Voice use of nurses working in the intensive care unit during the COVID-19 pandemic

OBJECTIVE

This study aimed to investigate the voice use of nurses working in intensive care units (ICUs) and their perception of acoustic environments.

SETTING AND SAMPLE

The research was conducted in four different hospitals in China during the COVID-19 pandemic. A total of 60 ICU nurses were recruited for their voice use monitoring and 100 nurses participated in the survey.

RESEARCH METHODOLOGY

Firstly, voice-related parameters such as voice level (SPL, dB), fundamental frequency (F0, Hz), and voicing time percentage (Dt, %) were measured using a vocal monitor. To collect data, a non-invasive accelerometer was attached to the participants' necks during their working hours. Secondly, the perception of the ICU acoustic environment was assessed using semantic differential.

RESULTS

The results showed that nurses spoke approximately 0.9-4 dB louder to patients and colleagues in ICUs compared to quiet rooms, and their fundamental frequency (F0) significantly increased during work. The voice levels of nurses were influenced by background noise levels, with a significant correlation coefficient of 0.44 (p < 0.01). Furthermore, the background noise levels ranged from 58.1 to 73.9 dBA, exceeding the guideline values set by the World Health Organisation (WHO). The semantic differential analysis identified 'Stress' and 'Irritation' as the two main components, indicating the prevalence of negative experiences within ICUs.

IMPLICATIONS FOR CLINICAL PRACTICE

This study highlights the potential risk of voice disorders among ICU nurses. The findings also underscore the importance of implementing strategies to reduce noise levels in ICUs to reduce voice disorders among nurses.

Water Resistance Therapy in Individuals with Parkinson's Disease: A Session-by-Session Analysis of the Vocal Quality

OBJECTIVES

Verify session-by-session effects of the water resistance therapy (WRT) on the vocal quality of individuals with Parkinson's disease (PD).

METHODS

This is a retrospective analytical study. Then, the samples were acquired from a database composed of 10 men aged between 50 and 90 years old diagnosed with PD. The participants underwent WRT with a resonance tube; then, they were guided to perform the following phonatory tasks: comfortable pitch and loudness, high pitch, low pitch, ascending and descending glissandos, and sentence uttering. Furthermore, tube depth ranged from 2 cm to 9 cm. Finally, WRT was implemented twice per week, totaling eight sessions, each lasting 45 minutes. Participants were assessed before and after each therapy session. Hence, the data were assessed with spectrographic analysis, vocal intensity, cepstral peak prominence-smoothed, alpha ratio, L1-L0, oscillatory frequency, and auditory-perceptual assessment of overall degree, roughness, breathiness, and instability. One-way repeated measures analysis of variance and Friedman tests were applied (P < 0.05). Furthermore, Holm-Sidak and Tukey tests were used as posthoc tests.

RESULTS

After the sixth session, the spectrographic analysis revealed that the tracing color intensity of medium frequencies darkened, whereas a better result could be observed after the eighth session. Regarding vocal intensity, the improvement could be observed from the third session. Additionally, L1-L0 followed the same results. The overall degree auditory-perceptual assessment revealed the best results only after the second, third, and fourth sessions; however, after the eighth session, the instability increased.

CONCLUSIONS

WRT allowed better results from the third session, with some improvements in the sixth session. However, the instability increased after the eighth session; thus, it is important to review the phonatory tasks and session numbers to avoid an overload in the phonatory system.

Laryngeal features in Lipoid proteinosis: a systematic review and meta-analysis of individual participant data

PURPOSE

Lipoid proteinosis (LP) or Urbach-Wiethe disease (OMIM 247100) is a rare syndrome characterised by early vocal folds infiltration and subsequent multi-organ involvement. LP is often unrecognised and its associated hoarseness is overlooked. The main objective of the study was to investigate hoarseness in LP and implement a diagnosis among otolaryngologists.

METHODS

PubMed/MEDLINE and OMIM databases were systematically searched. Authors concentrated the search on published articles starting from the discovery of the pathogenesis of LP by Hamada et al. in 2002. Only cases in which a diagnosis was reported both clinically and through biopsy and/or genetic molecular testing were included. Characteristics of the LP cases were extracted from each included study. Results were obtained through Generalized Estimating Equations.

RESULTS

The search strategy yielded 217 articles, of which 74 (34.1%) met the selection criteria. A total of 154 cases were included. Hoarseness was described in all LP cases and clearly stated as the onset symptom in 68.8%. The onset was on average at 19 months of age (CI: 3.00-20.00), while the mean age at diagnosis was 15 years (CI: 10.00-30.00). Therefore, the diagnostic delay amounted to 13.42 years (CI: 8.00-23.83). Hoarseness alone was responsible for an LP diagnosis in only 14.3% of cases. In 43.5% of cases, genetic analysis of the ECM1 gene was performed and exon 6 was the most frequently altered portion.

CONCLUSION

Analysing the largest number of published cases, the study underlined that hoarseness is the key symptom for diagnosing LP since early childhood, though frequently overlooked.

Rearranging Voice Disorders: Refining the New Two-Dimensional Continuous Model

BACKGROUND

Voice and laryngeal pathologies are traditionally arranged in categories. A recent study has suggested an alternative approach, using two continuous scales, Organicity and Tonicity, which form a two-dimensional plane on which all pathologies/conditions can be arranged.

OBJECTIVES

This study was designed to examine the validity and reliability of the new continuous 2D model and to learn how it is affected by experts' background characteristics.

METHODS

Ninety-three international experts from 16 countries participated in the study and rated a comprehensive list of 35 laryngeal and voice pathologies/conditions on two continuous scales. On the Organicity scale, 0 represented "nonorganic," and 10 defined "organic." Similarly, on the Tonicity scale, 0 described "hypotonic" and 10 represented "hypertonic."

RESULTS

Cronbach's alphas were high for Organicity and Tonicity (0.99), with varied interexpert agreement scores. Pathologies/conditions populated all four quadrants of the constructed two-dimensional plane, with a majority of 21 of the 35 located in the first quadrant (high-Tonicity, high-Organicity). Results showed strong replicability when compared to the preliminary study. In addition, ratings on the two scales were found consistent and statistically unaffected by the experts' background characteristics.

CONCLUSIONS

The new two-dimensional model is valid and reliable, and it provides a simple yet comprehensive approach for arranging voice disorders using a continuous perspective rather than a categorical one. Furthermore, the new model offers a framework that facilitates examination of the differences in how professional experts view different laryngeal pathologies and conditions.

Validity, reliability and reproducibility of the VLS parameters form for the collection of videolaryngostroboscopic basic findings

OBJECTIVE

The videolaryngostroboscopy parameters form (VLSP form) is a diagnostic tool for the collection of videolaryngostroboscopic basic findings through the evaluation of 12 parameters. The aim of the present study is to preliminarily investigate intra- and inter-rater reliability, validity and responsiveness of the VLSP form.

METHODS

A study on a total amount of 160 forms for the evaluation of VLS basic findings was carried out. 80 forms were scored through the VLSP form and 80 with the Voice Vibratory Assessment with Laryngeal Imaging (VALI) form Stroboscopy (S) by four expert phoniatricians, that blindly scored the VLS recordings of 5 subjects without voice disorders and 5 patients with organic voice disorder before and after successful phonosurgery. Intra-rater and inter-rater analysis have been performed for both forms. The scores obtained through VLSP form and VALI form S have been compared to analyse concurrent validity, while VLSP scores before and after phonosurgery have been compared to analyse responsiveness. Finally, each rater annotated the "difficulty" in rating every parameter and its "importance" for the diagnosis.

RESULTS

The VLSP form showed good inter- and intra-rater reliability. It showed a good accuracy for the documentation of changes of laryngeal anatomy and function after phonosurgery, similarly to the VALI form S. The 12 parameters of the VLSP form were judged "Slightly Important" in 28.3% of the samples, "Very Important" in 64.8% of the samples, "Not Difficult" in 73.1% of the samples.

CONCLUSIONS

The results of the present study suggest that the VLSP form is comparable to the VALI form S for the evaluation of videolaryngostroboscopic parameters and is a valid, reliable and reproducible diagnostic tool. It can help voice clinicians in the evaluation of VLS examinations and it allows for a punctual assessment of modifications in laryngeal anatomy and function in pathological conditions and after phonosurgery.

Relative Fundamental Frequency in Individuals with Globus Syndrome and Muscle Tension Dysphagia

OBJECTIVE

Relative fundamental frequency (RFF) has been investigated as an acoustic measure to assess for changes in laryngeal tension. This study aimed to assess RFF in individuals with globus syndrome, individuals with muscle tension dysphagia (MTDg), and individuals with typical voices.

METHODS

RFF values were calculated from the speech acoustics of individuals with globus syndrome (n = 12), individuals with MTDg (n = 12), and age- and sex-matched controls with typical voices (n = 24). An analysis of variance was performed on RFF values to assess the effect of group.

RESULTS

There was no statistically significant effect of group on RFF values, with similar values for individuals with globus syndrome, individuals with MTDg, and control participants.

CONCLUSIONS

These results suggest that individuals with these disorders do not appear to possess paralaryngeal muscle tension in a locus and/or manner that directly impacts voice production.

Potential Risks for Healthcare Disparities Among Individuals With Voice and Upper Airway Disorders: A Systematic Review

PURPOSE

To assess the potential epidemiological association between various possible risk factors and healthcare disparities specifically related to the access, use and/or quality of speech language pathology services for individuals with voice and upper airway disorders.

METHOD

A systematic review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis. Full text journal articles were identified through PubMed, PsycINFO and Web of Science. The reference sections of included articles were also manually screened and identified four additional studies for consideration of inclusion. Included articles specifically addressed healthcare disparities in voice and upper airway disorders related to speech pathology care. International literature was excluded. Eligible studies were reviewed and data extracted. Risk of bias of each eligible study was performed using the quality assessment tool from National Institute of Health for observational cohort and cross-sectional studies. Data from eligible studies were synthesized thematically.

