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Alves JDN, de Almeida AAF, Yamasaki R, Lopes LW. The influence of listener experience, measurement scale and speech task on the reliability of auditory-perceptual evaluation of vocal quality. Codas 2024; 36:e20230175. [PMID: 38629682 PMCID: PMC11065405 DOI: 10.1590/2317-1782/20232023175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/24/2023] [Indexed: 04/19/2024] Open
Abstract
PURPOSE To assess the influence of the listener experience, measurement scales and the type of speech task on the auditory-perceptual evaluation of the overall severity (OS) of voice deviation and the predominant type of voice (rough, breathy or strain). METHODS 22 listeners, divided into four groups participated in the study: speech-language pathologist specialized in voice (SLP-V), SLP non specialized in voice (SLP-NV), graduate students with auditory-perceptual analysis training (GS-T), and graduate students without auditory-perceptual analysis training (GS-U). The subjects rated the OS of voice deviation and the predominant type of voice of 44 voices by visual analog scale (VAS) and the numerical scale (score "G" from GRBAS), corresponding to six speech tasks such as sustained vowel /a/ and /ɛ/, sentences, number counting, running speech, and all five previous tasks together. RESULTS Sentences obtained the best interrater reliability in each group, using both VAS and GRBAS. SLP-NV group demonstrated the best interrater reliability in OS judgment in different speech tasks using VAS or GRBAS. Sustained vowel (/a/ and /ɛ/) and running speech obtained the best interrater reliability among the groups of listeners in judging the predominant vocal quality. GS-T group got the best result of interrater reliability in judging the predominant vocal quality. CONCLUSION The time of experience in the auditory-perceptual judgment of the voice, the type of training to which they were submitted, and the type of speech task influence the reliability of the auditory-perceptual evaluation of vocal quality.
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Affiliation(s)
| | | | - Rosiane Yamasaki
- Universidade Federal de São Paulo - UNIFESP - São Paulo (SP), Brasil.
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Krasnodębska P, Miaśkiewicz B, Szkiełkowska A, Skarżyński H. Vocal fold electromyography in patients with endoscopic features of unilateral laryngeal paralysis. Otolaryngol Pol 2024; 78:18-22. [PMID: 38623857 DOI: 10.5604/01.3001.0053.8704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
<b><br>Introduction:</b> Electromyography (EMG) of the larynx provides information on the electrophysiological condition of laryngeal muscles and innervation. Integration of information obtained from the EMG exams with the clinical parameters as obtained by other methods for laryngeal assessment (endoscopy, perceptual and acoustic analysis, voice self-assessment) provides a multidimensional picture of dysphonia, which is of particular importance in patients with vocal fold (VF) mobility disorders accompanied by glottic insufficiency.</br> <b><br>Aim:</b> The aim of this study was to evaluate laryngeal EMG records acquired in subjects with unilateral vocal fold immobilization with signs of atrophy and glottic insufficiency.</br> <b><br>Material and methods:</b> From the available material of 74 EMG records of patients referred for the exam due to unilateral laryngeal paralysis, records of 17 patients with endoscopic features suggestive of complete laryngeal muscle denervation were selected. The EMG study of thyroarytenoid muscles of mobile and immobile VFs was evaluated qualitatively and quantitatively at rest and during volitional activity involving free phonation of vowel /e/ [ε].</br> <b><br>Results:</b> In all patients, the EMG records from mobile VFs were significantly different from those from immobile VFs. Despite endoscopic features of paralysis, no VF activity whatsoever was observed in as few as 2 patients so as to meet the neurophysiological definition of paralysis. In 88% of cases, electromyographic activity of the thyroarytenoid muscle was observed despite immobilization and atrophy of the vocal fold. In these patients, neurogenic type of record was observed with numerous high- -amplitude mobility units. On the basis of the results, quantitative features of EMG records indicative of paralysis and residual activity of the thyroarytenoid muscle were determined.</br> <b><br>Conclusions:</b> Qualitative and quantitative analysis of laryngeal EMG records provides detailed information on the condition of vocal fold muscles and innervation. EMG records of mobile vs immobile VFs differ significantly from each other. Endoscopic evaluation does not provide sufficient basis for the diagnosis of complete laryngeal muscle denervation.</br>.
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Affiliation(s)
- Paulina Krasnodębska
- Audiology and Phoniatrics Clinic, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Beata Miaśkiewicz
- Audiology and Phoniatrics Clinic, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Agata Szkiełkowska
- Audiology and Phoniatrics Clinic, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Henryk Skarżyński
- Otorhinolaryngology Clinic, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
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Calaf N, Garcia-Quintana D. Development and Validation of the Bilingual Catalan/Spanish Cross-Cultural Adaptation of the Consensus Auditory-Perceptual Evaluation of Voice. J Speech Lang Hear Res 2024; 67:1072-1089. [PMID: 38527275 DOI: 10.1044/2024_jslhr-23-00536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
PURPOSE This study aimed to develop a valid and reliable bilingual version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) for the auditory-perceptual evaluation of voice in Catalan and Spanish speakers. METHOD The development of this CAPE-V adaptation included Delphi methodology with 20 voice and speech experts reaching consensus on the optimal adapted terminology of the perceptual vocal attributes, considering also input from the original instrument authors. The adaptation and validation of vocal tasks followed a sequential validation procedure, with input from phoneticians and speech-language pathologists. Following pilot testing with a large sample of speech-language pathology students, a refined adapted version was empirically tested for validity and reliability. Concurrent validity was assessed by comparing the adapted CAPE-V with the reference Grade, Roughness, Breathiness, Asthenia, Strain scale. Construct validity was assessed through convergent and discriminant validity analysis. Intrarater and interrater reliability were assessed via intraclass correlation coefficient calculations. User experience was evaluated through a questionnaire. Scale properties were validated using a confusion matrix, and cutoff values were calculated to achieve the optimal balance between sensitivity and specificity. RESULTS Through a formalized consensus process, optimal Catalan/Spanish terminology was determined for the perceptual attributes of voice present in the CAPE-V. An adapted protocol of tasks was obtained that preserves the objectives of the original instrument and the relevance of the phonetic criteria in the target languages. The results demonstrated concurrent validity, construct validity, and intrarater reliability. Interrater reliability was found to depend on the extent to which evaluators shared their internal standards. The raters identified CAPE-V as an effective and preferred instrument. CONCLUSION An adapted, validated version of the CAPE-V is made available to clinical professionals for the evaluation of voice in Catalan and Spanish speakers.
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Affiliation(s)
- Neus Calaf
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Bellaterra, Spain
- Voice Analysis Lab, Biophysics Unit, School of Medicine, Autonomous University of Barcelona, Bellaterra, Spain
| | - David Garcia-Quintana
- Voice Analysis Lab, Biophysics Unit, School of Medicine, Autonomous University of Barcelona, Bellaterra, Spain
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Srinivasan Y, Liu A, Rameau A. Machine learning in the evaluation of voice and swallowing in the head and neck cancer patient. Curr Opin Otolaryngol Head Neck Surg 2024; 32:105-112. [PMID: 38116798 DOI: 10.1097/moo.0000000000000948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to present recent advances and limitations in machine learning applied to the evaluation of speech, voice, and swallowing in head and neck cancer. RECENT FINDINGS Novel machine learning models incorporating diverse data modalities with improved discriminatory capabilities have been developed for predicting toxicities following head and neck cancer therapy, including dysphagia, dysphonia, xerostomia, and weight loss as well as guiding treatment planning. Machine learning has been applied to the care of posttreatment voice and swallowing dysfunction by offering objective and standardized assessments and aiding innovative technologies for functional restoration. Voice and speech are also being utilized in machine learning algorithms to screen laryngeal cancer. SUMMARY Machine learning has the potential to help optimize, assess, predict, and rehabilitate voice and swallowing function in head and neck cancer patients as well as aid in cancer screening. However, existing studies are limited by the lack of sufficient external validation and generalizability, insufficient transparency and reproducibility, and no clear superior predictive modeling strategies. Algorithms and applications will need to be trained on large multiinstitutional data sets, incorporate sociodemographic data to reduce bias, and achieve validation through clinical trials for optimal performance and utility.
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Affiliation(s)
- Yashes Srinivasan
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York
| | - Amy Liu
- University of California, San Diego, School of Medicine, San Diego, California, USA
| | - Anaïs Rameau
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York
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Reynolds V, Fleury A. A preliminary exploration of conversation sampling in pediatric voice disorders. LOGOP PHONIATR VOCO 2024; 49:41-46. [PMID: 35895095 DOI: 10.1080/14015439.2022.2102207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/08/2022] [Accepted: 07/08/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Current methods of eliciting running speech for subjective rating, or perceptual analysis, in the assessment of pediatric voice disorders are not standardized. Whilst different assessment tools have different requirements, a commonality is the requirement to judge the perceptual characteristics of the individual's everyday speaking voice. However, it is unclear whether current practices yield ecologically valid running speech samples. The aim of this study was to analyse the length and characteristics of conversational responses, to stimuli that were designed to elicit running speech samples from pediatric clients. METHOD Twenty conversations, conducted as part of the evaluation of voice in a pediatric population, were analysed. Length of responses, number of responses and question types were recorded. RESULTS The median maximum utterance length was 15.9 s; seven participants presented with a maximum of less than 10 s. Response length was significantly associated with question type, F = 10.68, p<.001. The most frequent number of responses produced was 11 (range = 17, IQR = 5, 11). There was a moderate correlation between response length and number of responses, r(18)=.53, p=.02. DISCUSSION These data demonstrated that informal conversational methods did not consistently yield running speech samples of greater than 10 s in length, the minimum sample length recommended by the CAPE-V protocol. There was considerable variability in the characteristics of the responses produced by participants. Using a task such as a narrative re-tell might allow for better standardization of responses, including elicitation of vocal behaviors of interest, as well as yield a longer sample.
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Affiliation(s)
- Victoria Reynolds
- College of Nursing and Health Sciences, Lewis University, One University Parkway, Romeoville, IL, USA
| | - Aimee Fleury
- Saranac Central School District, Dannemora, NY, USA
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Grama M, Barrichelo-Lindström V, Englert M, Kinghorn D, Behlau M. Resonant Voice: Perceptual and Acoustic Analysis After an Intensive Lessac Kinesensic Training Workshop. J Voice 2024; 38:541.e1-541.e12. [PMID: 34785115 DOI: 10.1016/j.jvoice.2021.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate whether actors' and actresses' voices post an Intensive Lessac Kinesensic Training Workshop - ILKTW can be perceptually identified as more resonant, and to assess if the Acoustic Voice Quality Index (AVQI), the Acoustic Breathing Index (ABI), and their acoustic measures are able to indicate the classified voices as more resonant. METHODS Eight vocally healthy English first-language actors and actresses, participants of the same ILKTW, were asked to sustain the vowel /a/ and to read a piece of the Rainbow Passage, pre and postworkshop, at a self-selected habitual frequency and intensity. The readings were divided into initial and final parts, both with 34 syllables, and combined with the vowel /a/ (3s). The pre and postworkshop recordings (pairs of the initial and final parts followed by the /a/ vowel) of each participant were randomly presented to a voice expert who rated the samples as more resonant or similar. The same samples were analyzed using the AVQI and ABI scripts. RESULTS 87,5% of the initial parts and 100% of the final in postworkshop were rated by the voice expert as more resonant. Tilt was higher for the postworkshop initial parts (P = 0.036), but a correlation with the perceptual rating wasn't found. HNR was higher (P = 0.018) and jitter was lower (P = 0.017) for the postworkshop final parts. The statistical analysis comparing the perceptive and acoustic data for the final samples couldn't be applied. CONCLUSION It seems that the ILKTW has a positive impact on the development of a resonant voice and that the perceptual auditory rating was more effective to describe resonant voices than the AVQI, ABI, and its acoustic measures.
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Affiliation(s)
- Marilene Grama
- Centro de Estudos da Voz - CEV, 361 Machado Bittencourt street, 10th floor. São Paulo, São Paulo, 04044-001, Brazil.
| | - Viviane Barrichelo-Lindström
- Centro de Estudos da Voz - CEV, 361 Machado Bittencourt street, 10th floor. São Paulo, São Paulo, 04044-001, Brazil
| | - Marina Englert
- Centro de Estudos da Voz - CEV, 361 Machado Bittencourt street, 10th floor. São Paulo, São Paulo, 04044-001, Brazil
| | - Deborah Kinghorn
- Lessac Training and Research Institute, 60 Seaman Avenue, New York, NY, 10034, United States
| | - Mara Behlau
- Centro de Estudos da Voz - CEV, 361 Machado Bittencourt street, 10th floor. São Paulo, São Paulo, 04044-001, Brazil
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Slavych BK, Zraick RI, Ruleman A. A Systematic Review of Voice-Related Patient-Reported Outcome Measures for Use with Adults. J Voice 2024; 38:544.e1-544.e14. [PMID: 34782227 DOI: 10.1016/j.jvoice.2021.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE This paper's purpose is to provide a resource for clinicians and researchers of select voice-related patient-reported outcome measures (PROMs) available in the English language. METHOD A systematic search for voice-related PROMs was conducted between September 2020 and July 17, 2021. Databases included APA PsychInfo, Nursing and Allied Health Source, MEDLINE via the EBSCO interface, and Science Direct. Reference lists for PROMs-related articles were mined for reference to PROMs protocols. RESULTS Thirty voice-related PROMs were identified and categorized as either developed primarily for use in the clinic (n = 12), developed primarily for use in a specific research study (n = 6), or translated into English for publication (n = 12). Twelve PROMs were summarized: Aging Voice Index, Disease Specific Self-Efficacy in Spasmodic Dysphonia, Evaluation of the Ability to Sing Easily, Evaluating Voice Disability - Quality of Life Questionnaire, Glottal Function Index, Linear Analog Scale of Assessment of Voice Quality, Quality of Life in Recurrent Respiratory Papillomatosis, Speech Disability Questionnaire, Trans Woman Voice Questionnaire, Vocal Cord Dysfunction Questionnaire, Vocal Fatigue Index, and the Vocal Tract Discomfort Scale. CONCLUSION The PROMs can be categorized into English-language voice-related PROMs developed primarily for clinical use, English-language PROMs developed primarily for research use, and English-language PROMs translated into English. The extent of reliability and validity testing completed varies in the PROMs developed primarily for clinical use. A PROM's psychometric properties as well as the language in which the PROM was tested, should guide clinicians and researchers as they consider which instrument(s) to use.
