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Baker CP, Sundberg J, Purdy SC, Rakena TO, Leão SHDS. CPPS and Voice-Source Parameters: Objective Analysis of the Singing Voice. J Voice 2024; 38:549-560. [PMID: 35000836 DOI: 10.1016/j.jvoice.2021.12.010] [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: 09/14/2021] [Revised: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In recent years cepstral analysis and specific cepstrum-based measures such as smoothed cepstral peak prominence (CPPS) has become increasingly researched and utilized in attempts to determine the extent of overall dysphonia in voice signals. Yet, few studies have extensively examined how specific voice-source parameters affect CPPS values. OBJECTIVE Using a range of synthesized tones, this exploratory study sought to systematically analyze the effect of fundamental frequency (fo), vibrato extent, source-spectrum tilt, and the amplitude of the voice-source fundamental on CPPS values. MATERIALS AND METHODS A series of scales were synthesised using the freeware Madde. Fundamental frequency, vibrato extent, source-spectrum tilt, and the amplitude of the voice-source fundamental were systematically and independently varied. The tones were analysed in PRAAT, and statistical analyses were conducted in SPSS. RESULTS CPPS was significantly affected by both fo and source-spectrum tilt, independently. A nonlinear association was seen between vibrato extent and CPPS, where CPPS values increased from 0 to 0.6 semitones (ST), then rapidly decreased approaching 1.0 ST. No relationship was seen between the amplitude of the voice-source fundamental and CPPS. CONCLUSION The large effect of fo should be taken into account when analyzing the voice, particularly in singing-voice research, when comparing pre and posttreatment data, and when comparing inter-subject CPPS data.
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Affiliation(s)
- Calvin P Baker
- Department of Voice, School of Music, University of Auckland, Auckland Central, Auckland, New Zealand.
| | - Johan Sundberg
- Division of Speech, Music and Hearing, School of Electrical Engineering and Computer Science, KTH (Royal Institute of Technology), Stockholm, Sweden; Department of Linguistics, Stockholm University, Stockholm, Sweden; University College of Music Education Stockholm, Sweden
| | - Suzanne C Purdy
- School of Psychology, University of Auckland, Auckland Central, Auckland, New Zealand
| | - Te Oti Rakena
- Department of Voice, School of Music, University of Auckland, Auckland Central, Auckland, New Zealand
| | - Sylvia H de S Leão
- Speech Science, School of Psychology, University of Auckland, Grafton, Auckland, New Zealand
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Abstract
OBJECTIVE There are different parts of a battery of voice assessments to assess voice functions and voice quality. The objective assessment of voice quality using acoustics is recommended and two measurements such as the Acoustic Voice Quality index, 03.01 (AVQI) and the Acoustic Breathiness Index (ABI) are leading in this domain. The purpose of this study was to verify the validity between these two acoustic measurements and other dimensions of the voice assessments (the Voice Handicap Index-10 (VHI-10) and the laryngeal imaging evaluation of the larynx and vocal folds). METHODS We used a retrospective database of 150 participants (37 vocally healthy participants and 113 dysphonic patients). To test the validity between the acoustic measurements and the other voice assessments the concurrent validity and diagnostic precision were analyzed using Pearson correlation coefficient and the receiver operating characteristic (ROC) statistics with likelihood ratios. RESULTS The VHI-10 score presented moderate-significant correlations with the AVQI and the ABI, r= 0.477, P < 0.001 (r2= 0.228) and r= 0.426, P < 0.001 (r2=0.181), respectively. The larynx alteration presented low-significant correlations with the AVQI (r= 0.362, P < 0.001, r2= 0.131), and ABI (r= 0.371, P < 0.001, r2= 0.138), respectively. The area under the curve (AUC) of ROC was almost reasonable ranging from 0.701 to 0.737; except between ABI and VHI-10 (AUC= 0.689). The highest AUC was between the AVQI and VHI-10 at a threshold of 2.10; the highest specificity was between the ABI and VHI-10 at a threshold of 3.77. However, the lowest sensitivity was between ABI and VHI-10 while the lowest specificity was between the laryngeal diagnosis and the ABI. CONCLUSION AVQI and ABI presented significantly lower concurrent validity and diagnostic precision when the reference is not the auditory-perceptual judgment of voice quality. However, AVQI seems to be for some validity aspects a more reasonable classifier of vocal handicap and laryngeal alteration than ABI. Both AVQI and ABI values can broaden their range of assessment for the clinical user, thus showing more relationships between the individual voice examination methods.
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Affiliation(s)
- Marina Englert
- Human Communication Disorders, Universidade Federal de São Paulo -UNIFESP, São Paulo, Brazil; Centro de Estudos da Voz - CEV, São Paulo, Brazil.
| | - Ben Barsties V Latoszek
- Speech-Language Pathology, SRH University of Applied Health Sciences, Düsseldorf, Germany; Department of Phoniatrics and Pediatric Audiology, University Hospital Münster, University of Münster, Münster, Germany
| | - Mara Behlau
- Human Communication Disorders, Universidade Federal de São Paulo -UNIFESP, São Paulo, Brazil; Centro de Estudos da Voz - CEV, São Paulo, Brazil
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Hseu AF, Spencer G, Jo S, Kagan S, Thompson K, Woodnorth G, Nuss RC. Telehealth for Treatment of Pediatric Dysphonia. J Voice 2024; 38:683-687. [PMID: 34969557 DOI: 10.1016/j.jvoice.2021.11.007] [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: 09/01/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Vocal fold nodules are the most common etiology of chronic dysphonia in the pediatric population. Voice therapy is an effective first line of treatment, with increasing evidence supporting the use of telepractice in speech pathology. Despite this, there is limited data on its effectiveness in the pediatric population. The aim of this retrospective study was to investigate the feasibility and efficacy of telepractice in delivering voice therapy to children diagnosed with vocal fold nodules. METHODS A retrospective review was conducted of patients treated with virtual voice therapy from April 2020 to June 2021. Patients were included if diagnosed with vocal fold nodules, 2-18 years of age, and completed therapy in a virtual format. Data includes demographics, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores and pediatric Voice Handicap Index (pVHI) scores. RESULTS Twenty-three children were included, 17 (74%) male and six (26%) female (with an age range of 2.4-9.9 years at the start of therapy). Prior to treatment, the average CAPE-V Overall Severity score was 37.9 (SD 13.8); the average posttreatment score was 22.4 (SD 10.2). The average pVHI total score prior to treatment was 26.3 (SD 12.1), with an average posttreatment score of 20.2 (SD 11.7). Patients who underwent virtual voice therapy had improved posttreatment CAPE-V severity scores than those prior to treatment (average difference = -15.5 points; 95% CI: -8.3 to -22.7; P < 0.001). An increased number of therapy sessions was associated with both higher initial CAPE-V severity scores (r = 0.72; P < 0.01) and a greater decrease in posttreatment CAPE-V scores (r = -0.55; P < 0.01). CONCLUSION Virtual voice therapy may be feasible and efficacious in treating dysphonic children diagnosed with vocal fold nodules. Significant improvements were found in perceptual CAPE-V scores in overall severity; positive changes were also seen in parental measures of quality of life. Delivery of voice therapy in a telehealth format may increase access of care and should be considered as a treatment option.
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Affiliation(s)
- Anne F Hseu
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts; Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.
| | - Grant Spencer
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Stacy Jo
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Sydney Kagan
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Karen Thompson
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Geralyn Woodnorth
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Roger C Nuss
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts; Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
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Wang F, Yiu EM. Is Surface Electromyography (sEMG) a Useful Tool in Identifying Muscle Tension Dysphonia? An Integrative Review of the Current Evidence. J Voice 2024; 38:800.e1-800.e12. [PMID: 34903394 DOI: 10.1016/j.jvoice.2021.10.006] [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: 05/29/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This integrative review aims to determine the quality level of evidence on using surface electromyography (sEMG) as a diagnostic tool in identifying muscle tension dysphonia. METHOD Two independent reviewers used one search engine and five databases to identify sEMG studies published between January 1980 and December 2020, using a set of specified search terms related to muscle tension dysphonia. The selected articles were systematically evaluated by two independent raters using a modified critical appraisal of diagnostic evidence (m-CADE) form. RESULTS Nine articles that satisfied the inclusion criteria were selected from among 576 studies for evaluation. These nine studies showed varied methodological approaches in sEMG measurements, including electrode configuration and position, tasks used in sEMG data collection, outcome measure, and normalization procedures. Five studies showed relatively high m-CADE scores, which were indicative of "suggestive validity and compelling importance". Two studies were rated as "suggestive validity and importance", while two remaining studies were rated as "less suggestive or equivocal validity and importance". CONCLUSIONS The review found a moderate level of evidence that sEMG can be a potentially useful tool with diagnostic value in identifying muscle tension dysphonia. However, evidence is not yet available to determine the diagnostic accuracy of sEMG for muscle tension dysphonia. More studies are needed, and it is recommended that future studies involving sEMG and reference measurements should be undertaken using a blinding procedure in order to control any subjective biases. Details of the population that the sEMG has been tested on should be outlined clearly so that spectrum bias could be eliminated or minimized in the application process. Furthermore, it is suggested that a reliable and valid protocol in collecting sEMG data during speech should be developed to minimize the variability of sEMG measures in assessing muscle activities during speech.
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Affiliation(s)
- Feifan Wang
- School of Humanities, Shanghai Normal University, Shanghai, China.
| | - Edwin Ml Yiu
- Voice Research Laboratory, The University of Hong Kong, Pokfulam, Hong Kong
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Sund LT, Cameron B, Johns MM, Gao WZ, O'Dell K, Hapner ER. Laryngologists' Reported Decision-Making in Presbyphonia Treatment. J Voice 2024; 38:723-730. [PMID: 34819238 DOI: 10.1016/j.jvoice.2021.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 09/11/2021] [Revised: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Decision-making regarding behavioral versus procedural intervention in the treatment of presbyphonia has not been well defined. The study objective was to survey laryngologists' reported practice patterns and decision-making in presbyphonia. METHODS All laryngology faculty in U.S. academic medical centers with residency programs were recruited to complete an anonymous 29-item survey regarding decision-making in presbyphonia treatment. The survey included 5 sections: demographics, first-line treatment distribution, factors that drive decision-making toward procedural intervention, treatment progression if first-line treatment is insufficient, durable treatment. RESULTS Of 153 laryngologists surveyed, 89 responded (58%). Voice therapy (VT) was the most often reported first-line treatment, with 57% of respondents indicating the majority of their patients receive VT initially. Most respondents (83%) indicated they occasionally use procedural intervention as first-line treatment. Factors driving first-line procedural intervention were severe glottal insufficiency (87%), high occupational/social voice demands (76%), voice not stimulable for change (73%), difficulty attending VT (70%), severe dysphonia (65%), and dysphagia (61%). The majority of respondents indicated the following do not affect their decision to pursue procedural intervention: patient age (88%); medical comorbidities (63%); patient's desire for a "quick fix" (55%); patient-reported outcome measures (51%). Most respondents (81%) use trial injection augmentation before durable treatment. Of durable treatments, bilateral thyroplasty was preferred (71%), followed by CaHA (15%) and lipoinjection (11%). CONCLUSIONS This study is the first to our knowledge to examine factors that influence decision-making in presbyphonia treatment. While VT remains the most frequent first-line treatment, study results better inform decision-making regarding first-line procedural intervention.
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Affiliation(s)
- Lauren Timmons Sund
- USC Voice Center, USC Caruso Department of Otolaryngology - Head and Neck Surgery, Keck Medicine of USC, Los Angeles, California
| | - Brian Cameron
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Texas - Houston, Cameron, Houston, Texas
| | - Michael M Johns
- USC Voice Center, USC Caruso Department of Otolaryngology - Head and Neck Surgery, Keck Medicine of USC, Los Angeles, California
| | - William Z Gao
- Department of Otolaryngology-Head & Neck Surgery, Georgetown University Medical Center, Gao, Washington, DC
| | - Karla O'Dell
- Department of Otolaryngology-Head & Neck Surgery, Georgetown University Medical Center, Gao, Washington, DC
| | - Edie R Hapner
- UAB Voice Center, Department of Otolaryngology, University of Alabama at Birmingham, Hapner, Birmingham, Alabama.
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Haddad G, El Hage A, Yammine Y, Hamdan AL. Prevalence of Obesity in Patients with Dysphonia. J Voice 2024; 38:741-745. [PMID: 35078699 DOI: 10.1016/j.jvoice.2021.12.001] [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: 08/17/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the prevalence of obesity in patients with dysphonia and the association between Body Mass Index (BMI) and the Voice Handicap Index-10 (VHI-10). MATERIAL AND METHODS This is a retrospective study that included 304 patients who visited the senior author's Otolaryngology practice between the years 2018 and 2020. Patients were divided into two groups, those presenting for dysphonia and those presenting for other otolaryngologic complaints (Controls). Patients were also stratified as Normal weight (BMI < 25 kg/m2) vs. Overweight (BMI between 25-30 kg/m2), vs. Obese (BMI ≥ 25 kg/m2). The VHI-10 was used as a subjective outcome measure reported by patients with dysphonia. RESULTS A total of 304 patients included in this study, 203 presenting with dysphonia and 101 with other otolaryngologic complaint. Within the dysphonia group, a significantly higher percentage of patients had a BMI ≥ 25 (70.4%) as compared to the control group (57.4%). The odds ratio were 1.76, meaning that obese patients were 1.76 times more likely to present with dysphonia. There was a weak negative correlation between overweight, obesity, and VHI-10 scores (r=-0.007 and r=-0.039, respectively). CONCLUSION There was a significantly higher prevalence of overweight and obesity in patients with dysphonia vs. patients with no dysphonia. Although there was a weak correlation between BMI and VHI, our results demonstrate that overweight and obese patients are more likely to have dysphonia.
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Affiliation(s)
- Ghassan Haddad
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Lebanon
| | - Aya El Hage
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Lebanon
| | - Yara Yammine
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Lebanon
| | - Abdul-Latif Hamdan
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Lebanon.
