after the 3rd COVID-19 mRNA vaccination (Comirnaty, Pfizer-BioNTech, USA). The patient was diagnosed with bilateral vocal fold paralysis (VFP) by laryngoscope. Respiratory distress was improved after the intubation and tracheostomy in sequence. The brain, chest, and neck imaging tests, serological tests, cardiological analysis, and immunological tests were performed to evaluate the cause of bilateral VFP. However, no definite cause was found except for the precedent vaccination. Because bilateral VFP can lead to a fatal condition, a quick evaluation is necessary in consideration of VFP when dyspnea with stridor occurs after vaccination.
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Affiliation(s)
- Soo Ah Son
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeon Ji Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So Yun Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Bum Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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133
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Xu XL, Wang X, Ma YL, Zhuang PY. [Analysis of vocal fold vibration characteristics of spasmodic dysphonia by laryngeal high speed photography combined with glottis area wave]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2022; 57:706-710. [PMID: 35725313 DOI: 10.3760/cma.j.cn115330-20220329-00141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To analyze the characteristics of vocal fold vibration of normal people and patients with spasmodic dysphonia (SD) using laryngeal high speed videoendoscopy combined with glottal area wave analysis. Methods: This prospective study examined twenty healthy subjects (10 males and 10 females), 12 patients with adductor spasmodic dysphonia(AdSD) (2 males,10 females)as AdSD group and 2 patients with abductor spasmodic dysphonia(AbSD) (2 males) as AbSD group. Twelve of healthy subjects (2 males,10 females) were selected as control group according to AdSD group gender match. All the subjects were recruited from the Department of Voice, Zhongshan Hospital, Xiamen University from October 2019 to December 2020. All subjects underwent laryngeal high speed videoendoscopy and 10 vibration periods were selected from each recording and were used to quantitatively analyze the change of glottal area and vocal fold vibration parameters (Speed Quotient (SQ), Open Quotient (OQ) and Close Quotient (CQ)). Results: 1. There were statistically significant differences in SQ, CQ and OQ between males and females in the healthy subjects (t=12.28, 5.59, 5.59, P<0.05). The change of the glottal area during each vibration period in healthy subjects was relatively stable(0.19-0.42). 2. The change of the glottal area during each vibration period in AdSD subjects had larger fluctuations, with the glottal area change index fluctuating in the range of 0.31 to 0.62. The SQ value of the AdSD group was significantly lower than that of control group (t=4.246, P<0.05). There were no significant differences in OQ and CQ between AdSD group and normal group (t=1.064, 1.332, P>0.05); The SQ value of the AbSD group tended to increase compared to normal group. Conclusions: Laryngeal high speed videoendoscopy combined with glottal area wave analysis has a certain reference value in the studying the vibration characteristics of SD patients. SQ has good specificity.
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Affiliation(s)
- X L Xu
- Department of Voice, Zhongshan Hospital of Xiamen University, Xiamen 361004, China
| | - X Wang
- School of Medicine, Xiamen University, Xiamen 361005, China
| | - Y L Ma
- Department of Voice, Zhongshan Hospital of Xiamen University, Xiamen 361004, China
| | - P Y Zhuang
- Department of Voice, Zhongshan Hospital of Xiamen University, Xiamen 361004, China
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134
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Wen MH, Wang CT. Treatment Options and Voice Outcomes for Patients With Unilateral Vocal Fold Paralysis After Thyroidectomy. Front Endocrinol (Lausanne) 2022; 13:886924. [PMID: 35685213 PMCID: PMC9170884 DOI: 10.3389/fendo.2022.886924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives This study investigated the treatment options and clinical outcomes of voice therapy (VT), hyaluronic acid (HA) injection, autologous fat injection (FI), and medialization thyroplasty (MT) in patients with unilateral vocal fold paralysis (UVFP) after thyroidectomy. Study Design Retrospective case series. Setting A tertiary teaching hospital. Methods This study included 51 patients with post-thyroidectomy UVFP who underwent VT (n = 20), HA injection (n = 14), FI (n = 12), or MT (n = 5) from January 2016 to June 2021. The treatment outcomes were evaluated using 10-item voice handicap index (VHI-10), maximal phonation time (MPT), and auditory perceptual rating using GRB scales (i.e., grade, roughness, and breathiness) before and 3 to 6 months after treatment. Results Patients received HA injection presented a significantly shorter interval after thyroidectomy (mean: 4.6 months), followed by VT (6.7 months), FI (12.3 months), and MT (22.4 months). The results exhibited improvement in most of the outcomes after all of the four treatments. Additional comparisons indicated that VHI-10 scores improved the most among patients receiving MT, followed by HA, FI, and VT. The differences of MPT and GRB scores among the 4 treatment groups were non-significant. Conclusions The results revealed that VT, HA, FI, and MT can all improve the voice outcomes of patients with post-thyroidectomy UVFP. The optimal treatment approach should be individualized according to the patient's preference and vocal demand, and the interval between thyroidectomy and intervention.