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Affiliation(s)
- Bonnie K Slavych
- Communication Disorders program, University of Central Missouri, Warrensburg, Missouri, USA.
| | - Richard I Zraick
- School of Communication Sciences and Disorders, University of Central Florida, Orlando, Florida, USA
| | - Alice Ruleman
- Communication Disorders program, University of Central Missouri, Warrensburg, Missouri, USA
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Cai H, Dong J, Mei L, Feng G, Li L, Wang G, Yan H. Functional and structural abnormalities of the speech disorders: a multimodal activation likelihood estimation meta-analysis. Cereb Cortex 2024; 34:bhae075. [PMID: 38466117 DOI: 10.1093/cercor/bhae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/12/2024] Open
Abstract
Speech disorders are associated with different degrees of functional and structural abnormalities. However, the abnormalities associated with specific disorders, and the common abnormalities shown by all disorders, remain unclear. Herein, a meta-analysis was conducted to integrate the results of 70 studies that compared 1843 speech disorder patients (dysarthria, dysphonia, stuttering, and aphasia) to 1950 healthy controls in terms of brain activity, functional connectivity, gray matter, and white matter fractional anisotropy. The analysis revealed that compared to controls, the dysarthria group showed higher activity in the left superior temporal gyrus and lower activity in the left postcentral gyrus. The dysphonia group had higher activity in the right precentral and postcentral gyrus. The stuttering group had higher activity in the right inferior frontal gyrus and lower activity in the left inferior frontal gyrus. The aphasia group showed lower activity in the bilateral anterior cingulate gyrus and left superior frontal gyrus. Across the four disorders, there were concurrent lower activity, gray matter, and fractional anisotropy in motor and auditory cortices, and stronger connectivity between the default mode network and frontoparietal network. These findings enhance our understanding of the neural basis of speech disorders, potentially aiding clinical diagnosis and intervention.
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Affiliation(s)
- Hao Cai
- Key Laboratory for Artificial Intelligence and Cognitive Neuroscience of Language, Xi'an International Studies University, Xi'an 710128, China
| | - Jie Dong
- Key Laboratory for Artificial Intelligence and Cognitive Neuroscience of Language, Xi'an International Studies University, Xi'an 710128, China
| | - Leilei Mei
- Philosophy and Social Science Laboratory of Reading and Development in Children and Adolescents (South China Normal University); School of Psychology; Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou 510631, China
| | - Genyi Feng
- Imaging Department, Xi'an GEM Flower Changqing Hospital, Xi'an 710201, China
| | - Lili Li
- Speech Language Therapy Department, Shaanxi Provincial Rehabilitation Hospital, Xi'an 710065, China
| | - Gang Wang
- Imaging Department, Xi'an GEM Flower Changqing Hospital, Xi'an 710201, China
| | - Hao Yan
- Key Laboratory for Artificial Intelligence and Cognitive Neuroscience of Language, Xi'an International Studies University, Xi'an 710128, China
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Chung HR, Lee Y, Reddy NK, Zhang Z, Chhetri DK. Effects of Thyroarytenoid Activation Induced Vibratory Asymmetry on Voice Acoustics and Perception. Laryngoscope 2024; 134:1327-1332. [PMID: 37676064 DOI: 10.1002/lary.31046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/25/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023]
Abstract
INTRODUCTION Asymmetry of vocal fold (VF) vibration is common in patients with voice complaints and also observed in 10% of normophonic individuals. Although thyroarytenoid (TA) muscle activation plays a crucial role in regulating VF vibration, how TA activation asymmetry relates to voice acoustics and perception is unclear. We evaluated the relationship between TA activation asymmetry and the resulting acoustics and perception. METHODS An in vivo canine model of phonation was used to create symmetric and increasingly asymmetric VF vibratory conditions via graded stimulation of bilateral TA muscles. Naïve listeners (n = 89) rated the perceptual quality of 100 unique voice samples using a visual sort-and-rate task. For each phonatory condition, cepstral peak prominence (CPP), harmonic amplitude (H1-H2), and root-mean-square (RMS) energy of the voice were measured. The relationships between these metrics, vibratory asymmetry, and perceptual ratings were evaluated. RESULTS Increasing levels of TA asymmetry resulted in declining listener preference. Furthermore, only severely asymmetric audio samples were perceptually distinguishable from symmetric and mildly asymmetric conditions. CPP was negatively correlated with TA asymmetry: voices produced with larger degrees of asymmetry were associated with lower CPP values. Listeners preferred audio samples with higher values of CPP, high RMS energy, and lower H1-H2 (less breathy). CONCLUSION Listeners are sensitive to changes in voice acoustics related to vibratory asymmetry. Although increasing vibratory asymmetry is correlated with decreased perceptual ratings, mild asymmetries are perceptually tolerated. This study contributes to our understanding of voice production and quality by identifying perceptually salient and clinically meaningful asymmetry. LEVEL OF EVIDENCE N/A (Basic Science Study) Laryngoscope, 134:1327-1332, 2024.
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Affiliation(s)
- Hye Rhyn Chung
- David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, California, U.S.A
| | - Yoonjeong Lee
- Department of Head & Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
- Department of Linguistics, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Neha K Reddy
- David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, California, U.S.A
| | - Zhaoyan Zhang
- Department of Head & Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Dinesh K Chhetri
- Department of Head & Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
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Walstrom A, Brehm SB, LeBorgne WD, Acord A, Gottliebson RO. Use of Terminology and the Effect of Training on Auditory-Perceptual Ratings of Speaking Voice by Singing Teachers. J Voice 2024; 38:543.e1-543.e11. [PMID: 34782224 DOI: 10.1016/j.jvoice.2021.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate group differences between singing teachers and speech-language pathologists when rating dysphonic speaking voices and whether training using reference samples and the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) improves inter-rater reliability between and among the two groups. Differences in use of terminology and ratings could reveal potential for miscommunication in the team treatment of singers with voice disorders. STUDY DESIGN This is a prospective pre test post test cohort study with between and within group comparisons. METHODS Recorded samples of dysphonic speaking voices were rated by 18 experienced singing teachers with free written descriptions and an Overall Severity (OS) rating of 0-100. Participants were then trained in application of the CAPE-V with verbal definitions and reference samples exemplifying characteristics of disordered voice. Participants rated the samples a second time using the CAPE-V. The pre and post training ratings of participants were compared to composite ratings of six speech-language pathologists. RESULTS Descriptive statistics indicated the mean aggregate Overall Severity rating of speech-language pathologist (SLP) raters as 25.79 (SD = 6.10, SE = 2.49), as compared to 35.05 (SD = 12.72, SE = 3.00) for singing teachers. Differences in ratings were more pronounced in samples rated by SLPs as "mild" (OS 6-20) or "mild-moderate" (OS 21-35). ANOVA revealed statistically significant group differences between SLPs and singing teachers for the parameters Overall Severity (P = 0.0109, F = 7.8) and Strain (P = 0.0085, F = 8.35). While CAPE-V training did not significantly change the OS ratings of singing teachers, it did improve their inter-rater reliability from 0.67 pre training to 0.83 post training, with agreement similar to that of SLP raters (0.86). After training, participants responded "yes" to the presence of dysphonia in disordered samples more frequently. CONCLUSIONS The results support the recommendation of training singing teachers in perceptual evaluation of speaking voice to increase sensitivity to the presence of organic voice disorders and to encourage compatibility in terminology used among SLPs and singing teachers.
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Affiliation(s)
| | | | - Wendy D LeBorgne
- The Blaine Block Institute for Voice Analysis and Rehabilitation, Dayton, Ohio
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Gama ACC, da Mata SM, Martins Dos Santos PC, Vieira MN, Sansão JPH, Quinino RDC. Auditory Training With Synthesized Voice Anchors: Effects on Rater Agreement. J Voice 2024; 38:366-375. [PMID: 34702611 DOI: 10.1016/j.jvoice.2021.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE To investigate the effects of auditory training with synthesized voices on intra- and inter-rater agreement of the auditory-perceptual voice analysis of roughness and breathiness. METHODS This was an experimental study consisting of four auditory training sessions. The sample consisted of twenty raters, students from a Speech-Language Pathology course, who had previous experience with auditory-perceptual assessment. The raters participated in the four training sessions with a seven-day break in between sessions. Each training consisted of three tasks: 1) Pre-training activity: Participants were asked to rate 20 natural voices, normal and dysphonic, from zero to three, according to the parameters of roughness and breathiness; 2) Training activity: Synthesized voice anchor stimuli were presented, and participants were asked to rate them from zero to three. Four stimuli were related to roughness and four to breathiness. Participants heard 20 voice stimuli and were instructed to pair the natural voice with the synthesized anchor stimulus that most resembled it; and 3) Post-training activity: the 20 voices from the pre-training activity were randomized and participants rated the same voices, without prior knowledge that these were repeated. Statistical analysis of data was performed using the AC2 test, to assess the extent of agreement between raters, and the Friedman test to compare the training sessions. A 5% significance level was considered. RESULTS For the auditory-perceptual voice analysis of roughness, intra-rater agreement results ranged from 79% to 86% between the first and fourth auditory training session, with improvement in intra-rater agreement from the fourth session forward (P = 0.005). For the analysis of breathiness, results ranged from 88% to 92% between the first and fourth auditory training sessions, with improvement from the fourth session forward (P = 0.036). Inter-rater agreement results for the auditory-perceptual analysis of roughness ranged from 23% to 34%, and from 48% to 61% for breathiness, with no differences regarding training (P = 0.855). CONCLUSION The auditory-perceptual breathiness parameter had a higher AC2 indicator compared to the roughness parameter, suggesting better agreement. The intra-rater agreement showed improvement starting from the fourth auditory training session for the assessment of roughness and breathiness. The auditory training program did not show a positive inter-rater agreement impact.
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Affiliation(s)
- Ana Cristina Côrtes Gama
- Department of Speech-language Pathology, Federal University of Minas Gerais. Belo Horizonte, Minas Gerais, Brazil; Researcher of Productivity at National Council of Scientific Research, Brazil.
| | - Sabrina Martins da Mata
- Speech-language Pathology, Department of Speech-language Pathology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Priscila Campos Martins Dos Santos
- Speech-language Pathology, Post-graduate program (MSc) in speech therapy Sciences; Department of Speech-language Pathology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maurílio Nunes Vieira
- Department of Electronic Engineering, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - João Pedro Hallack Sansão
- Department of Technology in Civil Engineering, Computing, Automation, Telematics and Humanities, Federal University of São João Del Rei - UFSJ - Ouro Branco, Minas Gerais, Brazil
| | - Roberto da Costa Quinino
- Department of Statistics of the Institute of Exact Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Tye S, Hamilton MB, Speights Atkins M, Weaver AJ, Dillon KW, Sandage MJ. Perceptions of employability related to severity of hypernasality: a pilot study. Clin Linguist Phon 2024; 38:21-39. [PMID: 36592048 DOI: 10.1080/02699206.2022.2155876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
The primary aim of this investigation was to evaluate listener auditory-perceptual assessment of employability for individuals with hypernasal speech. Using an online survey platform, listeners with managerial experience evaluated speech samples from individuals with varying hypernasal resonance disorder severity to determine auditory-perceptual judgements regarding intelligence and employability. Speech samples of individuals with hypernasal speech were rated lower on scales of intelligence and employability, and more likely to be selected for jobs with infrequent rates of communication and lower levels of responsibility. Additionally, males with hypernasal speech were perceived as less intelligent, less employable, and more likely to be selected for a job with infrequent communication in comparison to females with hypernasal speech. Results of this preliminary investigation suggest that individuals with hypernasal speech may face employment barriers. The conclusions collected from this initial investigation open the doors for further research addressing linguistic considerations and aspects of employability. This is an important consideration for individuals with either acquired or congenitally related hypernasal resonance disorder.