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Marks KL, Dahl KL, Stepp CE. The Impact of Foreign Language Accent on Expert Listeners' Auditory-Perceptual Evaluations of Dysphonia. Laryngoscope 2024; 134:2272-2276. [PMID: 37942827 PMCID: PMC11006577 DOI: 10.1002/lary.31160] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/06/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Auditory-perceptual evaluations of dysphonia, though essential for comprehensive voice evaluation, are subject to listener bias. Knowledge of an underlying voice disorder can influence auditory-perceptual ratings. Accented speech results in increased listener effort and delays in word identification. Yet, little is known about the impact of foreign language accents on auditory-perceptual ratings for dysphonic speakers. The purpose of this work was to determine the impact of a foreign language accent on experts' auditory-perceptual ratings of dysphonic speakers. METHODS Twelve voice-specializing SLPs who spoke with a General American English (GAE) accent rated vocal percepts of 28 speakers with a foreign language accent and 28 with a GAE accent, all of whom had been diagnosed with a voice disorder. Speaker groups were matched based on sex, age, and mean smoothed cepstral peak prominence. Four linear mixed-effects models assessed the impact of a foreign language accent on expert auditory-perceptual ratings of the overall severity of dysphonia, roughness, breathiness, and strain. RESULTS The twelve raters demonstrated good inter- and intra-rater reliability (ICC[3, k] = .89; mean ICC = .89). The linear mixed-effects models revealed no significant impact of foreign language accent on ratings of overall severity of dysphonia, roughness, breathiness, or strain. CONCLUSION Despite the possibility of increased listener effort and bias, foreign language accent incongruence had no effect on expert listeners' auditory-perceptual evaluations for dysphonic speakers. Findings support the use of auditory-perceptual evaluations for voice disorders across sociolinguistically diverse populations. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2272-2276, 2024.
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Affiliation(s)
- Katherine L Marks
- Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts, USA
| | - Kimberly L Dahl
- Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts, USA
| | - Cara E Stepp
- Speech, Language, and Hearing Sciences and Biomedical Engineering, Boston University, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
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Morrison RA, Fetzer DT, Patterson-Lachowicz A, McDowell S, Smeltzer JCC, Mau T, Shembel AC. Optical Flow Analysis of Paralaryngeal Muscle Movement. Laryngoscope 2024; 134:1792-1801. [PMID: 37772838 PMCID: PMC10947946 DOI: 10.1002/lary.31063] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/11/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVES The paralaryngeal muscles are thought to be hyperfunctional with phonation in patients with primary muscle tension dysphonia (pMTD). However, objective, quantitative tools to assess paralaryngeal movement patterns lack. The objectives of this study were to (1) validate the use of optical flow to characterize paralaryngeal movement patterns with phonation, (2) characterize phonatory optical flow velocities and variability of the paralaryngeal muscles before and after a vocal load challenge, and (3) compare phonatory optical flow measures to standard laryngoscopic, acoustic, and self-perceptual assessments. METHODS Phonatory movement velocities and variability of the paralaryngeal muscles at vocal onsets and offsets were quantified from ultrasound videos and optical flow methods across 42 subjects with and without a diagnosis of pMTD, before and after a vocal load challenge. Severity of laryngoscopic mediolateral supraglottic compression, acoustic perturbation, and ratings of vocal effort and discomfort were also obtained at both time points. RESULTS There were no significant differences in optical flow measures of the paralaryngeal muscles with phonation between patients with pMTD and controls. Patients with pMTD had significantly more supraglottic compression, higher acoustic perturbations, and higher vocal effort and vocal tract discomfort ratings. Vocal load had a significant effect on vocal effort and discomfort but not on supraglottic compression, acoustics, or optical flow measures of the paralaryngeal muscles. CONCLUSION Optical flow methods can be used to study paralaryngeal muscle movement velocity and variability patterns during vocal productions, although the role of the paralaryngeal in pMTD diagnostics (e.g., vocal hyperfunction) remains suspect. LEVEL OF EVIDENCE 2 Laryngoscope, 134:1792-1801, 2024.
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Affiliation(s)
- Robert A. Morrison
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
| | - David T. Fetzer
- Department of Radiology, CACTUS Lab, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Amber Patterson-Lachowicz
- Department of Radiology, CACTUS Lab, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Sarah McDowell
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
| | - Julianna C. Comstock Smeltzer
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
| | - Ted Mau
- Department of Otolaryngology-Head and Neck, Center for Voice Care, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Adrianna C. Shembel
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
- Department of Otolaryngology-Head and Neck, Center for Voice Care, University of Texas Southwestern Medical Center, Dallas, TX, United States
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Wang F, Yiu EML. Predicting Dysphonia by Measuring Surface Electromyographic Activity of the Supralaryngeal Muscles. J Speech Lang Hear Res 2024; 67:740-752. [PMID: 38315579 DOI: 10.1044/2023_jslhr-23-00110] [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: 02/07/2024]
Abstract
PURPOSE This study set out to investigate whether individuals with dysphonia, as determined by either self-assessment or clinician-based auditory-perceptual judgment, exhibited differences in perilaryngeal muscle activities using surface electromyography (sEMG) during various phonatory tasks. Additionally, the study aimed to assess the effectiveness of sEMG in identifying dysphonic cases. METHOD A total of 77 adults (44 women, 33 men, Mage = 30.4 years) participated in this study, with dysphonic cases identified separately using either a 10-item Voice Handicap Index (VHI-10) or clinician-based auditory-perceptual voice quality (APVQ) evaluation. sEMG activities were measured from the areas of suprahyoid and sternocleidomastoid muscles during prolonged vowel /i/ phonations at different pitch and loudness levels. Normalized root-mean-square value against the maximal voluntary contraction (RMS %MVC) of the sEMG signals was obtained for each phonation and compared between subject groups and across phonatory tasks. Additionally, binary logistic regression analysis was performed to determine how the sEMG measures could predict the VHI-10-based or APVQ-based dysphonic cases. RESULTS Participants who scored above the criteria on either the VHI-10 (n = 29) or APVQ judgment (n = 17) exhibited significantly higher RMS %MVC in the right suprahyoid muscles compared to the corresponding control groups. Although the RMS %MVC value from the right suprahyoid muscles alone was not a significant predictor of self-evaluated dysphonic cases, a combination of the RMS %MVC values from both the right and left suprahyoid muscles significantly predicted APVQ-based dysphonic cases with a 69.66% fair level. CONCLUSIONS This study found that individuals with dysphonia, as determined by either self-assessment or APVQ judgment, displayed more imbalanced suprahyoid muscle activities in voice production compared to nondysphonic groups. The combination of the sEMG measures from both left and right suprahyoid muscles showed potential as a predictor of dysphonia with a fair level of confidence. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25112804.
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Affiliation(s)
- Feifan Wang
- School of Humanities, Shanghai Normal University, Shanghai, China
- Voice Research Laboratory, The University of Hong Kong, Pokfulam
| | - Edwin M-L Yiu
- Voice Research Laboratory, The University of Hong Kong, Pokfulam
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Asiaee M, Nourbakhsh M, Vahedian-Azimi A, Zare M, Jafari R, Atashi SS, Keramatfar A. The feasibility of using acoustic measures for predicting the Total Opacity Scores of chest computed tomography scans in patients with COVID-19. Clin Linguist Phon 2024; 38:97-115. [PMID: 36592050 DOI: 10.1080/02699206.2022.2160659] [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: 07/30/2021] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
To study the possibility of using acoustic parameters, i.e., Acoustic Voice Quality Index (AVQI) and Maximum Phonation Time (MPT) for predicting the degree of lung involvement in COVID-19 patients. This cross-sectional case-control study was conducted on the voice samples collected from 163 healthy individuals and 181 patients with COVID-19. Each participant produced a sustained vowel/a/, and a phonetically balanced Persian text containing 36 syllables. AVQI and MPT were measured using Praat scripts. Each patient underwent a non-enhanced chest computed tomographic scan and the Total Opacity score was rated to assess the degree of lung involvement. The results revealed significant differences between patients with COVID-19 and healthy individuals in terms of AVQI and MPT. A significant difference was also observed between male and female participants in AVQI and MPT. The results from the receiver operating characteristic curve analysis and area under the curve indicated that MPT (0.909) had higher diagnostic accuracy than AVQI (0.771). A significant relationship was observed between AVQI and TO scores. In the case of MPT, however, no such relationship was observed. The findings indicated that MPT was a better classifier in differentiating patients from healthy individuals, in comparison with AVQI. The results also showed that AVQI can be used as a predictor of the degree of patients' and recovered individuals' lung involvement. A formula is suggested for calculating the degree of lung involvement using AVQI.
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Affiliation(s)
- Maral Asiaee
- Department of Linguistics, Faculty of Literature, Alzahra University, Tehran, Iran
| | - Mandana Nourbakhsh
- Department of Linguistics, Faculty of Literature, Alzahra University, Tehran, Iran
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Zare
- Department of Statistics, Faculty of Mathematics and Computer Science, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Ramezan Jafari
- Department of Radiology, Health Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyed Shahab Atashi
- Department of Food and Drug control, Jundishapour University of Medical Sciences, Ahvaz, Iran
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Rumbach A, Aiken P, Novakovic D. Treatment Outcome Measures for Spasmodic Dysphonia: A Systematic Review. J Voice 2024; 38:540.e13-540.e43. [PMID: 35513935 DOI: 10.1016/j.jvoice.2021.10.001] [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: 09/29/2021] [Accepted: 10/03/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE This systematic review aims to identify instruments used to evaluate treatment outcomes for people with spasmodic dysphonia. METHODS Electronic database (PubMed, Cochrane Library, Embase, and CINAHL) searches and hand-searching identified studies that evaluated treatment approaches for spasmodic dysphonia which included pre and post outcome data. RESULTS A total of 4714 articles were retrieved from searching databases; 1165 were duplicates. Titles and abstracts of 3549 were screened, with 171 being selected for full-text review. During full-text review, 101 articles were deemed suitable for inclusion. An additional 24 articles were identified as suitable for inclusion through hand-searching of reference lists. Data was extracted from 125 studies, identifying 220 outcome measures. As per the World Health Organization's International Classification of Functioning (ICF), the majority measured body functions (n = 212, 96%). Outcomes that explored communication and participation in everyday life and attitudes towards communication (ie, activity and participation domains) were infrequent (n = 8; 4%). Quality of life, a paradigm outside of the scope of the ICF, was also captured by four outcome measures. No instruments evaluating communication partners' perspectives were identified. CONCLUSIONS Currently there is no unified approach to the measurement of outcomes in SD treatment research. Development and implementation of a core outcome set is recommended to facilitate improved understanding of the efficacy of current and new treatment options.
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Affiliation(s)
- Anna Rumbach
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
| | - Patrick Aiken
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Daniel Novakovic
- Dr Liang Voice Program - Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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12
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Hamdan AL, Alam E, Feghali PAR, Fadel C, Jabbour C, Ghanem A. Risk of fibromyalgia in patients with primary muscle tension dysphonia: a possible local manifestation of a musculoskeletal systemic disorder. J Laryngol Otol 2024; 138:341-344. [PMID: 37417245 DOI: 10.1017/s0022215123001196] [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: 07/08/2023]
Abstract
OBJECTIVE To investigate the risk of fibromyalgia in patients with primary muscle tension dysphonia. METHODS A retrospective review was conducted of patients with primary muscle tension dysphonia, diagnosed based on history of dysphonia with evidence of laryngeal muscle tension on examination. Fibromyalgia was assessed using the Fibromyalgia Rapid Screening Tool ('FiRST'). RESULTS Fifty patients were enrolled: 25 with primary muscle tension dysphonia (study group) and 25 matched controls. The mean age of the study group was 50.7 ± 15.2 years versus 49.5 ± 18.6 years for the controls, with a male to female ratio of 3:2 for both groups. Fifty-six per cent tested positive for fibromyalgia in the study group versus 4 per cent in the controls (p < 0.001). The mean Voice Handicap Index 10 score in the study group was significantly higher for those who screened positive for fibromyalgia compared to those who screened negative. There was a positive, strong point-biserial correlation between Fibromyalgia Rapid Screening Tool and Voice Handicap Index 10 scores (r = 0.39; p = 0.09). CONCLUSION These results suggest that fibromyalgia is a significant co-morbid condition in primary muscle tension dysphonia.
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Affiliation(s)
- Abdul-Latif Hamdan
- Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Elie Alam
- Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Patrick A R Feghali
- Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Charbel Fadel
- Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christopher Jabbour
- Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Anthony Ghanem
- Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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13
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Ma EPM, Cheung YC, Siu AKY, Lo JFW. The Effectiveness of Vocal Hygiene Education With Resonant Voice Therapy for School-Aged Children With Vocal Nodules. J Voice 2024; 38:538.e23-538.e30. [PMID: 34785116 DOI: 10.1016/j.jvoice.2021.08.015] [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: 04/28/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study evaluated the effectiveness of vocal hygiene education with resonant voice therapy for school-aged children with vocal nodules. STUDY DESIGN A pre-test/post-test control group design was employed. METHODS Seventeen children aged between 6 and 9 years old with vocal nodules were randomly assigned to three groups: a treatment group, a placebo group and a control group. Children in the treatment group (n = 7) received six consecutive, weekly, one-hour sessions of vocal hygiene education with resonant voice therapy. Children in the placebo group (n = 5) received six consecutive, weekly, one-hour sessions on presentation skills training. Children in the control group (n = 5) did not receive any form of treatment. Subjective outcome measures included auditory-perceptual evaluation of overall dysphonia severity, the Pediatric Voice Handicap Index (pVHI) and the Children's Voice Handicap Index-10 (CVHI-10). Objective outcome measures included acoustic analysis of fundamental frequency, jitter, shimmer and noise-to-harmonic ratio. RESULTS AND CONCLUSIONS Significant improvements in perceptual ratings of overall dysphonia severity levels and pVHI scores were found in the treatment group. No significant changes in acoustic measures and CVHI-10 scores were noted in any of the three groups. Interestingly, an improvement in perceptual overall dysphonia severity levels at post-evaluation was observed in the no treatment control group.