RESULTS

A total of 1,101 resources were retrieved from the search; of these, 133 were duplicates. Titles and abstracts of 968 articles were screened, with 14 selected for full-text review. Eleven articles were considered eligible for inclusion. Voice disorders were the condition most frequently examined followed by only one article addressing upper airways disorders. There was considerable heterogeneity in the methodology and statistical analyses among the eligible papers. There was a lack of standard methodology for collecting and accurately determining patient characteristics as well as variability in measuring confounding variables and providing statistical analyses for such adjustments that may have impacted the findings. The information extracted from these articles revealed healthcare disparities related to sex/gender, age, insurance status/coverage, race/ethnicity, among others including etiology and preferred language.

CONCLUSIONS

This systematic review highlights the limited research on speech language pathology-specific healthcare disparities for individuals with voice and upper airway disorders. There was significant clinical and methodological heterogeneity between studies which may have contributed to varied results between studies. There is a need for greater methodological rigor and prospectively designed studies to better characterize the impact of disparities in the access to, use of, and quality of speech pathology care for this patient population.

Management of Contralateral Reactive Vocal Fold Lesions, a Retrospective Study

OBJECTIVE

To evaluate the anatomical and voice results of conservative management of patients diagnosed with contralateral reactive lesions (CRL) in our voice unit.

METHODS

A retrospective chart review was conducted of all new adult patients with benign vocal fold lesions with or without CRL, treated in the voice unit at Universidad Católica Clinical Hospital between 2015 and 2019. Patients were divided into two groups, without CRL (group A) and with CRL (group B). Analysis of preoperative and 1 month after surgery videostroboscopy, GRBASI, Voice Handicap Index-10 (VHI-10), Voice Related Quality of Life (VRQOL) surveys and management of CRL was conducted.

RESULTS

A total of 62 patients were included, 45 (72.6%) had CRL. When compared, bivariate and multivariate analysis revealed that age was significantly associated as a mild protective factor of presenting a CRL (P < 0.05). No significative differences were found between preoperative group A and B perceptual voice analysis or voice surveys. In terms of CRL management, 30 (66.6%) were injected, conservative management with observation was performed in 12 patients (26.7%) and, three (6.7%) were surgically resected. After 1 month follow-up, 32 (71.1%) had complete CRL resolution, eight (17.8%) had CRL persistence and, five (11.1%) had CRL recurrence. Postoperative vocal outcomes, GRBASI, VHI-10 and VRQOL showed significative improvement as compared with preoperative data for each group. No differences were seen between group A and B in terms of postoperative vocal outcomes.

CONCLUSION

CRL are prevalent, and their management is controversial. On our study 72.6% of BFVL presented with CRL and 93.3% of them were conservatively managed. Improvement in perceptual voice analysis and quality of life surveys were similar in both groups.

Noninvasive Management of Voice Disorders: An Umbrella Review

OBJECTIVES

The aim of this study was to assess published systematic reviews that discussed noninvasive management of voice disorders. An umbrella review was conducted to collect, organize, and summarize narratively all available pharmacologic and voice therapy interventions.

STUDY DESIGN

Umbrella review of systematic reviews.

METHODS

Pertinent systematic reviews were identified by searching Pubmed/Medline and Embase. A primary screen identified studies related to voice. The second round of screening focused on studies that involved noninvasive management of voice disorders such as pharmacologic or voice therapy interventions. Variables of interest included study design, number of studies included in the review, target population, method of intervention, and outcomes.

RESULTS

Forty-three systematic reviews were eligible and included in the umbrella review. Ten studies focused on pharmacologic interventions, and 33 studies focused on voice therapy. Individual studies included in the systematic reviews ranged from 2-47, with a total of 601 studies overall.

CONCLUSIONS

This study provides a detailed review of all available systematic reviews on noninvasive management of voice disorders. Explored medications included proton pump inhibitors, calcium channel blockers, tricyclic antidepressants, antibiotics, corticosteroids, and hormone replacement. Explored voice therapy techniques included hydration, vocal function exercises, laryngeal manual therapy, respiratory exercise, biofeedback, phonation, coping strategies, and others. This may be utilized to guide therapeutic decision-making and identify current gaps in the literature that may warrant future investigation.

Clinical Experiences of Voice Therapists in the Rehabilitation of Pediatric Vocal Fold Nodules

OBJECTIVES

The purpose of this study was to identify common clinical practices and experiences of voice therapists regarding the treatment of pediatric vocal fold nodules (VFNs) in Flanders, Belgium.

STUDY DESIGN

Observational survey study.

METHODS

A 38-item online survey was completed by 35 voice therapists (32 females, 3 males) with experience in treating pediatric VFNs. Demographic characteristics, occupational characteristics, educational characteristics, therapy content, therapy delivery model, and experience of the voice therapist were explored. Experiences of voice therapists were measured using visual analog scales (score 0-100). An extensive descriptive analysis was performed using IBM SPSS version 28.

RESULTS

The majority of voice therapists (93.9%) provide a combination of direct and indirect therapy techniques when treating children with VFNs. The most commonly used direct techniques are breathing exercises (84.4%), semioccluded vocal tract exercises (71.9%) with a clear preference for resonance tube in water and resonant voice therapy, and relaxation exercises (65.6%). On average, Flemish voice therapists provide 24.80 (SD: 11.5, range: 10-50) half-hour sessions, usually at a frequency of once a week. No respondents had experience with intensive therapy or group therapy in the treatment of pediatric VFNs. Regarding the experience of voice therapists with treating VFNs in children, respondents give a mean score of 77.28 (SD: 13.7, range: 50-100) on a scale of 0 (negative experience) to 100 (positive experience). Furthermore, 96.2% of voice therapists experience difficulties during treatment and 40% feel there are not enough targeted training opportunities on the topic of pediatric VFNs.

CONCLUSION

Flemish voice therapists generally feel comfortable treating pediatric VFNs. They usually provide a combination of direct and indirect therapy and use a wide range of different direct therapy techniques. However, there is still some need to organize more focused and tailor-made training initiatives.

Patients' Demographics and Risk Factors in Voice Disorders: An Umbrella Review of Systematic Reviews

OBJECTIVES

This study aimed to provide a comprehensive overview of the systematic reviews that focus on the prevalence of voice disorders (VDs), associated risk factors, and the demographic characteristics of patients with dysphonia. An umbrella review was conducted to identify general research themes in voice literature that might guide future research initiatives and contribute to the classification of VDs as a worldwide health concern.

STUDY DESIGN

Umbrella review of systematic reviews.

METHODS

Pubmed/Medline and Embase were searched for eligible systematic reviews by two authors independently. Extracted data items included the study publication details, study design, characteristics of the target population, sample size, region/country, and incidence and/or prevalence of the VD(s) of interest.

RESULTS

Forty systematic reviews were included. Sixteen reported a meta-analysis. Great heterogeneity in methods was found. A total of 277,035 patients across the included studies were included with a prevalence ranging from 0%-90%. The countries represented best were the United States and Brazil, with 13 studies each. Aging, occupational voice use, lifestyle choices, and specific comorbidities, such as obesity or hormonal disorders, seem to be associated with an increased prevalence of dysphonia.

CONCLUSIONS

This review underscores the influence of VDs on distinct patient groups and the general population. A variety of modifiable or non-modifiable risk factors, having varied degrees of impact on voice qualities, have been identified. The overall effect of VDs is probably underestimated due to factors, such as sample size, patient selection, underreporting of symptoms, and asymptomatic cases. Employing systematic reviews with consistent methodologies and criteria for diagnosing VDs would enhance the ability to determine the prevalence of VDs and their impact.

Development of a Voice Handicap Index for Clergymen: An Investigation of Its Validation and Reliability

OBJECTIVE

This study aims to is to develop a disorder-specific patient-reported outcome measure to be used in Islamic clergymen with voice disorders and to investigate its validity and reliability.

METHODS AND PROCEDURES

Employing an exploratory sequential mixed-methods design, this study conducted in two phases. Initially, semistructured interviews were conducted with 10 clergymen experiencing voice disorders. Subsequently, the questionnaire underwent rigorous validation, encompassing content, construct, and criterion validity assessments, in addition to test-retest reliability and internal consistency analyses. The index was administered to a sample of 110 male clergy, including imams, muezzins, and Quran course teachers, with an age range from 19 to 61years.

RESULTS

Construct validity was established through factor analysis, resulting in a final 23-item scale categorized into two factors: physical-functional and emotional. Known group validity demonstrated a significant distinction between the study and control groups. Criterion validity reinforced the index's validity, displaying a correlation coefficient of 0.758 between the Voice Handicap Index for Clergymen and the well-established Voice Handicap Index. The questionnaire exhibited commendable internal consistency, with a Cronbach's Alpha (α) coefficient value of 0.971. Test-retest reliability analysis exhibited strong consistency, with a Pearson correlation coefficient of 0.863.

CONCLUSIONS

It is recommended that the developed valid and reliable handicap index in the present study be included in the voice assessment batteries of Islamic clergymen with voice complaints with the clinical and research purposes. In future studies, the validity of the questionnaire can be investigated more by examining the difference between the Voice Handicap Index for Islamic Clergymen (CVHI) scores obtained before and after treatment. Identifying a cut-off point that discriminates between dysphonic and normophonic clergymen may allow the use of the CVHI as a screening tool for this population.

Voice Quality and Vocal Tract Discomfort Symptoms in Patients With COVID-19

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.

Prevalence and Risk Factors for Dysphonia in Preschoolers at Five Years Old in a Capital City in the Northeast of Brazil

GOALS

Identifying the prevalence and risk factors of childhood dysphonia in children turning 5 years old; and assess the link with the interactional, behavioral, sociodemographic, economic, and biological indicators METHOD: Analytical, transversal, nested within a birth cohort 5 years after its creation. Original cohort biologic data were recovered from the previous database. The current demographic and personal data were acquired from the official health institutions where the individuals were found. We managed to find 371 preschoolers, both sexes, enrolled in 141 public and private schools. Face-to-face interviews were performed with mothers regarding maternal and child health and biological, sociodemographic, economic, interactional-affective, and behavioral indicators. Speech therapists used the Consensus of Auditory-Perceptual Evaluation of Voice authorized for Portuguese for the perceptual-auditory judgment of children's voices. Bivariate and multivariate analyzes of the data were performed. A significance level of 5% (P < 0.05) was considered in all analyses.