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Affiliation(s)
- Scott Tye
- Department of Speech, Language, and Hearing Sciences, Auburn University, Auburn, Alabama, USA
| | - Megan-Brette Hamilton
- Department of Speech, Language, and Hearing Sciences, Auburn University, Auburn, Alabama, USA
| | - Marisha Speights Atkins
- Department of Speech, Language, and Hearing Sciences, Auburn University, Auburn, Alabama, USA
| | - Aurora J Weaver
- Department of Speech, Language, and Hearing Sciences, Auburn University, Auburn, Alabama, USA
| | - K W Dillon
- Center for Cleft and Craniofacial Disorders, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Mary J Sandage
- Department of Speech, Language, and Hearing Sciences, Auburn University, Auburn, Alabama, USA
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13
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de Oliveira AG, Fabbron EMG. Play-Based Strategies for Speech Therapy and Vocal Health Face-to-Face and Distance Learning Actions for Children: An Integrative Literature Review. J Voice 2024; 38:538.e1-538.e10. [PMID: 34732288 DOI: 10.1016/j.jvoice.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Diversifying voice therapy strategies is critical to get children and adolescents to adhere to the therapeutic process. PURPOSE To investigate the face-to-face and distance playful strategies have been used for vocal health education and voice therapy in children and adolescents. METHODS An integrative literature review was carried out based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). A search for full texts was conducted on the Virtual Health Library, Scientific Electronic Library Online (SCIELO) and PuBMed databases using the following descriptors, and their corresponding Medical Subject Headings (MeSH): voice (voz); voice quality (qualidade da voz); dysphonia (disfonia); voice disorders (distúrbios da fala); voice training (treinamento da voz); telemedicine (telemedicina); therapeutics (terapêutica); health promotion (promoção da saúde); group practice (prática de grupo); recreation therapy (terapia recreacional); child (criança); preschool (pré-escolar) and adolescent (adolescente). RESULTS After full reading of the studies, 15 articles were included and categorized into the following topics: face-to-face and distance playful strategies for voice therapy in children; playful strategies with gamification for education and for voice therapy in children; and vocal health educational actions in children. CONCLUSION The study found a higher number of studies that carried out educational actions and playful strategies, while fewer studies were related to the production of materials, gamification and online services for voice therapy in children. Given the proven benefits of this strategy for children, further studies focusing on the development and application of playful strategies, such as the use of gamification, should be conducted in order to stimulate the skills and adherence of this population to therapy.
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Affiliation(s)
- Amanda Gabriela de Oliveira
- Speech Therapist, Specialist in Voice by the Federal Council of Speech Therapy (CFFa), Master of Science from the Bauru School, Dentistry/University of São Paulo (FOB/USP); Doctoral Student in Speech-Language Pathology and Audiology at the School of Philosophy and Sciences/São Paulo State University 'Júlio de Mesquita Filho' (FFC/UNESP) Marília, São Paulo, Brazil; Speech-Language Pathology and Audiology Department, Acoustic and Articulatory Analysis Laboratory (LAAc), School of Philosophy and Sciences/São Paulo State University 'Júlio de Mesquita Filho' (FFC/UNESP), Marília, São Paulo, Brazil and Member of the research group Language Studies, of the Conselho Nacional de Desenvolvimento Científico e Tecnológico (GPEL/CNPq), São Paulo, Brazil.
| | - Eliana Maria Gradim Fabbron
- Speech Therapist, Professor of the Graduated Program in Speech-Language Pathology and Audiology; Speech-Language Pathology and Audiology Department, Acoustic and Articulatory Analysis Laboratory (LAAc), School of Philosophy and Sciences/São Paulo State University 'Júlio de Mesquita Filho' (FFC/UNESP), Marília, São Paulo, Brazil
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14
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Malregulative Dysphonie. Laryngorhinootologie 2024; 103:174-5. [PMID: 38228157 DOI: 10.1055/a-1293-1338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
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15
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Yu P, Xue C, Rosenthal J, Jiang JJ. Effects of vocal fold lesions on particle deposition in a mouth-throat model: A numerical study. Auris Nasus Larynx 2024; 51:120-124. [PMID: 37164816 DOI: 10.1016/j.anl.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Dysphonia is very common worldwide and aerosol drug inhalation is an important treatment for patients with dysphonia. This study aimed to explore the effects of vocal fold (VF) lesions on the particle deposition pattern using computational modeling. METHODS A realistic mouth-throat (MT) model of a healthy adult was constructed based on computed tomography images. Small and large vocal fold lesions were incorporated in the original model. A steady inhalation flowrate of 15 and 30 liter per minute (LPM) was used as the velocity inlet and monodisperse particles with diameters of 5 to 10 µm were simulated. RESULTS Particles of larger size are more likely to be deposited in MT models, most of them distributed in oral cavity, oropharynx and supraglottis. The ideal sizes at 30 LPM ranged over 7-10 µm for healthy VFs and 6-8 µm for VF lesions. The best sizes at 15 LPM ranged over 6-8 µm for healthy VFs and 8-9 µm for VF lesions. CONCLUSION Based on this study, VF lesions influence the deposition pattern in the glottis obviously. The ideal sizes differ at the flow rates of 15 and 30 LPM.
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Affiliation(s)
- Pengcheng Yu
- 1st Department of Otolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, 200031 Shanghai, China
| | - Chao Xue
- 1st Department of Otolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, 200031 Shanghai, China
| | - Jonah Rosenthal
- 2nd University of Wisconsin-Madison School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, 53792 Madison, WI, USA
| | - Jack J Jiang
- 1st Department of Otolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, 200031 Shanghai, China; 2nd University of Wisconsin-Madison School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, 53792 Madison, WI, USA.
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16
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Suresh A, Martha VV, Sataloff RT. Voice Outcomes Following Colon Interposition. Ear Nose Throat J 2024; 103:102-104. [PMID: 34427138 DOI: 10.1177/01455613211041786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
SIGNIFICANCE STATEMENT This case highlights the consequences of colon interposition on phonation and swallowing. Findings in this patient included laryngopharyngeal reflux, vocal fold paralysis, poor esophageal peristalsis, failed bolus transfers, and others. The mechanical and functional differences between the colon and the esophagus can impact bolus transfer, reflux, and phonation. Further research is required to identify the mechanisms by which colon interposition can impact voice and swallowing.
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Affiliation(s)
| | - Vishnu V Martha
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Robert T Sataloff
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Lankenau Institute for Medical Research, Philadelphia, PA, USA
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Sauder CL, Kapsner-Smith MR, Simmons E, Meyer T, Doyle PC, Eadie TL. The Effect of Rating Method on Reliability of Judgments of Strain Across Populations. Am J Speech Lang Pathol 2024; 33:393-405. [PMID: 38060689 PMCID: PMC11000812 DOI: 10.1044/2023_ajslp-23-00174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/17/2023] [Accepted: 10/17/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Variability in auditory-perceptual ratings of voice limits their utility, with the poorest reliability often noted for vocal strain. The purpose of this study was to determine whether an experimental method, called visual sort and rate (VSR), promoted stronger rater reliability than visual analog scale (VAS), for ratings of strain in two clinical populations: adductor laryngeal dystonia (ADLD) and vocal hyperfunction (VH). METHOD Connected speech samples from speakers with ADLD and VH as well as age- and sex-matched controls were selected from a database. Fifteen inexperienced listeners rated strain for two speaker sets (25 ADLD speakers and five controls; 25 VH speakers and five controls) across four rating blocks: VAS-ADLD, VSR-ADLD, VAS-VH, and VSR-VH. For the VAS task, listeners rated each speaker for strain using a vertically oriented 100-mm VAS. For the VSR task, stimuli were distributed into sets of samples with a range of severities in each set. Listeners sorted and ranked samples for strain within each set, and final ratings were captured on a vertically oriented 100-mm VAS. Intrarater reliability (Pearson's r) and interrater variability (mean of the squared differences between a listener's ratings and group mean ratings) were compared across rating methods and populations using two repeated-measures analyses of variance. RESULTS Intrarater reliability of strain was significantly stronger when listeners used VSR compared to VAS; listeners also showed significantly better intrarater reliability in ADLD than VH. Listeners demonstrated significantly less interrater variability (better reliability) when using VSR compared to VAS. No significant effect of population or interactions was found between listeners for measures of interrater variability. CONCLUSIONS VSR increases intrarater reliability for ratings of vocal strain in speakers with VH and ADLD. VSR decreases variability of auditory-perceptual judgments of strain between inexperienced listeners in these clinical populations. Future research should determine whether benefits of VSR extend to voice clinicians and/or clinical settings.
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Affiliation(s)
- Cara L. Sauder
- Department of Speech & Hearing Sciences, University of Washington, Seattle
| | | | - Emily Simmons
- Department of Speech & Hearing Sciences, University of Washington, Seattle
| | - Tanya Meyer
- Department of Otolaryngology—Head & Neck Surgery, University of Washington School of Medicine, Seattle
| | - Philip C. Doyle
- Division of Laryngology, Department of Otolaryngology—Head & Neck Surgery, Stanford University School of Medicine, CA
| | - Tanya L. Eadie
- Department of Speech & Hearing Sciences, University of Washington, Seattle
- Department of Otolaryngology—Head & Neck Surgery, University of Washington School of Medicine, Seattle
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18
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Fujiki RB, Sanders PW, Anthony BP, Parker NP, Sivasankar MP, Halum S. Can Resident Auditory-Perceptual Voice Assessments Predict Medical Urgency of Voice Disorders? J Voice 2024; 38:181-188. [PMID: 34479778 DOI: 10.1016/j.jvoice.2021.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND/OBJECTIVES Growing reliance on telemedicine has created new triaging challenges. This study investigated how effectively otolaryngology resident auditory-perceptual voice assessments performed via telemedicine determined the need for urgent in-person clinic visits. METHODS Twelve otolaryngology resident physicians (PGY1-PGY5) performed auditory-perceptual assessments on 25 voice samples recorded during initial voice evaluations. Voice samples were balanced in severity and taken in equal numbers from patients with the following diagnoses: benign laryngeal lesions, laryngeal cancer, functional voice disorders, laryngeal edema (associated with LPR), and laryngeal paralysis/paresis. Urgent diagnoses were defined as laryngeal cancer and severe unilateral laryngeal paralysis. For each voice sample, residents were initially blinded to patient medical history. Residents rated severity of voice disorder, predicted patient diagnosis, and determined the urgency of seeing the patient in clinic. Residents then reviewed information from the patient's medical history and again rated urgency of voice disorder. RESULTS On average, residents identified urgent voice disorders in 56% of cases. After reviewing medical history, this number significantly increased to 77% (P = 0.001). Voice severity, smoking history, time since onset, and course of symptoms were considered most influential when determining medical urgency of voice patients. Year in residency program had no effect on rating accuracy. As expected, diagnostic accuracy of auditory-perceptual assessments was low, ranging from 40% for laryngeal paralysis/paresis to 5% for laryngeal edema. CONCLUSION Auditory-perceptual voice assessment, combined with medical history, predicted most medically urgent voice disorders. Further work should investigate if task-specific training might improve these results and which medical history items are most critical. Until accuracy of auditory-perceptual assessment of medical urgency is improved, these data underscore the importance of laryngeal examination in identifying medical urgency and etiology of dysphonia.
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Affiliation(s)
| | | | - Benjamin P Anthony
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine
| | - Noah P Parker
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine
| | | | - Stacey Halum
- Department of Speech, Language, and Hearing Sciences, Purdue University; Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine.
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Huang M, Yu L, Hu J, Ren J, Li Z, Pan Z, Yang H, Lu D. Adaptation and Validation of the Mandarin Chinese Version of the Pediatric Voice Handicap Index-10 (pVHI-10). J Voice 2024; 38:243.e31-243.e35. [PMID: 34470707 DOI: 10.1016/j.jvoice.2021.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/25/2021] [Accepted: 07/28/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The purpose of this study was to adapt and validate the Mandarin Chinese version of the pediatric Voice Handicap Index-10 (pVHI-10). METHODS A cross-sectional study was conducted from January 2018 to December 2019. A total of 422 parents completed the questionnaire, including 283 parents of children with voice disorders (dysphonic group) and 139 parents of children without voice disorders (control group). Internal consistency, test-retest reliability, clinical effectiveness, and cut-off value were evaluated. RESULTS In the dysphonic group, the internal consistency of the Mandarin Chinese version of pVHI-10 was excellent (Cronbach's α = 0.95). The test-retest reliability was excellent for the total score of the Mandarin Chinese version of pVHI-10 (interclass correlation coefficient = 0.916). The total scores as well as scores on individual items were significantly higher in the dyphonic group compared to those in the control group (P <0.001). In addition, the optimum cut-off value for the Mandarin Chinese version of pVHI-10 was 6.5 (87% sensitivity and 86.3% specificity, respectively). CONCLUSION The Mandarin Chinese version of the pVHI-10 is a valid tool that evaluates the quality of life of children with voice disorders from the parents' perspective.
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Affiliation(s)
- Mengjie Huang
- Department of Otolaryngology, Chengdu Women's and Children's Central Hospital,School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, P.R. China
| | - Lingyu Yu
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Juanjuan Hu
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Jia Ren
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Zhen Li
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Zhongjing Pan
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Hui Yang
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Dan Lu
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.
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20
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Dupuch G, Mailly M, Guillaume J, Daval M, Ayache D, Brasnu D. Incidence and risk factors for secondary extralaryngeal dystonia in patients with laryngeal dystonia. Am J Otolaryngol 2024; 45:104090. [PMID: 37865985 DOI: 10.1016/j.amjoto.2023.104090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Laryngeal dystonia (LD) is a focal dystonia affecting adductor and/or abductor muscles of the larynx. It can be isolated or may spread to extra laryngeal muscles. The aim of this study was to report the characteristics of LD over time in a large single-center study with a long follow-up. METHODS Retrospective review of patients with LD referred to our institution between 1991 and 2021. Demographic data, time to diagnosis, type of LD, follow-up and spread of dystonia [SD] were recorded. Risk factors for spread of dystonia during follow-up were analyzed. RESULTS Over the 30-year period, 516 patients (77.3 % female, median age 50 years, range 5-87 years) were analyzed. Three hundred and fifteen patients (61 %) had adduction laryngeal dystonia, 136 patients (26.4 %) had abduction laryngeal dystonia, 46 patients (8.9 %) had adductor respiratory laryngeal dystonia, 12 patients (2.3 %) had mixed laryngeal dystonia, and seven patients (1.4 %) had singer's laryngeal dystonia. A previous history of dystonia was found in 47 patients (9.1 %). A laryngeal tremor was found in 68 patients (13.2 %). Since the onset of symptoms, LD was diagnosed after a median of 3 years (IQR: 1.0, 7.0). SD occurred in 55 patients (10.7 %) after a median time of 4 year (IQR: 1.5, 13.0). Patients with mixed laryngeal dystonia had higher probability of SD (p = 0.018). DISCUSSION This study reports a large European study of LD, with a long follow-up. SD occurred in 10.5 % of patients. Patients with mixed laryngeal dystonia had a higher probability of SD. A close follow-up may be recommended for patients with mixed laryngeal dystonia.
