Clinical Analysis of Benign Vocal Fold Lesions with Occult Sulcus Vocalis
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Yang Xiao*,
Feifei Liu*,†,
Lijing Ma*,
Tiantian Wang‡,
Wei Guo*,
Jun Wang*,
Correspondence information about the author Jun Wang
Email the author Jun WangJournal of Voice
Accepted: December 4, 2019; Published online: December 30, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.12.006
Publication stage: In Press Corrected Proof
Summary
Purpose
To discuss the correlation between benign vocal fold lesions and sulcus vocalis.
Methods
Analysis of the surgical data of 457 patients with benign vocal fold lesions and occult sulcus vocalis and preoperative voice evaluation and postoperative follow-up data from collected patients.
Results
A total of 61.7% of the patients had bilateral sulcus vocalis. Of the patients with bilateral sulcus vocalis, 64.9% had bilateral benign vocal fold lesions, and 35.1% had unilateral vocal fold benign lesions. Of the patients with unilateral sulcus vocalis, 74.3% showed associated ipsilateral vocal fold benign lesions, and 22.3% showed associated contralateral vocal fold lesions. In the 739 sides affected by sulcus vocalis, 255 sides of sulcus vocalis type I were not treated. There were 11 cases with 13 sides affected by mucosal bridges. The satisfaction rate for sound improvement was 79.6% by half a year after the operation.
Conclusion
The occurrence of benign vocal fold lesions may be related to occult sulcus vocalis. We should attach importance to the treatment of sulcus vocalis in the diagnosis and treatment of vocal fold diseases.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressEvaluation of the Relationship Between the Required Pressure Level in Continuous Positive Airway Pressure Treatment and Voice in Patients With Obstructive Sleep Apnea Syndrome
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Süleyman Emre Karakurt
Correspondence information about the author Süleyman Emre KarakurtEmail the author Süleyman Emre Karakurt, Mehmet Fatih Karakuş,
Fakih Cihat Eravcı,
Nurcan Kum,
Müge Özcan,
Kürşat Murat Özcan
Department of Otorhinolaryngology, Head and Neck Surgery, Health Sciences University, Ankara Numune Training and Research Hospital, Ankara, Turkey
Journal of Voice
Accepted: December 5, 2019; Published online: December 28, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.12.007
Publication stage: In Press Corrected Proof
Summary
Objective
The aim of this study was to investigate the effect of obstructive sleep apnea syndrome on voice, the relationship between the required pressure levels in continuous positive airway pressure (CPAP) and voice, and the effects of CPAP therapy on voice.
Material and Methods
A total of 73 subjects consisting of 53 patients and 20 control subjects were included in the study. The patient group was further divided into low- (Group A) and high- (Group B) pressure groups according to the required pressure level. All subjects underwent acoustic sound analysis to evaluate fundamental frequency (F0), jitter, shimmer, and noise-to-harmonics ratio (NHR). Acoustic voice analysis was repeated after 3 months of regular CPAP treatment in the patient group. The mean F0, jitter, shimmer, and NHR values of the patient group and control group were compared. Intergroup comparisons were also performed between Group A and the control group, and between Group B and the control group. Finally, before and after CPAP treatment values of mean F0, jitter, shimmer, and NHR were compared in Group A and Group B.
Results
The mean shimmer and NHR values of the patient group were significantly higher than the control group (P = 0.01 and P = 0.023, respectively). The mean shimmer and NHR values of Group B were statistically higher than the control group (P = 0.002 and P < 0.001, respectively). The mean jitter, shimmer, and NHR values after CPAP treatment were significantly lower than those measured before CPAP treatment in Group B (P = 0.003, P = 0.001, and P = 0.001, respectively).
