Auditory-perceptual voice characteristics in pre-operative patients undergoing thyroid or parathyroid surgery

Voice perturbations under the stress overload in young individuals: phenotyping and suboptimal health as predictors for cascading pathologies

Verbal communication is one of the most sophisticated human motor skills reflecting both-the mental and physical health of an individual. Voice parameters and quality changes are usually secondary towards functional and/or structural laryngological alterations under specific systemic processes, syndrome and pathologies. These include but are not restricted to dry mouth and Sicca syndromes, body dehydration, hormonal alterations linked to pubertal, menopausal, and andropausal status, respiratory disorders, gastrointestinal reflux, autoimmune diseases, endocrinologic disorders, underweight versus overweight and obesity, and diabetes mellitus. On the other hand, it is well-established that stress overload is a significant risk factor of cascading pathologies, including but not restricted to neurodegenerative and psychiatric disorders, diabetes mellitus, cardiovascular disease, stroke, and cancers. Our current study revealed voice perturbations under the stress overload as a potentially useful biomarker to identify individuals in suboptimal health conditions who might be strongly predisposed to associated pathologies. Contextually, extended surveys applied in the population might be useful to identify, for example, persons at high risk for respiratory complications under pandemic conditions such as COVID-19. Symptoms of dry mouth syndrome, disturbed microcirculation, altered sense regulation, shifted circadian rhythm, and low BMI were positively associated with voice perturbations under the stress overload. Their functional interrelationships and relevance for cascading associated pathologies are presented in the article. Automated analysis of voice recordings via artificial intelligence (AI) has a potential to derive digital biomarkers. Further, predictive machine learning models should be developed that allows for detecting a suboptimal health condition based on voice recordings, ideally in an automated manner using derived digital biomarkers. Follow-up stratification and monitoring of individuals in suboptimal health conditions are recommended using disease-specific cell-free nucleic acids (ccfDNA, ctDNA, mtDNA, miRNA) combined with metabolic patterns detected in body fluids. Application of the cost-effective targeted prevention within the phase of reversible health damage is recommended based on the individualised patient profiling.

Voice Characteristics in Patients with Thyroid Disorders

Objective

This study investigated acoustic and perceptual characteristics of the voice of patients with thyroid gland disorders such as hypothyroidism and hyperthyroidism immediately after the diagnosis was made and six months later, after using drug therapy.

Materials and Methods

The study includes 20 female outpatients with hypothyroidism and 27 female outpatients with hyperthyroidism. The criterion for the selection of the patients was a thyroid gland disorder medical diagnosis, no history of voice disorders and absence of other possible causes of voice changes. Acoustic, perceptual and aerodynamic parameters were assessed. Acoustic analysis was performed by specific software. Experienced speech and language pathologists made perceptual voice assessment by using grade, roughness, breathiness, asthenia, and strain (GRBAS) scale.

Results

Significant differences in patients with hypothyroidism were established on parameter amplitude perturbation, jitter and noise-to-harmonics ratio between pretreatment and posttreatment period, in which patients took drug therapy. In group of patients with hyperthyroidism significant difference was noted only on aerodynamic parameter maximum phonation time. There were a significant differences in all perceptual parameters in both groups of patients (p<0.05) in pre and posttreatment, except on grade and asthenia parameter in the group of patients with hypothyroidism and parameter grade was borderline insignificant in the group of patients with hyperthyroidism.

Conclusion

Voice quality is affected by thyroid disease. Thyroid gland disorders cause minor changes in acoustic voice parameters of patients with hypothyroidism and hyperthyroidism, but perceptual deviations in these patients are especially noticeable.

Changes in Oral Vowel Sounds and Hyoid Bone Movement After Thyroidectomy

OBJECTIVES

Voice and speech alterations after total thyroidectomy may be associated with other extralaryngeal factors, such as neck muscle dysfunction and neck scar contracture. We evaluated the acoustic characteristics of oral vowel sounds and changes in hyoid bone movement before and after thyroidectomy.