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Affiliation(s)
- Guillaume Dupuch
- Department of Otolaryngology Head &Neck Surgery, Rothschild Hospital Foundation, Paris, France.
| | - Marie Mailly
- Department of Otolaryngology Head &Neck Surgery, Rothschild Hospital Foundation, Paris, France
| | - Jessica Guillaume
- Department of Clinical Research, Rothschild Hospital Foundation, Paris, France
| | - Mary Daval
- Department of Otolaryngology Head &Neck Surgery, Rothschild Hospital Foundation, Paris, France
| | - Denis Ayache
- Department of Otolaryngology Head &Neck Surgery, Rothschild Hospital Foundation, Paris, France
| | - Daniel Brasnu
- Department of Otolaryngology Head &Neck Surgery, Rothschild Hospital Foundation, Paris, France
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21
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Bobin M, Sulzer N, Bründler G, Staib M, Imbach LL, Stieglitz LH, Krauss P, Bichsel O, Baumann CR, Frühholz S. Direct subthalamic nucleus stimulation influences speech and voice quality in Parkinson's disease patients. Brain Stimul 2024; 17:112-124. [PMID: 38272256 DOI: 10.1016/j.brs.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/21/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND DBS of the subthalamic nucleus (STN) considerably ameliorates cardinal motor symptoms in PD. Reported STN-DBS effects on secondary dysarthric (speech) and dysphonic symptoms (voice), as originating from vocal tract motor dysfunctions, are however inconsistent with rather deleterious outcomes based on post-surgical assessments. OBJECTIVE To parametrically and intra-operatively investigate the effects of deep brain stimulation (DBS) on perceptual and acoustic speech and voice quality in Parkinson's disease (PD) patients. METHODS We performed an assessment of instantaneous intra-operative speech and voice quality changes in PD patients (n = 38) elicited by direct STN stimulations with variations of central stimulation features (depth, laterality, and intensity), separately for each hemisphere. RESULTS First, perceptual assessments across several raters revealed that certain speech and voice symptoms could be improved with STN-DBS, but this seems largely restricted to right STN-DBS. Second, computer-based acoustic analyses of speech and voice features revealed that both left and right STN-DBS could improve dysarthric speech symptoms, but only right STN-DBS can considerably improve dysphonic symptoms, with left STN-DBS being restricted to only affect voice intensity features. Third, several subareas according to stimulation depth and laterality could be identified in the motoric STN proper and close to the associative STN with optimal (and partly suboptimal) stimulation outcomes. Fourth, low-to-medium stimulation intensities showed the most optimal and balanced effects compared to high intensities. CONCLUSIONS STN-DBS can considerably improve both speech and voice quality based on a carefully arranged stimulation regimen along central stimulation features.
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Affiliation(s)
- Marine Bobin
- Cognitive and Affective Neuroscience Unit, University of Zürich, 8050 Zürich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, 8057 Zurich, Switzerland
| | - Neil Sulzer
- Cognitive and Affective Neuroscience Unit, University of Zürich, 8050 Zürich, Switzerland
| | - Gina Bründler
- Cognitive and Affective Neuroscience Unit, University of Zürich, 8050 Zürich, Switzerland
| | - Matthias Staib
- Cognitive and Affective Neuroscience Unit, University of Zürich, 8050 Zürich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, 8057 Zurich, Switzerland
| | - Lukas L Imbach
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, 8057 Zurich, Switzerland; Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland; Swiss Epilepsy Center, Klinik Lengg, 8008 Zurich, Switzerland
| | - Lennart H Stieglitz
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Philipp Krauss
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; Department of Neurosurgery, University Hospital Augsburg, 86159 Augsburg, Germany
| | - Oliver Bichsel
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Christian R Baumann
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, 8057 Zurich, Switzerland; Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Sascha Frühholz
- Cognitive and Affective Neuroscience Unit, University of Zürich, 8050 Zürich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, 8057 Zurich, Switzerland; Department of Psychology, University of Oslo, 0373 Oslo, Norway.
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Schraut T, Schützenberger A, Arias-Vergara T, Kunduk M, Echternach M, Döllinger M. Machine learning based estimation of hoarseness severity using sustained vowelsa). J Acoust Soc Am 2024; 155:381-395. [PMID: 38240668 DOI: 10.1121/10.0024341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024]
Abstract
Auditory perceptual evaluation is considered the gold standard for assessing voice quality, but its reliability is limited due to inter-rater variability and coarse rating scales. This study investigates a continuous, objective approach to evaluate hoarseness severity combining machine learning (ML) and sustained phonation. For this purpose, 635 acoustic recordings of the sustained vowel /a/ and subjective ratings based on the roughness, breathiness, and hoarseness scale were collected from 595 subjects. A total of 50 temporal, spectral, and cepstral features were extracted from each recording and used to identify suitable ML algorithms. Using variance and correlation analysis followed by backward elimination, a subset of relevant features was selected. Recordings were classified into two levels of hoarseness, H<2 and H≥2, yielding a continuous probability score ŷ∈[0,1]. An accuracy of 0.867 and a correlation of 0.805 between the model's predictions and subjective ratings was obtained using only five acoustic features and logistic regression (LR). Further examination of recordings pre- and post-treatment revealed high qualitative agreement with the change in subjectively determined hoarseness levels. Quantitatively, a moderate correlation of 0.567 was obtained. This quantitative approach to hoarseness severity estimation shows promising results and potential for improving the assessment of voice quality.
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Affiliation(s)
- Tobias Schraut
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Anne Schützenberger
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Tomás Arias-Vergara
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Melda Kunduk
- Department of Communication Sciences and Disorders, Louisiana State University, Baton Rouge, Louisiana 70803, USA
| | - Matthias Echternach
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Munich, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Michael Döllinger
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
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Adessa M, Kim J, Tierney WS, Benninger M. Temporomandibular Dysfunction and Voice-Related Quality of Life Impairment. Laryngoscope 2024; 134:315-317. [PMID: 37530589 DOI: 10.1002/lary.30927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/30/2023] [Accepted: 07/18/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE Muscle tension in the head and neck may co-occur with temporomandibular dysfunction (TMD) possibly leading to voice change. Several studies have reported a correlation between TMD and dysphonia. However, literature on TMD and voice-related quality of life (QOL) is scant. This study aimed to investigate the relationship between TMD and self-perceived voice-related QOL impairment. METHODS Patients from TMD clinic were prospectively surveyed on voice-related quality of life using the Voice Handicap Index (VHI) questionnaire. Patients were queried using paper and pen upon initial evaluation in dentistry clinic for temporomandibular disorders by a single dentist or dental assistant in the otolaryngology department. RESULTS A total of 53 patients completed the VHI. 80% of patients presenting to TMD clinic had VHI scores above zero, but most had minimal to mild impairment. Forty-two patients had scores between 1 and 86, (average 10.98); 11 patients had a score of zero (20.75%). Total average score: 8.70, range: 0-86, median: 4. Functional average score: 3.13, range: 0-29, median: 1. Physical average score: 3.58. range: 0-25, median: 2. Emotional average score: 1.98, range: 0-32, median: 0; these averages did not differ from historical controls. CONCLUSION The majority of patients presenting to TMD clinic also presented with some level of voice-related QOL impairment, although minimal and consistent with historical VHI controls. Data indicates that TMD disease may be primarily defined as functionally and physically uncomfortable. Incorporation of interdisciplinary care, with laryngology, speech pathology, physical therapy, counseling, and pain management may be warranted. LEVEL OF EVIDENCE 4 Laryngoscope, 134:315-317, 2024.
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Affiliation(s)
- Michelle Adessa
- The Voice Center, Head & Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Jaehee Kim
- Case Western Reserve School of Medicine, Cleveland, Ohio, USA
| | - William S Tierney
- The Voice Center, Head & Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Michael Benninger
- The Voice Center, Head & Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
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Naunheim MR, Puka E, Huston MN. Do You Like Your Voice? A Population-Based Survey of Voice Satisfaction and Voice Enhancement. Laryngoscope 2023; 133:3455-3461. [PMID: 37309825 DOI: 10.1002/lary.30822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/06/2023] [Accepted: 05/29/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Voice enhancement for patients without obvious vocal pathology or loss of function is rarely discussed clinically or in academic research. Our objectives were to: (1) determine voice satisfaction on a population level, and (2) assess willingness to consider interventions to change one's voice. METHODS A standardized questionnaire was created to assess current and past voice disorders. Questions assessed demographics, health status, prevalence of voice disorders, and questions regarding satisfaction with voice. Iterative survey testing and piloting were performed. A cohort with age, gender, and geographic distribution of the general adult population was then queried in an online survey. Qualitative analysis and both descriptive and multivariate statistics were performed. RESULTS A total of 1522 respondents were included, with an age, gender, and regional distribution reflective of the US population. A minority (38.8%) of respondents reported that they did not like the sound of their own voice in normal conversation; when asked about listening to a recording of their own voice, a majority (57.5%) reported dissatisfaction with voice. Discontent with one's voice was associated with being middle age (p = 0.005), female gender (p < 0.0001), and white race (p < 0.0001). Approximately 50.6% of respondents without a history of dysphonia would consider interventions to change their voice. Of those who indicated they may elect to change their voice, qualities regarding clarity and pitch were paramount. CONCLUSION Dissatisfaction with one's speaking voice is common. A considerable percentage of the general population without a voice disorder would consider interventions to change their voice. LEVEL OF EVIDENCE 3 Laryngoscope, 133:3455-3461, 2023.
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Affiliation(s)
- Matthew R Naunheim
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Elefteria Puka
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Molly N Huston
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Griffin L, Kamarunas E, Smith JB, Kuo C, O'Donoghue C. Dysphonia Outperforms Voice Change as a Clinical Predictor of Dysphagia. Am J Speech Lang Pathol 2023; 32:2676-2690. [PMID: 37669615 DOI: 10.1044/2023_ajslp-23-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
PURPOSE Changes in voice quality after consuming food or drink have been used as a clinical indicator of dysphagia during the clinical swallowing evaluation (CSE); however, there is conflicting evidence of its efficacy. This study investigated if dysphonia and/or voice change after swallowing are valid predictors of penetration, aspiration, or pharyngeal residue. Our approach aimed to improve current methodologies by collecting voice samples in the fluoroscopy suite, implementing rater training to improve interrater reliability and utilizing continuous measurement scales, allowing for regression analyses. METHOD In this prospective study, 30 adults (aged 49-97 years) referred for a videofluoroscopic swallowing study (VFSS) were audio-recorded completing a sustained /i/ prior to VFSS and again after swallowing each bolus during the VFSS. Swallowing function was measured using the reorganized Penetration-Aspiration Scale and the Normalized Residue Ratio Scale. Following listener training, 84 voice samples were perceptually rated using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Ordinal and logistic regression were used to determine whether voice quality and voice quality change after swallowing were predictors of airway invasion and pharyngeal clearance. RESULTS Results indicated that the presence of dysphonia at baseline during a sustained /i/ task as measured by the CAPE-V predicted airway invasion but not pharyngeal residue. Voice change after swallowing associated with vowel /i/ production as measured by the CAPE-V did not predict either dysphagia measure. CONCLUSION These results indicate that voice change during a sustained /i/ after swallowing appears unrelated to airway invasion or pharyngeal residue; however, in the absence of known laryngeal pathology, dysphonia prior to a CSE should alert speech-language pathologists of a possible comorbid dysphagia.