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Affiliation(s)
- Estella P-M Ma
- Voice Research Laboratory, Unit of Human Communication, Development and Information Sciences, Faculty of Education, The University of Hong Kong, Hong Kong.
| | - Yan-Chi Cheung
- Voice Research Laboratory, Unit of Human Communication, Development and Information Sciences, Faculty of Education, The University of Hong Kong, Hong Kong
| | - Alice K-Y Siu
- Department of Otorhinolaryngology Head-and-Neck Surgery, Kowloon East Cluster, affiliated academic unit of Department of Otorhinolaryngology Head-and-Neck Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Jacky F-W Lo
- Department of Otorhinolaryngology Head-and-Neck Surgery, Kowloon East Cluster, affiliated academic unit of Department of Otorhinolaryngology Head-and-Neck Surgery, The Chinese University of Hong Kong, Hong Kong
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14
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Feinstein H, Daşdöğen Ü, Libertus ME, Awan SN, Galera RI, Dohar JE, Abbott KV. Cognitive Mechanisms in Pediatric Voice Therapy - An Initial Examination. J Voice 2024; 38:538.e11-538.e22. [PMID: 34750034 PMCID: PMC9068827 DOI: 10.1016/j.jvoice.2021.09.014] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/19/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Voice disorders are a common communication disorder in children. Behavioral voice therapy is recommended by both Otolaryngologists and Speech-Language Pathologists as a first-line approach for treatment of benign vocal fold lesions that affect children in large numbers. However, the role of cognitive mechanisms critical to voice therapy have not yet been explored. OBJECTIVE This proof-of-concept study aims to provide preliminary data on the potential relation between cognitive abilities and behavioral results of voice therapy for children with benign phonotraumatic vocal fold lesions. METHODS Six children (4;05 -9;02 years) diagnosed with vocal fold nodules completed a battery of cognitive tests from the NEuroPSYchological (NEPSY-II) Assessment and a standard course of "Adventures in Voice" therapy. Recordings pre and post intervention were analyzed acoustically using the Cepstral Spectral Index of Dysphonia (CSID) and perceptually using visual analog scales (VAS) for severity and resonance separately. Raw and age-corrected scaled scores from the NEPSY-II were then examined for their possible relation to voice outcomes. RESULTS Multiple cognitive functions correlated with voice outcomes. Raw score measures for Design Fluency, Inhibition, Fingertip Tapping, and Narrative Memory correlated favorably with all voice outcome measures. Age correlated with all NEPSY-II raw scores and perceptual voice outcome measures. Scaled scores for Auditory Attention, Design Fluency, Fingertip Tapping (Dominant hand), and Narrative Memory correlated with all voice outcome measures. CONCLUSION Results suggest that there is merit to further investigation of the relation between cognitive skills and their development and voice treatment outcomes in children with benign phonotraumatic lesions. Future studies with larger samples will build on present findings.
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Affiliation(s)
- Hagar Feinstein
- Department of Communication Sciences and Disorders, University of Delaware, Newark, Delaware, USA.
| | - Ümit Daşdöğen
- Department of Communication Sciences and Disorders, University of Delaware, Newark, Delaware, USA
| | - Melissa E Libertus
- Department of Psychology and Learning Research and Development Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shaheen N Awan
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, Florida, USA
| | - Rhona I Galera
- Department of Rehabilitation Services, Lucile Packard Children's Hospital Stanford University, Palo Alto, California, USA
| | - Joseph E Dohar
- Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh - UPMC, Pittsburgh, Pennsylvania, USA; Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Communication Science and Disorders, University of Pittsburgh School of Health and Rehabilitation, Pittsburgh, Pennsylvania, USA
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15
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Josep VR, Laura GS, Jesús VG. Relations Between Dysphonia and Personality: An Approximation From Gray' Theories. J Voice 2024; 38:542.e1-542.e7. [PMID: 34782228 DOI: 10.1016/j.jvoice.2021.09.037] [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: 07/22/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 11/23/2022]
Abstract
Our study sought to show the relation between dysphonia and personality traits as explained by Gray's theories. Personality traits were analyzed in a patient group of 141 patients who showed functional and congenital voice disorders. The results were compared to the control group made up of 99 vocally healthy individuals. Their objective voice quality was measured by using the Dysphonia Severity Index, Voice Handicap level was measured using the VHI-10, and a perceptive analysis was conducted with a listening jury. The results showed significant differences in Introversion and Neuroticism and a greater tendency for activating the behavioral inhibition system in the patient group. Such an influence was also evident in voice quality measures. The results were similar to specialized literature.
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Affiliation(s)
- Vila-Rovira Josep
- Facultat de Psicologia i Ciències de l'Educació i de l'Esport, Universitat Ramon Llull, Barcelona, Spain.
| | - González-Sanvisens Laura
- Facultat de Psicologia i Ciències de l'Educació i de l'Esport, Universitat Ramon Llull, Barcelona, Spain
| | - Valero-Garcia Jesús
- Facultat de Psicologia i Ciències de l'Educació i de l'Esport, Universitat Ramon Llull, Barcelona, Spain
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16
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Tohidast SA, Mansuri B, Memarian M, Ghobakhloo AH, Scherer RC. Voice Quality and Vocal Tract Discomfort Symptoms in Patients With COVID-19. J Voice 2024; 38:542.e29-542.e33. [PMID: 34776316 PMCID: PMC8511652 DOI: 10.1016/j.jvoice.2021.09.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Dysphonia and laryngeal problems are some of the manifestations of the COVID-19 pandemic due to respiratory disease as a primary effect of COVID-19. The aim of the present study was to investigate voice quality and vocal tract discomfort symptoms in patients with COVID-19. MATERIALS AND METHODS Forty-four COVID-19 patients with a mean age of 49.61 ± 16.48 years and 44 healthy subjects with a mean age of 48.52 ± 13.8 years participated in the study. The voice quality of the participants was evaluated using auditory-perceptual evaluation with the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale. The vocal tract discomfort symptoms of the participants were assessed using the Persian version of the VTD scale. RESULTS Patients with COVID-19 had higher scores in all items of the GRBAS, including grade, roughness, breathiness, asthenia, and strain, than healthy subjects, and these differences were statistically significant (P < 0.05). Among the GRBAS parameters, grade had the highest effect size and asthenia had the lowest effect size in both speech tasks. The COVID-19 patients had a greater frequency of vocal tract discomfort symptoms than healthy subjects in all items of the VTDp scale and these differences were statistically significant (P < 0.05) in the following items: burning, tight, dry, pain, sore, irritable, and lump in the throat. The most and the least effect size in frequency of the vocal tract discomfort symptoms were related to dry (d = 1.502) and tickling (d = 0.157), respectively. Also, COVID-19 patients had more significant severity in all items of the VTDp scale except tight and tickling. The most and the least effect size in severity of the vocal tract discomfort symptoms was related to dry (d = 1.416) and tickling (d = 0.152), respectively. CONCLUSION The present study suggests that COVID-19 patients have more deviations in voice quality than healthy subjects. Moreover, mild vocal tract discomfort is prevalent in patients with COVID-19, and patients have more frequent and severe physical discomforts of the vocal tract than healthy subjects.
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Affiliation(s)
- Seyed Abolfazl Tohidast
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Banafshe Mansuri
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran.
| | - Mohammad Memarian
- Department of Internal Medicine, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | | | - Ronald Callaway Scherer
- Department of Communication Sciences and Disorders, Bowling Green State University, Bowling Green, Ohio
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17
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Hencke D, Rosa CO, Antonetti AEDS, Silverio KCAS, Siqueira L. Immediate Effects of Performance Time of the Voiced High-frequency Oscillation With Two Types of Breathing Devices in Vocally Healthy Individuals. J Voice 2024; 38:293-303. [PMID: 34607733 DOI: 10.1016/j.jvoice.2021.08.022] [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: 06/23/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To verify safety and compare the immediate effects of voiced high-frequency oscillation (VHFO) using two types of breathing devices on self-perception and vocal quality according to performance time in vocally healthy individuals. METHOD Thirty individuals (15 women and 15 men) without vocal complaints or any history of dysphonia participated. Each participant performed the VHFO technique with the New Shaker and Shaker Plus devices for 3 (T3), 5 (T5), and 7 minutes (T7). All answered a questionnaire that investigated the intensity of laryngopharyngeal and vocal symptoms before and after performing the VHFO with each device and at different times. After VHFO, at each time, the voice was recorded for further analysis of vocal quality. The participants also answered a self-assessment questionnaire about vocal, laryngeal, breathing, and articulatory sensations. RESULTS T3 showed a decrease in the laryngopharyngeal symptoms "pain when swallowing," "secretion in the throat," and "phlegm" for both genders and both devices. T7 showed an increase in "dry throat" for both genders and both devices. There was an increase in the symptom "fatigue when speaking" in T3 for both genders after VHFO with the New Shaker device. We also observed a decrease in the symptoms "voice failure" and "dry cough" after VHFO with the Shaker Plus for men in T3, and "voice failure" after VHFO with the New Shaker for women in T5. We found a decrease in the acoustic parameter shimmer for women in T5 and the NHR parameter in T7 for both genders, regardless of the breathing device. There were no changes in the auditory-perceptual analysis of the voice and self-assessment of sensations after VHFO with both devices and for both genders. CONCLUSION VHFO performed with New Shaker and Shaker Plus is safe and can be used in clinical vocal practice in vocally healthy individuals.
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Affiliation(s)
- Daniela Hencke
- Universidade Estadual do Centro-Oeste, UNICENTRO, Irati, Paraná, Brazil
| | | | | | | | - Larissa Siqueira
- Bauru School of Dentistry/University of São Paulo - FOB/USP, Bariri, São Paulo, Brazil.
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18
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Lechien JR, Carroll TL, Nowak G, Huet K, Harmegnies B, Lechien A, Horoi M, Dequanter D, Bon SDL, Saussez S, Hans S, Rodriguez A. Impact of Acid, Weakly Acid and Alkaline Laryngopharyngeal Reflux on Voice Quality. J Voice 2024; 38:479-486. [PMID: 34702613 DOI: 10.1016/j.jvoice.2021.09.023] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To analyze pre to posttreatment voice changes regarding the type of reflux in patients with acid, weakly acid or alkaline laryngopharyngeal reflux (LPR). METHODS Patients with LPR, diagnosed using hypopharyngeal-esophageal multichannel intraluminal impedance pH-monitoring (HEMII-pH), were prospectively recruited from three University Hospitals. Patients were treated with a combination of diet, proton pump inhibitors, magaldrate and alginate for 3 months. The following clinical and voice quality outcomes were studied pre to posttreatment according to the type of reflux (acid, weakly acid, nonacid): HEMII-pH, gastrointestinal endoscopy features, reflux symptom score (RSS), reflux sign assessment (RSA), voice handicap index (VHI), perceptual voice assessment (grade of dysphonia and roughness), aerodynamic and acoustic measurements. RESULTS From December 2018 to March 2021, 160 patients completed the evaluations, accounting for 60 acid, 52 weakly acid, and 48 alkaline cases of LPR. There were no baseline differences in clinical and voice quality outcomes between groups. RSS and RSA significantly improved from pre to posttreatment in the entire cohort and in all patient groups. VHI, dysphonia and roughness, maximum phonation time, Jitter, Shimmer and noise to harmonic ratio significantly improved from pre to posttreatment. Individuals with alkaline reflux reported better voice quality improvements as compared to acid and weakly acid reflux patients. CONCLUSION Patients with acid and alkaline reflux reported better posttreatment voice quality outcomes as compared to weakly acid reflux patients. Future basic science and clinical studies are needed to better understand the histological changes of the vocal folds due to reflux of varying pH types and gastroduodenal enzyme content.
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Affiliation(s)
- Jerome R Lechien
- Department of Otolaryngology, ELSAN Hospital, Paris, France; Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, University Paris Saclay, Paris, France; Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
| | - Thomas L Carroll
- Department of Otolaryngology, Division of Otolaryngology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Géraldine Nowak
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Kathy Huet
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Bernard Harmegnies
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Alain Lechien
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Mihaela Horoi
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Didier Dequanter
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Serge D Le Bon
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Sven Saussez
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Stéphane Hans
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, University Paris Saclay, Paris, France; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandra Rodriguez
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
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Kaneko M, Sugiyama Y, Fuse S, Mukudai S, Hirano S. Physiological Effects of Voice Therapy for Aged Vocal Fold Atrophy Revealed by EMG Study. J Voice 2024; 38:376-383. [PMID: 34649741 DOI: 10.1016/j.jvoice.2021.09.006] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Age-related voice changes are characterized as breathy, weak and strained, and a deterioration in vocal function in the elderly has been putatively linked to a reduced intensity of speech. They contribute to undesirable voice changes known as presbyphonia. These changes are caused by histological alterations in the lamina propria of the vocal fold mucosa and atrophy of the thyroarytenoid muscle, as well as by decreased respiratory support. There are several clinical studies on presbylarynx dysphonia showing the effectiveness of voice therapy. However, physiological changes of the presbylarynx following voice therapy have not been verified. The purpose of this prospective study was to demonstrate the clinical effectiveness of voice therapy for rehabilitating presbylarynx dysphonia, using vocal function assessments and thyroarytenoid muscular activity detection on laryngeal electromyography (LEMG). METHODS 10 patients who were diagnosed with aged vocal fold atrophy from ages 60 to 87 years (mean age: 72 years) underwent approximately 12 weeks of voice therapy, mainly using forward-focused voice and vocal resistance training. Stroboscopic examination, aerodynamic assessment, acoustic analysis, Voice Handicap Index (VHI)-10, and LEMG were performed pre- and post-voice therapy. Vocal fold vibratory amplitude (VFVA) was measured by image analysis from the stroboscopic examinations. Turns analysis during steady phonation on LEMG was also assessed. RESULTS Maximum phonation time, subglottic pressure, jitter, shimmer, VFVA, and VHI-10 significantly improved after voice therapy. The number of turns per second on LEMG also significantly increased. CONCLUSION Our data suggest that voice therapy may improve vocal function and thyroarytenoid muscle activity in patients with aged vocal fold atrophy.