RESULTS

The prevalence of mild-moderate general dysphonia occurred in 26.4% of the preschoolers assessed with tense, rough, and breathy voice quality; low pitch; strong loudness and laryngeal resonance. There was a contrast between preschoolers with dysphonia, calm temperament, and family income of up to three minimum wages and those without these characteristics. We also have noted that a greater chance of dysphonia occurred in preschoolers with a calm temperament, family income of up to three minimum wages, nocturnal bruxism up to 3 years old and who did not use a pacifier.

CONCLUSION

There was a high prevalence of dysphonia at 5 years old. Biological indicators have an impact on voice, while interactional, behavioral, sociodemographic, and economic indicators have a higher impact. There is a great need for investments in prevention, promotion, and vocal treatment to minimize negative socio-educational impacts and provide higher quality of life for children at greater risk for dysphonia.

Special Education Teachers' Self-Assessed Voice Health Regarding Voice Use Habits

OBJECTIVES

Special education teachers (SETs) work with students with disabilities. To get and keep these students' attention during the lesson, they may use their voices with high loudness and frequent pitch changes. These situations can be tiring for their voices and affect their vocal health. This study aimed to compare SETs' voice fatigue, reflux symptoms, and self-assessments according to their voice use habits in their work and social lives.

METHODS

A total of 208 SETs were included. A Teacher Voice Use Habits Questionnaire was developed by considering the literature, taking expert opinion, and conducting a pilot study. In addition, the Vocal Fatigue Index (VFI), Voice Handicap Index-30 (VHI-30), and Reflux Symptom Index (RSI) were used. One-way ANOVA, Mann-Whitney U, Kruskal Wallis-H, and Pearson correlation analyses were performed.

RESULTS

Of SETs, 37.5% reported frequent hoarseness, and 65.4% reported voice fatigue during/at the end of the day. Those who answered "yes" to the questions about talking loudly at home, having the television on at home, feeling stressed in the work environment, eating and drinking before going to bed at night, smoking, having frequent colds, talking loudly during the day, and voice fatigue during/at the end of the day had significantly higher scores in all scales. Those who used their voice for more than 6hours were found to have significantly higher scores on the VFI and RSI. In all scales, the scores of those who made very frequent long phone calls were significantly higher.

CONCLUSION

According to the SETs' reports, it was concluded that they did not comply with the rules of vocal hygiene, although they used their voices for a long time. This situation should be considered an occupational health problem in schools, and it may be helpful to screen this group's voice disorders and design preventive programs.

Geriatric Voice: Distinctive Clinical Profiles of Working Seniors in a Tertiary Laryngology Clinic

OBJECTIVES

Voice disorders have been reported in up to 47% of the geriatric population. Few studies have assessed dysphonia in the elderly, with none examining vocal function in working seniors. This study aims to profile the clinical characteristics of individuals aged 65 years and older, comparing working and non-working seniors.

STUDY DESIGN

Retrospective cohort study.

METHODS

Medical charts were reviewed for patients aged 65 years and older referred to the McGill University Health Centre Laryngology Clinic (January 2018-March 2020). Variables studied included sociodemographics, comorbidities, voice complaints, lifestyle factors, diagnoses, voice acoustics [maximum phonation time (MPT), S/Z ratio, F0], GRBAS scale, Voice Handicap Index-10 (VHI-10), Reflux Symptom Index (RSI), and treatment modalities.

RESULTS

A total of 267 patients were included, with a mean [standard deviation (SD)] age of 74.2 (6.6) years and 61% of female patients. Occupation information was available in 148 cases, of which 31.1% were still working and 12.8% were professional voice users. The predominant voice complaint was dysphonia/hoarseness (48.8%) and the most prevalent diagnosis was presbyphonia (31.8%). The mean (SD) VHI-10 and RSI scores were 19.8 (9.0) and 18.7 (9.4) points, respectively. Voice therapy was prescribed for 155 patients (58.7%): 124 attended at least one session with significant post-treatment improvements in the GRBAS and VHI-10 scores (P < 0.01). In the univariate analysis, working seniors had a significantly more prevalent singing habit (P = 0.04) and laryngopharyngeal reflux diagnosis (P = 0.01), displaying a significantly longer MPT (P < 0.001) and lower G-B-S scores (P < 0.05). After adjusting mean differences, only MPT and the G-S scores were significantly different between both groups.

CONCLUSIONS

The predominant diagnosis in elders with voice complaints was presbyphonia. Voice therapy proved effective in improving the VHI-10 and GRBAS scores for geriatric patients. Almost one-third of seniors remained in the workforce, demonstrating superior vocal profiles, specifically in the MPT and the grade and strain of perceptual voice quality.

Psychometric Properties of the Vocal Fatigue Handicap Questionnaire in Kannada Among Teachers

BACKGROUND

As the literature review suggests, most professional voice users, such as teachers and singers, are prone to vocal abuse or misuse and frequently experience vocal fatigue. Therefore, validating the Vocal Fatigue Handicap Questionnaire among professional voice users with and without the symptoms of vocal fatigue might provide appropriate external validity of the questionnaire.

OBJECTIVE

The objective of the study was to validate the Kannada version of the Vocal Fatigue Handicap Questionnaire (VFHQ-K) among a cohort of Kannada-speaking primary and secondary school teachers with and without self-reported vocal fatigue symptoms.

STUDY DESIGN

This was a validation study.

METHOD

The study consisted of two groups of participants. Group 1 included 40 teachers with self-reported vocal fatigue symptoms, and Group 2 included 57 teachers without self-reported vocal fatigue symptoms. The VFHQ-K was administered to each participant after obtaining informed consent. The questionnaire was again readministered between 1 and 2 weeks to assess the test-retest reliability. All the responses that were obtained were tabulated for analysis.

RESULTS

The VFHQ-K demonstrated good test-retest reliability, internal consistency, and acceptable discriminant validity. The cutoff value of VFHQ-K obtained in the present study between the teachers with and without self-reported symptoms of vocal fatigue was much less than the cutoff values reported by the earlier version of VFHQ-K.

CONCLUSION

The VFHQ-K can be a helpful tool in the early identification of teachers with vocal fatigue and in improving the vocal health of professional voice users.

The Patient Experience: The Relationship Between Vocal Handicap, Congruency, Perceived Present Control, and Mood Across Four Voice Disorders

OBJECTIVE

The potential for negative sequalae in psychosocial well-being presents clinical importance to the assessment of voice disorders. Despite the impairment voice disorders cause in the psychosocial domain, the clinical assessment of these disorders relies heavily on visual perceptual judgments of the larynx, audio-perceptual, as well as acoustic and aerodynamic measures. While these measures aid in accurate diagnosis and are necessary for standard of care, they present little insight into the patient experience of having a voice disorder.

DESIGN

Retrospective between-subject, non-experimental design.

METHODS

Data from 335 patients from the University of Pittsburgh Voice Center were collected from scores of the Voice Handicap Index-10 (VHI-10) and two recent questionnaires, the Voice Present Perceived Control scale (VPPC), and the Vocal Congruency Scale (VCS). Examining how these voice-specific scales related to three mental health screeners for stress (Perceived Stress Scale-4), anxiety (Generalized Anxiety Disorder-7) and depression (Patient Health Questionnaire-9) were also examined. Patient diagnoses included primary muscle tension dysphonia (pMTD), unilateral vocal fold paralysis (UVFP), vocal fold atrophy, and mid membranous vocal fold lesions.

RESULTS

There were significant differences in scores from the voice-specific scales between diagnostic groups with UVFP being the highest (worst) in VHI-10 and UVFP being the lowest (worst) in VCS compared to healthy controls. There was no significant difference in VPPC scores between diagnostic groups. Results showed statistically significant inverse relationships between the VHI-10 and the VPPC and between the VHI-10 and VCS for all diagnostic groups. A significant direct relationship was found between the VPPC and the VCS for patients diagnosed with MTD, UVFP and Lesions. In sum, patients with UVFP presented with the most frequent and sometimes strongest relationships between voice and mental health measures.

DISCUSSION

This study marks an initial investigation into the nuanced patient experience of having a voice disorder. Three theoretically unrelated voice constructs: handicap, perceived control, and sense of self, were measured via self-report. Results from this study describe the patient experience correlating to these constructs with weak correlations to stress, anxiety, and depression. Findings also clearly suggest that patient experience varies among diagnostic groups, as well as varying constructs. Measures of multiple constructs of patient perception provide valuable insight into a patient's experience of their voice disorder, guidance on the direction of voice treatment, and justification for such treatments.

COVID-19 and Remote Learning: Predictive Factors of Perceived Improvement or Worsening of the Voice in Brazilian Teachers

OBJECTIVES

Given the transformations in teaching modalities as a result of the COVID-19 pandemic, this study aimed to evaluate the factors associated with vocal self-perception during the pandemic and to investigate the ability of selected variables to predict changes in vocal self-perception in teachers with professional vocal demands during the investigated period.

STUDY DESIGN

Cross-sectional survey.

METHOD

A total of 1,126 teachers of both genders (ages 19-78 years, average 43.23 years) who were participating in remote teaching activities using their voice answered the online questionnaire. To characterize vocal changes (improvement, worsening or no change), the teachers' self-assessment of their voice quality was considered; the association between the variables reported in the questionnaire and vocal changes was analyzed, as was the capacity of these variables for predicting voice changes.

RESULTS

Most of the teachers worked at a public school, reported having no previous voice changes or difficulties with their voice during online classes and indicated that they began to use their voice less often and with reduced intensity during the pandemic. Vocal demands were divided between teaching synchronous online classes, recording video lessons and participating in online meetings. Several variables were associated with voice improvement and worsening, and some had the capacity to predict voice changes: improvement in voice quality was associated with working in a public school or as an autonomous teacher, reduced voice use and, to a lesser extent, participating in online meetings, certain vocal habits and a reduction in vocal symptoms; worsening voice quality was associated with working in a private school, increased voice use, using the voice at a higher intensity, difficulty with the voice in online classes, vocal habits and vocal symptoms.

CONCLUSION

The context of remote education has changed the way teachers communicate during classes, and monitoring is necessary to ensure that necessary adaptations are made to preserve the voice and ensure effective communication.