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Affiliation(s)
- Lindsay Griffin
- Department of Communication Sciences & Disorders, School of Communication, Emerson College, Boston, MA
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
- Voice and Swallow Clinic, Sentara Rockingham Memorial Hospital, Harrisonburg, VA
| | - Erin Kamarunas
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
- Voice and Swallow Clinic, Sentara Rockingham Memorial Hospital, Harrisonburg, VA
| | - Julian Bergen Smith
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
- Department of Communication Disorders, College of Health and Human Services, Southern Connecticut State University, New Haven
| | - Christina Kuo
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
| | - Cynthia O'Donoghue
- Department of Communication Sciences and Disorders, College of Health and Behavioral Studies, James Madison University, Harrisonburg, VA
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Boominathan P, Mahalingam S, Arunachalam R, Venkatesh L. An eclectic Voice Therapy Program for the Treatment of Hyperfunctional Voice Disorders (HFVD). J Voice 2023; 37:969.e1-969.e21. [PMID: 34261583 DOI: 10.1016/j.jvoice.2021.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE An eclectic voice therapy program includes sequenced and structured set of exercises combining direct and indirect intervention methods. Tailor-made exercise prescription with specific cultural adaptations are needed to provide a holistic change to voice quality.1 This study detailed the construction of an exercise prescription for participants with hyperfunctional voice disorder [HFVD] in the Indian context. METHOD The exercise program was developed based on literature related to vocal therapy approaches and delivery methods. Adaptations were introduced to a selected set of exercises. Five voice experts verified the exercises and their prescription for content and feasibility of use in the Indian context. Modification suggested by the experts were included for framing the final version of the exercise program. This structured therapy program was planned for 6 weeks (30 minutes duration/session offered individually twice per week, with a gap of two days between sessions in a week) with the goals to improve voice quality, flexibility, and endurance while speaking. Five participants with HFVD partook in the study for pilot testing. Stroboscopy, perceptual voice analysis, Dysphonia Severity Index (DSI) and Vocal Fatigue Index in Tamil (VFI-T) were used to report the therapy outcomes. Participants' report on the learning process and generalization of the program were documented. Wilcoxon-signed rank test was used to test the pre-post outcome measures. RESULTS An eclectic voice therapy program, i.e., Comprehensive Voice Habilitation Program [CVHP] was constructed and it included vocal hygiene instructions, warm-up & cool-down, easy onset, resonant voice, and carry over exercises. Participants completed the program in 14-18 sessions (over 7 to 9 weeks of therapy). All participants showed significant changes in vocal fold movement patterns, reduction in ventricular hyperadduction, overall grade of voice quality, DSI and VFI-T. Participants reported that pictorial illustrations, feedback, and monitoring sheets were useful in learning the exercises. CONCLUSION CVHP showed significant change in the voice-related outcome measures and was a viable program for treating HFVD.
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Affiliation(s)
- Prakash Boominathan
- Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India.
| | - Shenbagavalli Mahalingam
- Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
| | - Ravikumar Arunachalam
- SRM Institute of Science & Technology, Kattankulathur, Chengalpattu, Tamil Nadu, India
| | - Lakshmi Venkatesh
- Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India
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Paiva MAAD, Machado LDS, Lopes LW. Proposal of requirements for the development of a training simulator for the auditory-perceptual judgment of voice. Codas 2023; 35:e20220209. [PMID: 37820100 DOI: 10.1590/2317-1782/20232022209pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/05/2022] [Indexed: 10/13/2023] Open
Abstract
PURPOSE to identify a set of requirements for the development of an auditory-perceptual training simulator (APT) based on the experience of professors who provide APT. METHODS This is a cross-sectional, descriptive study with a quantitative approach. Twenty-two professors answered an online questionnaire containing 31 items related to APT, involving items about the professional profile, conditions for APT in undergraduate and postgraduate courses in Speech Therapy, APT structure, and evaluation of the APT effect. RESULT it was observed that there is a variation in APT procedures performed in Brazil. The main requirements indicated by the respondents for the APT involve the use of synthesized voices in the initial moments, followed by human voices later; the use of speech tasks with sustained vowels and connected speech; the insertion of complementary information such as gender, age, the profession of the speaker and the spectrography of the vocal signal; training with a minimum time of six hours; the evaluation of the training effect by comparing intra- and inter-judge agreement before and after training; the addition of the parameters of general degree of vocal deviation, roughness, breathiness, and strain; the use of validated continuous and numerical scales; and offering it from the second year of the undergraduate program. CONCLUSION although there is variability in the response of experts, a minimum set of requirements indicated for performing APT with new judges was identified.
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Kuo YL, Chen M, Kimberley TJ. Probing the inhibitory motor circuits in adductor laryngeal dystonia during a dystonia-unrelated task. Parkinsonism Relat Disord 2023; 115:105812. [PMID: 37651926 PMCID: PMC10592018 DOI: 10.1016/j.parkreldis.2023.105812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/04/2023] [Accepted: 08/13/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND The pathophysiology of adductor laryngeal dystonia (AdLD) remains unknown; however, there is growing evidence that dystonia is associated with disruptions in the inhibitory regulation of sensorimotor cortical areas. Using functional MRI (fMRI) and transcranial magnetic stimulation (TMS) complementarily, we previously demonstrated an overly activated laryngeal motor cortex and revealed correlations between blood-oxygen-level dependent (BOLD) activation and intracortical inhibition in a phonation (dystonia-related) task in adductor laryngeal dystonia (AdLD). OBJECTIVE Here, we aimed to characterize the brain-based findings in the primary motor cortex (M1) during a dystonia-unrelated (finger tapping) task in AdLD and controls (CTL). METHODS We examined the between-group differences in task-dependent BOLD activation and intracortical inhibition, measured by the TMS-evoked cortical silent period (cSP), in the M1. The correlations between fMRI and TMS responses were assessed. RESULTS There is more broadly dispersed BOLD activation, not confined to the hand motor cortex, and reduced intracortical inhibition in AdLD compared to CTL. Further, there are more positive correlations between cSP and BOLD activation in a task unrelated to dystonic symptoms in AdLD compared with CTL. This is in contrast to our previous work that demonstrated fewer positive correlations in AdLD during a dystonic phonation task. CONCLUSIONS In unaffected musculature activation, there is dispersed BOLD activation that is correlated with intracortical inhibition suggesting a possible compensatory strategy in the non-dystonic muscles.
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Affiliation(s)
- Yi-Ling Kuo
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA.
| | - Mo Chen
- Neuroscience Research Program, Gillette Children's Specialty Healthcare, St. Paul, MN, USA; Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA.
| | - Teresa J Kimberley
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA; Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA, USA.
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Kelly E, Hirschwald J, Clemens J, Regan J. Persistent Features of Laryngeal Injury Following Endotracheal Intubation: A Systematic Review. Dysphagia 2023; 38:1333-1341. [PMID: 36774422 PMCID: PMC9922098 DOI: 10.1007/s00455-023-10559-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 01/27/2023] [Indexed: 02/13/2023]
Abstract
This systematic review examined (i) prevalence, severity, and impact of persistent post-extubation laryngeal injury beyond hospital discharge and (ii) differences in persistent laryngeal injury between COVID-19 and non-COVID-19 populations. The review was completed following PRISMA-2020 guidelines. Four databases (PubMed, CINHAL complete, EMBASE, Web of Science) were searched (inception to March 2021). Screening, full text review and data extraction were completed by two reviewers. Primary outcomes were swallow, voice and cough and airway measures obtained after hospital discharge. Quality assessment was measured using Downs & Black Tool and Johanna Briggs Institute Checklist for Cohort Studies. Meta-analysis was not completed due to study heterogeneity. Six cohort studies were included. Total number of participants across the included studies was 436. ICU admission diagnoses included respiratory disease 46% (COVID-19 and non-COVID-19), sepsis 14%, non-sepsis-related organ dysfunction 9%, general medical 11%, general surgical 10%, trauma 2%, ENT 0.6% and other not specified by authors 7%. Outcomes were obtained between 2 and 60 months post hospital discharge. Assessment methods included endoscopic evaluation, clinician ratings and patient-reported outcomes. Persistent features of laryngeal injury identified were airway abnormalities (18.9-27%), dysphonia (13.2-60%) and dysphagia (23-33%). Persistent laryngeal injury was associated with ICU length of stay, respiratory diagnosis and tracheostomy. Study quality ranged from poor-good. This is the first systematic review to examine post-extubation laryngeal injury beyond hospital discharge. Significant gaps in the literature were identified. Given the impact on clinical and patient outcomes, large scale, well-designed research is needed to guide post-ICU service delivery.
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Affiliation(s)
- Eileen Kelly
- Department of Clinical Speech & Language Studies, Trinity College Dublin, Dublin, Ireland.
- Highly Specialist Speech & Language Therapist, Adult Critical Care Unit, Royal London Hospital, London, UK.
| | - Julia Hirschwald
- Department of Clinical Speech & Language Studies, Trinity College Dublin, Dublin, Ireland
| | | | - Julie Regan
- Department of Clinical Speech & Language Studies, Trinity College Dublin, Dublin, Ireland
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Lechien JR, Hans S, Crevier-Buchman L. Influence of age on voice quality after transoral CO 2 laser microsurgery. J Otolaryngol Head Neck Surg 2023; 52:59. [PMID: 37697412 PMCID: PMC10496204 DOI: 10.1186/s40463-023-00664-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/28/2023] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVE To study the post-operative evolution of voice quality of patients treated by transoral CO2 laser microsurgery (TLM) according to the age. METHODS Patients treated by type I to VI TLM and post-operative speech therapy were prospectively recruited from our hospital. The voice quality was assessed pre-, 1-, 3- 6- and 12-month posttreatment with voice handicap index (VHI), dysphonia, roughness, breathiness, asthenia, strain (GRBAS), maximal phonation time (MPT), F0, F0 standard deviation (STD), percent jitter, percent shimmer, noise-to-harmonic ratio (NHR), vocal fold vibration assessment and speech fluency. Evolution of voice outcomes was analyzed considering age of patients (< 60 vs. ≥ 60 years). RESULTS Seventy-five patients completed the evaluations. Thirty-four and forty-one patients were < 60 or ≥ 60 yo, respectively. Subjective and objective voice parameters (VHI, G, R, B), jitter and fluency significantly improved from 1- to 6-month post-TLM in < 60 yo individuals. The voice parameters improved 12-month post-TLM in the ≥ 60 yo group at the exception of VHI that improved 3-month post-TLM. There were positive associations between age and 12-month NHR, G and A parameters. CONCLUSION The post-operative evolution of voice quality parameters may vary between patients according to the age. Preoperative VHI is predictive of 12-month subjective and objective voice outcomes.
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Affiliation(s)
- Jerome R Lechien
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
- Department of Otolaryngology-Head & Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, Brussels, Belgium.
- Department of Otolaryngology, Polyclinic of Poitiers, Elsan Hospital, Poitiers, France.
- Faculty of Medicine, Department of Human Anatomy and Experimental Oncology, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
- Phonetics and Phonology Lab, CNRS UMR7018, Univ. Sorbonne University, Paris, France.
| | - Stephane Hans
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
- Phonetics and Phonology Lab, CNRS UMR7018, Univ. Sorbonne University, Paris, France
| | - Lise Crevier-Buchman
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
- Phonetics and Phonology Lab, CNRS UMR7018, Univ. Sorbonne University, Paris, France
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Latoszek BBV, Hetjens S. [Efficacy of Novafon Local Vibration Voice Therapy and Water Resistance Therapy: a meta-analysis]. Laryngorhinootologie 2023; 102:662-668. [PMID: 36580973 DOI: 10.1055/a-1976-9766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Treatment approaches for voice therapy are diverse and two treatment approaches in voice therapy with assistive devices will be evaluated and compared for efficacy. Evaluations of the treatment effects of different approaches are important for clinical consultation and evidence-based practice. AIM To evaluate the efficacy of Novafon Local Vibration Voice Therapy (NLVVT) and Water Resistance Therapy (WRT) using Voice Handicap Index (VHI). DESIGN Systematic literature search and meta-analysis with random effects model. DATA SOURCES The analysis of two databases (MEDLINE and CENTRAL) and a manual search from inception to September 19th 2021. STUDY SELECTION Any clinical trial with case series in a pre-post design written in English or German that tested the efficacy of NLVVT or WRT using VHI (functional [F], physical [P], and emotional [E] aspects, and total score [T]) in adult voice patients with an organic or functional voice disorder was considered. RESULTS Five eligible studies were identified (NLVVT n= 22; WRT n= 42). Both treatment approaches showed highly significant improvement in all aspects of the VHI (p-values< 0.01). In direct comparison, NLVVT achieved significantly higher improvements in VHI-T, VHI-F and VHI-E than WRT (p-values< 0.01). Comparable improvement was received in VHI-P (p= 0.28). CONCLUSION NLVVT and WRT are effective treatments for voice disorders related to the subjective evaluation of a voice disorder. In direct comparison, NLVVT achieved higher improvements than WRT in most VHI aspects.
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Affiliation(s)
| | - Svetlana Hetjens
- Abteilung für Medizinische Statistik, Biomathematik und Informationsverarbeitung, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
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Page AD, Schroeder JR, Knowles T, Jog M, Adams SG. A Comparison of Voice Amplifiers and Personal Communication Systems for Hypophonia: An Exploration of Communicative Participation. Am J Speech Lang Pathol 2023; 32:1850-1865. [PMID: 36958017 DOI: 10.1044/2023_ajslp-22-00161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE The primary purpose of this study was to evaluate how individuals with hypophonia (HP; also referred to as HP participants) and their primary communication partners (PCPs; also referred to as PCP participants) rate communicative participation before and after experience with a speech amplification device. A secondary purpose was to evaluate pre- and post-device effects on self-rated communicative participation for each of the three speech amplification devices trialed outside of the laboratory. METHOD Seventeen individuals with HP and their PCPs participated in a crossover design study that compared three different amplification devices: a wired belt-pack amplifier, a wireless stationary amplifier, and a personal frequency modulation (FM) system. Both the individuals with HP and their PCPs self-rated communicative participation at baseline and after trialing each device following 1-week device trial periods at home. Patient-reported outcome measures included the Communicative Effectiveness Survey (CES) and the Voice Activity and Participation Profile (VAPP). Following study completion, participants indicated whether they would like to select a specific device to continue using. RESULTS Overall, HP participants rated communicative participation following device use higher than that in the pre-device condition, with the FM system resulting in the overall highest VAPP ratings and second highest CES ratings. Furthermore, HP and PCP participants rated these measures similarly. Finally, HP participants who selected a device to continue using self-reported lower total communicative effectiveness scores and greater voice activity limitations and participation restrictions at baseline in comparison to the nonselectors. CONCLUSIONS This study contributes to an increased understanding of how communicative participation is experienced within this clinical population resulting from speech amplification. It is suggested that the inclusion of participation-based outcome measurement is essential to ensure a multidimensional and comprehensive approach to device prescription for individuals with HP.