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Affiliation(s)
- Mami Kaneko
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan.
| | - Yoichiro Sugiyama
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Shinya Fuse
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Shigeyuki Mukudai
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
| | - Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, Japan
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Liu K, Mousset M, Schafer A, Rowlands N, Quinn N, Bourgeois T, Bergman M, Pattisapu P, Chiang T, Wiet G, Elmaraghy C. Surgical management of vocal cord nodules in children: Trends and outcomes. Am J Otolaryngol 2024; 45:104174. [PMID: 38101141 DOI: 10.1016/j.amjoto.2023.104174] [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: 10/02/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVES Vocal cord nodules (VCNs) are the most common cause of dysphonia in school-aged children, with potential negative impacts on quality of life including diminished self-esteem and academic performance. The standard of care for VCNs is conservative management which ranges from voice hygiene to speech therapy with a focus on voice otherwise known as voice therapy, with surgical excision reserved for refractory cases. Thus, few studies have analyzed outcomes of surgical management of VCNs. The purpose of this study is to assess the prevalence and efficacy of surgical excision of VCNs when compared to speech therapy. METHODS Children with VCNs seen at a single tertiary care institution between 2015 and 2020 were identified by ICD-9 code 478.5 and ICD-10 code J38.2. Demographics, objective voice assessment, intervention, and follow-up assessment data were reviewed. Frequencies, medians, and interquartile ranges were calculated. Time to resolution and improvement were assessed by Cox proportional hazards model. Univariate logistic regression was performed. A P value of <0.05 was considered statistically significant. RESULTS Three hundred sixty-eight patients diagnosed with VCNs were identified. 169 patients received intervention for VCNs, with 159 (43.2 %) receiving speech therapy alone and 5 (1.4 %) receiving surgery alone. On bivariate analysis, there was no significant difference in demographic features between treatment groups, however speech therapy patients did have a longer follow-up time. 154 patients underwent objective voice assessment at the time of VCN diagnosis. Among these patients, 95 (61.7 %) received speech therapy and 59 (40.3 %) received no intervention. Speech therapy patients had significantly higher pVHI scores, however there was no significant difference in CAPE-V Overall Severity scores or computerized voice assessment analysis. On Cox proportional hazards analysis, surgical intervention was associated with faster resolution and faster improvement of dysphonic symptoms. On binary logistic regression, surgery was associated with a significantly greater proportion of patients reporting resolution of dysphonic symptoms, however there was no significant difference in proportion of patients reporting improvement of dysphonia. CONCLUSION For most patients with VCNs, conservative measures such as voice hygiene and speech therapy remain first line, however certain patients may benefit from the rapid improvement and resolution of symptoms that surgical intervention may provide.
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Affiliation(s)
- Kevin Liu
- The Ohio State University College of Medicine, Columbus, OH, USA; Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Marike Mousset
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA; Arizona College of Osteopathic Medicine of Midwestern University, Glendale, AZ, USA
| | - Austin Schafer
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Neil Rowlands
- Ohio University Heritage College of Osteopathic Medicine, Dublin, OH, USA
| | - Natalie Quinn
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Tran Bourgeois
- Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, Columbus, OH, USA
| | - Maxwell Bergman
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Prasanth Pattisapu
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA; Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, Columbus, OH, USA
| | - Tendy Chiang
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Gregory Wiet
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Charles Elmaraghy
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA.
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21
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Pimenta J, Macedo J, de Rezende Neto AL, de Moraes Marchiori LL. Sensation and Repercussion of the Use of Humid Heat in the Treatment of Dysphonia due to Laryngitis in Singers. J Voice 2024; 38:496-502. [PMID: 35078701 DOI: 10.1016/j.jvoice.2021.09.038] [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: 12/19/2020] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE To verify the efficiency of thermotherapy perceptively and acoustically with hot vapor in the treatment of acute laryngitis. METHODS This is a pre and post test quasi-experimental study without a control group, approved by the ethics committee. Its sample counted with 65 singers - 37 females (56.9%) and 28 males (43.1%), mean age 33.7 years (±7.9) years, nonsmokers, with dysphonia due to acute laryngitis. They were submitted to videolaryngostroboscopy and perceptive-acoustic assessment of the voice before and 30 minutes after applying the inhalation of hot vapor. The appropriate statistical tests were used, adopting the significance level lower than 0.05. RESULTS In the acoustic assessment, there was a statistically significant improvement in jitter and shimmer for vowels A and E, P < 0.001. The F0 assessed separately per sex, as it presented a significant difference, P < 0.001. The women's F0 results before and after the heat were higher than the men's. In the analysis of the acoustic results based on harmonics-to-noise ratio and normalized noise energy, there was significant improvement after the heat. All the mean values increased after the heat. There was a statistically significant decrease in the parameters related to the perceptive-auditory assessment for G (grade of hoarseness), R (roughness), B (breathiness), and S (strain). Of the 47 singers that scored 2 for G, 28 (59.6%) reduced it to 1 after the heat, P < 0.001. All the 45 that scored 2 for R reduced it to 1, P = 0.011. Of the 8 who scored 2 for B, 6 (75%) reduced it to 1, P = 0.020. All the 28 singers that scored 1 for S reduced it to 0, P < 0.001. Only for A (asthenia), there was no significant improvement, P = 0.513. The results of the videolaryngostroboscopy revealed a statistically significant difference in all parameters analyzed, such as hyperemia, edema, muco-undulatory movement, and glottal coaptation. CONCLUSION The thermotherapy with using humid heat, provide symptomatic benefits in the treatment of dysphonia caused by laryngitis, demonstrating that the hyperthermoterapy is a potential auxiliary therapeutic resource for the treatment of acute dysphonia due to laryngitis since the intervention with the technique proposed increased the voice quality. It is suggested that this method be used in speech-language clinical practice and that new studies be conducted with stronger designs for its efficacy to be confirmed.
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Affiliation(s)
- Janaina Pimenta
- Postgraduation Program in University Veiga de Almeida, Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Julya Macedo
- Postgraduation Program in Italian Institute of Rosario (IUNIR), Department Biomedical Sciences, Rosario, Santa Fe, Argentina
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22
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Oliveira GMGF, de Melo DC, Serra LSM, Granjeiro RC, Sampaio ALL. Dysphonia Interference in Schoolteachers' Speech Intelligibility in the Classroom. J Voice 2024; 38:316-324. [PMID: 34772594 DOI: 10.1016/j.jvoice.2021.09.004] [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: 07/01/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
Abstract
"Among the most common occupations, schooteachers are the ones who experience the most changes throughout their career. Considering this, the present study aims to verify whether dysphonia in three different degrees may compromise the speech intelligibility of schoolteachers in the classroom. METHOD Overall, 39 students, average age 10 years, randomly selected from a public school in the Federal District, Brazil (Distrito Federal, Brasil) performed a transcription task of 20 sentences spoken by four distinct female voices in a classroom, one with a control voice (normal), another with mild dysphonia, 1 with moderate dysphonia and another with severe dysphonia. None of the voices in the study presented changes, neither in fluency nor articulation nor neurological changes. The sentences were previously recorded in an acoustically treated booth, with a microphone on a pedestal 5 cm away from the speaker's mouth. For each sentence to be recorded, the speech model was provided by the speech therapist and then repeated by the speaker according to the model. Each voice recorded 5 different sentences, phonetically balanced and with equivalent number of words. The students included in the study underwent auditory, auditory processing, sequential memory for verbal sounds and sound source location tests, fulfilling the normality criteria. They also did not have neurological or motor disorders or learning, speech or language disorders. Academic success was also taken into account. For the experiment, a speaker was placed in front of the classroom, 1 m from the wall and 1 m from the floor, and students were randomly assigned to the classroom seats. After listening to each sentence, some time was assigned for its transcription by each student. RESULTS The occurrence of errors was higher in voices with moderate and severe dysphonia, in which a significant difference was found (P ≤0.003) showing that voices with moderate and severe dysphonia were less intelligible than the normal voice (control voice). No difference was found between the normal voice and the mild dysphonic voice. Binary logistic regression analysis also showed that students had a 2.55 times higher chance of making mistakes with moderate dysphonic voice (P ≤0.011), and that this chance was 3.06 times greater for severe dysphonic voice (P ≤0.002) when compared to the normal voice (control voice). CONCLUSION Moderate and severe dysphonia in the voices of schoolteachers interferes with the intelligibility of students, and the greater the degree of dysphonia of the teacher, the greater the chance that the student will make intelligibility errors."
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23
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Başer E, Denizoğlu İİ. The efficiency of the DoctorVox voice therapy technique in conversion dysphonia and aphonia. J Laryngol Otol 2024; 138:224-231. [PMID: 37334556 DOI: 10.1017/s002221512300110x] [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: 06/20/2023]
Abstract
OBJECTIVE The main purpose of this study was to retrospectively evaluate the efficiency of DoctorVox voice therapy in psychogenic dysphonia or aphonia patients, and to share the mid- to long-term results of the method. METHODS The study was carried out on patients who underwent DoctorVox voice therapy for psychogenic dysphonia or aphonia between January 2015 and September 2019. The evaluation methods used were: the Voice Handicap Index-10; the grade, roughness, breathiness, asthenia and strain ('GRBAS') scale; and videolaryngostroboscopy recordings. RESULTS The mean Voice Handicap Index-10 values of the patients were 30.91 ± 2.97 before treatment, 8.14 ± 3.82 after treatment, and 3.36 ± 1.78 in the final follow-up examination. The grade, roughness, breathiness, asthenia and strain scale scores were: 9 ± 0.67 pre-treatment, 0.78 ± 0.80 post-treatment, and 0.57 ± 0.64 at the final follow up. CONCLUSION DoctorVox voice therapy seems to be an efficient treatment method for psychogenic dysphonia or aphonia; it helps develop phonatory muscle functions, using multidimensional biofeedback mechanisms, and increases the patients' therapy adherence.
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Affiliation(s)
- Engin Başer
- Otorhinolaryngology, Head and Neck Surgery Department, ENTU Clinic, Balıkesir, Turkey
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24
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Gray AJ, Hoffman MR, Yang ZM, Vandiver B, Purvis J, Morgan JP, Hapner ER, Dominguez L, Tibbetts K, Simpson CB. Indications and Short-Term Outcomes for In-Office Therapeutic Superior Laryngeal Nerve Block. Ann Otol Rhinol Laryngol 2024; 133:174-180. [PMID: 37608685 PMCID: PMC10771019 DOI: 10.1177/00034894231194384] [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: 08/24/2023]
Abstract
OBJECTIVE Superior laryngeal nerve (SLN) block consists of injection of steroid and anesthetic at the internal branch of the SLN entry site. Prior case series have demonstrated beneficial effects on neurogenic cough. SLN blocks have also recently shown benefit for paralaryngeal pain. We describe short-term outcomes for multiple symptoms of irritable larynx syndrome (ILS) including neurogenic cough, dysphonia related to laryngeal hypersensitivity, inducible laryngeal obstruction (ILO), paralaryngeal pain, and isolated globus. METHODS Retrospective review from 2 institutions of patients undergoing a single SLN block for the indications listed. Variables include age, sex, indication(s), known vagus neuropathy, and patient-reported outcomes at short-term follow-up. RESULTS A total of 209 patients were included (59 males, 150 females; age: 58 ± 13 years). Twenty-six patients (12%) had a history of a vagus nerve injury. Indications included neurogenic cough (n = 149), dysphonia related to laryngeal hypersensitivity (n = 66), paralaryngeal pain (n = 50), ILO (n = 23), and isolated globus (n = 3). Some patients had multiple indications. Significant improvements in patient-reported measures occurred after a single SLN block within 2 to 4 weeks for neurogenic cough (cough severity index; 25.2 ± 11.2 to 19.0 ± 12.8; P < .001), dysphonia (voice handicap index-10; 22.1 ± 12.2-18.0 ± 13.3; P = .005), and ILO (dyspnea index; 21.0 ± 14.9-14.7 ± 15.7; P = .017). Subjective pain improved in 23 of 39 patients with paralaryngeal pain. There was no observed improvement for isolated globus. Presence of known vagal neuropathy or therapy around the time of SLN block did not affect outcome. CONCLUSION SLN block can be an effective component of treatment for a variety of ILS symptoms. Patients may experience some improvement after 1 injection. LAY SUMMARY Symptoms of irritable larynx syndrome, such as neurogenic cough, paralaryngeal pain, inducible laryngeal obstruction, and dysphonia related to laryngeal hypersensitivity can be challenging to manage. In-office Superior Laryngeal Nerve blocks can serve as a quick, well tolerated, adjunctive treatment with positive short-term outcomes. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Alan J. Gray
- Department of Otolaryngology—Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Matthew R. Hoffman
- Department of Otolaryngology—Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, AL, USA
- Department of Otolaryngology—Head and Neck Surgery, University of Iowa, Iowa City, IA, USA
| | - Zao M. Yang
- Department of Otolaryngology—Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Beau Vandiver
- Department of Otolaryngology—Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Joshua Purvis
- Department of Otolaryngology—Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Jake P. Morgan
- Department of Otolaryngology—Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Edie R. Hapner
- Department of Otolaryngology—Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Laura Dominguez
- Department of Otolaryngology—Head and Neck Surgery, Cleveland Clinic Florida, Coral Springs, FL, USA
| | - Kathleen Tibbetts
- Department of Otolaryngology—Head and Neck Surgery, University of Texas-Southwestern, Dallas, TX, USA
| | - C. Blake Simpson
- Department of Otolaryngology—Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, AL, USA
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Yaşar Ö, Tahir E, Erensoy I, Terzi M. Comparing dysphonia severity index, objective, subjective, and perceptual analysis of voice in patients with multiple sclerosis and healthy controls. Mult Scler Relat Disord 2024; 82:105378. [PMID: 38142514 DOI: 10.1016/j.msard.2023.105378] [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: 07/20/2023] [Revised: 11/17/2023] [Accepted: 12/11/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Impairments in voice quality in Multiple Sclerosis (MS) have recently been investigated and different results were found. A voice-centered multidimensional assessment protocol with patient-reported outcome measures was conducted to evaluate all the aspects of the voice changes. OBJECTIVES The study aimed to compare the objective, subjective, and perceptual measures of voice between the people with MS and the healthy control group. METHODS A total of 128 participants, including 64 people with MS age, and gender-matched healthy controls were enrolled in the study. Subjective, objective, and auditory-perceptual voice assessments of the participants were performed. The auditory-perceptual evaluation was performed with GRBAS. The Dysphonia Severity index was computed for both groups. All the participants completed the Turkish version of The Voice Handicap Index-10 (VHI-10) and the Voice-Related Quality of Life (VRQoL). RESULTS Acoustic and aerodynamic parameters of voice were found significantly different for both males and females between the MS and control group. DSI was found significantly different for both males and females in the MS group compared to the control group (p<0.05). All components of the GRBAS scale were significantly higher in the MS group (p<0.001). Using a multivariate regression model, it was determined that age, gender, EDSS score, number of MS attacks, and disease duration did not affect the DSI. The overall VHI-10 score was higher in the MS group (median=1.0 range= 0-28) and lower in the control group (median=0 range= 0-4). The mean VRQoL was lower in the MS group (median=95 range= 62.5-100) than in controls (median=100 range= 85-100) (p<0.001). CONCLUSION Our results indicated that people with MS have significant differences in acoustic and aerodynamic parameters of voice compared to healthy individuals. A significant number of persons with MS are aware that their voice problem affects their quality of life. People with MS must be monitored for voice changes and a multidimensional voice assessment protocol should be implemented.