Conclusion
Voice is negatively affected in obstructive sleep apnea syndrome patients who require high pressure in CPAP treatment. CPAP treatment leads to improved voice in these patients.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressVoice After Rhinoplasty. An Important Question for the Opera Singers
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Pedro Clarós*,1,
Correspondence information about the author Pedro ClarósEmail the author Pedro Clarós, Cristina Blebea†,
Maria Carmen Pujol*,
Astrid Clarós-Pujol*,
Andrés Clarós*
Journal of Voice
Accepted: November 27, 2019; Published online: December 27, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.11.024
Publication stage: In Press Corrected Proof
Summary
Objective
The primary goal of the study was to evaluate the influence of cosmetic and functional rhinoplasty on quality of life and voice performance preservation in opera singers.
Materials and methods
This study was conducted in the ENT Department of Clarós Clinic and included 18 opera singers: 16 women (8 sopranos, 5 mezzos, 2 contralto, and 1 unclassified) and 2 men (1 tenor and 1 baritone). Patients underwent either cosmetic or functional rhinoplasty. We excluded patients with previous nasal surgery, allergic or vasomotor rhinitis, laryngeal pathology, nasal pathology except septal deviation, hormonal or psychiatric disorders, psychic lability, or younger than 18 years of age. We evaluated the fundamental frequency, jitter, shimmer, maximal phonation time, Voice Handicap Index-10, and subjective perception of the patient before and 6 months after surgery.
Results
Rhinoplasty was indicated for aesthetic reasons in 12 cases. Six patients also associated nasal obstruction due to septal deviation. The fundamental frequency presented no variation and jitter, shimmer and the maximal time phonation improved slightly. Voice Handicap Index-10 scores decreased after the intervention (5.3 vs 5) and the overall perception of the surgical intervention was considered positive both aesthetically and vocally.
Conclusions
Singers evaluated long-term influence of rhinoplasty as positive. Over 88.8% admitted a beneficial effect on vocal emission and function while 11.1% perceived no change regarding their previous voice.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressCross-Cultural Adaptation and Validation of the Evaluation of the Ability to Sing Easily (EASE) for Kannada-Speaking Carnatic Classical Singers
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Usha Devadas*,
Devika Vinod†,
Santosh Maruthy†,
Correspondence information about the author Santosh MaruthyEmail the author Santosh MaruthyJournal of Voice
Accepted: November 27, 2019; Published online: December 27, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.11.021
Publication stage: In Press Corrected Proof
Summary
Objective
The present study aimed to cross-culturally adapt and validate the Evaluation of the Ability to Sing Easily (EASE) into Kannada for the benefit of Carnatic classical singers.
Methods
Following a standard translation procedure, the original English version was translated to develop a prefinal EASE-K version. This was further field-tested on 12 Carnatic singers to obtain the final EASE-K version. Upon validating the same on 104 Carnatic singers, intercorrelation between EASE-K subscales- Vocal Fatigue (VF) and Pathologic Risk Indicators (PRI) were assessed using the Spearman correlation coefficient. The internal consistency of the subscales was obtained based on the Cronbach's alpha coefficient. Nonparametric tests were carried out to study the effect of age and gender on EASE-K subscales. Further, the raw scores of the English version were compared to the EASE-K.
Results
Spearman correlation coefficient indicated a statistically significant positive correlation (P < .01) between the two subscales (r = .745). Each scale showed good internal consistency (Cronbach's alpha was .84). Test-retest reliability carried on 12 singers indicated an excellent reliability for the subscales. Nonparametric tests indicated no significant effect of age and gender on the subscales of EASE-K (P > .05). Comparison across the original and EASE-K revealed significant differences for both VF (P = .02) and PRI (P = .00) subscales.
Conclusions
Current findings indicate that EASE-K is a reliable and valid tool that can be used to document the subtle changes in voice in healthy Carnatic classical singers. Further, the current tool can be used to study the effect of vocal loading across different singing styles.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressCharacteristics of the Voice of Dysphonic School Children from 4:0 to 7:11 Years Old
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Carla Franco Hoffmann,
Carla Aparecida Cielo
Correspondence information about the author Carla Aparecida CieloEmail the author Carla Aparecida CieloDepartamento de Fonoaudiologia, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
Journal of Voice
Accepted: December 2, 2019; Published online: December 27, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.12.004
Publication stage: In Press Corrected Proof
Summary
Background
Childhood dysphonia is frequent and has many origins, with the most common initial symptom being the altered vocal quality.