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Affiliation(s)
- Allyson D Page
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
| | - Jessi-Rae Schroeder
- Health & Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - Thea Knowles
- Department of Communicative Disorders and Sciences, The State University of New York at Buffalo
| | - Mandar Jog
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Scott G Adams
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
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Tsai LYJ, Chan RW, Shen C, Chen Z, Zhuang P, Chiang YN, Tai SK, Xue K. A 4-Week Straw Phonation in Water Exercise Program for Aging-Related Vocal Fold Atrophy. J Speech Lang Hear Res 2023; 66:2581-2599. [PMID: 37459605 DOI: 10.1044/2023_jslhr-23-00071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
PURPOSE This study evaluated the efficacy of a 4-week straw phonation in water (SPW) exercise program on aging-related vocal fold atrophy (VFA), with a secondary objective to examine the immediate effects of SPW exercises. METHOD Thirty-eight older adults aged 60 years and above formally diagnosed with aging-related VFA were randomly assigned into an experimental group undergoing SPW exercises with an 8-cm depth of straw submersion into water for 4 weeks plus vocal hygiene practice (n = 20), and a control group with only vocal hygiene practice (n = 18). Outcome measures included laryngeal endoscopic measures of glottal gap, auditory-perceptual ratings of voice quality, acoustic measures, aerodynamic measures, and standardized self-assessment questionnaire scores. An additional round of acoustic and aerodynamic assessment following 20 min of SPW exercises was conducted to examine the immediate effects. RESULTS Significant improvements in normalized glottal gap area, perceptual rating of breathiness, smoothed cepstral peak prominence, harmonics-to-noise ratio (HNR), mean oral airflow, subglottal pressure and laryngeal airway resistance at comfortable loudness, Voice-related Quality of Life scores, and Chinese Vocal Fatigue Index Factor 3 scores were observed in the experimental group relative to the control group. There were also significant immediate effects for HNR, mean oral airflow, subglottal pressure, and laryngeal airway resistance. CONCLUSIONS These findings suggested significant immediate improvements in vocal function following SPW exercises, with additional significant improvements in vocal function as well as significant improvements in quality of life following the 4-week SPW exercise program. Further studies with more long-term follow-up are recommended to better understand the efficacy of SPW exercises with deep levels of straw submersion into water as an effective clinical option for the management of hypofunctional dysphonia associated with aging-related VFA.
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Affiliation(s)
- Lydia Yueh-Ju Tsai
- Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taiwan
| | - Roger W Chan
- Geriatric Care Research Center, Xiamen Medical College, Xiamen, Fujian, China
- Department of Voice Medicine, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Cuiling Shen
- Geriatric Care Research Center, Xiamen Medical College, Xiamen, Fujian, China
| | - Zusen Chen
- Geriatric Care Research Center, Xiamen Medical College, Xiamen, Fujian, China
| | - Peiyun Zhuang
- Department of Voice Medicine, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Yu-Ning Chiang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shyh-Kuan Tai
- Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taiwan
| | - Keying Xue
- Institute of Respiratory Diseases, Xiamen Medical College, China
- Department of Respiratory Medicine, Second Affiliated Hospital, Xiamen Medical College, Xiamen, Fujian, China
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Park DS, Cho EH, Park KH, Jo SM, Park B, Huh S. A case of vocal cord gnathostomiasis diagnosed with sectional morphologies in a histopathological specimen from a Chinese woman living in Korea. Parasites Hosts Dis 2023; 61:298-303. [PMID: 37648235 PMCID: PMC10471466 DOI: 10.3347/phd.23065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/23/2023] [Indexed: 09/01/2023]
Abstract
This study aimed to describe a rare case of gnathostomiasis in the vocal cord. A 54-year-old Chinese woman living in Korea visited with a chief complaint of voice change at the outpatient department of otorhinolaryngology in Hallym Sacred Heart Hospital, Hallym University on August 2, 2021. She had eaten raw conger a few weeks before the voice change developed, but her medical history and physical examinations demonstrated neither gastrointestinal symptoms nor other health problems. A round and red cystic lesion, recognized in the anterior part of the right vocal cord, was removed using forceps and scissors through laryngeal microsurgery. The histopathological specimen of the cyst revealed 3 cross-sections of a nematode larva in the lumen of the cyst wall composed of inflammatory cells and fibrotic tissues. They differ in diameter, from 190 μm to 235 μm. They showed characteristic cuticular layers with tegumental spines, somatic muscle layers, and gastrointestinal tracts such as the esophagus and intestine. Notably, intestinal sections consisted of 27-28 lining cells containing 0-4 nuclei per cell. We tentatively identified the nematode larva recovered from the vocal cord cystic lesion as the third-stage larva of Gnathostoma, probably G. nipponicum or G. hispidum, based on the sectional morphologies.
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Affiliation(s)
- Doo Sik Park
- Department of Otorhinolaryngology, Hallym University Sacred Heart Hospital, Anyang 14068,
Korea
| | - Eun Hyun Cho
- Department of Otorhinolaryngology, Hallym University Sacred Heart Hospital, Anyang 14068,
Korea
| | - Kyung Hoon Park
- Department of Otorhinolaryngology, Hallym University Sacred Heart Hospital, Anyang 14068,
Korea
| | - Soo Min Jo
- Department of Otorhinolaryngology, Hallym University Sacred Heart Hospital, Anyang 14068,
Korea
| | - Bumjung Park
- Department of Otorhinolaryngology, Hallym University Sacred Heart Hospital, Anyang 14068,
Korea
| | - Sun Huh
- Department of Parasitology and Institute of Medical Education, College of Medicine, Hallym University, Chuncheon 24252,
Korea
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Buckley DP, Abur D, Stepp CE. Normative Values of Cepstral Peak Prominence Measures in Typical Speakers by Sex, Speech Stimuli, and Software Type Across the Life Span. Am J Speech Lang Pathol 2023; 32:1565-1577. [PMID: 37257202 PMCID: PMC10473385 DOI: 10.1044/2023_ajslp-22-00264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/15/2022] [Accepted: 03/16/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE The purpose of this study was to determine normative values for cepstral peak prominence measures across the life span as a function of sex using clinically relevant stimuli (/ɑ/, /i/, and two sentences of The Rainbow Passage) and two commonly used software types: Praat (Version 6.0.50) and Analysis of Dysphonia in Speech and Voice (ADSV). METHOD One hundred fifty speakers (75 males, 75 females; evenly distributed into three age groups) without voice disorders aged 18-91 years were recorded via headset microphone in a sound-treated booth. Cepstral measures were analyzed using common analysis methods in Praat and ADSV by sex, stimuli, and software type. Kruskal-Wallis tests and post hoc Mood's Median tests for significant factors were performed on cepstral measures to assess the effects of age group, sex, stimuli, and software type. RESULTS The results revealed statistically significant effects of sex, stimuli, and software type on cepstral measures, but no statistical effect of age group on cepstral values. Females had lower average cepstral values compared to males. Across stimuli, the highest average cepstral measure was found for sustained /ɑ/, followed by sustained /i/, and then of the two sentences of The Rainbow Passage. Average cepstral measures in Praat were higher than those from ADSV. CONCLUSIONS The current work did not find a statistical effect of age group on cepstral values; thus, normative cepstral values were reported by sex, stimuli, and software type. Future work should examine the applicability of these normative values for discriminating speakers with and without voice disorders.
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Affiliation(s)
- Daniel P. Buckley
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- Department of Otolaryngology – Head and Neck Surgery, Boston University School of Medicine, MA
| | - Defne Abur
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- Department of Computational Linguistics, University of Groningen, the Netherlands
- Research School of Behavioral and Cognitive Neurosciences, University of Groningen, the Netherlands
| | - Cara E. Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- Department of Otolaryngology – Head and Neck Surgery, Boston University School of Medicine, MA
- Department of Biomedical Engineering, Boston University, MA
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Colletti L, Heller Murray E. Voice Onset Time in Children With and Without Vocal Fold Nodules. J Speech Lang Hear Res 2023; 66:1467-1478. [PMID: 36940476 PMCID: PMC10457081 DOI: 10.1044/2023_jslhr-22-00463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/21/2022] [Accepted: 01/16/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Voice onset time (VOT) of voiceless consonants provides information on the coordination of the vocal and articulatory systems. This study examined whether vocal-articulatory coordination is affected by the presence of vocal fold nodules (VFNs) in children. METHOD The voices of children with VFNs (6-12 years) and age- and gender-matched vocally healthy controls were examined. VOT was calculated as the time between the voiceless stop consonant burst and the vocal onset of the vowel. Measures of the average VOT and VOT variability, defined as the coefficient of variation, were calculated. The acoustic measure of dysphonia, cepstral peak prominence (CPP), was also calculated. CPP provides information about the overall periodicity of the signal, with more dysphonic voices having lower CPP values. RESULTS There were no significant differences in either average VOT or VOT variability between the VFN and control groups. VOT variability and average VOT were both significantly predicted by the interaction between Group and CPP. There was a significant negative correlation between CPP and VOT variability in the VFN group, but no significant relationship was found in the control group. CONCLUSIONS Unlike previous studies with adults, there were no group differences in average VOT or VOT variability in this study. However, children with VFNs who were more dysphonic had increased VOT variability, suggestive of a relationship between dysphonia severity and control of vocal onset during speech production.
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Affiliation(s)
- Lauren Colletti
- Department of Communication Sciences and Disorders, College of Public Health, Temple University, Philadelphia, PA
| | - Elizabeth Heller Murray
- Department of Communication Sciences and Disorders, College of Public Health, Temple University, Philadelphia, PA
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Hernandez BO, Nagatsuka M, Wright SC, Marcellino AJ, Lovin BD, Walker FO, Madden LL. Hemodynamic Changes Associated With Transcervical Laryngeal Injection of Botulinum Toxin. J Voice 2023; 37:452-455. [PMID: 33541763 PMCID: PMC8325702 DOI: 10.1016/j.jvoice.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/01/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Laryngeal dystonia is a chronic neurologic disorder characterized by intention-induced spasms of the vocal folds driven by aberrant central motor processing. The use of in-office transcervical botulinum toxin injection for the treatment of laryngeal disorders, such as laryngeal dystonia, has been deemed safe and efficacious. There is, however, no available data outlining the hemodynamic changes experienced by patients undergoing this frequently performed procedure. METHODS One hundred and one patients diagnosed with laryngeal dystonia were enrolled in this prospective study. These patients underwent transcervical laryngeal botulinum toxin injection to address their dysphonia. Vital signs where acquired prior to, and at the time of injection. Alterations in these parameters were then evaluated for statistical significance. RESULTS Statistically significant increases in mean heart rate (5.8 ± 10.8 bpm, P < 0.0001), systolic blood pressure and diastolic blood pressure (7.0 ± 9.5 mm Hg, P < 0.0001; 8.7 ± 14.7 mm Hg, P < 0.0001) were discovered. No statistically significant difference in oxygen saturation was noted and no patients in the study faced major adverse outcomes. CONCLUSIONS Though these findings may not have related to clinically significant complication, our study demonstrates the importance of understanding potential stressors in a procedure routinely performed by laryngologists. This may result in more careful patient selection, alterations in procedure, and improved safety by acting in a timely fashion if alarming changes in hemodynamic parameters are noted.
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Affiliation(s)
- Brian O Hernandez
- Department of Otolaryngology Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Moeko Nagatsuka
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Stephen Carter Wright
- Department of Otolaryngology Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Amanda J Marcellino
- Department of Otolaryngology Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Benjamin D Lovin
- Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Francis O Walker
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lyndsay L Madden
- Department of Otolaryngology Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina.
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Sotome T, Kanazawa T, Konomi U, Maeara N, Misawa K, Takahashi S, Fukaura J, Watanabe Y. Analysis of Speech Fundamental Frequencies for Different Tasks in Japanese. J Voice 2023; 37:299.e1-299.e8. [PMID: 33455851 DOI: 10.1016/j.jvoice.2020.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE Speech fundamental frequency (SFF) assessment is essential for all dysphonia patients to effectively evaluate the therapeutic effects of voice therapy, especially in patients with disturbances in their voice pitch due to mutational dysphonia, Reinke's edema, or as side effects of hormone therapy. A standard method of SFF measurement remains unknown. Speech tasks such as sustained vowel phonation, counting, reading passage, and spontaneous speech have generally been used for SFF measurements. Ideally, spontaneous speech best reflects SFF; however, this task has not yet been clearly defined and is limited with regard to its adaptation to a clinical setting. A reliable task for SFF measurement in Japanese, which corresponds to a speech task that most closely reflects the value that would be observed with typical spontaneous speech, has not been investigated. This study aimed to identify a reliable speech task by measuring the SFF values elicited by different widely used speech tasks in Japanese, and assess its reliability and coefficient of determination (R2). METHODS Sixty healthy volunteers (30 men and 30 women; aged 19-30 years; mean age 22.5 years) were enrolled. All experimental procedures were performed in Japanese. The SFF values for the speech tasks were determined through the voice samples recorded using a Pulse Code Modulation (PCM) recorder. Each task, except spontaneous speech, was repeated five times, and the average fundamental frequency in each task was determined as the SFF. To assess the reliability of the SFF values across daily variations within individual speakers, the SFF measurements were repeated on two different days, separated by at least 1 week. RESULTS The SFF values of sustained /a/ phonation, sustained vowel-average, counting, reading passage, and spontaneous speech had excellent reliability, in terms of their reproduction based on intraclass correlation. Significantly high SFF values were observed, in decreasing order, for sustained vowels-average, counting, reading passage, and spontaneous speech in both males and females. The highest R2 for spontaneous speech was that of reading passage in both males (R2 = 0.771) and females (R2 = 0.806) (P < 0.01). CONCLUSION When spontaneous speech was presented as a task most reflective of daily conversation, reading passage was determined to be the reliable task to assess the therapeutic effect of voice therapy in Japanese.