METHODS

Twenty-nine female patients undergoing total thyroidectomy were included. Fundamental frequencies (Fo), formants and vowel space areas were evaluated before surgery and 7 days and 3 months after surgery to acoustically analyze the oral vowel sounds. Videofluoroscopic images were taken at the same times to evaluate hyoid bone movement.

RESULTS

The Fo levels of seven vowels decreased significantly after surgery. The vowel formant changes the F1 of vowel /[e]/ decreased significantly from baseline at 3 months postoperatively, and the F3 of vowel /[i]/ decreased significantly from baseline 7 days postoperatively. The change in the vowel space area was not observed. The Y coordinate of the vowels /[i]/ and /[e]/ decreased significantly from baseline 7 days postoperatively due to changes in hyoid movement.

CONCLUSION

The damage to the neck muscles after thyroidectomy changes in Fo, formant and hyoid bone position. These quantitative results could be used as basic data for voice management in patients who undergo thyroidectomy.

Qualidade de vida em voz de pacientes no pré-operatório de tireoidectomia

RESUMO Objetivo: avaliar a qualidade de vida em voz de indivíduos encaminhados à tireoidectomia, antes da realização do procedimento. Métodos: participaram do presente estudo pacientes do sexo feminino de um hospital de referência encaminhados para cirurgia de tireoide ou colelitíase. Os indivíduos foram subdivididos em: Grupo Estudo - 30 mulheres (média de 44,26 anos), encaminhadas para cirurgia de tireoidectomia parcial ou total; Grupo Controle - 30 mulheres (média de 45,3 anos), encaminhadas para cirurgia de colelitíase. Os participantes responderam um questionário de triagem e ao protocolo Qualidade de Vida em Voz. Os dados foram analisados estatisticamente por meio dos testes Fisher Two Tailed, Teste T de Student e coeficiente de correlação de Pearson, adotando-se nível de significância de 5%. Resultados: houve maior ocorrência de queixa vocal (48,3%), e escores inferiores de qualidade de vida em voz em todos os domínios no grupo estudo, que no grupo controle. Na análise exclusiva ao grupo estudo, observou-se que o domínio físico foi o mais afetado, com diferença em relação ao domínio socioemocional (p=0,002), havendo ainda correlação positiva forte entre os escores dos dois domínios (r=0,047; p=<0,001). Conclusão: conclui-se que o grupo de mulheres com doenças tireoidianas pré-tireoidectomia estudado apresenta impacto negativo na qualidade de vida em voz, principalmente no que se refere ao domínio físico, sendo que à medida que os acometimentos físicos relacionados à voz acontecem, há acometimento do domínio socioemocional.

Voice Assessment and Voice-related Quality of Life in Patients with Benign Thyroid Disease

Objective

To identify the relationship between vocal self-assessment, the assessment of voice by a speech-language pathologist (SLP), and the effect of voice on the quality of life of patients with benign thyroid diseases.

Study Design

Cross-sectional study.

Setting

University hospital.

Subjects and Method

A total of 67 women with a mean age of 44.7 ± 14.8 years and a diagnosis of benign thyroid disease were included in the study. Vocal self-assessment and SLP assessment were performed using a visual analogue scale (VAS). The Voice-related Quality of Life Questionnaire (V-RQOL) was used to identify the effect of voice on quality of life. The Mann-Whitney and Kruskal-Wallis nonparametric tests were used. Correlations between assessments were verified by the Spearman correlation test. The significance level was 5%.

Results

Patients with vocal complaints had lower scores in all assessments. Patients with thyroid nodules performed worse on the SLP assessment and on the physical functioning domain of V-RQOL. A moderate correlation was found between the self-assessment and quality of life and between the physical functioning domain of V-RQOL and the SLP assessment. A weak correlation existed between the self-assessment and the SLP assessment.