Objective
Describe and correlate the auditory-perceptual and acoustic characteristics of the voice, and the maximum phonation time (MPT), of dysphonic schoolchildren from private and public schools from 4:0 to 7:11 years old, female and male.
Methods
MPT, acoustic (Multi-Dimensional Voice Program Advanced and Real Time Spectrogram), and auditory-perceptual (Consensus Auditory-Perceptual Evaluation of Voice) evaluations of 115 schoolchildren were statistically analyzed.
Results
Auditory-perceptual parameters values were classified as mild, and MPT values were reduced, in most children. Fundamental frequency and Jitt values decreased significantly with age; MPT/i/ increased significantly with age. Relative average perturbation, voice turbulence index (VTI), and number of sub-harmonic segments values were significantly higher in 4:0 years old children. The number of unvoiced segments was higher in 6:0 years old children. Shimmer percent was higher in 7:0 years old children. There were negative correlations between the high frequency spectrographic tracing color intensity and the vocal strain; the VTI and the MPT; the degree of unvoiced segments and the MPT. There was a positive correlation between the smoothed pitch period perturbation quotient and the roughness.
Conclusion
In dysphonic schoolchildren, auditory-perceptual parameters were moderate, MPT was reduced, several acoustic parameters were altered, and these vocal characteristics improved with age.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressAnatomical Study of Two Cricothyroid Approaches to the Cadaver Larynx
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Haig Panossian*,
Luke J. Pasick*,
Robert T. Sataloff*,†,
Correspondence information about the author Robert T. SataloffEmail the author Robert T. SataloffJournal of Voice
Accepted: November 11, 2019; Published online: December 27, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.11.007
Publication stage: In Press Corrected Proof
Summary
Objective
The purpose of this study was to measure the angle and depth at which the vocal folds are accessed via transcutaneous injection through two different approaches through the cricothyroid membrane.
Methods
Twenty-five cadavers preserved with formalin were studied. The larynges were bisected through the thyroid notch, and the skin and soft tissue were removed. A 27-gauge needle was inserted through the cricothyroid membrane, once from just inferior to the thyroid cartilage and once from just superior to the cricoid cartilage, and advanced to the midpoint of the musculomembranous vocal fold (determined as the halfway point from anterior commissure to vocal process), immediately lateral to the vocalis muscle without penetrating the epithelium. The angle of approach was determined after taking multiple measurements with a Castroviejo caliper. The depth of the needle was measured.
Results
Ten male and 15 female cadavers were studied. Their average age was 85.5 ± 12.4 years. The mean distance from midline for an injection performed with 0° of lateral angle was 5.7 ± 0.7 mm for the males, which was significantly greater than for females (4.8 ± 0.8 mm, P = 0.012). The insertion angle for the infrathyroid approach was 22.2 ± 6.9°, which was significantly different from the supracricoid angle, which was 33.0 ± 5.2° (P < 0.001). The mean insertion depth of the subthyroid approach was 11.3 ± 1.8 mm (range 8.0-15.5 mm), which was significantly less than the depth for the supracricoid approach (18.2 ± 2.4 mm, range 11.0–22.0 mm, P < 0.001.). The infrathyroid approach angle for males was 26.0 ± 8.5°, which was significantly greater than the angle for females (19.3 ± 3.4°, P = 0.016.). The supracricoid approach angle for males was 37.5 ± 2.4°, which was significantly greater than the angle for females (29.7 ± 4.1°, P < 0.001.). The insertion depth for males was 19.6 ± 1.4 mm, which was significantly greater than that for females (17.2 ± 2.6 mm, P = 0.021).