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Affiliation(s)
- Ming-Hsun Wen
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Chi-Te Wang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
- Department of Special Education, University of Taipei, Taipei, Taiwan
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135
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King RE, Ward-Shaw ET, Hu R, Lambert PF, Thibeault SL. Expanded Basal Compartment and Disrupted Barrier in Vocal Fold Epithelium Infected with Mouse Papillomavirus MmuPV1. Viruses 2022; 14:v14051059. [PMID: 35632798 PMCID: PMC9146965 DOI: 10.3390/v14051059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/07/2022] [Accepted: 05/11/2022] [Indexed: 02/01/2023] Open
Abstract
Laryngeal infection with low-risk human papillomaviruses can cause recurrent respiratory papillomatosis (RRP), a disease with severe effects on vocal fold epithelium resulting in impaired voice function and communication. RRP research has been stymied by limited preclinical models. We recently reported a murine model of laryngeal MmuPV1 infection and disease in immunodeficient mice. In the current study, we compare quantitative and qualitative measures of epithelial proliferation, apoptosis, differentiation, and barrier between mice with MmuPV1-induced disease of the larynx and surrounding tissues and equal numbers of uninfected controls. Findings supported our hypothesis that laryngeal MmuPV1 infection recapitulates many features of RRP. Like RRP, MmuPV1 increased proliferation in infected vocal fold epithelium, expanded the basal compartment of cells, decreased differentiated cells, and altered cell–cell junctions and basement membrane. Effects of MmuPV1 on apoptosis were equivocal, as with RRP. Barrier markers resembled human neoplastic disease in severe MmuPV1-induced disease. We conclude that MmuPV1 infection of the mouse larynx provides a useful, if imperfect, preclinical model for RRP that will facilitate further study and treatment development for this intractable and devastating disease.
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Affiliation(s)
- Renee E. King
- McArdle Laboratory for Cancer Research, Department of Oncology, University of Wisconsin-Madison, Madison, WI 53705, USA; (R.E.K.); (E.T.W.-S.); (P.F.L.)
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Ella T. Ward-Shaw
- McArdle Laboratory for Cancer Research, Department of Oncology, University of Wisconsin-Madison, Madison, WI 53705, USA; (R.E.K.); (E.T.W.-S.); (P.F.L.)
| | - Rong Hu
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI 53705, USA;
| | - Paul F. Lambert
- McArdle Laboratory for Cancer Research, Department of Oncology, University of Wisconsin-Madison, Madison, WI 53705, USA; (R.E.K.); (E.T.W.-S.); (P.F.L.)
| | - Susan L. Thibeault
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53705, USA
- Correspondence:
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136
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Nudelman CJ, Ortiz AJ, Fox AB, Mehta DD, Hillman RE, Van Stan JH. Daily Phonotrauma Index: An Objective Indicator of Large Differences in Self-Reported Vocal Status in the Daily Life of Females With Phonotraumatic Vocal Hyperfunction. Am J Speech Lang Pathol 2022; 31:1412-1423. [PMID: 35394805 PMCID: PMC9567307 DOI: 10.1044/2022_ajslp-21-00285] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/08/2021] [Accepted: 02/03/2022] [Indexed: 06/03/2023]
Abstract
PURPOSE The purpose of this study is to evaluate if the Daily Phonotrauma Index (DPI) can quantitatively discriminate large differences in overall vocal status in the daily life of patients with phonotraumatic vocal hyperfunction (PVH). METHOD For 1-4 weeks, 23 females with PVH wore an ambulatory voice monitor and answered three vocal status questions (i.e., difficulty producing soft, high-pitched phonation; discomfort; and fatigue) at the beginning, at 5-hr intervals, and the end of each day. DPI values were obtained for each patient's time periods of worst and best self-rated vocal status, and data for the group were analyzed for significant changes using a linear mixed-effects regression model. RESULTS The DPI was significantly lower during periods self-rated as "best vocal status" compared to during periods self-rated as "worst vocal status" (mean difference in DPI = 0.53) with a medium-to-large effect size (Cohen's d = -0.68). CONCLUSIONS In a group of patients with phonotraumatic lesions, the DPI indicated lower potential for phonotrauma during time periods of better vocal status compared to time periods of worse vocal status. Assuming that a large portion of variance in vocal status for patients with PVH is associated with the extent to which voicing is phonotraumatic, these results support the validity of obtaining estimates of DPI for much shorter time periods (i.e., an estimate every 2 min of voicing) than previous studies (i.e., a single estimate for the entire day or week). Future work can investigate the DPI's use for in-clinic assessment/treatment and ambulatory biofeedback and can gain further insights into phonatory mechanisms that underlie DPI via comparisons with other physiologically relevant measures and computational vocal fold modeling.