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Affiliation(s)
- Taisuke Sotome
- Center of Rehabilitation, Sanno Hospital, Tokyo 107-0052, Japan; Tokyo Voice Center, International University of Health and Welfare, Tokyo 107-0052, Japan
| | - Takeharu Kanazawa
- Tokyo Voice Center, International University of Health and Welfare, Tokyo 107-0052, Japan; Department of Otolaryngology-Head and Neck Surgery, School of Medicine, International University of Health and Welfare, Tokyo 107-0052, Japan; Divison of Laryngeal Surgery, Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Jichi Medical University, Shimotsuke 329-0498, Japan.
| | - Ujimoto Konomi
- Tokyo Voice Center, International University of Health and Welfare, Tokyo 107-0052, Japan; Voice and Dizziness Clinic Futakotamagawa Otolaryngology, Tokyo 158-0094, Japan
| | - Naoshi Maeara
- Department of Speech and Hearing Sciences, School of Health Sciences, International University of Health and Welfare, Ohtawara, 324-8501, Japan
| | - Kiyoshi Misawa
- Department of Otolaryngology-Head and Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Satoka Takahashi
- Divison of Laryngeal Surgery, Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Jichi Medical University, Shimotsuke 329-0498, Japan
| | - Junichi Fukaura
- Department of Speech, Language and Hearing Sciences, International University of Health and Welfare Graduate School, Okawa 831-8501, Japan
| | - Yusuke Watanabe
- Tokyo Voice Center, International University of Health and Welfare, Tokyo 107-0052, Japan; Department of Otolaryngology-Head and Neck Surgery, School of Medicine, International University of Health and Welfare, Tokyo 107-0052, Japan
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Vance D, Shah P, Sataloff RT. COVID-19: Impact on the Musician and Returning to Singing; A Literature Review. J Voice 2023; 37:292.e1-292.e8. [PMID: 33583675 PMCID: PMC7808728 DOI: 10.1016/j.jvoice.2020.12.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this study was to review current literature of the impact of COVID-19 on musicians and returning to singing. METHODS A comprehensive search of peer-review articles was completed using PubMed, GoogleScholar, Scopus, and Web of Science. The search was completed using many key terms including voice, hoarseness, dysphonia, aphonia, cough, singers, and public speakers. The bibliography from each article found was searched to find additional articles. The search process revealed 56 peer-reviewed articles, 18 primary articles, ranging from the years 2019 to 2020. CONCLUSION COVID-19 has had a major impact on singers and other musicians worldwide. It can affect the voice and can lead to paresis/paralysis of laryngeal nerves to long-term changes in respiratory function. There is a risk from aerosolization/droplet formation transmission with singing, and with playing wind and brass instruments that can be mitigated by following COVID-19 guidelines. Ways to reduce possible transmission during singing and instrument play include virtual rehearsals or performances, mask-wearing, instrument covers, smaller choirs, performing outside, excellent ventilation being socially distanced, shorter rehearsals, regularly cleaning commonly touched surfaces and washing hands, avoiding contact with others, and temperature screening.
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Affiliation(s)
- Dylan Vance
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Priyanka Shah
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Lankenau Institute for Medical Research, Wynnewood, Pennsylvania.
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Antonetti AEDS, Vitor JDS, Guzmán M, Calvache C, Brasolotto AG, Silverio KCA. Efficacy of a Semi-Occluded Vocal Tract Exercises-Therapeutic Program in Behavioral Dysphonia: A Randomized and Blinded Clinical Trial. J Voice 2023; 37:215-225. [PMID: 33413982 DOI: 10.1016/j.jvoice.2020.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE Semi-occluded vocal tract exercises (SOVTE) may improve the source and filter interaction by changing the acoustic characteristics and the impedance of the vocal tract, both in dysphonic and vocally healthy populations. However, there are a few studies that verify the effects of these exercises in a clinical trial. Thus, this study's purpose was to analyze the effectiveness of the SOVTE-Therapeutic Program (SOVTE-TP) in vocal quality and self-assessment, comparing it with Vocal Function Exercises. METHOD Eighteen (eight men; 10 women), ages 18-50, with behavioral dysphonia participated in this randomized and blinded clinical trial. The participants were equally randomized into two groups: Experimental Group and Vocal Function Exercises Group. They were assessed at three moments: before the treatment, after finishing it, and one month after finishing the treatment--follow up. Acoustic measures (ie, fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, cepstral peak-smoothed, alpha ratio, and L1-L0), auditory-perceptual analysis, vocal fatigue index (VFI), self-perceived resonant voice, and vocal handicap index-30 (VHI-30) were measured at all assessment moments. For the two groups, the interventions happened twice per week (four weeks) and lasted 35 minutes. It was applied the repeated-measures ANOVA test (P< 0.05) and Tukey Test. RESULTS The acoustic measures and auditory-perceptual had no differences between the groups and moments, respectively, which means that SOVTE-TP did not cause any harm. The auditory-perceptual analysis showed a mild deviation of participants' vocal quality. All groups reduced the VFI and VHI-30 scores in M2 and kept these results at M3 also, the vocal economy sensation increased in M2, decreasing slightly in M3. CONCLUSION SOVTE-TP has positive effects regarding self-assessment (VFI, VHI, and resonant voice quality) on patients with mild behavioral dysphonia, and it provides the same effects as VFE.
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Affiliation(s)
- Angélica Emygdio da Silva Antonetti
- Speech-Language Pathology and Audiology Department at Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brazil.
| | | | - Marco Guzmán
- Department of Communication Sciences and Disorders at Universidad de los Andes, Santiago, Chile
| | - Carlos Calvache
- Master, professor at the Department fo Communication Sciences and Disorders at Corporación Universitária Iberoamericana and Vocology Center, Bogotá, Colombia
| | - Alcione Ghedini Brasolotto
- Speech-Language Pathology and Audiology Department at Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brazil
| | - Kelly Cristina Alves Silverio
- Speech-Language Pathology and Audiology Department at Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brazil
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Nacci A, Capobianco S, Mazzoni L, Fattori B, Barillari MR, Genovese E, Berrettini S, Bastiani L. Development of a New Self-Assessment Tool for Laryngopharyngeal Reflux Screening in Singers (SVHI-12-LPR). Folia Phoniatr Logop 2023; 75:284-294. [PMID: 36822157 DOI: 10.1159/000529800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/16/2023] [Indexed: 02/25/2023] Open
Abstract
INTRODUCTION The present study aimed to develop a new tool for the evaluation of singers with self-reported symptoms suggestive of laryngopharyngeal reflux (LPR) (the SVHI-12-LPR), by correlating RSI with SVHI in a population sample of 163 subjects (both professional and amateur singers), evaluated also by videolaryngostroboscopy. This study was a cross-sectional, double-observational study. METHODS RSI and SVHI were administered to 159 singers (amateurs, singing students, and professional singers). All subjects underwent videolaryngostroboscopy to objectively identify four subgroups: normal subjects (41.5%), subjects with organic lesions occupying the glottic space (17.6%), subjects with functional dysphonia (18.2%), and subjects presenting solely signs suggestive of LPR (22.6%). Using the validated RSI threshold, 33.9% of participants presented an RSI total score >13, suggestive of LPR. RESULTS Subjects with a suspected diagnosis of LPR at videolaryngostroboscopy presented a mean RSI significantly higher than other subgroups (p < 0.001). Moreover, the SVHI-36 score did not statistically differ between pathological subgroups. A significant positive relationship was observed between RSI and SVHI total score (Spearman's rank correlation coefficient [ρ] = 0.474, p < 0.001). 12 SVHI items (items 1, 2, 4, 5, 6, 7, 12, 20, 24, 25, 26, 30) showed a significant association with RSI pathology classification. Statistical analysis demonstrated for the 12 selected items (SVHI-12-LPR) acceptable specificity (0.691) and sensibility (0.833) for the suspected diagnosis of LPR with a cut-off of 15. CONCLUSIONS From the SVHI-36, 12 items were extracted that correlated with the specific impact that LPR has on the singer's voice (SVHI-12-LPR), as evaluated by RSI and videolaryngostroboscopy. Such questionnaire represents a new tool that could be applied to singers with symptoms suggestive of LPR to select which patients would benefit from a further phoniatric and videolaryngostroboscopic evaluation.
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Affiliation(s)
- Andrea Nacci
- ENT, Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Silvia Capobianco
- ENT, Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Laura Mazzoni
- Department of Diagnostic, Clinical and Public Health, Audiology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Bruno Fattori
- ENT, Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Maria Rosaria Barillari
- Department of Mental and Physical Health and Preventive Medicine, "L. Vanvitelli" University, Naples, Italy
| | - Elisabetta Genovese
- Department of Diagnostic, Clinical and Public Health, Audiology Unit, University of Modena and Reggio Emilia, Modena, Italy
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Swift WM, Churnin IT, Hamdi OA, Strumpf AM, Koehn HA, Cottler PS, Daniero JJ. A Simple and Reproducible In Vivo Rabbit Phonation Model for Glottic Insufficiency. Otolaryngol Head Neck Surg 2023; 168:203-209. [PMID: 35763368 DOI: 10.1177/01945998221107813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/27/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study is to describe an in vivo rabbit phonation model for glottic insufficiency that is simple and reproducible by means of unilateral transcricothyroid laryngeal muscle stimulation and high-speed video recordings of evoked phonation. STUDY DESIGN Nonrandomized controlled animal trial. SETTING Academic medical center. METHODS A single operation including evoked phonation with bilateral and unilateral transcricothyroid laryngeal muscle stimulation conditions was modeled using 6 New Zealand white rabbits. The effect of stimulation method on glottic cycle, pitch, and loudness was compared. Endoscopic recordings using 5000 frames-per-second image capture technology and audiologic recordings were obtained for all phonation conditions. Primary outcome measures included means of maximum glottal area (MGA)/length pixel ratio, right and left amplitude/length pixel ratios, calculated cycle frequency, auditory recorded frequency, and maximum auditory intensity. Measurements were obtained via pixel counts using ImageJ. RESULTS Mean MGA/length was significantly greater with unilateral, 20.30, vs bilateral, 9.62, stimulation (P = .043). Mean frequency of 479.92 Hz vs 683.46 Hz (P = .027) and mean maximum intensity of 76.3 dB vs 83.5 dB (P = .013) were significantly increased from unilateral to bilateral stimulation. There was no significant difference in mean right amplitude/length between unilateral and bilateral. CONCLUSION The described model demonstrates a simple and reproducible means of producing glottic insufficiency due to unilateral vocal fold bowing and represents a pathway for better understanding the biomechanics and pathophysiology of glottic insufficiency due to superior laryngeal nerve injury and vocal fold immobility and offers the potential to compare treatment modalities through in vivo study.
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Affiliation(s)
- William M Swift
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
| | - Ian T Churnin
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Osama A Hamdi
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Andrew M Strumpf
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Heather A Koehn
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta, Georgia, USA
| | - Patrick S Cottler
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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Abstract
PURPOSE Autonomic nervous system dysfunction has been implicated in the development and persistence of hyperfunctional voice disorders (HVDs). The purpose of this study was to determine the effects of cognitive stress, which is known to arouse the autonomic nervous system, on voice acoustics in female speakers with and without HVDs. METHOD Adult female speakers-66 with HVDs, 66 without-were recorded while speaking with and without a cognitive stressor. Root-mean-square (RMS) of amplitude, fundamental frequency (f o), low-to-high spectral energy ratio (L/H ratio), cepstral peak prominence (CPP), and relative f o (RFF) were measured for each speaker and cognitive stress condition. Mixed-model analyses of variance and post hoc t tests were conducted to determine if cognitive stress affected voice acoustics and whether voice changes were greater for those with HVDs. RESULTS All measures differed significantly under cognitive stress for speakers with and without HVDs. RMS and CPP increased whereas f o, CPP, and RFF decreased under cognitive stress. Changes in these measures were not greater in those with HVDs. CONCLUSION Cognitive stress and presumed autonomic arousal affect voice similarly in female speakers with and without HVDs.
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Affiliation(s)
- Kimberly L. Dahl
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - Cara E. Stepp
- Department of Biomedical Engineering, Boston University, MA
- Department of Otolaryngology—Head & Neck Surgery, Boston University School of Medicine, MA
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Venkatraman Y, Mahalingam S, Boominathan P. Development and Validation of Sentences in Tamil for Psychoacoustic Evaluation of Voice Using the Consensus Auditory-Perceptual Evaluation of Voice. J Speech Lang Hear Res 2022; 65:4539-4556. [PMID: 36368051 DOI: 10.1044/2022_jslhr-22-00169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) is a standardized instrument used in voice assessment to assess voice quality. It has been translated and culturally adapted in several languages. This study aimed at developing and validating a Tamil version of CAPE-V through auditory perceptual evaluation of remotely recorded voice samples. METHOD The Tamil version was adapted with permission from the American Speech-Language-Hearing Association to match the rationale in English CAPE-V. The sentences were constructed by the first author and validated for content by two panels of experts. Forty-five participants (15 cases and 30 controls) were included in the study. Data recording was conducted online (Zoom Video Communications, Inc., app) for all samples. Three raters participated in the auditory evaluation and scored all samples using Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale followed by CAPE-V with a week gap in between. Twenty percent of samples were repeated to assess intrarater reliability. The intrarater and interrater reliability measures for Tamil CAPE-V were established using intraclass coefficients (ICCs). To ensure construct validity, group differences were determined between the cases and controls. The concurrent validity was established by correlating Tamil CAPE-V with the GRBAS scale. RESULTS The intrarater reliability for Tamil CAPE-V ranged from moderate to excellent (ICC: .610-.998). The Tamil CAPE-V obtained moderate to good interrater reliability for all parameters (ICC: .525-.790) except pitch (ICC: .405). The differences between the cases and controls were statistically significant (p < .01). The correlation between CAPE-V and GRBAS was strong for overall severity, breathiness, and strain (r s = .725-.861) and moderate for roughness (r s = .678). CONCLUSION The Tamil CAPE-V is a reliable and valid tool for auditory perceptual evaluation in Tamil-speaking populations. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21513885.