Instrument adaptation and preliminary validation study of the Laryngeal Hypersensitivity Questionnaire used for assessment of laryngeal symptoms in patients with artificial airways

BACKGROUND

The Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ) was developed to measure abnormal laryngeal sensation and was originally validated in a patient sample from otolaryngologic and respiratory outpatient clinics. Modification is needed for patients who are mechanically ventilated via an endotracheal tube or a tracheostomy tube.

OBJECTIVES

We sought to adapt and preliminarily validate a modified version of the LHQ appropriate for nurses and other clinicians to administer in acute hospital settings called the LHQ-Acute (LHQ-A).

METHODS

Internal consistency and construct validity analyses using secondary data from patients at a tertiary teaching hospital who presented with symptoms of laryngeal irritability/hypersensitivity between September 2012 and October 2013 were performed.

RESULTS

A total of 131 patients, most complaining of coughing and dysphonia, with a median age of 58 (interquartile range: 48, 66) years and 29 healthy participants with a median age of 62 (interquartile range: 50, 66) years were analysed. The original LHQ was reduced from 14 questions with responses on a 7-point scale to the LHQ-A containing 13 questions with responses on a 4-point scale. Correlations between items of the LHQ and LHQ-A were similar, and internal consistency was excellent and highly comparable, with Cronbach's alpha = 0.906 and 0.902, respectively.

CONCLUSIONS

The LHQ-A, which has been adapted for nurses and other clinicians to administer to a critically ill patient population, demonstrated comparable reliability and validity to the original LHQ. Validation of the LHQ-A in independent patient populations from acute settings is necessary to better understand norms and changes during recovery from acute illness.

Voice Acoustic Parameters as Predictors of Depression

OBJECTIVE

To analyze whether voice acoustic parameters are discriminant and predictive in patients with and without depression.

METHODS

Observational case-control study. The following instruments were administered to the participants: Self-Reporting Questionnaire (SRQ-20), Beck Depression Inventory-Second Edition (BDI-II), Voice Symptom Scale (VoiSS) and voice collection for subsequent extraction of the following acoustic parameters: mean, mode and standard deviation (SD) of the fundamental frequency (F0); jitter; shimmer; glottal to noise excitation ratio (GNE); cepstral peak prominence-smoothed (CPPS); and spectral tilt. A total of 144 individuals participated in the study: 54 patients diagnosed with depression (case group) and 90 without a diagnosis of depression (control group).

RESULTS

The means of the acoustic parameters showed differences between the groups: F0 (SD), jitter, and shimmer values were high, while values for GNE, CPPS and spectral tilt were lower in the case group than in the control group. There was a significant association between BDI-II and jitter, shimmer, CPPS, and spectral tilt and between CPPS and the class of antidepressants used. The multiple linear regression model showed that jitter and CPPS were predictors of depression, as measured by the BDI-II.

CONCLUSION

Acoustic parameters were able to discriminate between patients with and without depression and were associated with BDI-II scores. The class of antidepressants used was associated with CPPS, and the jitter and CPPS parameters were able to predict the presence of depression, as measured by the BDI-II clinical score.

Vocal Self-Perception of Singers During COVID-19 Pandemic

OBJECTIVE

to compare the self-perception of vocal fatigue and use of singing voice during the COVID-19 pandemic between professional and amateur singers and to relate this self-perception with vocal use characteristics during this period.

METHODOLOGY

Participants were 121 singers divided into professional singers group (PSG) (12 men and 20 women) comprising singers who depended exclusively on singing as a profession and an amateur singers group (ASG) (37 men and 52 women) of singers who did not depend exclusively on singing for their livelihood. All answered online questionnaires through Google Forms ®. Sociodemographic and vocal characteristics were investigated before and during the pandemic; symptoms of vocal fatigue were assessed through the vocal fatigue index (VFI); and self-perception of use of singing voice through the evaluation of the ability to sing easily protocol for Brazil (EASE-Br).

RESULTS

In the comparison between groups, the PSG presented higher scores of vocal fatigue in fatigue and vocal limitation (P = 0.045), vocal restriction (P = 0.002), and recovery with vocal rest (P = 0.008) domains than did the ASG. There was no difference between the groups regarding the use of singing voice. Based on the relationship between self-perception and vocal use characteristics during the pandemic, it was observed that the presence of vocal complaint was the only factor associated with self-perception of fatigue symptomatology in both groups. Regarding the self-perception of the current status of the singing voice, singing time, the presence of vocal complaints, the need to increase visual concentration, and the perception of vocal worsening during the pandemic were considered predictive for amateur singers. For professional singers, vocal complaints and vocal training were predictors for self-perception of the current status of the singing voice.

CONCLUSION

Professional singers presented with higher scores of vocal fatigue than did amateur singers. The symptomatology of vocal fatigue was associated with the presence of vocal complaints in both groups. However, self-perception of the current status of the singing voice was different between the groups and was associated with vocal training for professional singers and characteristics of vocal demand of singing voice during the pandemic period for amateur singers.

Volitional and Non-volitional Devices Used in Voice Therapy and Training: A Scoping Review-Part A

OBJECTIVE

To map the volitional and non-volitional devices used by speech and language pathologists (SLPs) in voice training and therapy and characterize their use in research on voice interventions.

METHODS

This scoping review is the first part of a larger study. The electronic search was carried out by mapping the references in PubMed/Medline, LILACS/BVS, Scopus, Web of Science, EMBASE, and the Cochrane Library, and the manual search was carried out in the grey literature. Two blind independent reviewers selected and extracted data; divergences were solved by consensus. The data extracted in this part of the study were the authorship and year of publication, country, study design, sample characteristics, intervention modality, ingredient, target, mechanism of action, dosage, and outcome measures. They were addressed with descriptive analysis.

RESULTS

Publications that use devices as ingredients are mostly from the last two decades, mainly carried out in the United States of America and Brazil, in adults of both sexes with behavioral dysphonia. Forty-two types of devices were used, many of them with similar approaches but different nomenclatures. Most devices were used voluntarily, focusing on vocal function, and aiming to increase source and filter interaction. Most studies used silicone tubes. The most reported technical specification to apply the ingredient was surface electrodes on the neck. Device dosage was time-controlled, and the most used outcomes were self-assessment and acoustic analysis.

CONCLUSION

Devices are currently used as ingredients in vocal interventions, with a greater focus on increasing the source and filter interaction, associated with silicone tubes (the most used devices in these studies), which have been dosed with performance time. Outcomes were measured with self-assessment instruments.

A General Survey of Pharynlaryngeal Diseases and Voice Disorders Among Basic Education Teachers in Tianjin

OBJECTIVE

In this study, we created a city-wide database of pharynlaryngeal diseases and voice disorders among basic education teachers to analyze the incidence, distribution, and risk factors of pharynlaryngeal diseases and voice disorders.

METHODS

A total of 47,823 teachers in primary and secondary schools and kindergartens of Tianjin were enrolled in this study and underwent questionnaires and throat examinations. In addition, the data were subjected to descriptive statistics, chi-square analysis, and univariate and multivariate logistic regression analyses.

RESULTS

Pharynlaryngeal diseases and voice disorders had an overall prevalence of 69.42% among basic education teachers in Tianjin, wherein the prevalence of chronic pharyngitis, chronic hyperplastic laryngitis, and chronic simple laryngitis were the highest at 39.45%, 19.80%, and 15.59%, respectively. The results of multivariate logistic regression analysis suggest that pharynlaryngeal diseases and voice disorders were statistically correlated with gender (P < 0.001), years of teaching (P < 0.001), school district (P < 0.001), class size (P < 0.001), subjective assessment of teachers on vocal loudness (P < 0.001), neck and shoulder discomfort (P < 0.001), smoking (P < 0.001), psychological stress (P = 0.002), and frequent habitual throat clearing (P < 0.001). Furthermore, the risk factors for pharynlaryngeal diseases and voice disorders were age (P = 0.002), school district (P < 0.001), class size (P = 0.008), neck and shoulder discomfort (P = 0.038), smoking (P < 0.001), water intake habits during class (P = 0.023), and frequent habitual throat clearing (P = 0.001) for male teachers, and for female teachers, it was age (P < 0.001), school district (P < 0.001), daily teaching hours (P = 0.005), class size (P < 0.001), subjective assessment of teachers on vocal loudness (P < 0.001), neck and shoulder discomfort (P < 0.001), smoking (P = 0.033), psychological stress (P = 0.003), and frequent habitual throat clearing (P < 0.001).

CONCLUSION

Due to the high prevalence of pharynlaryngeal diseases and voice disorders among basic education teachers, throat and voice health education-related activities should be conducted for teachers to intervene in the occurrence of pharynlaryngeal diseases and voice disorders at an early stage.

The Vocal Hygiene Treatment Programs for Singers: A Systematic Review

OBJECTIVES

This systematic review aims to explore the effectiveness of voice health education interventions among singers, particularly focusing on vocal hygiene treatment programs tailored for professional voice users.

STUDY DESIGN

Systematic review.

METHODS

Preferred Reporting Items on Systematic Reviews and Meta-Analysis guidelines were followed to conduct this systematic review. Comprehensive searches were conducted in PubMed, Web of Science, Scopus, Science Direct, and Cochrane Library databases. Four articles were selected for detailed review. The studies were evaluated using the Effective Public Health Practice Project tool for quality assessment.

RESULTS

The four reviewed studies primarily utilized the pretest-posttest design to examine the effectiveness of vocal hygiene interventions on singers' vocal health. Two studies investigated the effect of hydration as a treatment method, while the remaining two focused on vocal hygiene instruction. Significant improvements were observed in various vocal health parameters, including maximum phonation time, intensity, Dysphonia Severity Index, and number of daily vocal breaks taken.

CONCLUSION

This systematic review provides valuable insights into the efficacy of vocal hygiene treatment programs for singers. The positive outcomes observed in the reviewed studies underscore the importance of voice health education tailored to singers' specific needs. However, the limited number of eligible studies and the common limitation of small sample sizes highlight the need for further research in this area. Vocal health practitioners, educators, and researchers can utilize the findings of this review to develop evidence-based vocal hygiene interventions that promote the well-being and longevity of singers' vocal performance careers.