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Affiliation(s)
| | | | | | - Daryush D. Mehta
- MGH Institute of Health Professions, Boston, MA
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Robert E. Hillman
- MGH Institute of Health Professions, Boston, MA
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Jarrad H. Van Stan
- MGH Institute of Health Professions, Boston, MA
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
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137
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Deng JJ, Serry MA, Zañartu M, Erath BD, Peterson SD. Modeling the influence of COVID-19 protective measures on the mechanics of phonation. J Acoust Soc Am 2022; 151:2987. [PMID: 35649932 PMCID: PMC9068248 DOI: 10.1121/10.0009822] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/24/2022] [Accepted: 02/27/2022] [Indexed: 06/15/2023]
Abstract
In an effort to mitigate the 2019 novel coronavirus disease pandemic, mask wearing and social distancing have become standard practices. While effective in fighting the spread of the virus, these protective measures have been shown to deteriorate speech perception and sound intensity, which necessitates speaking louder to compensate. The goal of this paper is to investigate via numerical simulations how compensating for mask wearing and social distancing affects measures associated with vocal health. A three-mass body-cover model of the vocal folds (VFs) coupled with the sub- and supraglottal acoustic tracts is modified to incorporate mask and distance dependent acoustic pressure models. The results indicate that sustaining target levels of intelligibility and/or sound intensity while using these protective measures may necessitate increased subglottal pressure, leading to higher VF collision and, thus, potentially inducing a state of vocal hyperfunction, a progenitor to voice pathologies.
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Affiliation(s)
- Jonathan J Deng
- Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
| | - Mohamed A Serry
- Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
| | - Matías Zañartu
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso, Chile
| | - Byron D Erath
- Mechanical and Aerospace Engineering, Clarkson University, Potsdam, New York 13699, USA
| | - Sean D Peterson
- Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
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138
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Wang YY, Hamad AS, Palaniappan K, Lever TE, Bunyak F. LARNet-STC: Spatio-temporal orthogonal region selection network for laryngeal closure detection in endoscopy videos. Comput Biol Med 2022; 144:105339. [PMID: 35263687 PMCID: PMC8995389 DOI: 10.1016/j.compbiomed.2022.105339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/18/2022] [Accepted: 02/19/2022] [Indexed: 11/28/2022]
Abstract
The vocal folds (VFs) are a pair of muscles in the larynx that play a critical role in breathing, swallowing, and speaking. VF function can be adversely affected by various medical conditions including head or neck injuries, stroke, tumor, and neurological disorders. In this paper, we propose a deep learning system for automated detection of laryngeal adductor reflex (LAR) events in laryngeal endoscopy videos to enable objective, quantitative analysis of VF function. The proposed deep learning system incorporates our novel orthogonal region selection network and temporal context. This network learns to directly map its input to a VF open/close state without first segmenting or tracking the VF region. This one-step approach drastically reduces manual annotation needs from labor-intensive segmentation masks or VF motion tracks to frame-level class labels. The proposed spatio-temporal network with an orthogonal region selection subnetwork allows integration of local image features, global image features, and VF state information in time for robust LAR event detection. The proposed network is evaluated against several network variations that incorporate temporal context and is shown to lead to better performance. The experimental results show promising performance for automated, objective, and quantitative analysis of LAR events from laryngeal endoscopy videos with over 90% and 99% F1 scores for LAR and non-LAR frames respectively.
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Affiliation(s)
- Yang Yang Wang
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, 65211, Missouri, USA
| | - Ali S Hamad
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, 65211, Missouri, USA
| | - Kannappan Palaniappan
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, 65211, Missouri, USA
| | - Teresa E Lever
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri, Columbia, 65211, Missouri, USA
| | - Filiz Bunyak
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, 65211, Missouri, USA.
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139
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Abstract
BACKGROUND In a bid to end the ongoing coronavirus disease 2019 pandemic, many countries, including the UK, have rolled out mass immunisation programmes. While considered generally safe and effective, vaccines against coronavirus disease 2019 have been reported to be associated with rare and potentially adverse reactions and side effects. CASE REPORT This paper reports an unusual case of a patient who developed a unilateral vocal fold paralysis shortly after receiving the first dose of the Oxford-AstraZeneca ChAdOx1 nCov-19 vaccine. CONCLUSION To our knowledge, this is the first reported case of vocal fold paralysis following administration of the Oxford-AstraZeneca vaccine. The authors support the position that currently approved coronavirus disease 2019 vaccines remain safe and effective; however, further surveillance and vigilance using real-world data are highly encouraged.