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Affiliation(s)
- Yamini Venkatraman
- Department of Speech, Language and Hearing Sciences, Sri Ramachandra Faculty of Audiology & Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, India
| | - Shenbagavalli Mahalingam
- Department of Speech, Language and Hearing Sciences, Sri Ramachandra Faculty of Audiology & Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, India
| | - Prakash Boominathan
- Department of Speech, Language and Hearing Sciences, Sri Ramachandra Faculty of Audiology & Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, India
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Park Y, Anand S, Kopf LM, Shrivastav R, Eddins DA. Interactions Between Breathy and Rough Voice Qualities and Their Contributions to Overall Dysphonia Severity. J Speech Lang Hear Res 2022; 65:4071-4084. [PMID: 36260821 PMCID: PMC9940885 DOI: 10.1044/2022_jslhr-22-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE Dysphonic voices typically present multiple voice quality dimensions. This study investigated potential interactions between perceived breathiness and roughness and their contributions to overall dysphonia severity. METHOD Synthetic stimuli based on four talkers were created to systematically map out potential interactions. For each talker, a stimulus matrix composed of 49 stimuli (seven breathiness steps × seven roughness steps) was created by varying aspiration noise and open quotient to manipulate breathiness and superimposing amplitude modulation of varying depths to simulate roughness. One-dimensional matching (1DMA) and magnitude estimation (1DME) tasks were used to measure perceived breathiness, roughness, their potential interactions, and overall dysphonia severity. Additional 1DME tasks were used to assess a set of natural stimuli that varied along both breathiness and roughness. RESULTS For the synthetic stimuli, the 1DMA task indicated little interaction between the two voice qualities. For the 1DME task, breathiness magnitude was influenced by roughness step to a greater extent than roughness magnitude was influenced by breathiness step. The additive contributions of breathiness and roughness to overall severity gradually diminished with increasing breathiness and roughness steps, possibly reflecting a ceiling effect in the 1DME task. For the natural stimuli, little consistent interaction was observed between breathiness and roughness. CONCLUSIONS The matching task revealed minimal interaction between perceived breathiness and roughness, whereas the magnitude estimation task revealed some interaction between the two qualities and their cumulative contributions to overall dysphonia severity. Task differences are discussed in terms of differences in response bias and the role of perceptual anchors. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21313701.
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Affiliation(s)
- Yeonggwang Park
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
| | - Supraja Anand
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
| | - Lisa M. Kopf
- Department of Speech, Language and Hearing Sciences, The George Washington University, Washington, DC
| | - Rahul Shrivastav
- Office of the Provost and Executive Vice President, Indiana University, Bloomington
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing
| | - David A. Eddins
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing
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Marks KL, Feaster TF, Baker S, Díaz-Cádiz ME, Doyle PC, Stepp CE. Spectral Aggregate of the High-Passed Fundamental Frequency and Its Relationship to the Primary Acoustic Features of Adductor Laryngeal Dystonia. J Speech Lang Hear Res 2022; 65:4085-4095. [PMID: 36198059 PMCID: PMC9940896 DOI: 10.1044/2022_jslhr-22-00157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Currently, no clinically feasible objective measures exist that are specific to the signs of adductor laryngeal dystonia (LD), deterring effective diagnosis and treatment. This project sought to establish concurrent validity of a new automated acoustic outcome measure, designed to be specific to adductor laryngeal dystonia (AdLD): the spectral aggregate of the high-passed fundamental frequency contour (SAHf o). METHOD Twenty speakers with AdLD read voiced phoneme-loaded (more symptomatic) and voiceless phoneme-loaded (less symptomatic) sentences. LD discontinuities (defined as phonatory breaks, frequency shifts, and creak), the acoustic ramifications of laryngeal spasms, were manually identified. The frequency content of the f o contour was examined as a function of time, and content above 1000 Hz was summed to automatically calculate SAHf o. Multiple linear regression analysis was applied to SAHf o based on LD discontinuities and sentence type (voiced or voiceless phoneme-loaded). RESULTS The regression model accounted for 41.1% of the variance in SAHf o. Both the LD discontinuities and sentence type were statistically related to SAHf o. CONCLUSION Results of this study provide evidence of concurrent validity. SAHf o is an automatic outcome measure specific to acoustic signs of AdLD that may be useful to track treatment progress.
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Welden K, Kelchner L, Silbert N, Rule DW. Listening for Dysphagia: Voice Quality Sequelae of Material in the Airway. J Speech Lang Hear Res 2022; 65:3337-3364. [PMID: 35998282 DOI: 10.1044/2022_jslhr-22-00120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Postswallow voice abnormality is often assumed to indicate the presence of material in the laryngeal airway (MIA), but prior research has not shown definitive evidence of a causal relationship. This study investigated if endoscopically confirmed MIA (prandial material or secretions) generates specific voice quality attributes that can be perceptually identified by experienced listeners. METHOD Forty-four dysphagic adults underwent endoscopic evaluation of swallowing. Time-linked audiovisual recordings of pre- and postswallow phonation were analyzed to determine the presence, amount, and location of prandial material or secretions in the larynx during phonation. Expert listeners completed auditory-perceptual ratings of phonation samples. RESULTS Voice quality ratings did not differ significantly when there was MIA during postswallow phonation. However, judgments of voice quality abnormality for MIA samples were elevated when analyses controlled for effects of baseline dysphonia. Listeners were most likely to perceive voice quality abnormality when larger amounts of secretions were present, as compared to prandial material. Interrater reliability was variable and ranged from low to moderate across perceptual parameters. CONCLUSIONS MIA during phonation occurred for many participants, but perception of voice quality abnormality was variable when MIA was present. Baseline dysphonia is common among individuals with dysphagia and may limit perception of voice quality abnormalities generated by MIA. Secretions in the laryngeal airway may have a greater impact on voice quality parameters.
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Affiliation(s)
- Kathy Welden
- Cincinnati Veterans Affairs Medical Center, OH
- Department of Communication Sciences & Disorders, College of Allied Health, University of Cincinnati, OH
| | - Lisa Kelchner
- Department of Communication Sciences & Disorders, College of Allied Health, University of Cincinnati, OH
| | | | - David W Rule
- Department of Otolaryngology, College of Medicine, University of Cincinnati, OH
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Kissel I, D'haeseleer E, Meerschman I, Bettens K, Van Lierde K. Listeners' attitudes towards voice disorders: An interaction between auditory and visual stimuli. J Commun Disord 2022; 99:106241. [PMID: 35728450 DOI: 10.1016/j.jcomdis.2022.106241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE People with dysphonia are judged more negatively than peers with normal vocal quality. This preliminary study aims to (1) investigate correlations between both auditory-perceptual and objective measures of vocal quality of dysphonic and non-dysphonic speakers and attitudes of listeners, and (2) discover whether these attitudes towards people with dysphonia vary for different types of stimuli: auditory (A) stimuli and combined auditory-visual (AV) stimuli. Visual (V) stimuli were included as a control condition. METHOD Ten judges with no experience in the evaluation of dysphonia were asked to rate A, AV and V stimuli of 14 different speakers (10 dysphonic and 4 non-dysphonic speakers) Cognitive attitudes, evaluation of voice characteristics and behavioral attitudes were examined. Pearson and Spearman correlation coefficients were calculated to examine correlations between both Dysphonia Severity Index (DSI) values and perceptual vocal quality as assessed by a speech-language pathologist (PVQSLP) or perceptual vocal quality as assessed by the judges (PVQjudge). Linear mixed model (LMM) analyses were conducted to investigate differences between speakers and stimuli conditions. RESULTS Statistically significant correlations were found between both perceptual and objective measures of vocal quality and mean attitude scores for A and AV stimuli, indicating increasingly negative attitudes with increasing dysphonia severity. Fewer statistically significant correlations were found for the combined AV stimuli than for A stimuli, and no significant correlations were found for V stimuli. LMM analyses revealed significant group effects for several cognitive attitudes. CONCLUSION Generally, people with dysphonia are judged more negatively by listeners than peers without dysphonia. However, the findings of this study suggest a positive influence of visual cues on the judges' cognitive and behavioral attitudes towards dysphonic speakers. Further research is needed to investigate the significance of this influence.
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Affiliation(s)
- Imke Kissel
- Centre for Speech and Language Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Evelien D'haeseleer
- Centre for Speech and Language Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium; Royal Conservatory Brussels, Musical Department, Brussels, Belgium
| | - Iris Meerschman
- Centre for Speech and Language Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Kim Bettens
- Centre for Speech and Language Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Kristiane Van Lierde
- Centre for Speech and Language Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Faculty of Humanities, Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
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Tan L, Chen C, Li Q. Outcomes of endoscopic percutaneous suture lateralization for neonatal and infantal bilateral vocal ford paralysis. Braz J Otorhinolaryngol 2022; 89:271-278. [PMID: 35725949 PMCID: PMC10071537 DOI: 10.1016/j.bjorl.2022.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/13/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Bilateral Vocal Fold Paralysis (BVFP) is a rare but significant resource of respiratory distress in neonates and infants. The objective of this study was to evaluate the efficacy and functional outcomes of Endoscopic Percutaneous Suture Lateralization (EPSL) for the treatment of BVFP in neonates and infants. METHODS A case series study of nine patients undergoing EPSL for BVFP between January 2019 and June 2021 was conducted. All patients were candidates for tracheostomy prior to EPSL. Demographic features including gender, age at diagnosis and surgery, main symptoms, airway comorbidities, airway support, and etiology were collected preoperatively. Patients were evaluated for breathing, swallowing and phonation postoperatively. Surgical success was defined as the ability to avoid tracheostomy. Functional Endoscopic Evaluation of Swallowing (FEES) was conducted to identify aspiration. Voice evaluation was based on clinical observation. RESULTS Nine patients underwent ten EPSL procedures (one in the left vocal fold, and nine in the right vocal fold). Eight patients (8/9) were able to successfully avoid tracheostomy and feed orally without aspiration after the procedure. One patient experienced clinical improvement in respiratory support requirements and underwent laparoscopic nissen and gastrostomy tube placement. At the last follow-up, two patients regained normal voice, two patients had mild dysphonia, and five patients had moderate dysphonia. Five patients showed partial return of the contralateral vocal fold function. CONCLUSION EPSL is an effective and safe treatment for neonatal and infantal BVFP, which enables patients free from tracheostomy without significant impact on swallowing function or phonation. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Letian Tan
- Children's Hospital of Fudan University, Department of Otolaryngology-Head and Neck Surgery, Shanghai, China
| | - Chao Chen
- Children's Hospital of Fudan University, Department of Otolaryngology-Head and Neck Surgery, Shanghai, China.
| | - Qi Li
- Children's Hospital of Fudan University, Department of Otolaryngology-Head and Neck Surgery, Shanghai, China
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Liu Y, Lee SAS, Chen W. The Correlation Between Perceptual Ratings and Nasalance Scores in Resonance Disorders: A Systematic Review. J Speech Lang Hear Res 2022; 65:2215-2234. [PMID: 35500290 DOI: 10.1044/2022_jslhr-21-00588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Assessment of resonance characteristics is essential in research and clinical practice in individuals with velopharyngeal impairment. The purpose of this study was to systematically review correlations between auditory-perceptual ratings and nasalance scores obtained by a nasometer in individuals with resonance disorders and to identify factors that affected the correlations between these two measures. METHOD Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search was conducted for studies reporting a correlation between nasality ratings and nasalance scores using six electronic databases based on predefined inclusion and exclusion criteria. RESULTS A total of 27 studies were included in this systematic review. Characteristics of study components including participants, types of assessment and stimuli, correlation coefficients, and reliability values of each study were identified, and a narrative synthesis was conducted. The methodological quality of each study was also appraised. The correlation level between nasalance values and nasality ratings varied from nonsignificant to strong (r = .92). The quality rating scores of the selected studies ranged from 44% to 94%, with an average score of 75%. DISCUSSION Factors that did or did not affect the varied correlation between nasality ratings and nasalance scores were discussed. Speech stimuli and the listeners' background were associated with correlations between the two measures. In addition, the sex of the speakers could be a factor affecting its correlation. However, the types of perceptual scales and listening conditions did not influence its correlations between the two measures. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19653207.
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Affiliation(s)
- Yilan Liu
- PhD Program in Rehabilitation Science, Texas Tech University Health Sciences Center, Lubbock
- Department of Speech-Language-Hearing Sciences, Texas Tech University Health Sciences Center, Lubbock
| | - Sue Ann S Lee
- PhD Program in Rehabilitation Science, Texas Tech University Health Sciences Center, Lubbock
- Department of Speech-Language-Hearing Sciences, Texas Tech University Health Sciences Center, Lubbock
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