Effects of an 8-Week Mindfulness Course in People With Voice Disorders

OBJECTIVES

Nearly every modern textbook on the etiology and treatment of voice disorders (VD) recommends stress reduction for VD patients. The benefits of mindfulness for stress reduction are well documented, but published literature on mindfulness and VD is sparse. Our objective was to determine whether an 8-week mindfulness course could increase mindfulness and lower stress in people with VD, leading to a decrease in vocal handicap.

STUDY DESIGN

Mixed methods study.

METHODS

Participants: 69 individuals with VD: 39 were mindfulness course participants (MCP), 30 were in a waitlist control group (WCG). Exclusionary criteria: patients in voice therapy. Before and after the 8-week timeframe, participants took the Mindful Attention and Awareness Scale (MAAS), Perceived Stress Scale-10 (PSS-10), Voice Handicap Index (VHI), and-for singers (n = 36)-the Singing Voice Handicap Index (SVHI). Follow-up interviews were conducted with select participants.

RESULTS

In the MCP, each of the outcomes significantly changed in the direction hypothesized, resulting in increased MAAS (P = 0.000) and decreased PSS-10 (P = 0.007), VHI (P = 0.000), and SVHI (P = 0.021, n = 22) scores. Using a 2 × 2 Repeated Measures ANOVA, two outcomes were statistically different for the MCP from pre to postcourse-MAAS increased (P = 0.006, ES = 0.107) and VHI decreased (P = 0.034, ES = 0.065)-in comparison to no change in the WCG. Follow-up interviews revealed increased acceptance of the VD; reduced stress, physical tension, and pain/discomfort; increased somatic (or interoceptive) awareness; community with other VD patients; and positive speaking and singing voice changes.

CONCLUSIONS

An 8-week mindfulness course shows promise for reducing stress in people with VD, lowering voice handicap, and improving quality of life. Future research should evaluate mindfulness in patients with specific voice disorders; patients with higher and lower VHI scores; singers; and patients who experience throat pain. Mindfulness should also be evaluated within a standard voice therapy protocol.

What Factors Determine the Use of Volitional and Non-Volitional Devices in Vocal Interventions Performed by Brazilian Speech-Language Pathologists?

OBJECTIVE

To analyze the determining factors for using devices in vocal interventions and characterize their use by Brazilian speech-language pathologists (SLPs).

METHODS

This cross-sectional observational study had a sample of 148 SLPs with clinical practice in voice. They answered an online questionnaire via Google Forms about sociodemographic data, training, work in the area, and the use of devices in vocal interventions. Data were analyzed descriptively and inferentially.

RESULTS

Tubes, straws, and masks were the most commonly used devices. SLPs specializing in voice are more inclined to use thermotherapy and kinesio tapings while being less inclined to use therapeutic ultrasounds and nebulizers. Voice specialists are less likely to employ electrostimulation. The choice to use photobiomodulation and auditory monitoring devices is influenced by the years of clinical experience, whereas the speech-language therapy training duration affects the use of electrostimulation. The age of the professional also plays a role in the utilization of vibratory stimulation. Vibratory stimulation, auditory monitoring devices, thermotherapy, and nebulization are more frequently utilized among individuals who rely on their voices for occupational purposes, whereas electrostimulation is less common. The use of photobiomodulation is infrequent in children; vibratory stimulation is more common in adolescents, and thermotherapy is relatively common among older individuals. Most of these devices are typically prescribed in execution time during vocal intervention.

CONCLUSION

The specialization, the time since graduation and in the occupation, and the target population of the service are the determining factors for the use of devices. They are used in vocal therapy and training, targeting vocal function.

Development and Psychometric Evaluation of the Laryngeal Palpation Pain Scale (LPPS)

INTRODUCTION

One of the most important assessment and therapy methods for patients with muscle tension dysphonia (MTD) and other voice disorders is laryngeal palpation. However, there is no comprehensive scale for measuring pain during laryngeal palpation. The goal of the present study was to develop and validate a new scale to evaluate pain during palpation for patients with MTD.

METHODS

The present study consisted of two phases: (1) Development of the Laryngeal Palpation Pain Scale (LPPS) based on an in-depth literature review, the palpatory evaluation of MTD patients, interviews with experts in the field of voice disorders, and consultation with a registered pain expert, and (2) evaluation of the validity and reliability of the LPPS. The validity of the LPPS was investigated using qualitative and quantitative content validity, qualitative face validity, discriminant validity, and convergent validity. Content validity of the LPPS was assessed by experts' opinions (10 speech-language pathologists and five laryngologists), and face validity was investigated using the opinions of speech-language pathologists. The reliability of the LPPS was determined using test-retest and inter-rater reliability.

RESULTS

The item generation phase of the study led to the development of a scale to assess pain during palpation that included eleven locations in the neck region for palpatory assessment. These 11 items were divided into 13 different items (neck locations) based on the opinions of the experts. The content validity ratio values of all scale items were higher than 0.78. The content validity index (CVI) value for each of the items of the scale was higher than 0.79 and for the entire scale CVI (S-CVI) was 0.915. The results of the reliability of the LPPS items were satisfactory with weighted kappa values ranging from 0.655 to 1 for the test-retest and 0.77-1 for the inter-rater reliability. Convergent validity of the LPPS was shown with a significant positive correlation (r = 0.68) between the LPPS and the pain severity of vocal tract discomfort (P < 0.001). Moreover, MTD patients had more pain severity than the control group in all items of the LPPS (P < 0.05) except for the submental item (P = 0.89). These results indicate that the LPPS can differentiate MTD patients from healthy subjects. The final version of the LPPS includes 13 potential pain locations. The severity of pain at each of these locations is determined on a numeric pain rating scale of zero (no pain) to ten (the most severe pain).

CONCLUSION

The study showed that the LPPS is a valid and reliable scale to assess pain in MTD patients during palpation evaluations. More studies are recommended for further psychometric evaluation of the LPPS including responsiveness to change (the use in before-and-after intervention studies) and concurrent validity of the LPPS. The LPPS can be used for clinical and research purposes.

Translation and Validation of an Arabic Version of the Voice Disability Coping Questionnaire

OBJECTIVES/HYPOTHESES

Voice disorders can significantly affect the quality of life. This study aimed to translate, culturally adapt, and validate an Arabic version of the voice disability coping questionnaire (A-VDCQ) for use in Arabic-speaking populations with dysphonia.

STUDY DESIGN

This was a cross-sectional study involving the translation and cultural adaptation of the VDCQ into Arabic. The validation process included reliability and validity assessments. Participants were categorized into cases (individuals with dysphonia) and controls (individuals without dysphonia) to compare coping strategies between the two groups.

METHODS

ccccccccThe 15-item VDCQ was translated from English into Arabic using the forward and backward translation methods. The questionnaire's reliability was assessed using Cronbach's alpha and test-retest reliability (intraclass correlation coefficient, ICC). Validity was evaluated by comparing cases and controls using the Mann-Whitney test. Differences in coping strategies across different diagnoses were examined using the Kruskal-Wallis test.

RESULTS

The A-VDCQ demonstrated satisfactory internal consistency (Cronbach's alpha = 0.769) and excellent test-retest reliability (ICC = 0.993). Significant differences in coping strategies between the cases and controls were also observed (P < 0.001), supporting the instrument's validity. Notably, item 4, which is related to information seeking, had the highest impact score among the cases. However, no statistically significant differences were found in coping strategies across different diagnoses (P = 0.249).

CONCLUSIONS

The A-VDCQ demonstrated robust psychometric properties for assessing coping strategies in individuals with voice disorders and such strategies' potential implications for clinical practice and research.

Urica-VV Scale: A New Research Perspective of The Stage of Readiness for Treatment in Patients with Dysphonia

OBJECTIVE

To obtain evidence of validity for the URICA-V scale and estimate the psychometric properties of its items based on item response theory (IRT).

METHOD

A total of 658 individuals of both sexes over 18 years of age were allocated into two groups: with dysphonia group (WDG) and vocally healthy group (VHG). A digital database was constructed with personal and professional data and item-by-item responses on the URICA-V scale. Subsequently, Cronbach's alpha, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), application of IRT using Samejima's model and ROC curve analysis were used to obtain the cutoff point for the URICA-V scale.

RESULTS

A different version of the original URICA-V scale was obtained. Of the 32 items from the original protocol, 25 better explained the instrument and were regrouped into two domains: contemplation and maintenance. It was possible to identify which items generated higher difficulty (b) and discrimination (a) values and which contributed to the presentation of a calculation based on the theta of each participant. The ROC curve was analyzed, and a cutoff point of -0.236 was established; establishing a cutoff point facilitates the decision of which individuals are in a state of readiness for voice treatment.

CONCLUSION

The present study provided evidence that allows us to propose the URICA-Voice validated (URICA-VV) scale within a more contemporary perspective and with a reduced number of items and domains. In addition, a cutoff point was obtained based on IRT to measure, with greater accuracy, sensitivity and specificity, the stage of readiness and to differentiate individuals who have an indication for speech therapy.

Voice Pathologies and the General Population's Perception

OBJECTIVES

To examine how the general population perceives voice pathology based on subjective qualities.

STUDY DESIGN

Descriptive, cross-sectional, survey-based study.

METHODS

This is an IRB-approved Qualtrics survey on Amazon MTurk for respondents ages 18 and older. Ten subjects with voice pathologies supplied voice recordings of the Rainbow Passage to be assessed by the respondents. Respondents then assessed the voice conditions on perceived qualities of intelligence, leadership ability, and employability. One-way analysis of variance (ANOVA) and Dunnett's multiple comparison test with Sidak correction compared the mean scores of the samples (alpha = 0.05).

RESULTS

A total of 1754 responses were included in the final dataset. The female control voice was scored as more likely to be a Fortune 500 leader as well as more intelligent, friendly, attractive, and employable when compared to the female vocal fry and muscle tension dysphonia (MTD) recordings (P < 0.0001). Conversely, the male MTD was the only male pathology that received a significantly lower score on friendliness, attractiveness, Fortune 500 leader status and employability than the male control (P = 0.0102, P = 0.0007, P = 0.0338, and P = 0.0039, respectively).

CONCLUSIONS

This study demonstrates the more critical appraisal of voice pathologies of female patients compared to their male counterparts. People with voice disorders are perceived as being less successful, a disadvantage to potential leadership and career opportunities.