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Affiliation(s)
- G M Jama
- Department of Otolaryngology, Queen's Hospital, Romford, UK
| | - M Amin
- Department of Otolaryngology, Queen's Hospital, Romford, UK
| | - A Hassaan
- Department of Otolaryngology, Queen's Hospital, Romford, UK
| | - H Kaddour
- Department of Otolaryngology, Queen's Hospital, Romford, UK
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140
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Diabetes, Vocal Cord Dysfunction, Periodontal Disease, Light Therapy, and More. Am Fam Physician 2022; 105:462. [PMID: 35559628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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141
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Lee JM, Roy N, Park A, Muntz H, Redmond SM, Smith M. Self-regulation in children with vocal fold nodules: A multilevel analysis. J Commun Disord 2022; 97:106203. [PMID: 35272152 DOI: 10.1016/j.jcomdis.2022.106203] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 02/09/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Vocal fold nodules (VNs) represent the most common cause of voice disorders in children. Phonotrauma related to chronic, repetitive, intense vocal activity is often cited as the proximate cause of VNs. However, diminished self-regulation (SR) may predispose some children toward extreme phonotraumatic voice use, thereby contributing secondarily to their development. This case-control study examined the association between features of SR and VNs in children. METHOD Parents of children with VNs (N = 40, Age Mean = 7.5, SD = 2.03 years) and vocally normal, medical controls (VNCs; N = 40, Age Mean = 7.6, SD = 1.54 years) completed the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2; Gioia, Isquith, Guy & Kenworthy, 2015), an inventory that evaluates components of SR in children. RESULTS Children with VNs, as compared with the vocally normal control group, were described as (i) impulsive (i.e., scoring significantly worse on the Behavior Regulation Index, BRI; P < 0.001, Cohen's d = 0.86), and (ii) emotionally dysregulated (i.e., scoring significantly worse on the Emotional Regulation Index, ERI; P < 0.001, Cohen's d = 0.81). CONCLUSIONS Diminished SR in some children with VNs may contribute to phonotraumatic vocal behaviors and potentially attenuate the effectiveness of voice therapy.
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Affiliation(s)
- Jeong Min Lee
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, UT, United States.
| | - Nelson Roy
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, UT, United States
| | - Albert Park
- Pediatric Otolaryngology Clinic, Primary Children's Medical Center, Salt Lake City, UT, United States; Division of Otolaryngology, Head and Neck Surgery, The University of Utah, School of Medicine, Salt Lake City, UT, United States
| | - Harlan Muntz
- Pediatric Otolaryngology Clinic, Primary Children's Medical Center, Salt Lake City, UT, United States; Division of Otolaryngology, Head and Neck Surgery, The University of Utah, School of Medicine, Salt Lake City, UT, United States
| | - Sean M Redmond
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, UT, United States
| | - Marshall Smith
- Pediatric Otolaryngology Clinic, Primary Children's Medical Center, Salt Lake City, UT, United States; Division of Otolaryngology, Head and Neck Surgery, The University of Utah, School of Medicine, Salt Lake City, UT, United States
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142
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Honda T, Kanaya M, Tokuda IT, Bouvet A, Van Hirtum A, Pelorson X. Experimental study on the quasi-steady approximation of glottal flows. J Acoust Soc Am 2022; 151:3129. [PMID: 35649918 DOI: 10.1121/10.0010451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
To examine the quasi-steady approximation of the glottal flow, widely used in the modeling of vocal fold oscillations, intraglottal pressure distributions were measured in a scaled-up static vocal fold model under time-varying flow conditions. The left and right vocal folds were slightly open and set to a symmetric and oblique configuration with a divergence angle. To realize time-varying flow conditions, the flow rate was sinusoidally modulated with a frequency of 2 and 10 Hz, which correspond to 112.5 and 562.5 Hz, respectively, in real life. Measurements of the intraglottal pressures under both steady and time-varying flows revealed that the pressure profiles of the time-varying flow conditions are non-distinguishable from those of the steady flow conditions as far as they have the same subglottal pressure as an input pressure. The air-jet separation point was also non-distinguishable between the steady and the time-varying flow conditions. Our study therefore suggests that the time-varying glottal flow can be approximated as a series of steady flow states with a matching subglottal pressure in the range of normal vocalization frequencies. Since the glottal closure was not taken into account in the present experiment, our argument is valid except for such a critical situation.