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Affiliation(s)
- Özlem Yaşar
- Ondokuz Mayıs University Faculty of Health Sciences, Department of Speech and Language Therapy, Samsun, Turkey.
| | - Emel Tahir
- Ondokuz Mayıs University School of Medicine, Department of Otolaryngology, Samsun, Turkey
| | - Ibrahim Erensoy
- Ondokuz Mayıs University Faculty of Health Sciences, Department of Speech and Language Therapy, Samsun, Turkey.
| | - Murat Terzi
- Ondokuz Mayıs University School of Medicine, Department of Neurology, Samsun, Turkey
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Leung JS, Rosenbaum A, Holmberg J, Villarroel P, Napolitano C, Badía PI, Lagos-Villaseca A. Improved vocal quality and decreased vocal effort after botulinum toxin treatment for laryngeal dystonia. Auris Nasus Larynx 2024; 51:106-112. [PMID: 37365040 DOI: 10.1016/j.anl.2023.06.004] [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: 01/08/2023] [Revised: 05/24/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES Laryngeal dystonia (LD) is characterized by irregular and involuntary task-specific spasms of the intrinsic laryngeal muscles. There is no curative treatment for it, however, laryngeal botulinum neurotoxin injections (BoNT-I) are considered the standard of care therapy. This study aims to characterize the population of LD patients and to assess the results of laryngeal BoNT-I. METHODS A Retrospective cohort study was conducted. Medical records were reviewed for all the patients with LD diagnosis seen in the Voice Unit of the Red de Salud UCChristus between January 2013 and October 2021. Biodemographic, clinical and treatment data were collected. Additionally, a telephonic survey was completed by the patients that underwent laryngeal BoNT-I, including self-reported voice outcomes and Voice Handicap Index 10 (VHI-10). RESULTS Of the 34 patients with LD included in the study, 23 received a total of 93 laryngeal BoNT-I and 19 completed the telephone survey. The majority (97%) of the injections corresponded to patients with adductor LD and 3% to abductor LD. Patients received a median of 3 (1-17) injections, with a more frequent cricothyroid approach (94.4%), while the thyrohyoid approach accounted for 5.6% of cases. Most injections were bilateral (96.8%). A significant improvement in the vocal quality and effort was noted after the last injection and the overall BoNT-I treatment (P < 0.001). Similarly, the VHI-10 score improved from a median of 31 (7-40) to 2 (0-19) (P < 0.001) after the last injection. A post-treatment breathy voice was reported in 95% of patients, and dysphagia to liquids and solids in 68% and 21%, respectively. CONCLUSIONS Laryngeal BoNT-I is an effective treatment for LD, achieving an improvement in self-reported vocal quality and VHI-10 scores, and a reduction of the self-reported vocal effort. Adverse effects are mild in the majority of cases, constituting a safe and effective therapy for these patients.
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Affiliation(s)
- Jai-Sen Leung
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile. Diagonal Paraguay 362, Otorrinolaringología, Santiago Centro, Santiago 8330077, Chile
| | - Andrés Rosenbaum
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile. Diagonal Paraguay 362, Otorrinolaringología, Santiago Centro, Santiago 8330077, Chile
| | - Jorge Holmberg
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile. Diagonal Paraguay 362, Otorrinolaringología, Santiago Centro, Santiago 8330077, Chile
| | - Pablo Villarroel
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile. Diagonal Paraguay 362, Otorrinolaringología, Santiago Centro, Santiago 8330077, Chile
| | - Carla Napolitano
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile. Diagonal Paraguay 362, Otorrinolaringología, Santiago Centro, Santiago 8330077, Chile
| | - Pedro I Badía
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile. Diagonal Paraguay 362, Otorrinolaringología, Santiago Centro, Santiago 8330077, Chile
| | - Antonia Lagos-Villaseca
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile. Diagonal Paraguay 362, Otorrinolaringología, Santiago Centro, Santiago 8330077, Chile.
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Momah T, Lijofi O. Squamous Cell Carcinoma of the Supraglottis Presenting as Hoarseness. West Afr J Med 2024; 41:97-99. [PMID: 38412544] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Hoarseness is a well-known condition in primary care offices, with over 1% of primary care visits secondary to this ailment.1 The most common causes are acute laryngitis (40%), functional dysphonia (30%), benign and malignant tumors (2.2 to 30%), neurogenic factors such as vocal cord paralysis (8%), physiological aging (2%), and psychogenic factors (2.2%). Most of these cases are secondary to viral infections and do not require antibiotics on most occasions. These viral infections subside after 1 to 2 weeks, and in the case of persistent hoarseness (above 4 weeks) the American Academy of Otolaryngology recommends direct visualization with a laryngoscopy before treatment with proton pump inhibitors, antibiotics, or steroids. Our patient presented with prolonged hoarseness (greater than eight weeks) but had a quick turn around time interval between primary care visit and laryngoscopy evaluation (less than 2 weeks). This led to her diagnosis and treatment with chemo and radiation therapy within three months of diagnosis with Squamous Cell Carcinoma of the Supraglottis. The Primary care physician serves as the number one point of visitation by sufferers of hoarseness. It is important that they are knowledgeable and up to date with recommendations and guidelines for managing this condition, as unwarranted delay can affect overall outcome on the part of the patient. This is especially important in patients such as ours with high risk factors including Nicotine dependence, alcohol use, asbestos exposure, and HPV infection.
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Affiliation(s)
- Tobe Momah
- Department of Family Medicine, University of Mississippi Medical Center (UMMC) Jackson, MS Clinical Science Building, 2500 North State Street, Jackson (Fourth Floor), MS 39216 USA. Emails include , 1-6019846800 (Office Phone)
| | - Olusegun Lijofi
- Department of Family and Pain Medicine , University of Mississippi Medical Center (UMMC) Jana, Taylor, School of Medicine, UMMC, USA
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Toles LE, Shembel AC. Acoustic and Physiologic Correlates of Vocal Effort in Individuals With and Without Primary Muscle Tension Dysphonia. Am J Speech Lang Pathol 2024; 33:237-247. [PMID: 37931092 PMCID: PMC11000796 DOI: 10.1044/2023_ajslp-23-00159] [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: 05/04/2023] [Revised: 08/23/2023] [Accepted: 09/16/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES The aims of this study were to determine relationships between vocal effort and (a) acoustic correlates of vocal output and (b) supraglottic compression in individuals with primary muscle tension dysphonia (pMTD) and without voice disorders (controls) in the context of a vocal load challenge. METHOD Twenty-six individuals with pMTD and 35 vocally healthy controls participated in a 30-min vocal load challenge. The pre- and postload relationships among self-ratings of vocal effort, various acoustic voice measures, and supraglottic compression (mediolateral and anteroposterior) were tested with multiple regression models and post hoc Pearson's correlations. Acoustic measures included cepstral peak prominence (CPP), low-to-high spectral ratio, difference in intensity between the first two harmonics, fundamental frequency, and sound pressure level (dB SPL). RESULTS Regression models for CPP and mediolateral compression were statistically significant. Vocal effort, diagnosis of pMTD, and vocal demand were each significant variables influencing CPP measures. CPP was lower in the pMTD group across stages. There was no statistical change in CPP following the vocal load challenge within either group, but both groups had an increase in vocal effort postload. Vocal effort and diagnosis influenced the mediolateral compression model. Mediolateral compression was higher in the pMTD group across stages and had a negative relationship with vocal effort, but it did not differ after vocal loading. CONCLUSIONS CPP and mediolateral supraglottic compression were influenced by vocal effort and diagnosis of pMTD. Increased vocal effort was associated with lower CPP, particularly after vocal load, and decreased mediolateral supraglottic compression in the pMTD group.
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Affiliation(s)
- Laura E. Toles
- Department of Otolaryngology–Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas
| | - Adrianna C. Shembel
- Department of Otolaryngology–Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, The University of Texas at Dallas, Richardson
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Circiu MP, Lechien JR, Gravel G, Hans S. An Unusual Cause of Laryngeal Dyspnea. J Voice 2024; 38:247.e27-247.e29. [PMID: 34384661 DOI: 10.1016/j.jvoice.2021.06.030] [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: 02/18/2021] [Revised: 06/20/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Medialization laryngoplasty with autologous fat (MLA) is indicated in some patients with glottic insufficiency. The approach is usually safe but long-term complications are poorly described. CASE REPORT We present the history of a patient who developed progressive dyspnea and dysphonia two decades after bilateral MLA, which were due to the development of laryngea lipoma into the site of fat injection. DISCUSSION The potential relationship between MLA and the development of laryngeal lipoma was discussed. The lipoma may be a long-term survival of too much fat tissue, which was reorganized into a well-limited lipoma over the long-term. Another hypothesis consisted of the injection of fat tissue, including fatty stem cells, and the development of a lipoma over the year through the neovascularization process. CONCLUSION We reported the first case of lipoma developed into the laryngeal site of fat injection. Future studies are needed to explore the long-term evolution of injected fat tissue in the context of MLA.
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Affiliation(s)
- Marta P Circiu
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Jérôme R Lechien
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
| | - Guillaume Gravel
- Department of Radiology, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | - Stéphane Hans
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
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Ryan W, Alnouri G, Sataloff RT. Neurectomy and Myomectomy for Treatment of Spasmodic Dysphonia. J Voice 2024; 38:239-242. [PMID: 35738960 DOI: 10.1016/j.jvoice.2021.07.026] [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: 06/21/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/21/2022]
Abstract
Spasmodic dysphonia (SD) is a debilitating neurological disorder affecting the muscles of voice production. Sudden involuntary movements of the vocal folds lead to phonatory breaks and to forced, strained, and strangled voice quality in adductor SD, or breathy breaks in abductor SD. There is currently no cure for spasmodic dysphonia, and the gold standard for treatment is the injection of botulinum toxin in small amounts to the intrinsic laryngeal musculature.1 However, botulinum treatment requires periodic reinjection, produces vocal instability immediately after injection, lacks uniform results among patients, and patients can develop antibodies to botulinum toxin. Long-term or permanent symptom relief would be ideal. We present four patients with adductor and one patient with abductor spasmodic dysphonia who underwent neurectomy and myomectomy for treatment. The mean age was 64 years (age range 45-83). The mean duration of adductor spasmodic dysphonia was 11.8 years. The duration of abductor spasmodic was 4 years. All patients had previously been treated with voice therapy and botulinum toxin A. The mean duration of follow up was 1.7 years. Four patients had subjective and objective improvement after surgery. One patient had subjective improvement.
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Affiliation(s)
- William Ryan
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Ghiath Alnouri
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Senior Associate Dean for Clinical Academic Specialties, Drexel University College of Medicine, Director of Otolaryngology, and Communication Sciences Research, Lankenau Institute for Medical Research, Philadelphia, Pennsylvania.
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Clayton NA, Freeman-Sanderson A, Walker E. Prevalence and recovery of dysphonia in COVID-19 patients requiring intensive care treatment. Aust Crit Care 2024; 37:151-157. [PMID: 37709656 DOI: 10.1016/j.aucc.2023.07.043] [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: 02/07/2023] [Revised: 06/27/2023] [Accepted: 07/31/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Dysphonia and laryngeal pathology are considerable issues in patients hospitalised with COVID-19 with prevalence rates cited between 29% and 79%. Most studies currently are limited to reporting single-institution data with many retrospective. OBJECTIVES The aims of this study were to prospectively explore the following: (i) prevalence; (ii) treatment; and (iii) recovery pattern and outcomes for dysphonia, in patients with COVID-19 requiring intensive care unit (ICU) treatment. METHODS Patients admitted to 26 ICUs over 12 months, diagnosed with COVID-19, treated for survival, and seen by speech-language pathology for clinical voice assessment were considered. Demographic, medical, speech-language pathology treatment, and voice outcome data (grade, roughness, breathiness, asthenia, strain [GRBAS]) were collected on initial consultation and continuously monitored throughout the hospital admission. FINDINGS Two-hundred and thirty five participants (63% male, median age = 58 yrs) were recruited. Median mechanical ventilation duration and ICU and hospital lengths of stay (LOSs) were 16, 20, and 42 days, respectively. Dysphonia prevalence was 72% (170/235), with 22% (38/170) exhibiting profound impairment (GRBAS score = 3). Of those with dysphonia, rehabilitation was provided in 32% (54/170) cases, with dysphonia recovery by hospital discharge observed in 66% (112/170, median duration = 35 days [interquartile range = 21-61 days]). Twenty-five percent (n = 42) of patients underwent nasendoscopy: oedema (40%, 17/42), granuloma (31%, 13/42), and vocal fold palsy/paresis (26%, 11/42). Presence of dysphonia was inversely associated with the number of intubations (p = 0.002), intubation duration (p = 0.037), ICU LOS (p = 0.003), and hospital LOS (p = 0.009). Conversely, duration of dysphonia was positively associated with the number of intubations (p = 0.012), durations of intubation (p = 0.000), tracheostomy (p = 0.004), mechanical ventilation (p = 0.000), ICU LOS (p = 0.000), and hospital LOS (p = 0.000). More severe dysphonia was associated with younger age (p = 0.045). Proning was not associated with presence (p = 0.075), severity (p = 0.164), or duration (p = 0.738) of dysphonia. CONCLUSIONS Dysphonia and laryngeal pathology are common in critically ill patients with COVID-19 and are associated with younger age and protracted recovery in those with longer critical care interventions.