Spectrographic Voice Analysis Protocol (SAP): Convergent, Concurrent, and Accuracy Validity

OBJECTIVE

To verify the convergent and concurrent validity of the Spectrographic Voice Analysis Protocol (SAP) and its accuracy to discriminate dysphonic from nondysphonic patients.

METHOD

The study used 82 vowel /Ɛ/ samples and their respective narrowband spectrograms, analyzed with SAP. Cepstral peak prominence (CPP) and cepstral peak prominence smoothed (CPPS) verified the convergent validity of the SAP total score, while the general grade of vocal deviation (GG) verified the concurrent validity of the SAP total score. The ROC (receive operator curve) curve and its accuracy, sensitivity, and specificity values, positive predictive value (PPV) and negative predictive value (NPV), and positive likelihood ratio (LR+) and negative likelihood ratio (LR-) verified the accuracy of the SAP score to discriminate dysphonic from nondysphonic individuals.

RESULTS

Dysphonic and nondysphonic had different SAP total scores. In the convergent validity, the SAP score had a weak and moderate negative correlation, respectively, with CPP and CPPS, as well as a moderate positive correlation with GG. SAP performed well in discriminating dysphonic from nondysphonic individuals (area under the curve = 82.0%; sensitivity = 91.7%; specificity = 51.7%; PPV = 93.7%; NPV = 44.0%; LR+ = 6.21; LR- = 0.53) based on the 8-point cutoff score.

CONCLUSION

SAP has convergent validity with CPP and CPPS and concurrent validity with GG. The SAP total score performed well in discriminating dysphonic from nondysphonic individuals. However, the specificity, NPV, and LR- values justify cautiously using SAP, always in combination with other information in clinical voice assessment.

Study on relationship between self-recognition of voice disorder and mental health status: Korea National Health and Nutrition Examination Survey

BACKGROUND

The voice has been thought to be associated with emotions, but conducting large-scale research on this relationship has some limitations. To overcome these limitations, questionnaires have been utilized as a research tool.

METHODS

A population-based cross-sectional study was done. A total of 15,977 participants completed questionnaires regarding self-recognition of voice disorder (SRVD), and mental health status.

RESULTS

1053(6.6 %) participants answered that they had SRVD. In the multivariate Cox proportional hazard model, psychological stress (Hazard ratio (HR) = 1.371, 95 % confidence interval (CI) = 1.154-1.629), depressive symptoms (HR = 1.626, 95 % CI = 1.323-1.997), suicidal ideation (HR = 1.739, 95 % CI = 1.418-2.133), and suicide attempt (HR =2.206, 95 % CI = 1.067-4.56) were all associated with SRVD. In SRVD lasting over three weeks, psychological stress (HR = 1.604, 95 % CI = 1.278-2.014), depressive symptoms (HR = 1.807, 95 % CI = 1.384-2.36), and suicidal ideation (HR = 2.073, 95 % CI = 1.587-2.709) were also significant factors. As the number of mental health problems increased, the odds ratio of both SRVD (OR = 2.49, 95 % CI = 1.839-3.37) and SRVD lasting over three weeks (OR = 3.254, 95 % CI = 2.242-4.725) increased, respectively.

LIMITATIONS

SRVD and mental health status were judged only by simple questionnaires. Cross-sectional design and retrospective data could not draw causal relationships.

CONCLUSIONS

SRVD and SRVD lasting over three weeks had a significant relationship with mental health status, including psychological stress, depressive symptoms, and suicidal ideation. There is a need to consider psychiatric treatment for individuals who visit hospitals with voice disorders.

Cross-Linguistic Adaptation of Vocal Fatigue Handicap Questionnaire into Kannada (VFHQ-K)

BACKGROUND

It is often considered appropriate to assess vocal fatigue using a self-reported tool or a subjective measure, as vocal fatigue is primarily described through self-reported symptoms. The vocal fatigue handicap questionnaire (VFHQ) is a self-rated questionnaire that addresses the concern of vocal fatigue in persons with voice disorders. Adapting and validating this questionnaire into the Kannada language can be helpful in assessing the physical, emotional, and functional effects of vocal fatigue among Kannada-speaking individuals.

OBJECTIVE

Adaptation and Validation of the VFHQ into the Kannada language.

STUDY DESIGN

A validation study.

METHOD

Initially, the VFHQ was translated into Kannada. The translated questionnaire was given to two SLPs and two Linguists for content validation and to assess the cultural and linguistic equivalency. 65 participants (34 males and 31 females) were diagnosed with voice disorders, and 65 participants who were age and gender-matched and had healthy voices were administered the Kannada version of VFHQ (VFHQ-K).

RESULTS

The results showed that the VFHQ-K had good test-retest reliability, internal consistency, and known groups' discriminative validity. The cut-off point of the VFHQ-K was equal to 26.50, indicating that the VFHQ-K had acceptable discrimination between the patients with and without dysphonia.

CONCLUSION

VFHQ-K is a valid, reliable, and sensitive questionnaire to assess the emotional, physical, and functional effects of vocal fatigue in the Kannada-speaking population.

Differences and Reliability of Linear and Nonlinear Acoustic Measures as a Function of Vocal Intensity in Individuals With Voice Disorders

PURPOSE

Linear acoustic indices are significantly influenced by speaking voice intensity. The main aim of this work was to compare acoustic measures based on linear and nonlinear models in different speaking voice intensity levels and to analyze the reliability of those measures in different intensity levels in subjects with voice disorders.

METHODS

435 samples from subjects (314 women, 121 men with a mean age of 41.07 ± 13.73) diagnosed with various voice disorders were used. In total, 17 acoustic measures were derived from the vowel /ɛ/ sustained at three intensity levels (soft, comfortable, and loud). Five were linear (standard deviation of the fundamental frequency (f0), jitter, shimmer, harmonics-to-noise ratio (HNR) and smoothed cepstral peak prominence (CPPS)), and twelve were nonlinear measures, namely correlation dimension (D2), correlation entropy (H2), first minimum of the mutual information function (FMMI), relative entropy (ENTR-R), largest Lyapunov exponent (Lyap), determinism (DET), transitivity, mean diagonal line length (Lmed), Shannon entropy (ENTR-S), mean length of vertical structures, also known as trapping time (TT), laminarity (LAM) and recurrence period density entropy (RPDE). Differences between speaking voice intensity levels were assessed by Friedman's test and Nemenyi as posthoc test. Intraclass correlation coefficient was used to investigate if each acoustic measure remains in agreement (reliability) between different voice intensity levels.

RESULTS

There were significant differences in all acoustic measures about vocal intensity level (P < 0.001). Intraclass correlation coefficient was very good for HNR (>0.61) and good for Lyap, DET, ENTR-S, Lmed, RPDE, and TT (0.41-0.60).

CONCLUSIONS

All acoustic measures varied as a function of vocal intensity in voice disordered adults, while this relation was different for linear and nonlinear measures. Only the measures HNR, Lyap, DET, ENTR-S, Lmed, RPDE and TT had an acceptable reliability between different voice intensity levels. Therefore, patient`s voice SPL should be controlled or indicated during acoustic vocal assessment.

Adaptation and Validation of the Self-Evaluation of Communication Experiences after Laryngectomy (SECEL) Questionnaire into Bahasa Malaysia

BACKGROUND

Communication adjustment from patients' perspective is paramount to ensure optimization of voice rehabilitation post laryngectomy. Very few specific self-rating tools exist with the Self-Evaluation of Communication Experiences after Laryngectomy (SECEL) having the most evidence regarding validity, reliability and clinical utility.

OBJECTIVES

This study aimed to translate and validate a Bahasa Malaysia version of SECEL (mSECEL) using a validated framework of transcultural adaptation.

METHODS

This cross-sectional study was conducted in the Otorhinolaryngology, Department of Universiti Kebangsaan Malaysia Medical Centre from February 2019 to May 2020. The mSECEL was produced following a rigorous forward and backward translation. Eighty-three laryngectomees (78 male, five female) using various methods of alaryngeal communication (47 voice prosthesis, 29 electrolarynx, three esophageal speech and four pen and paper), completed the mSECEL and mVHI-10 before head and neck and flexible laryngoscopic examinations. The mSECEL was repeated in 2 weeks via telephone interview or clinic visit. Its reliability was assessed using intraclass correlation. The Pearson product-moment correlation test was used to analyze correlation between the mSECEL and mVHI-10.

RESULTS

The mSECEL questionnaire showed strong internal consistency with the Cronbach alpha of >0.90 for total score, Environmental and Attitude subscale. The test-retest reliability for total mSECEL score was high with the intraclass correlation of 0.97. There was a highly significant positive correlation between the mSECEL total score and mVHI-10 (P < 0.001). Items in the General subscale showed poorer internal consistency with Cronbach alpha ranging 0.55-0.46 and poor correlation with mVHI-10.

CONCLUSIONS

The Bahasa Malaysia version of the SECEL measure is a valid and reliable instrument to evaluate communication perception after laryngectomy. Future studies should consider subscale validation and further abbreviation of its items to make this measure clinically relevant.

Evaluation of the Effectiveness of Resonant Voice Therapy in Patients with Functional Voice Disorder

OBJECTIVE

This study aims to determine the effectiveness of resonant voice therapy (RVT) in patients with functional voice disorder and to examine the subjective and objective voice changes after the therapy.

STUDY DESIGN

This study adopted an experimental research design with a pretest-posttest control group.

METHOD

Thirty-four women participated in the study-17 in the experimental group and 17 in the control group. Voice hygiene training and RVT were applied to the experimental group. The Turkish version of the Voice Handicap Index (VHI-10) and GRBAS (Grade, Roughness, Breathiness, Asthenia, and Strain) scale were used for subjective voice assessment. Voice recordings were subjected to acoustic analysis on the PRAAT program. After an 8-week therapy program, the same process was repeated for post-test assessment.

RESULTS

In the voice analyses performed after RVT, which was applied to patients with functional voice disorders, the results of the acoustic analysis showed statistically significant differences in jitter, PPQ5, RAP, shimmer, APQ11, and NHR parameters. Subjective voice analysis indicated a statistically significant decrease in VHI-10 scores from 20.88 ± 5.33-9.06 ± 3.3 in the experimental group. The GRBAS score was 4.29 ± 1.2 before the therapy and 1.71 ± 1.1 after the therapy, which is a statistically significant decrease. The results point out that RVT has been effective in improving the objective and subjective parameters of patients with functional voice disorders.