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Affiliation(s)
- Takuto Honda
- Graduate School of Science and Engineering, Ritsumeikan University, Noji-higashi, Kusatsu, Shiga 525-8577, Japan
| | - Mayuka Kanaya
- Graduate School of Science and Engineering, Ritsumeikan University, Noji-higashi, Kusatsu, Shiga 525-8577, Japan
| | - Isao T Tokuda
- Graduate School of Science and Engineering, Ritsumeikan University, Noji-higashi, Kusatsu, Shiga 525-8577, Japan
| | - Anne Bouvet
- LEGI, UMR CNRS 5519, Grenoble Alpes University, France
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143
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Campello C, Lima-Silva M, de Lima E, Nunes G, Silva H, Dellalibera E, de Britto L, Lemos C, Muniz M. Genetic polymorphisms and protein levels in vocal fold leukoplakia: a systematic review. Braz J Med Biol Res 2022; 55:e11920. [PMID: 35293553 PMCID: PMC8922550 DOI: 10.1590/1414-431x2022e11920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/13/2022] [Indexed: 12/03/2022] Open
Abstract
Vocal fold leukoplakia (VFL) has a risk of malignant transformation. Therefore, patients can have symptoms such as dysphonia, vocal strain, difficulty breathing, and dysphagia. Additionally, there is a genetic predisposition that can be associated with genetic polymorphisms. We aimed to evaluate the influence of genetic polymorphisms and protein levels in the etiology of VFL. Our study followed the PRISMA checklist and was registered on PROSPERO database. The questions were: "Are genetic polymorphisms involved in the etiology of VFL? Are protein levels altered in patients with VFL?". Eligibility criteria were case control studies that compared the presence of polymorphisms or/and protein levels of subjects diagnosed with VFL and healthy controls. Of the 905 articles retrieved, five articles with a total of 1038 participants were included in this study. The C allele of the single nucleotide polymorphisms (SNP)-819 T/C IL-10, A allele of the SNP -592 A/C IL-10, CT genotype of the SNP rs11886868 C/T BCL11A, GG genotype of the SNP rs4671393 A/G BCL11A, LL genotype, and L allele of (GT)n repeat polymorphisms of the HO-1 were risk factors for VFL development. Nevertheless, there was a lack of association between VFL and the -1082 A/G IL-10, rs14024 CK-1, and -309 T/G Mdm2 SNPs. The concentrations of the MDM2, BCL11A, and HO-1 proteins were modified, while IL-10 levels were normally expressed in these subjects. In conclusion, most markers evaluated in this review could be potential indicators to develop effective therapies, avoiding a malignant transformation of the lesion.
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Affiliation(s)
- C.P. Campello
- Programa Associado de Pós-Graduação em Fonoaudiologia,
Universidade Federal da Paraíba, João Pessoa, PB, Brasil
- Laboratório de Biologia Molecular, Centro de Oncohematologia
Pediátrica, Hospital Universitário Oswaldo Cruz, Universidade de Pernambuco,
Recife, PE, Brasil
| | - M.F.B. Lima-Silva
- Programa Associado de Pós-Graduação em Fonoaudiologia,
Universidade Federal da Paraíba, João Pessoa, PB, Brasil
| | - E.L.S. de Lima
- Laboratório de Biologia Molecular, Centro de Oncohematologia
Pediátrica, Hospital Universitário Oswaldo Cruz, Universidade de Pernambuco,
Recife, PE, Brasil
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de
Ciências Médicas, Universidade de Pernambuco, Recife, PE, Brasil
| | - G.R.S. Nunes
- Programa Associado de Pós-Graduação em Fonoaudiologia,
Universidade Federal da Paraíba, João Pessoa, PB, Brasil
| | - H.A.M. Silva
- Laboratório de Biologia Molecular, Centro de Oncohematologia
Pediátrica, Hospital Universitário Oswaldo Cruz, Universidade de Pernambuco,
Recife, PE, Brasil
- Instituto de Ciências Biológicas, Universidade de Pernambuco,
Recife, PE, Brasil
| | - E. Dellalibera
- Laboratório de Biologia Molecular, Centro de Oncohematologia
Pediátrica, Hospital Universitário Oswaldo Cruz, Universidade de Pernambuco,
Recife, PE, Brasil
| | | | - C.A.A. Lemos
- Departamento de Odontologia, Universidade Federal de Juiz de
Fora, Governador Valadares, MG, Brasil
| | - M.T.C. Muniz
- Laboratório de Biologia Molecular, Centro de Oncohematologia
Pediátrica, Hospital Universitário Oswaldo Cruz, Universidade de Pernambuco,
Recife, PE, Brasil
- Instituto de Ciências Biológicas, Universidade de Pernambuco,
Recife, PE, Brasil
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144