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Affiliation(s)
- Nicola A Clayton
- Speech Pathology Department & Intensive Care Unit, Concord Repatriation General Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
| | - Amy Freeman-Sanderson
- Speech Pathology Department & Intensive Care Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia; Critical Care Division, The George Institute for Global Health, Sydney, NSW, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Elizabeth Walker
- Speech Pathology Department & Intensive Care Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Kodama N, Sanuki T, Miyamoto T, Tashiro J. Effects and Differences of Voice Therapy on Spasmodic Dysphonia and Muscle tension dysphonia: A Retrospective Pilot Study. J Voice 2024; 38:129-135. [PMID: 34389220 DOI: 10.1016/j.jvoice.2021.07.003] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Laryngeal and voice findings of adductor spasmodic dysphonia (AdSD) and muscle tension dysphonia (MTD) are similar, and it is difficult to distinguish between both disorders. The purpose of this study is to ascertain the effect of voice therapy on MTD and AdSD and clarify their difference. METHODS A total of 49 patients, including 22 patients with MTD (MTD group) and 27 patients with AdSD (SD group), were included in the study. The MTD scores were evaluated, and aerodynamic analysis (maximum phonation time [MPT], mean airflow rate [MFR], highest pitch, lowest pitch, and pitch range), perceptual evaluation (Strangulation, Interruption, and Tremor), acoustic analysis (PPQ, APQ, NHR, and DVB), and subjective assessment (voice handicap index-10 [VHI-10]) were performed before and after voice therapy. RESULTS The MTD score, highest pitch, pitch range, strangulation, PPQ, APQ, NHR, and VHI-10 showed significant improvement after treatment in the MTD groups. On the other hand, the effect of voice treatment on AdSD was poor despite the improvement in the MTD score. CONCLUSIONS This study could serve as a basis for conducting prospective studies to verify the effects of voice therapy on MTD and AdSD.
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Affiliation(s)
- Narihiro Kodama
- Department of Rehabilitation Kumamoto Health Science University, Kita-ku, Kumamoto 861-5598, Japan.
| | - Tetsuji Sanuki
- Department of Otolaryngology-Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences
| | - Takumi Miyamoto
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Graduate School of Medicine
| | - Joji Tashiro
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Graduate School of Medicine
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Jafari N, Izadi F, Ebadi A, Talebian S, Dabirmoghadam P, Jordens K, Bahmani K, Van Lierde K. Comparison of Laryngeal Palpatory Scale (LPS), With Surface Electromyographic Measures in Patients with Muscle Tension Dysphonia. J Voice 2024; 38:245.e37-245.e48. [PMID: 34627703 DOI: 10.1016/j.jvoice.2021.08.021] [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: 06/28/2021] [Revised: 08/08/2021] [Accepted: 08/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this study was to examine the laryngeal palpatory scale (LPS) to ascertain possible correlation with neck surface electromyography (sEMG). METHODS Two otolaryngologists and one certified speech-language pathologist assessed 21 participants (seven women and 14 men; with a mean age of 42.8 years; ranged: 21 to 70 years) with muscle tension dysphonia (MTD) diagnosed with the current version of the LPS rating system. Consequently, relationships between LPS and objective measures of sEMG were evaluated using Spearman's rank correlation coefficient (r). RESULTS The results show that there was a low to moderate between correlations, (statistically positive and significant in 10 correlations among the examined items/states). CONCLUSIONS In conclusion, low-moderate positive correlations between sEMG and LPS ratings were found with particular strength for LPS ratings of tightness and ratings made during dynamic tasks. Further investigations can provide useful evidence for researchers and clinicians to document treatment outcomes by using LPS and sEMG in patients with MTD and leading to the more standardized care and improved information about patient progress.
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Affiliation(s)
- Narges Jafari
- Centre for Speech and Language Sciences (CESLAS), Department of rehabilitation Sciences, University Ghent, Ghent, Belgium.
| | - Farzad Izadi
- ENT and Head and Neck Research Center and Department, Iran University of Medical Science, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Saeed Talebian
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Payman Dabirmoghadam
- Otolaryngology Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Karolien Jordens
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University Newcastle, United Kingdom
| | - Kamran Bahmani
- Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Kristiane Van Lierde
- Centre for Speech and Language Sciences (CESLAS), Department of rehabilitation Sciences, University Ghent, Ghent, Belgium; Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South-Africa
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de Brito VM, Neto HP, Gama ACC. Manual Therapy with Neural Mobilization: Immediate Effect on the Vocal Quality of Women with Dysphonia. J Voice 2024; 38:120-128. [PMID: 34312025 DOI: 10.1016/j.jvoice.2021.06.020] [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: 04/18/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the immediate effect of neural mobilization on the voice quality, self-perceived phonatory effort, and laryngeal muscles of women with behavioral dysphonia. METHOD This is an intrasubject comparative study. The research included 21 women aged 18 to 59 years with vocal complaints. Therefore, the selection of this sample excluded the lower limit of the voice change period and the upper limit of presbyphonia. The participants were assessed by voice acoustic and auditory-perceptual analysis, self-reported vocal effort, and laryngeal palpation performed at three moments: at baseline, after 10 minutes of vocal resting, and after manual therapy. The participants were divided into two groups: the group with 10 minutes of vocal resting (G1) and the group with intervention (G2). The patients in the intervention group underwent manual therapy using neural mobilization in the laryngeal region. For the statistical analysis, a descriptive analysis of the data was performed first with measures of central tendency and dispersion. Subsequently, the Anderson-Darling test was used to verify sample normality. To analyze the difference between three groups were used the parametric One-Way ANOVA or the non-parametric Friedman's test. The McNemar's or chi-squared tests were used to compare categorical variables and to compare an ordinal variable a non-parametric Wilcoxon test was used. The Gwet's AC1 test was used to assess intra-rater agreement in the auditory-perceptual analysis response. RESULTS Neural mobilization in the laryngeal region showed no positive effects on the acoustic voice parameters and voice quality of women with dysphonia. Phonatory effort improved after neural mobilization in the laryngeal region (p = 0.004). There was no significant change in supralaryngeal resistance, lateral laryngeal resistance, and laryngeal position after neural mobilization in the laryngeal region. CONCLUSION Neural mobilization improved phonatory comfort but did have any effect on the voice quality and laryngeal musculature of women with dysphonia.
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Affiliation(s)
| | - Hugo Pasin Neto
- Department of Physiotherapy, University of Sorocaba - UNISO; Director of the Brazilian College of Osteopathy - CBO, São Paulo, Brazil
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Ghio A, Revis J, Smithson-Barrière D, Jarzé S, Giovanni A. Reliability and Correlations Between Overall Severity, Roughness and Breathiness in the Perception of Dysphonic Voices: Investigating Cognitive Aspects. J Voice 2024; 38:136-143. [PMID: 34452778 DOI: 10.1016/j.jvoice.2021.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 03/17/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES this study concerns the subjective perception of the quality of the voice, more particularly in the case of dysphonia. Our general objective is to study the perceptual mechanisms, which constitute Hirano's GRBAS multidimensional perceptual rating scale. MATERIAL AND METHODS We tested the reliability of the GRB perceptual scale both in terms of test-retest reliability (intra-listener stability) and in terms of inter-listener agreement. We also studied how listeners process the three different parameters of the scale by varying the perceptual rating conditions of G, R, and B. The three attributes were rated simultaneously in one condition and in isolation in a second condition. The experiment was based on texts read by fifty dysphonic speakers. We selected five listeners specialized in voice assessment to provide perceptual judgments of the voices. RESULTS AND CONCLUSIONS Our results show that G is strongly correlated with R and/or B. When the GRB rating process is simultaneous, G is almost equal to the maximum score assigned to the R and/or B parameter (R² = 0.97). Conversely, R and B are poorly correlated. While intra-listener variability was limited, inter-judge variability was important even in a homogeneous panel of judges.
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Affiliation(s)
- Alain Ghio
- Aix-Marseille University, CNRS, LPL, Aix-en-Provence, France.
| | - Joana Revis
- Aix-Marseille University, CNRS, LPL, Aix-en-Provence, France; Department of Otolaryngology - Head and Neck Surgery, Conception University Hospital, Marseille, France
| | | | - Sylvie Jarzé
- Aix-Marseille University, CNRS, LPL, Aix-en-Provence, France; Department of Otolaryngology - Head and Neck Surgery, Conception University Hospital, Marseille, France
| | - Antoine Giovanni
- Aix-Marseille University, CNRS, LPL, Aix-en-Provence, France; Department of Otolaryngology - Head and Neck Surgery, Conception University Hospital, Marseille, France
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36
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Pozzali I, Pizzorni N, Ruggeri A, Schindler A, Dal Farra F. Effectiveness of Semi-Occluded Vocal Tract Exercises (SOVTEs) in Patients with Dysphonia: A Systematic Review and Meta-Analysis. J Voice 2024; 38:245.e17-245.e35. [PMID: 34284924 DOI: 10.1016/j.jvoice.2021.06.009] [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: 04/05/2021] [Revised: 05/29/2021] [Accepted: 06/02/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dysphonia is a disorder characterized by an alteration in the overall quality of the voice which reduces quality of life. Therefore, we assessed the effectiveness of SOVTEs in the management of dysfunctional and organic dysphonia for acoustic, perceptual-auditive, aerodynamic parameters and self-perception of the disease. METHODS a systematic review and meta-analysis were conducted. Findings were reported according to the PRISMA statement. Five databases were searched for RCTs and non- or quasi-RCTs. Studies were independently assessed using the Cochrane Risk of bias (RoB) and ROBINS-I tools. Effect sizes (ES) were calculated only at post-treatment. GRADE criteria were used to assess the quality of evidence. RESULTS eight articles were included. Studies investigated several SOVTEs, alone or in combination. None of the study was completely judged at low RoB. The quality of evidence resulted very low for each analysis. SOVTEs revealed to be statistically more effective than control interventions in improving F0 (ES: -14.42; CI 95%: -27.16, -1.69); P = 0.03), whereas shimmer did not change significantly (ES: -0.43; CI 95%:-02.02, 1.15; P = 0.59). Not significant changes in favor of control groups were found for jitter (ES: 0.13; CI 95%: -0.14, 0.40; P = 0.34) and overall gravity in the perceptual-auditory evaluation (ES: 0.13 CI 95%: -0.50, 0.77; P = 0. 68). Among secondary outcomes, evidence suggested that SOVTEs are more effective than control interventions in Psub reduction (ES: -1.47; CI 95%: -2.84, -0.10; P = 0.03); self-assessment resulted not significantly in favor of SOVTEs (VHI/VRQoL: ES -0.23; CI 95% -1.14, 0.69; P = 0.63 and VTDS/VDSI: ES -4.85, CI 95% -25.13, 15.42; P = 0.64). CONCLUSION results obtained showed that voice therapy based on SOVTEs is not to consider significantly superior if compared to other treatments, even if a favorable trend was detected and should be taken into consideration. Further high-quality RCTs on specific SOVTEs are recommended to produce better-quality evidence.
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Affiliation(s)
- Ilaria Pozzali
- Ospedale Maggiore, ENT Department, Lodi, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.
| | - Nicole Pizzorni
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Anna Ruggeri
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Fulvio Dal Farra
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Research Department, SOMA- Osteopathic Institute Milan, Milan, Italy
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Storr M. [What to do with cough, dysphonia, hoarseness and scratching throat?]. MMW Fortschr Med 2024; 166:52-53. [PMID: 38261208 DOI: 10.1007/s15006-023-3503-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Affiliation(s)
- Martin Storr
- Zentrum für Endoskopie, Internistenzentrum, Oßwaldstr. 1, 82319, Starnberg, Deutschland.
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38
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Correia C, Ribeiro VV, Silva POC, Behlau M. Cross-cultural adaptation of the Dysphonia Screening Tool (DST-Br) for European Portuguese (EP). Codas 2023; 36:e20230080. [PMID: 38126594 PMCID: PMC10750892 DOI: 10.1590/2317-1782/20232023080pt] [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: 04/08/2023] [Accepted: 08/07/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To perform a cross-cultural adaptation of the Brazilian Dysphonia Screening Tool (DST-Br) for European Portuguese (EP). METHODS The cross-cultural adaptation of the DST-Br for EP was carried out in four stages: translation, back-translation, expert committee review, and pre-testing. The pre-testing involved 30 dysphonic individuals (24 women and 6 men) aged between 18 and 87 years old. RESULTS An additional statement was required in the EP version of the instrument. Disagreement in the back-translation of the title was resolved through an expert committee review. One item presented discrepancies in the translation and back-translation, with the final version determined through an expert committee review. One item and the answer key reached a consensus in all stages. During pre-testing, all items received 100% "yes" or "no" responses, and none were marked as "not applicable". CONCLUSION The cross-cultural adaptation of DST-Br for use in EP was successfully carried out. The European Portuguese version of the instrument was named the Instrumento de Rastreio para a Disfonia em português europeu (IRD-PT) / Dysphonia Screening Tool in European Portuguese.
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Affiliation(s)
| | - Vanessa Veis Ribeiro
- Centro de Estudos da Voz - CEV - São Paulo (SP), Brasil.