Conclusions
Comparison of a supracricoid and infrathyroid approach through the cricothyroid membrane to the middle third of the vocal folds demonstrated significant differences in angle of approach. We also identified a significant difference in the angle of entry between male and female larynges in both approaches, as well as an increased depth of insertion required in males for the supracricoid approach.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressBehavioral Management of Laryngeal Complaints Caused by Vagal Nerve Stimulation for Medically Refractory Epilepsy
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Lisa Muratore Beckelhymer,
Daniel S. Fink,
Juliana K. Litts
Correspondence information about the author Juliana K. LittsEmail the author Juliana K. LittsDepartment of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado
Journal of Voice
Accepted: November 22, 2019; Published online: December 27, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.11.018
Publication stage: In Press Corrected Proof
Summary
Objectives/hypothesis
This study investigated behavioral management of dysphonia and laryngeal dyspnea secondary to use of vagal nerve stimulation (VNS) in an individual with medically refractory epilepsy.
Study design
Retrospective chart review.
Methods
Medical records from a single patient were reviewed. The patient received treatment with the speech-language pathologist (SLP) and laryngologist to observe patterns of laryngeal hyperfunction using biofeedback, and treatment with the SLP to learn to perform rescue breathing techniques, relaxation techniques, and awareness of muscle tension to aid the control of symptoms during activation. Data collected included neurology and laryngology notes. Neurology notes were used to track VNS settings, tolerance, and incidence of seizures. Laryngology notes included documentation of diagnosis, treatment, and measures of patient perception of severity (ie, Voice Handicap Index, Dyspnea Index, Cough Severity Index).
Results
Prior to treatment, the patient was unable to receive benefits from VNS due to severe laryngeal adverse effects, such that the device remained off for eight months postimplantation. Following treatment, the patient effectively managed laryngeal side effects and was able to tolerate increases in VNS output current, signal frequency, and duration.
Conclusions
Voice therapy was effective in managing changes in vocal fold mobility and laryngeal tension. As the number of individuals receiving VNS for epilepsy and inflammatory conditions increases, the SLP and laryngologist may play a key role in interdisciplinary management of laryngeal side effects secondary to vagal nerve stimulation.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressDevelopment of an Acoustic Simulation Method during Phonation of the Japanese Vowel /a/ by the Boundary Element Method
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Mami Shiraishi,
Katsuaki Mishima
Correspondence information about the author Katsuaki MishimaEmail the author Katsuaki Mishima, Hirotsugu Umeda
Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
Journal of Voice
Accepted: November 27, 2019; Published online: December 27, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.11.022
Publication stage: In Press Corrected Proof
Summary
Objectives
The purpose of the present study was to establish the method for an acoustic simulation of a vocal tract created from CT data during phonation of the Japanese vowel /a/ and to verify the validity of the simulation.
Material and methods
The subjects were 15 healthy adults (8 males, 7 females). The vocal tract model was created from CT data acquired during sustained phonation of the Japanese vowel /a/. After conversion to a mesh model for analysis, a wave acoustic analysis was performed with a boundary element method. The wall and the bottom of the vocal tract model were regarded as a rigid wall and a nonrigid wall, respectively. The acoustic medium was set to 37°C, and a point sound source was set in the place corresponding to the vocal cord as a sound source. The first and second formant frequencies (F1 and F2) were calculated. For 1 of the 15 subjects, the range from the upper end of the frontal sinus to the tracheal bifurcation was scanned, and 2 models were created: model 1 included the range from the frontal sinus to the tracheal bifurcation; and model 2 included the range from the frontal sinus to the glottis and added a virtually extended trachea by 12 cm cylindrically. F1 and F2 calculated from models 1 and 2 were compared. To evaluate the validity of the present simulation, F1 and F2 calculated from the simulation were compared with those of the actual voice and the sound generated using a solid model and a whistle-type artificial larynx. To judge the validity, the vowel formant frequency discrimination threshold reported in the past was used as a criterion. Namely, the relative discrimination thresholds (%), dividing ▵F by F, where F was the formant frequency calculated from the simulation, and ▵F was the difference between F and the formant frequency of the actual voice and the sound generated using the solid model and artificial larynx, were obtained.