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Curtis JA, Borders JC, Troche MS. Visual Analysis of Swallowing Efficiency and Safety (VASES): Establishing Criterion-Referenced Validity and Concurrent Validity. Am J Speech Lang Pathol 2022; 31:808-818. [PMID: 35077197 DOI: 10.1044/2021_ajslp-21-00116] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The primary aim of this study was to examine the criterion-referenced validity of the Visual Analysis of Swallowing Efficiency and Safety (VASES). As a secondary aim, we examined the concurrent validity of using verbal numerical ratings for VASES as a potential substitute for visual analog scale ratings. METHOD Fifty-seven novice raters were prospectively recruited to rate 26 flexible endoscopic evaluations of swallowing (FEES) images (2 times each, randomized)-once using VASES and once using a criterion-referenced scale. Ratings were made for the valleculae, piriforms, epiglottis, laryngeal vestibule, vocal folds, and subglottis. Criterion validity was determined by examining the correlation between VASES and the criterion-referenced scales. The novice raters also provided visual analog scale ratings following verbal numerical ratings. Concurrent validity of using verbal numerical ratings as a potential substitute for visual analog scale ratings was determined by examining the correlation and absolute agreement between both rating methods. RESULTS Three thousand five hundred eighty-seven ratings were analyzed. Spearman's correlation revealed strong correlations between VASES ratings and criterion-referenced ratings across all anatomic landmarks (ρ = .882-.915). Lin's concordance revealed substantial agreement between numerical ratings and visual analog scale ratings (ρc = .986). CONCLUSIONS The strong correlations between VASES and the criterion-referenced scales suggest that VASES is a valid method for interpreting pharyngeal residue, penetration, and aspiration during FEES. Furthermore, numerical ratings exhibited substantial agreement with visual analog scales. This suggests that clinicians could provide verbal numerical ratings in lieu of visual analog scale ratings as a potential way to enhance the ease and feasibility of implementing VASES into clinical practice. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.18737072.
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Affiliation(s)
- James A Curtis
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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145
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Zhang Z. Estimating subglottal pressure and vocal fold adduction from the produced voice in a single-subject study (L). J Acoust Soc Am 2022; 151:1337. [PMID: 35232110 PMCID: PMC9013286 DOI: 10.1121/10.0009616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
We previously reported a simulation-based neural network for estimating vocal fold properties and subglottal pressure from the produced voice. This study aims to validate this neural network in a single-human subject study. The results showed reasonable accuracy of the neural network in estimating the subglottal pressure in this particular human subject. The neural network was also able to qualitatively differentiate soft and loud speech conditions regarding differences in the subglottal pressure and degree of vocal fold adduction. This simulation-based neural network has potential applications in identifying unhealthy vocal behavior and monitoring progress of voice therapy or vocal training.
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Affiliation(s)
- Zhaoyan Zhang
- Department of Head and Neck Surgery, University of California, Los Angeles, 31-24 Rehab Center, 1000 Veteran Avenue, Los Angeles, California 90095-1794, USA
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146
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Fukusho R, Ruane L, Phyland D, Koh J, Avram A, Leong P, MacDonald M, Lau KK, Baxter M, Bardin PG. A multidisciplinary team clinic for vocal cord dysfunction reduces corticosteroid burst therapy. J Allergy Clin Immunol Pract 2022; 10:612-614.e1. [PMID: 34718216 DOI: 10.1016/j.jaip.2021.10.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/22/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Risa Fukusho
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, VIC, Australia
| | - Laurence Ruane
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, VIC, Australia; Hudson Institute, Melbourne, VIC, Australia
| | - Debra Phyland
- Otolargyngology, Monash Health and University, Melbourne, VIC, Australia
| | - Joo Koh
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, VIC, Australia; Otolargyngology, Monash Health and University, Melbourne, VIC, Australia
| | - Adriana Avram
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, VIC, Australia
| | - Paul Leong
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, VIC, Australia; Hudson Institute, Melbourne, VIC, Australia
| | - Martin MacDonald
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, VIC, Australia; Hudson Institute, Melbourne, VIC, Australia
| | - Kenneth K Lau
- Diagnostic Imaging, Monash Health and University, Melbourne, VIC, Australia
| | - Malcolm Baxter
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, VIC, Australia; Otolargyngology, Monash Health and University, Melbourne, VIC, Australia
| | - Philip G Bardin
- Monash Lung Sleep Allergy & Immunology, Monash Health and University, Melbourne, VIC, Australia; Hudson Institute, Melbourne, VIC, Australia.