- Curso de Fonoaudiologia, Faculdade de Ceilândia, Universidade de Brasília - UnB - Brasília (DF), Brasil.
| | | | - Mara Behlau
- Centro de Estudos da Voz - CEV - São Paulo (SP), Brasil.
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Anand S, Park Y, Shrivastav R, Eddins DA. Evaluating the Effect of Voice Quality Covariance on Auditory-Perceptual Evaluation Using a Novel Two-Dimensional Magnitude Estimation Task. J Speech Lang Hear Res 2023; 66:4849-4859. [PMID: 37902504 PMCID: PMC11001379 DOI: 10.1044/2023_jslhr-23-00226] [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: 04/04/2023] [Revised: 08/12/2023] [Accepted: 09/03/2023] [Indexed: 10/31/2023]
Abstract
PURPOSE Most people with dysphonia present with voices that vary along more than one voice quality (VQ) dimension. This study sought to examine the effect of covariance between breathy and rough VQ in natural voices. METHOD A two-dimensional matrix of 16 /a/ vowels was selected such that two VQ dimensions (breathiness and roughness) were sampled on a 4-point severity scale (none, mild, moderate, and severe). Ten listeners evaluated 480 stimuli (16 stimuli × 10 repetitions × 3 blocks) on one-dimensional magnitude estimation (1DME) tasks and a novel two-dimensional magnitude estimation (2DME) task that allowed for simultaneous measurement of breathiness and roughness. RESULTS Data indicated high intra- and interrater reliabilities for both breathiness and roughness in the 2DME and 1DME tasks. Correlation analyses revealed a strong correlation between 2DME and 1DME judgments for breathiness and roughness (r > .95). There was also a minimal correlation between breathy and rough VQ in the 2DME task (r < .10). CONCLUSIONS Covarying roughness or breathiness had less impact on the perception of the other VQ in natural dysphonic voices in 2DME compared to 1DME. An understanding and quantification of the perceptual interactions among the dimensions will aid in the refinement of computational models and in the establishment of the validity of clinical scales for VQ perception.
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Affiliation(s)
- Supraja Anand
- Department of Communication Sciences & Disorders, University of South Florida, Tampa
| | - Yeonggwang Park
- Department of Communication Sciences and Disorders, University of Central Florida, Orlando
| | - Rahul Shrivastav
- Office of the Provost & Executive Vice President, Indiana University Bloomington
| | - David A. Eddins
- Department of Communication Sciences and Disorders, University of Central Florida, Orlando
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Aziz D, Dávid S. Multitask and Transfer Learning Approach for Joint Classification and Severity Estimation of Dysphonia. IEEE J Transl Eng Health Med 2023; 12:233-244. [PMID: 38196819 PMCID: PMC10776101 DOI: 10.1109/jtehm.2023.3340345] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Despite speech being the primary communication medium, it carries valuable information about a speaker's health, emotions, and identity. Various conditions can affect the vocal organs, leading to speech difficulties. Extensive research has been conducted by voice clinicians and academia in speech analysis. Previous approaches primarily focused on one particular task, such as differentiating between normal and dysphonic speech, classifying different voice disorders, or estimating the severity of voice disorders. METHODS AND PROCEDURES This study proposes an approach that combines transfer learning and multitask learning (MTL) to simultaneously perform dysphonia classification and severity estimation. Both tasks use a shared representation; network is learned from these shared features. We employed five computer vision models and changed their architecture to support multitask learning. Additionally, we conducted binary 'healthy vs. dysphonia' and multiclass 'healthy vs. organic and functional dysphonia' classification using multitask learning, with the speaker's sex as an auxiliary task. RESULTS The proposed method achieved improved performance across all classification metrics compared to single-task learning (STL), which only performs classification or severity estimation. Specifically, the model achieved F1 scores of 93% and 90% in MTL and STL, respectively. Moreover, we observed considerable improvements in both classification tasks by evaluating beta values associated with the weight assigned to the sex-predicting auxiliary task. MTL achieved an accuracy of 77% compared to the STL score of 73.2%. However, the performance of severity estimation in MTL was comparable to STL. CONCLUSION Our goal is to improve how voice pathologists and clinicians understand patients' conditions, make it easier to track their progress, and enhance the monitoring of vocal quality and treatment procedures. Clinical and Translational Impact Statement: By integrating both classification and severity estimation of dysphonia using multitask learning, we aim to enable clinicians to gain a better understanding of the patient's situation, effectively monitor their progress and voice quality.
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Affiliation(s)
- Dosti Aziz
- Department of Telecommunications and Media InformaticsBudapest University of Technology and Economics1117BudapestHungary
| | - Sztahó Dávid
- Department of Telecommunications and Media InformaticsBudapest University of Technology and Economics1117BudapestHungary
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Sanuki T, Takemoto N. Comparison of Botulinum Toxin Injections and Type 2 Thyroplasty for Adductor Spasmodic Dysphonia. Laryngoscope 2023; 133:3443-3448. [PMID: 37278482 DOI: 10.1002/lary.30806] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/01/2023] [Accepted: 05/25/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Injection of botulinum toxin type A (BTX) into intrinsic laryngeal muscles is the current gold standard therapy for adductor spasmodic dysphonia (AdSD). However, a surgical procedure could potentially offer more stable and long-lasting voice quality to AdSD patients. Here, we report the long-term results of type 2 thyroplasty (TP2) with TITANBRIDGE® (Nobelpharma, Tokyo, Japan) compared with those of BTX injections. METHODS In total, 73 AdSD patients visited our hospital between August 2018 and February 2022. Patients were provided the option of BTX injections or TP2. They were assessed via the Voice Handicap Index (VHI)-10 before treatments and at scheduled clinical follow-ups at 2, 4, 8, and 12 weeks for BTX and at 4, 12, 26, and 52 weeks for TP2. RESULTS Overall, 52 patients selected the BTX injection and had a pre-injection mean VHI-10 score of 27.3 ± 8.8. Following injections, the scores significantly improved to 21.0 ± 11.1, 18.6 ± 11.5, and 19.4 ± 11.7 at 2, 4, and 8 weeks, respectively. There were no significant differences between the pre-injection scores and the 12-week scores (21.5 ± 10.7). Alternately, 32 patients opted to be treated with TP2 and had a pre-treatment mean VHI-10 score of 27.7. All patients reported an improvement in their symptoms. Additionally, the mean VHI-10 score significantly improved to 9.9 ± 7.4 at 52 weeks following treatment. There was a significant difference between the two treatment groups at 12 weeks. Some patients received both treatments. CONCLUSION These preliminary results provide important insights into the value of TP2 as a potential permanent treatment for AdSD patients. LEVEL OF EVIDENCE 3 Laryngoscope, 133:3443-3448, 2023.
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Affiliation(s)
- Tetsuji Sanuki
- Department of Otolaryngology-Head & Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Naoki Takemoto
- Department of Otolaryngology-Head & Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Montalbaron MB, Achlatis E, Johnson AM, Ma Y, Young VN, Rosen CA, Amin MR, Kwak PE. Presumptive Diagnosis in Tele-Health Laryngology: A Multi-Center Observational Study. Ann Otol Rhinol Laryngol 2023; 132:1511-1519. [PMID: 37070580 DOI: 10.1177/00034894231165811] [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: 04/19/2023]
Abstract
OBJECTIVES Early in the COVID-19 pandemic, outpatient visits were adapted for the virtual setting, forcing laryngologists to presume certain diagnoses without the aid of laryngoscopy, solely based on history and the limited physical exam available via video visit. This study aims to examine the accuracy of presumptive diagnoses made via telemedicine, compared to subsequent in-person follow up, where endoscopic examination could confirm or refute suspected diagnoses. METHODS A retrospective chart review was conducted of 38 patients evaluated for voice-related issues at NYU Langone Health and the University of California-San Francisco. Presumptive diagnoses at the initial telemedicine encounter were noted, along with diagnostic cues used for clinical reasoning and recommended treatment plans. These presumptive diagnoses were compared to diagnoses and plans established following laryngoscopy at follow-up in-person visits. RESULTS After laryngoscopy at the first in-person visit, 38% of presumptive diagnoses changed, as did 37% of treatment plans. The accuracy varied among conditions. Muscle tension dysphonia and Reinke's edema were accurately diagnosed without laryngoscopy, but other conditions, including vocal fold paralysis and subglottic stenosis, were not initially suspected, relying on laryngoscopy for diagnosis. CONCLUSIONS While some laryngologic conditions may be reasonably identified without in-person examination, laryngoscopy remains central to definitive diagnosis and treatment. Telemedicine can increase access to care, but it may provide more utility as a screening tool, triaging which patients should present more urgently for in-person laryngoscopy. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Michael B Montalbaron
- NYU Voice Center, Department of Otolaryngology - Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Efstratios Achlatis
- NYU Voice Center, Department of Otolaryngology - Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Aaron M Johnson
- NYU Voice Center, Department of Otolaryngology - Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Yue Ma
- UCSF Voice and Swallowing Center, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA
| | - VyVy N Young
- UCSF Voice and Swallowing Center, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Clark A Rosen
- UCSF Voice and Swallowing Center, Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Milan R Amin
- NYU Voice Center, Department of Otolaryngology - Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Paul E Kwak
- NYU Voice Center, Department of Otolaryngology - Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
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Han J, Morrison R, Mau T, Shembel A. Quantification of False Vocal Fold Hyperfunction During Quiet Breathing in Muscle Tension Dysphonia. Laryngoscope 2023; 133:3449-3454. [PMID: 37314219 PMCID: PMC10719413 DOI: 10.1002/lary.30814] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/21/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND/OBJECTIVES False vocal fold (FVF) hyperfunction during phonation is thought to be a diagnostic sign of primary muscle tension dysphonia (pMTD). However, hyperfunctional patterns with phonation are also observed in typical speakers. This study tested the hypothesis that FVF posturing during quiet breathing, as measured by the curvature of FVF, could differentiate patients with pMTD from typical speakers. METHODS Laryngoscopic images were collected prospectively in 30 subjects with pMTD and 33 typical speakers. Images were acquired at the end of expiration and maximal inspiration during quiet breathing, during sustained /i/, and during loud phonation before and after a 30-min vocal loading task. The FVF curvature (degree of concavity/convexity) was quantified using a novel curvature index (CI, >0 for hyperfunctional/convex, <0 for "relaxed"/concave) and compared between the two groups. RESULTS At end-expiration, the pMTD group adopted a convex FVF contour, whereas the control group adopted a concave FVF contour (mean CI 0.123 [SEM 0.046] vs. -0.093 [SEM 0.030], p = 0.0002) before vocal loading. At maximal inspiration, the pMTD group had a neutral/straight FVF contour, whereas the control group had a concave FVF contour (mean CI 0.012 [SEM 0.038] vs. -0.155 [SEM 0.018], p = 0.0002). There were no statistically significant differences in FVF curvature between groups in either the sustained voiced or loud conditions. Vocal loading did not change any of these relationships. CONCLUSIONS A hyperfunctional posture of the FVFs during quiet breathing especially at end-expiration may be more indicative of a hyperfunctional voice disorder than supraglottic constriction during voicing. LEVEL OF EVIDENCE 3 Laryngoscope, 133:3449-3454, 2023.
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Affiliation(s)
- Jasper Han
- Clinical Center for Voice Care, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert Morrison
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Dallas, TX, United States
| | - Ted Mau
- Clinical Center for Voice Care, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Adrianna Shembel
- Clinical Center for Voice Care, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Dallas, TX, United States
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Hogue S, Guo X, Morrison RA, McDowell S, Shembel A. Use of Motion Capture Technology to Study Extrinsic Laryngeal Muscle Tension and Hyperfunction. Laryngoscope 2023; 133:3472-3481. [PMID: 37326124 PMCID: PMC10724377 DOI: 10.1002/lary.30829] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/27/2022] [Revised: 05/28/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Patients with primary muscle tension dysphonia (pMTD) commonly report paralaryngeal pain and discomfort, and extrinsic laryngeal muscle (ELM) tension and hyperfunction are commonly implicated. However, quantitative physiological metrics to study ELM movement patterns for the characterization of pMTD diagnosis and monitoring of treatment progress are lacking. The objectives of this study were to validate motion capture (MoCap) technology to study ELM kinematics, determine whether MoCap could distinguish ELM tension and hyperfunction between individuals with and without pMTD, and investigate relationships between common clinical voice metrics and ELM kinematics. METHODS Thirty subjects (15 with pMTD and 15 controls) were recruited for the study. Sixteen markers were placed on different anatomical landmarks on the chin and anterior neck. Movements across these regions were tracked during four voice and speech tasks using two three-dimensional cameras. Movement displacement and variability were determined based on 16 key-points and 53 edges. RESULTS Intraclass correlation coefficients demonstrated high intra- and inter-rater reliability (p's < 0.001). Other than greater movement displacements around the thyrohyoid space during longer phrasing (reading passage, 30-s diadochokinetics) and more movement variability in patients with pMTD, kinematic patterns between groups were similar across the 53 edges for the four voice and speech tasks. There were also no significant correlations between ELM kinematics and standard voice metrics. CONCLUSION Results demonstrate the feasibility and reliability of MoCap for the study of ELM kinematics. LEVEL OF EVIDENCE 3 Laryngoscope, 133:3472-3481, 2023.