Conclusion

Patients with benign thyroid diseases had lower scores in vocal self-assessment, the clinical evaluation of voice, and the V-RQOL. These dimensions of voice assessment showed correlations ranging from mild to moderate and should complement the clinical routine.

Autoavaliação vocal e avaliação perceptivo-auditiva da voz em mulheres com doença tireoidiana

Objetivo comparar a autoavaliação vocal e a avaliação perceptivo-auditiva da voz em mulheres com doença tireoidiana. Métodos o estudo foi realizado com 40 pacientes do sexo feminino, idade média de 49,50±10,40 anos, utilizando a escala analógica-visual (EAV) para realizar a autoavaliação vocal e a análise perceptivo-auditiva pelo fonoaudiólogo. A paciente considerou a emissão habitual do dia a dia na sua autoavaliação e para a análise fonoaudiológica da voz foram gravadas amostras da contagem de 1 a 20. A análise considerou o tamanho total da amostra e também sua categorização grupos de acordo com a presença ou não de queixa e por faixa etária. A análise descritiva das variáveis considerou média, mediana e desvio-padrão. Foram aplicados os testes de Wilcoxon e Mann-Whitney para comparação de médias e o teste de Spearman para testar correlação entre as duas avaliações.O nível de significância foi de 5%. Resultados 19 (47,5%) pacientes relataram queixa de disfonia. A média e desvio-padrão da EAV das pacientes e da EAV do fonoaudiólogo foram 32,58±27,99 e 37,23±15,92, respectivamente, sem diferença estatisticamente significante. Pacientes com queixa vocal apresentaram pior média na autoavaliação quando comparadas às que não tiveram queixa. Não houve diferença estatisticamente significante entre esses grupos em relação à avaliação perceptivo-auditiva. Não foi encontrada correlação estatisticamente significante entre a percepção que a paciente tem sobre sua voz e a avaliação do fonoaudiólogo. Conclusão não houve diferença entre as médias da autoavaliação vocal e da avaliação perceptivo-auditiva; a autoavaliação da voz foi pior em pacientes com queixa vocal; não houve correlação entre as duas avaliações estudadas.

How can we screen voice problems effectively in patients undergoing thyroid surgery?

BACKGROUND

Voice problems following thyroid surgery are well known, and perioperative voice analysis in patients undergoing thyroidectomy no longer seems optional. However, multiple means of assessing vocal function are time-consuming, require specific instruments and specialists, and increase costs. Therefore, we designed this study to develop an efficient and cost-effective screening tool for detecting voice disorders following thyroidectomy.

METHODS

We developed the Perioperative Voice-Screening Protocol for Thyroid Surgery (PVST) using the Thyroidectomy-Related Voice Questionnaire (TVQ) to provide a cost-effective diagnostic flow chart for patients following thyroidectomy. The TVQ is a simple questionnaire that was developed at our institution and has already demonstrated its effectiveness in detecting pre- and postthyroidectomy voice-related disorders in our previous studies. To investigate the PVST, we enrolled 242 subjects who underwent thyroidectomy and let them follow the PVST. All subjects underwent a voice work-up by a voice specialist to verify the predictive value of the protocol.

RESULTS

Using PVST, we could effectively screen for abnormal preoperative laryngeal findings with sensitivity and specificity of 82.1% and 50.5%, respectively, especially laryngeal benign mucosal disease with sensitivity and specificity of 100% and 45.6%, respectively. We could also screen for postoperative voice-related problems with sensitivity and specificity of 100% and 50.4% for detecting vocal-cord palsy, and 66.7% and 51.2% for detecting a low-pitched voice, respectively. If all 242 patients followed the protocol, US $42,768 would be saved, and the PVST was estimated to decrease costs by 43.5%.

CONCLUSIONS

The PVST is a reliable and cost-effective perioperative screening tool that enables thyroid surgeons to detect patients with voice problems in their routine outpatient clinic for early and appropriate referral to voice specialists.