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147
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Osipenko EV, Karneeva OV, Kim IA, Orlova OS, Kotelnikova NM, Mikhalevskaya IA, Krivykh YS, Isaeva ML. [Results of a prospective observational study of the effectiveness of the complex drug Homeovox in adult patients with various types of dysphonia]. Vestn Otorinolaringol 2022; 87:71-78. [PMID: 36107184 DOI: 10.17116/otorino20228704171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
UNLABELLED The voice as the most important means of communication is of great importance in a person's life. Every year the number of specialties for which voice and speech are a key tool of professional activity increases. Diseases of the vocal apparatus reduce the ability to work, and for some people pose a threat of professional unfitness. The relevance of the study is determined not only by the significant prevalence of dysphonia, but also by the insufficient effectiveness of existing methods of treating voice disorders. OBJECTIVE To evaluate the clinical efficacy and safety of the use of the drug Homeovox in patients with acute and chronic catarrhal laryngitis as monotherapy. To fulfill the set goal of the study, the following tasks were solved: evaluation of the clinical effectiveness of the drug Homeovox as monotherapy for various types of dysphonia; evaluation of the effectiveness of the drug Homeovox as monotherapy from the 1st day of use. MATERIAL AND METHODS The basis for the implementation of the tasks was the analysis of the results of the examination and treatment of 60 patients with voice disorders aged 18 to 75 years. Among them, 10 (17%) patients with acute laryngitis and 50 (83%) patients with chronic laryngitis. To establish the diagnosis, a comprehensive examination was carried out, involving examination, videolaryngostroboscopy, acoustic analysis of the voice. The study design included three patient visits, during which the functional state of the vocal apparatus was examined by subjective and objective methods. RESULTS As a result of the treatment with the use of the drug Homeovox, the efficacy and safety of this drug in the treatment of dysphonia in adult patients with acute and chronic laryngitis from the first days of therapy has been proven, which is confirmed by the method of videolaryngostroboscopy and acoustic analysis of the voice. CONCLUSION The drug Homeovox is an effective, safe remedy and can be included in the complex treatment of laryngeal pathology in order to increase its effectiveness and achieve a therapeutic effect in a shorter time, manifested by an improvement in the clinical and functional state of larynx.
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Affiliation(s)
- E V Osipenko
- National Medical Research Center for Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - O V Karneeva
- National Medical Research Center for Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - I A Kim
- National Medical Research Center for Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - O S Orlova
- National Medical Research Center for Otorhinolaryngology, Moscow, Russia
- Moscow Pedagogical State University, Moscow, Russia
- FFederal Center for Brain and Neurotechnology, Moscow, Russia
| | - N M Kotelnikova
- National Medical Research Center for Otorhinolaryngology, Moscow, Russia
| | - I A Mikhalevskaya
- National Medical Research Center for Otorhinolaryngology, Moscow, Russia
| | - Yu S Krivykh
- National Medical Research Center for Otorhinolaryngology, Moscow, Russia
| | - M L Isaeva
- National Medical Research Center for Otorhinolaryngology, Moscow, Russia
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148
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Topolnitskiy EB, Shefer NA, Podgornov VF. [A non-standard approach in the treatment of post-traumatic multifocal cicatricial tracheal stenosis with atresia of subglottic larynx, involvement of vocal cords and 33-year cannulation]. Vestn Otorinolaringol 2022; 87:113-117. [PMID: 36107191 DOI: 10.17116/otorino202287041113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The report presents a case of non-standard two-stage treatment of post-traumatic multifocal cicatricial tracheal stenosis with atresia of subglottic larynx, involvement of vocal cords, and 33-year cannulation. At the first stage, bougienage through a tracheostomy, endoscopic argon plasma exposure, circular tracheoglottic resection with tracheostomy and 3/4 circle anastomosis, formation of a laryngotracheostomy with endoprosthetics were applied simultaneously. The second step was to eliminate the extensive fenestrated tracheo-laryngeal defect using titanium nickelide reinforcing implants. The individual algorithm made it possible to successfully eliminate complex tracheo-laryngeal stenosis with long-term cannulation and demonstrate excellent long-term treatment results.
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Affiliation(s)
- E B Topolnitskiy
- Siberian State Medical University, Tomsk, Russia
- Tomsk Regional Clinical Hospital, Tomsk, Russia
| | - N A Shefer
- Tomsk Regional Clinical Hospital, Tomsk, Russia
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149
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Stager SV, Gupta S, Amdur R, Bielamowicz SA. Objective Laryngoscopic Measures From Older Patients With Voice Complaints and Signs of Aging. J Speech Lang Hear Res 2021; 64:4705-4717. [PMID: 34735274 DOI: 10.1044/2021_jslhr-21-00095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE The purpose of this study was to use objective measures of glottal gap, bowing, and supraglottic compression from selected images of laryngoscopic examinations from adults over 60 years of age with voice complaints and signs of aging to test current hypotheses on whether degree of severity impacts treatment recommendations and potential follow-through with treatment. METHOD Records from 108 individuals 60 years or older with voice complaints and signs of aging were reviewed. Three objective measures (normalized glottal gap area [NGGA], total bowing index, and normalized true vocal fold width) were derived. Each measure was subsequently divided into three categories by severity: absence, small degree, or large degree. Nonparametric statistics tested associations between severity and treatment recommendations as well as potential follow-through. RESULTS Noninvasive treatments (observation/voice therapy) were marginally associated with no glottal gap (p = .09). More invasive treatments (injection/bilateral thyroplasty) were associated with glottal gaps being present (p = .026), but bilateral thyroplasty recommendations were not significantly associated with the largest gaps. Treatment modalities were not characterized by specific severity categories for any of the objective measures. No significant differences were found for any of the three objective measures between those who followed through with recommended treatment and those who did not. DISCUSSION Results demonstrated some support for current hypotheses on how degrees of severity of objective measures relate to treatment recommendations. Of the three measures, NGGA appears to be more informative regarding treatment recommendations and follow-through, but due to low power, larger sample sizes are needed to confirm clinical relevance.