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Affiliation(s)
- Steven Hogue
- Erik Jonsson School of Engineering and Computer Science, Department of Computer Science, University of Texas at Dallas, Richardson, TX, United States
| | - Xiaohu Guo
- Erik Jonsson School of Engineering and Computer Science, Department of Computer Science, University of Texas at Dallas, Richardson, TX, United States
| | - Robert A. Morrison
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
| | - Sarah McDowell
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
| | - Adrianna Shembel
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Richardson, TX, United States
- Department of Otolaryngology-Head and Neck, Voice Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
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Meisner JW, Izadi S, Kamran A, Shieh HF, Smithers CJ, Bennett J, Demehri FR, Mohammed S, Lawlor C, Choi SS, Zendejas B. Screening for Vocal Fold Movement Impairment in Children Undergoing Esophageal and Airway Surgery. Laryngoscope 2023; 133:3564-3570. [PMID: 36892035 DOI: 10.1002/lary.30646] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 12/02/2022] [Revised: 02/04/2023] [Accepted: 02/27/2023] [Indexed: 03/10/2023]
Abstract
INTRODUCTION Children undergoing cervical and/or thoracic operations are at risk for recurrent laryngeal nerve injury, resulting in vocal fold movement impairment (VFMI). Screening for VFMI is often reserved for symptomatic patients. OBJECTIVE Identify the prevalence of VFMI in screened preoperative patients prior to an at-risk operation to evaluate the value of screening all patients at-risk for VFMI, regardless of symptoms. METHODS A single center, retrospective review of all patients undergoing a preoperative flexible nasolaryngoscopy between 2017 and 2021, examining the presence of VFMI and associated symptoms. RESULTS We evaluated 297 patients with a median (IQR) age of 18 (7.8, 56.3) months and a weight of 11.3 (7.8, 17.7) kilograms. Most had a history of esophageal atresia (EA, 60%), and a prior at-risk cervical or thoracic operation (73%). Overall, 72 (24%) patients presented with VFMI (51% left, 26% right, and 22% bilateral). Of patients with VFMI, 47% did not exhibit the classic symptoms (stridor, dysphonia, and aspiration) of VFMI. Dysphonia was the most prevalent classic VFMI symptom, yet only present in 18 (25%) patients. Patients presenting with a history of at-risk surgery (OR 2.3, 95%CI 1.1, 4.8, p = 0.03), presence of a tracheostomy (OR 3.1, 95%CI 1.0, 10.0, p = 0.04), or presence of a surgical feeding tube (OR 3.1, 95%CI 1.6, 6.2, p = 0.001) were more likely to present with VFMI. CONCLUSION Routine screening for VFMI should be considered in all at-risk patients, regardless of symptoms or prior operations, particularly in those with a history of an at-risk surgery, presence of tracheostomy, or a surgical feeding tube. LEVEL OF EVIDENCE 3 Laryngoscope, 133:3564-3570, 2023.
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Affiliation(s)
- Jay W Meisner
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Shawn Izadi
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Ali Kamran
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Hester F Shieh
- Department of Surgery, Johns Hopkins All Childrens, St Petersburg, Florida, U.S.A
| | - C Jason Smithers
- Department of Surgery, Johns Hopkins All Childrens, St Petersburg, Florida, U.S.A
| | - John Bennett
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Farokh R Demehri
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Somala Mohammed
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Claire Lawlor
- Department of Ear, Nose and Throat Surgery, Children's National, Washington, District of Columbia, U.S.A
| | - Sukgi S Choi
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Benjamin Zendejas
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A
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Paiva GM, Silva POC, Silva LJAD, Nascimento KA, Silva ABDVE, Abreu SRD, Almeida AAFD, Lopes LW. Spectral and cepstral measurements in women with behavioral dysphonia. Codas 2023; 36:e20220327. [PMID: 37970895 DOI: 10.1590/2317-1782/20232022327pt] [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: 12/16/2022] [Accepted: 03/20/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE To investigate whether there are differences in cepstral and spectral acoustic measures between women with behavioral dysphonia with and without laryngeal lesions and verify whether there is a correlation between such measures and the auditory-perceptual evaluation of voice quality. METHODS The sample comprised 78 women with behavioral dysphonia without laryngeal lesions (BDWOL) and 68 with behavioral dysphonia with laryngeal lesions (vocal nodules) (BDWL). Cepstral peak prominence (CPP), cepstral peak prominence-smoothed (CPPS), spectral decrease, and H1-H2 (difference between the amplitude of the first and second harmonics) were extracted. They were submitted to the auditory-perceptual evaluation (APE) of the grade of hoarseness (GH), roughness (RO), breathiness (BR), and strain (ST). RESULTS BDWL women had higher H1-H2 values and lower CPP and CPPS values than BDWOL women. More deviant voices had lower CPP and CPPS values. Breathy voices had lower CPP and CPPS values and higher H1-H2 values than rough ones. There was a weak negative correlation between CPP and RO, a moderate negative correlation with GH, and a strong negative correlation with BR. CPPS had a moderate negative correlation with GH, RO, and BR. H1-H2 had a weak positive correlation with BR. There was a weak positive correlation between spectral decrease and ST. CONCLUSION H1-H2, CPP, and CPPS were different between BDWOL and BDWL women. Furthermore, cepstral and spectral measures were correlated with the different APE parameters.
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Chang FC, Doan TN, Wang LH, To TL, Ho WC, Chou LW. Prevalence of Presbyphonia in Older Adults With Dysphonia: A Systematic Review and Meta-Analysis. Am J Speech Lang Pathol 2023; 32:3064-3076. [PMID: 37816221 DOI: 10.1044/2023_ajslp-23-00143] [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: 10/12/2023]
Abstract
PURPOSE This study aims to investigate the prevalence of presbyphonia among older adults who report voice complaints. METHOD We conducted a systematic search of five medical databases to identify studies that reported on presbyphonia as the cause of voice disorders in older adults. The pooled prevalence was calculated using random-effects models and presented as percentages with 95% confidence intervals (CI). The degree of heterogeneity among studies was assessed using I2 statistics. Subgroup analyses were performed to identify the sources of heterogeneity. RESULTS Out of 764 abstracts from five libraries, 11 studies were included in this systematic review. The pooled prevalence of presbyphonia among older adults with voice disorders is 17.78% (95% CI [12.69, 23.51]). We conducted a subgroup analysis on studies that used laryngeal visualization to confirm the diagnosis for all patients and found that the prevalence of presbyphonia was lower in studies with unrestrictive inclusion criteria (12.84%, 95% CI [8.38, 18.08]) compared to studies with restricted inclusion criteria (22.59%, 95% CI [14.49, 31.88]). CONCLUSIONS This study suggests that voice disorders in older adults have multiple causes, not predominantly presbyphonia. Overestimation of presbyphonia prevalence occurs if certain diagnoses are excluded at recruitment. This study emphasizes the importance of recognizing the diverse underlying etiologies of dysphonia in older adults; therefore, comprehensive examination and accurate diagnosis are crucial. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24263029.
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Affiliation(s)
- Fei-Chun Chang
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
- Ph.D. Program for Aging, China Medical University, Taichung, Taiwan
| | - Thanh-Nhan Doan
- Department of Public Health, China Medical University, Taichung, Taiwan
- Department of Rehabilitation, Quang Nam Northern Mountainous Region General Hospital, Vietnam
| | - Liang-Hui Wang
- Ph.D. Program for Aging, China Medical University, Taichung, Taiwan
- Department of Speech Language Pathology and Auditory, Hungkuang University, Taichung, Taiwan
| | - Thi-Lien To
- Faculty of Nursing, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Wen-Chao Ho
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Li-Wei Chou
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
- Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung, Taiwan
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Toya Y, Hiroshiba S. Durability of Titanium Implants Following Type II Thyroplasty for Adductor Type Spasmodic Dysphonia. Laryngoscope 2023; 133:3028-3033. [PMID: 37070643 DOI: 10.1002/lary.30707] [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: 02/23/2023] [Revised: 03/20/2023] [Accepted: 04/02/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE To determine the durability of current titanium implants (TI) used in voice improvement surgery for adductor spasmodic dysphonia (ADSD), which is type II thyroplasty (T2T), and identify the effects of their fractures on vocal functions. METHODS A total of 36 ADSD patients who underwent T2T had the following exams: The CT scans of the larynx were performed 1 year after the surgery to assess the fractures of TI. The improvement in the mean voice handicap index 10 (VHI-10) scores and the success rate between nonfractured (NFR) and fractured (FR) groups were compared. RESULTS It was indicated that TI was broken in 21 cases (58.3%). In one case (2.7%), a fracture on the part of the bridge that connects both sides of the plates was observed, and fractures at holes placed on the plates in the other 35 cases (55.6%). The mean VHI-10 score improved from 27.2 ± 8.1 to 11.4 ± 7.9 in the NFR group and from 26.3 ± 4.9 to 9.7 ± 7.9 in the FR group. The success rates were 66.6% in the NFR group and 71.5% in the FR group. No statistical difference was observed in the improvement in the mean VHI-10 scores, and the success rate between the two groups. However, two cases resulted in failure in the FR group, whereas no worsened case was observed in the NFR group. CONCLUSION The current TI used in T2T has low durability and could result in the worsening of vocal symptoms after the surgery. LEVEL OF EVIDENCE 4 Laryngoscope, 133:3028-3033, 2023.
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Kaya T, Yılmaz G, Zraick RI, Konrot A, Cangi ME. Reliability and validity of the Turkish voice handicap index-partner (VHI-P-TR). J Commun Disord 2023; 106:106380. [PMID: 37738707 DOI: 10.1016/j.jcomdis.2023.106380] [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: 02/24/2023] [Revised: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE This study examines the Turkish validity, reliability and diagnostic performance of the Voice Handicap Index-Partner (VHI-P-TR), which is used to obtain the perceptions of communication partners of individuals with dysphonia about the functional, physical and emotional handicap resulting from the patient experiencing dysphonia. METHOD The study included 160 individuals with dysphonia and their communication partners. First, translation, back translation, expert validity and pilot study were performed in the scale adaptation process. Then, a confirmatory factor analysis (CFA) was conducted to assess the construct validity of the VHI-P-TR. Correlations between the VHI-P-TR and Voice Handicap Index (VHI-TR) scores of dysphonic individuals were examined to evaluate the concurrent validity of the VHI-P-TR. To assess the reliability of the VHI-P-TR, a test-retest analysis was performed, and internal consistency coefficients (α) were calculated. A receiver operating characteristic (ROC) analysis was conducted to determine the cut-off point for the VHI-P scores. RESULTS A high positive correlation was found between the participants' VHI-P-TR and VHI-TR total and subscales mean scores (r's > 0.782; p < 0.01). The VHI-P-TR had high internal consistency regarding for its subscales and total score (α's > 0.94; p < 0.01). Factor loadings of all VHI-P-TR items were higher than 0.30 and their error variances were lower than 0.90. In addition, factor loadings were statistically significant for all the items (p < 0.05). The data fit the model well according to all CFA indices except for GFI (scale = 0.69). An adequate sensitivity and specificity were achieved for the VHI-P-TR, and the cut-off point was found as 11.50 for the total score and ranged from 2.50 to 5.50 for the subscales. CONCLUSION The VHI-P-TR is a valid and reliable measurement tool with high diagnostic performance in all subscales and total score, and has high levels of agreement with the VHI-TR.
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Affiliation(s)
- Tuğba Kaya
- University of Health Sciences, Speech and Language Deparment, İstanbul, Türkiye.
| | - Göksu Yılmaz
- Uskudar University, Speech and Language Deparment, İstanbul, Türkiye
| | - Richard I Zraick
- University of Central Florida, School of Communication Sciences and Disorders, Orlando, United States of America
| | - Ahmet Konrot
- Uskudar University, Speech and Language Deparment, İstanbul, Türkiye
| | - Mehmet Emrah Cangi
- University of Health Sciences, Speech and Language Deparment, İstanbul, Türkiye
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Oliveira Santos A, Godoy J, Silverio K, Brasolotto A. Vocal Changes of Men and Women from Different Age Decades: An Analysis from 30 Years of Age. J Voice 2023; 37:840-850. [PMID: 34284927 DOI: 10.1016/j.jvoice.2021.06.003] [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: 03/08/2021] [Revised: 06/02/2021] [Accepted: 06/06/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To verify the modifications in auditory-perceptual and acoustic parameters of the fundamental frequency, short-term perturbation, noise, and cepstral measures of voice in young and elderly were distributed over the age of decades. METHODS The study was conducted on 265 subjects (140 females and 125 males), aged 30 to 79 years, without a history of vocal complaints or dysphonia, distributed in five age groups for females and males (30-39 years until 70-79 years). Three speech therapists voice specialists performed the perceptual-auditory analysis using a 100-mm visual analog scale, based on the overall dysphonia grade (overall grade), roughness, and breathiness from the sustained vowel /a/. The smoothed cepstral peak prominence (CPPS), average fundamental frequency (F0), standard deviation of the fundamental frequency (std-F0), jitter percentage (%), shimmer percentage (%), noise-to-harmonic ratio (NHR), voice turbulence index (VTI), and soft phonation index (SPI) were extracted for the acoustic analysis RESULTS: In the case of the auditory-perceptual characteristics, the comparison between aged groups showed that, in men, the vocal quality did not show significant differences in the overall grade, roughness, and breathiness. However, women in the 3rd decade of life presented higher breathiness than those in the 5th, 6th, and 7th decades. Men had a higher overall grade and roughness than women. In the case of the acoustic data, the cepstral measure showed that in the 3rd decade, men presented higher CPPS than females. The noise measures, in the comparison by age groups, only VTI and SPI were different for women: VTI was higher in the 7th decade than in the 4th, whereas SPI was higher in the 4th decade than in older women. In the male population, the SPI in the 4th decade was also higher than that in the older population CONCLUSION: The analysis by age groups of life allowed the identification of breathiness as a sensitive parameter in the different stages of adult life in women. The CPPS analysis showed that the 7th age decade is the period of the appearance of vocal changes for females, characterized by higher CPPS. The results related to traditional short-term perturbation and noise measurements showed that changes in F0, jitter, shimmer, and NHR were not found. Among the other noise measurements, VTI and SPI demonstrated some changes in different decades of life.
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Affiliation(s)
- Aline Oliveira Santos
- Department of Speech Hearing and Language Disorders, University of São Paulo, São Paulo.
| | - Juliana Godoy
- Department of Speech-Language Pathology and Audiology, Federal University of Rio Grande do Norte, Natal
| | - Kelly Silverio
- Department at Speech-Language Pathology and Audiology, University of São Paulo, São Paulo
| | - Alcione Brasolotto
- Department at Speech-Language Pathology and Audiology, University of São Paulo, São Paulo
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