CONCLUSION

RVT applied to patients with functional voice disorders provides significant improvement in acoustic and perceptual voice parameters. The RVT is an effective therapy method in the treatment of patients with functional voice disorders and should be considered as a therapeutic option.

Work-Related Vocal Challenges of Online Teaching: A Study of Female College Professors

BACKGROUND

College professors are at an elevated risk of developing voice disorders due to increased vocal demands associated with their working conditions, including high background noise levels, long reverberation times, prolonged voice use duration, and large class sizes. However, the impact of online classes on vocal health among college professors remains unclear.

OBJECTIVE

This longitudinal study aimed to characterize voice changes associated with online teaching among female Colombian college professors.

METHODS

Thirteen female college professors teaching online classes completed an online survey that included questions about voice functioning, working conditions, the Spanish translation of the Vocal Fatigue Index (VFI), and the Spanish translation of the Voice-Related Quality of Life. Instrumental measurements were also performed, including environmental background noise levels, hearing screening, and voice recordings before and after a synchronous online class.

RESULTS

This study found a decreased fundamental frequency in connected speech (reading) associated with the number of students per class, the number of classes per week, and background noise levels measured with a sound level meter. L1L0 was statistically smaller among experienced teachers with higher background noise levels compared with less-experienced colleagues in quieter classes. 1558kHz was statistically associated with the average number of students, whereas HNR was slightly higher for professors with more students and more classes per week.

CONCLUSION

The findings suggest that online teaching has important implications for voice production among participating teachers. This study highlights the importance of considering working conditions during online classes when designing workplace prevention programs for college professors.

Rapid Implementation of Teletherapy for Voice Disorders: Challenges and Opportunities for Speech-Language Pathologists

INTRODUCTION

The COVID-19 pandemic necessitated a rapid restructuring of the clinical management of voice and upper airway disorders by speech-language pathologists (SLPs). As in-person therapy sessions were suspended, voice-specialized SLPs across healthcare settings shifted to online teletherapy. In this survey study, we queried voice therapists on their experiences with and opinions regarding the adoption of teletherapy into routine clinical practice.

METHODS

Voice-specialized SLPs were recruited nationwide to complete an online survey which included questions about the usability of software and hardware, patient management, the effectiveness of therapy, overall satisfaction, and suggestions for improvement.

RESULTS

48 participants completed the survey. The majority of respondents reported frequent technical difficulties and poor access to or understanding of appropriate equipment. Overall, participants endorsed better patient access, attendance, and compliance, as well as increased scheduling flexibility. While 95% of the respondents stated they would recommend teletherapy to another SLP, only 20% supported a shift to exclusively virtual sessions. Forty percent of respondents endorsed a hybrid model consisting of initial in-person sessions followed by virtual ones.

DISCUSSION

Incorporating teletherapy into clinical voice practice has, for the most part, followed Carl May's normalization process theory framework, in that clinicians have invested understanding, training, time and effort, and appraisal into its implementation. However, the unusually rapid pace of change necessitated by the pandemic has presented its own set of challenges. Given the inherent conveniences of virtual therapy, the online modality is likely here to stay. It is critical that we understand the facilitators and barriers to its successful adoption.

The Occurrence of Laryngeal Pathologies in a Treatment-Seeking Pediatric Population

OBJECTIVES

The purpose of this study was to 1) describe the age- and sex-specific occurrence of laryngeal pathologies in a treatment-seeking pediatric population in the voice unit of Ghent University Hospital, Belgium, and 2) describe this population in terms of vocal parameters, vocal complaints, influencing factors, and treatment history and recommendation.

STUDY DESIGN

Retrospective, observational study.

METHODS

All patient records were analyzed for children (0-18 years) who consulted the ear, nose, and throat department of Ghent University Hospital for the first time between July 2015 and June 2021 with complaints of dysphonia. In total, 103 children (66 males, 37 females) with a mean age of 10.01 years (SD: 3.4, range 3.93-17.96) were included in this study. Laryngeal pathology was diagnosed using a flexible videolaryngo(strobo)scopy. The influence of age and sex on laryngeal etiology (organic/functional voice disorder) was examined using a Welch-modified t test and a Fisher's exact test, respectively.

RESULTS

Organic lesions were observed in 77.7% of the participants, with vocal fold nodules (VFNs) being the most common diagnosis (66.0%). A functional voice disorder was diagnosed in 22.3% of the children. Children with a functional voice disorder are significantly older than children with an organic voice disorder. There was no statistically significant difference between males and females in laryngeal etiology. Mean dysphonia severity index was -2.7 (SD: 3.2, range -9.3 to +3.7), the mean acoustic voice quality index 4.70 (SD: 1.5, range 2.35-8.27), and the mean pediatric voice handicap index 29.8 (SD: 13.6, range 5-60). The occurrence of vocal misuse was mentioned in 80.6% of the patient records.

CONCLUSION

Organic voice disorders, especially VFNs, are predominant in treatment-seeking children with dysphonia. Functional voice disorders become more common with increasing age during childhood. A disordered vocal quality, reduced vocal capabilities and reduced voice-related quality of life were found.

Pediatric Dysphonia and the Access to Voice Therapy: A Study in Speech Therapy Services Available in a Capital City in the Northeast of Brazil

OBJECTIVES

Defining the laryngeal and vocal alterations in the pediatric group studied in private speech therapy facilities; and estimating the time period between the problem being identified by the parents and the access to the proper provided services.

METHODS

A cross-sectional analytical observational research with data collected from medical records by the speech therapist of each private facility. A written form was prepared and sent to the speech therapists of the 40 existing facilities. We received 124 of them from the pediatric group being assisted in 15 of the facilities. The form included questions about gender, age, vocal complaints; general degree of dysphonia; otorhinolaryngological diagnosis of vocal fold alterations; the age that the problem was identified by the parents and the beginning of speech therapy. The larynx was examined by videonasopharyngolaryngoscopy, and voice quality by auditory-perceptual assessment.

RESULTS

The time period between the identification of the participant's dysphonia by the parents and the start of speech therapy was considered long (3.5years). The group showed variance in the proportion of nodule and cyst between genders. The highest prevalence of nodules occurred in boys; and the cyst in girls. Moderate general dysphonia occurred between 4 and 17years old, average age of 7years and 7months, with greater distribution between 5 and 10years of age.

CONCLUSIONS

The average time delay until the start of speech therapy was 3.5years, more frequently in the 5-10years group and due to nodules in boys and cysts in girls.

Patient Profiling: Determining the Effects of Patient Factors on Vocal Fatigue

OBJECTIVES

The phenomenon of vocal fatigue and the types of patients that are at greatest risk for vocal fatigue are not fully understood. The goal was to investigate patient profiles such as voice disorder type, demographics (age and gender), singing identity, interoceptive awareness, and psychosocial impacts on the severity of vocal fatigue.

STUDY DESIGN

Prospective cohort study.

METHODS

Ninety-five subjects with voice disorders were asked to complete Part 1 of the Vocal Fatigue Index (VFI-Part1), the Voice Handicap Index-10 (VHI-10), and the Multidimensional Assessment of Interoceptive Awareness, version 2 (MAIA-2). The effects of voice disorder type (structural, neurological, functional), psychosocial impact, age, gender, self-reported singing identity, and interoceptive awareness on self-perceived vocal fatigue (VFI-Part1) were determined using multivariate linear regression.

RESULTS

Vocal fatigue had a significant psychosocial impact on patients with voice disorders, as measured by the VHI-10 (P < 0.001). However, there were no significant effects of vocal fatigue across any of the three voice disorder types (P's >0.05). Age (P = 0.220), gender (P = 0.430), and self-identified singing experience (P = 0.360) also did not have significant effects on vocal fatigue. Additionally, there were no significant relationships between interoceptive awareness MAIA-2 sum scores (P = 0.056) or any of the MAIA-2 sub-scores (P's > 0.05) and vocal fatigue severity (VFI-Part1).

CONCLUSION

Vocal fatigue has a significant psychosocial impact on patients with voice disorders. However, patient profiles, including voice disorder type, patient age, gender, singing identity, and level of interoceptive awareness do not appear to play a major role in vocal fatigue symptom reporting. These findings suggest caution should be exercised when attributing patient profiles to vocal fatigue presentation and severity. Studying pathophysiological mechanisms underlying vocal fatigue may help better distinguish unconscious bias in patient profiling from the etiology and severity of vocal fatigue.

Risk of Dysphonia in Theater Actors: Proposal for a Screening Protocol

OBJECTIVE

To propose a Dysphonia Risk Screening Protocol for Actors (DRSP-A), test its usability in conjunction with the General Dysphonia Risk Screening Protocol (G-DRSP), determine the cut-off point for a high risk of dysphonia in actors, and compare the risk of dysphonia between actors with and without voice disorders.

METHOD

Observational cross-sectional study with 77 professional actors or students. The questionnaires were applied individually and the total scores were summed to calculate the final score of the Dysphonia Risk Screening (DRS-Final). The validity of the questionnaire was verified from the area under the Receiver Operating Characteristic (ROC) curve, and cut-offs were obtained based on diagnostic criteria for screening procedures. Voice recordings were collected for auditory-perceptual analysis and subsequent division into groups with and without vocal alteration.

RESULTS

The sample showed a high risk of dysphonia. Higher scores in the G-DRSP and in the DRS-Final were found in the group that presented vocal alteration. The cut-off points established for the DRSP-A and DRS-Final were 0.623 and 0.789, respectively, with higher degrees of sensitivity than specificity. Thus, above these values, the risk of dysphonia is greater.

CONCLUSION

A cut-off value was calculated for the DRSP-A. This instrument was proven to be viable and applicable. The group with vocal alteration had a higher score in the G-DRSP and DRS-Final, but there was no difference in the DRSP-A.

Dysphonia and Throat Clearing in Singers During the COVID-19 Pandemic in Brazil

OBJECTIVE

The COVID-19 pandemic in Brazil affected the lives of singers, with negative impacts of the disease on the voice, such as dysphonia and throat clearing. This study aims to evaluate the presence of dysphonia and throat clearing in singers during the COVID-19 pandemic in Brazil.