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Affiliation(s)
- Sheila V Stager
- Medical Faculty Associates Voice Treatment Center, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, The George Washington University School of Medicine & Health Sciences
| | - Simran Gupta
- The George Washington University School of Medicine & Health Sciences
| | - Richard Amdur
- Department of Surgery, The George Washington University School of Medicine & Health Sciences
| | - Steven A Bielamowicz
- Medical Faculty Associates Voice Treatment Center, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, The George Washington University School of Medicine & Health Sciences
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Frey R, Wyman MT, Johnston M, Schofield M, Locatelli Y, Reby D. Roars, groans and moans: Anatomical correlates of vocal diversity in polygynous deer. J Anat 2021; 239:1336-1369. [PMID: 34342877 PMCID: PMC8602020 DOI: 10.1111/joa.13519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/15/2021] [Accepted: 07/06/2021] [Indexed: 02/01/2023] Open
Abstract
Eurasian deer are characterized by the extraordinary diversity of their vocal repertoires. Male sexual calls range from roars with relatively low fundamental frequency (hereafter fo ) in red deer Cervus elaphus, to moans with extremely high fo in sika deer Cervus nippon, and almost infrasonic groans with exceptionally low fo in fallow deer Dama dama. Moreover, while both red and fallow males are capable of lowering their formant frequencies during their calls, sika males appear to lack this ability. Female contact calls are also characterized by relatively less pronounced, yet strong interspecific differences. The aim of this study is to examine the anatomical bases of these inter-specific and inter-sexual differences by identifying if the acoustic variation is reflected in corresponding anatomical variation. To do this, we investigated the vocal anatomy of male and female specimens of each of these three species. Across species and sexes, we find that the observed acoustic variability is indeed related to expected corresponding anatomical differences, based on the source-filter theory of vocal production. At the source level, low fo is associated with larger vocal folds, whereas high fo is associated with smaller vocal folds: sika deer have the smallest vocal folds and male fallow deer the largest. Red and sika deer vocal folds do not appear to be sexually dimorphic, while fallow deer exhibit strong sexual dimorphism (after correcting for body size differences). At the filter level, the variability in formants is related to the configuration of the vocal tract: in fallow and red deer, both sexes have evolved a permanently descended larynx (with a resting position of the larynx much lower in males than in females). Both sexes also have the potential for momentary, call-synchronous vocal tract elongation, again more pronounced in males than in females. In contrast, the resting position of the larynx is high in both sexes of sika deer and the potential for further active vocal tract elongation is virtually absent in both sexes. Anatomical evidence suggests an evolutionary reversal in larynx position within sika deer, that is, a secondary larynx ascent. Together, our observations confirm that the observed diversity of vocal behaviour in polygynous deer is supported by strong anatomical differences, highlighting the importance of anatomical specializations in shaping mammalian vocal repertoires. Sexual selection is discussed as a potential evolutionary driver of the observed vocal diversity and sexual dimorphisms.
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Affiliation(s)
- Roland Frey
- Department of Reproduction ManagementLeibniz Institute of Zoo and Wildlife Research (IZW)BerlinGermany
| | - Megan Tompkins Wyman
- Department of Evolutionary Biology and Environmental ScienceUniversity of ZurichZurichSwitzerland
| | - Malcolm Johnston
- Clinical Imaging Sciences CentreUniversity of SussexBrightonUK
- Department of RadiologyBrighton and Sussex University HospitalsBrightonUK
| | - Michael Schofield
- Genome Damage and Stability CentreSchool of Life SciencesUniversity of SussexBrightonUK
| | - Yann Locatelli
- Réserve de la Haute ToucheMuséum National d’Histoire NaturelleObterreFrance
| | - David Reby
- Equipe de Neuro‐Ethologie Sensorielle (ENES)/Centre de Recherche en Neurosciences de Lyon (CRNL)University of Saint‐Étienne, CNRS UMR5292, INSERM UMR_S 1028Saint‐ÉtienneFrance
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