MATERIAL AND METHODS

This is a cross-sectional analytical study with a sample of 154 singers from all over Brazil. Data collection was carried out online, by completing the questionnaire created by the researcher using Google Forms. The following were considered the outcome variables: voice impairment and throat clearing. The bivariate analysis was performed to test the relationship between COVID-19 infection and voice impairment, COVID-19 infection and throat clearing, COVID-19 infection and laryngeal complaints (voice impairment and throat clearing).

RESULTS

In this study, the mean age of the singers was 35.8 (Standard deviation = ±10.2 years) and 59.2% were female. Most of them worked as professional singers (81.1%) and had more than 10 years of professional experience (57.4%), mainly singing pop music (85.4%). A total of 62% reported vocal alterations during the COVID-19 infection and 53% had vocal alterations after the infection, with 44.0% reporting the onset of throat clearing after the infection. There was a significant association between COVID-19 infection and having voice impairment (P = 0.03; prevalence ratio - PR: 2.33; CI: 1.04-5.46). An association was observed between the onset of throat clearing and the occurrence of COVID-19 infection (P = 0.001; PR: 9.13; CI: 2.47-64.42).

CONCLUSIONS

The results indicated that there is an association between COVID-19 infection and complaints of dysphonia and throat clearing in Brazilian singers. This study demonstrates the importance of guidance to singers infected with COVID-19 by health voice processionals.

Comprehensive Index of Vocal Fatigue (CIVF): Development and Clinical Validation

OBJECTIVES

In this study, we sought to investigate whether auditory-perceptual and acoustic measures change after a passage-reading task and to develop a multidimensional index of performance fatigue in voice disorders. The clinical usefulness and cut-off scores of the newly developed index were also explored.

METHODS

A total of 150 patients (age = 35.65 ± 11.44 years) with voice disorders and 100 healthy controls (age = 35.04 ± 11.26 years) were enrolled in the study. Overall severity (OS) and acoustic measures of sentence samples were obtained before and after a passage-reading task and compared between the two positions. Acoustic features included cepstral peak prominence (CPP), σCPP, L/H spectral ratio (SR), and σSR. Using the changes (Δ) in those acoustic measures and the scores of the Vocal Fatigue Index (VFI), a predictive model of the ΔOS was established. The clinical cut-off point of the index was also identified.

RESULTS

For the patient group, OS was higher, but CPP and σCPP were lower for the rear position (after reading the passage) compared to the front position (before reading the passage). A significant portion (adjusted R² = 77.7%) of the ΔOS was predicted by ΔCPP, tiredness score of the VFI, ΔσCPP, ΔσSR, and ΔSR. The area under the curve of the newly developed index was .864 (sensitivity, 78.67%; specificity, 78.00%), and the index's criterion was >2.6489.

CONCLUSIONS

The newly developed Comprehensive Index of Vocal Fatigue (CIVF) can quantify vocal fatigue in voice disorders, reflecting both acoustic and auditory perceptual changes after a passage-reading task. Further studies should explore the responsiveness of the CIVF and the impact of related factors on the CIVF in various voice disorders.

Acoustic-Aerodynamic Voice Outcome Ratios Identify Changes in Vocal Function Following Vocal Fold Medialization for Unilateral Vocal Fold Paralysis

PURPOSE

This study aimed to determine whether ratio-based measures that combine acoustic (output) and aerodynamic (input) parameters detect postoperative change in vocal function following vocal fold medialization for unilateral vocal fold paralysis.

METHOD

Pre- and postoperative acoustic and aerodynamic measures were analyzed retrospectively from 149 patients who underwent vocal fold medialization for unilateral vocal fold paralysis. A 2 × 2 repeated-measures analysis of variance was conducted for each of four acoustic-aerodynamic ratios-traditional vocal efficiency (VE), sound pressure level to aerodynamic power (SPL/AP), SPL to average airflow (SPL/AFLOW), and SPL to subglottal pressure (SPL/Ps)-to investigate the main effects and interaction of treatment stage and loudness level (comfortable and loud).

RESULTS

The patient group showed significant postoperative improvements in self reports of vocal function (voice-related quality of life) and clinical auditory-perceptual judgments of dysphonia (consensus auditory-perceptual evaluation of voice). Main effects for both treatment stage and loudness level were statistically significant for all measures except SPL/Ps. There were interaction effects for VE and SPL/AP, suggesting that magnitude of the treatment effect differs based on loudness. SPL/AFLOW had medium-to-large effect sizes in both loudness conditions. There were postoperative changes in SPL/Ps that were dependent on the magnitude of the reduction in AFLOW; as expected, SPL/Ps increased postoperatively in a subgroup that had large postoperative reductions in AFLOW at the comfortable loudness level.

CONCLUSIONS

Acoustic-aerodynamic ratios can aid in tracking changes in vocal function following vocal fold medialization. SPL/AFLOW exhibited the largest effect size, which is expected since a reduction in abnormally high AFLOW typically accompanies the increased modulation of glottal air flow associated with successful vocal fold medialization. Future study is needed to model physiological changes in acoustic-aerodynamic voice outcome ratios across different types of voice disorders.

Office-based blue laser therapy for dyspnea in patients with type 3 Reinke's edema

PURPOSE

To investigate the effectiveness of in-office blue laser therapy on dyspnea in patients with type 3 Reinke's edema.

METHODS

The medical records and video-recordings of patients with Reinke's edema type 3 who had undergone office-based blue laser therapy between March 2022 and January 2023 were reviewed. The primary outcome measures assessed before and after surgery were dyspnea severity, risk of obstructive sleep apnea (OSA), and disease regression. The severity of dyspnea was measured using the Dyspnea Severity Index (DSI), the risk of OSA was assessed using the STOP-BANG questionnaire, and disease regression was assessed by reviewing the laryngeal examination before and after surgery. The Voice Handicap Index-10 (VHI-10) was used as a secondary outcome measure.

RESULT

A total of 10 patients were included. The mean age of the study population was 58.9 ± 4.2 years. The male-to-female ratio was 2:3. In total, 20 vocal fold lesions were treated among which 18 were reviewed. Eight lesions regressed completely and 10 partially. There was a statistically significant drop in the mean score of DSI after surgery (16.1 ± 10.2 pre-operatively vs 2.3 ± 2.3 post-operatively, p-value < 0.001). The mean STOP-BANG score decreased from 4.8 ± 1.47 to 3.1 ± 1.28 (p-value = 0.001). There was also a significant improvement in VHI-10 score (22.7 ± 7.0 vs 4.4 ± 5.6, p-value < 0.001).

CONCLUSION

Office-based blue laser therapy offers a safe and effective treatment for shortness of breath in patients with type 3 Reinke's edema.

The role of patient perceptions and hyperfunctional voice disorders in predicting voice therapy attendance

OBJECTIVES/HYPOTHESIS

Attendance is essential to voice therapy's effectiveness in the treatment of voice and laryngeal disorders. With such high rates of drop-out and non-attendance, it is important to understand the factors that influence this behavior. This study sought to identify potential predictors of attendance to voice therapy at an interdisciplinary voice clinic.

STUDY DESIGN

Single-institution retrospective cohort study.

METHODS

In this retrospective cohort study, patients evaluated at an interdisciplinary voice clinic who received a referral for voice therapy were identified. Age, gender, voice-related diagnoses, Voice Handicap Index-10 scores, Reflux Symptom Index scores, and measures of patient perceptions (self-rated severity, importance of voice in one's life, and "feelings about voice therapy") were recorded to evaluate associations with attendance to at least one therapy session. Standard statistical analysis and logistic regressions were performed.

RESULTS

Of 168 subjects included, 111 (66.1 %) attended at least one session of voice therapy. Patients diagnosed with primary hyperfunctional voice disorders had a significantly higher attendance rate than other groups. Attenders had higher self-ratings of severity and more positive "feelings about voice therapy" compared to non-attenders. Regression models found three significant predictors of therapy attendance: primary diagnosis of hyperfunctional voice disorder, self-rated severity, and "feelings about voice therapy."

CONCLUSION

In this cohort, patients with more positive feelings about voice therapy, higher self-rated severity, and a diagnosis of primary hyperfunctional voice disorder were more likely to attend voice therapy.

LEVEL OF EVIDENCE: 3

[Laryngeal-preservation surgery in laryngeal cancer]

After oral cavity and pharyngeal cancer, laryngeal cancer is the third most common malignant tumor in the head and neck region. According to the current German S3 guideline on the diagnosis, treatment, and follow-up of laryngeal cancer, larynx-preserving surgical interventions are part of the standard treatment of this disease, even in advanced tumor stages. However, in order to achieve the desired function-preserving effect, an exact indication is of crucial importance. In this article, the most important larynx-preserving interventions and their indications but also the respective contraindications are presented, with the aim of illuminating the surgical treatment options up to just before total laryngectomy.

Nyquist Plot Parametrization for Quantitative Analysis of Vibration of the Vocal Folds

OBJECTIVES

The Nyquist plot provides a graphical representation of the glottal cycles as elliptical trajectories in a 2D plane. This study proposes a methodology to parameterize the Nyquist plot with application to support the quantitative analysis of voice disorders.

METHODS

We considered high-speed videoendoscopy recordings of 33 functional dysphonia (FD) patients and 33 normophonic controls (NC). Quantitative analysis was performed by computing four shape-based parameters from the Nyquist plot: Variability, Size (Perimeter and Area), and Consistency. Additionally, we performed automatic classification using a linear support vector machine and feature importance analysis by combining the proposed features with state-of-the-art glottal area waveform (GAW) parameters.

RESULTS

We found that the inter-cycle variability was significantly higher in FD patients compared to NC. We achieved a classification accuracy of 83% when the top 30 most important features were used. Furthermore, the proposed Nyquist plot features were ranked in the top 12 most important features.

CONCLUSIONS

The Nyquist plot provides complementary information for subjective and objective assessment of voice disorders. On the one hand, with visual inspection it is possible to observe intra- and inter-glottal cycle irregularities during sustained phonation. On the other hand, shaped-based parameters allow quantifying such irregularities and provide complementary information to state-of-the-art GAW parameters.