Results
F1 and F2 calculated from models 1 and 2 were similar. Therefore, to reduce the exposure dose, the remaining 14 subjects were scanned from the upper end of the frontal sinus to the glottis, and model 2 with the trachea extended by 12 cm virtually was used for the simulation. The averages of the relative discrimination thresholds against F1 and F2 calculated from the actual voice were 5.9% and 4.6%, respectively. The averages of the relative discrimination thresholds against F1 and F2 calculated from the sound generated by using the solid model and the artificial larynx were 4.1% and 3.7%, respectively.
Conclusions
The Japanese vowel /a/ could be simulated with high validity for the vocal tract models created from the CT data during phonation of /a/ using the boundary element method.
© 2019 The Authors. Published by Elsevier Inc.
Article in PressAn Appraisal of Printed Online Education Materials on Spasmodic Dysphonia
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Mohamedkazim M. Alwani*,†,
Correspondence information about the author Mohamedkazim M. AlwaniEmail the author Mohamedkazim M. Alwani, Khaled A. Campa†,
Thomas J. Svenstrup†,
Elhaam H. Bandali‡,
Benjamin P. Anthony*,†
Journal of Voice
Accepted: November 27, 2019; Published online: December 26, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.11.023
Publication stage: In Press Corrected Proof
Summary
Objective
The use of the Internet for seeking health-related information has increased exponentially. We aimed to comprehensively appraise the readability, understandability, actionability, and quality of printed online education materials (POEMs) pertaining to Spasmodic Dysphonia (SD).
Study Design
Descriptive, correlational study.
Methods
POEMs were identified using the Google search engine with the phrase “spasmodic dysphonia.” The first 50 websites meeting criteria were included. Accreditation of POEMs was evaluated using Health on the Net Foundation Code of Conduct (HONcode) toolbar. Readability of the content was analyzed using the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) tests. Understandability and actionability was evaluated using the Patient Education Material Assessment Tool for Printed Materials. Overall quality of POEMs was appraised using the DISCERN instrument.
Results
The overall mean [SD] FKGL and mean [SD] FRE score was 11.5 [2.5] and 42.1 [12.8], respectively. The mean understandability score was 65% [14], while the mean [SD] actionability score was only 17% [12]. The overall mean [SD] quality score for all websites was 43.5 [13]. Only four websites (8%) were HONcode certified. A moderately positive correlation was discovered between understandability and overall quality of POEMs (r = 0.38, P 0.01)
Conclusions
POEMs pertaining to SD are written above recommended reading levels with subsequent poor understandability and actionability. We recommend that authors assess POEMs prior to publication to ensure alignment with the needs of the target audience.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressFundamental Frequency and Intensity Effects on Cepstral Measures in Vowels from Connected Speech of Speakers with Voice Disorders
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Marília Carvalho Sampaio*,†,1,
Correspondence information about the author Marília Carvalho SampaioEmail the author Marília Carvalho Sampaio, Jörg Edgar Bohlender†,‡,
Meike Brockmann-Bauser†,‡
Journal of Voice
Accepted: November 18, 2019; Published online: December 26, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.11.014
Publication stage: In Press Corrected Proof
Summary
Objective
Cepstral peak prominence (CPP) and smoothed CPP (CPPS) have been described as reliable parameters to detect overall dysphonia in standardized connected speech samples. Recent studies indicate that vocal intensity (sound pressure level, SPL) and fundamental frequency (fo) changes may influence cepstral measurement results in healthy speakers. The main aim of the present work was to investigate the effects of prosody related SPL and fo variations on cepstral measures in speech of adults with voice disorders.
Study design
Retrospective cross-sectional study.
Methods
Recordings of CAPE-V sentences from 27 voice disordered Brazilian Portuguese speakers (19 women, eight men) with a mean age of 45 years (SD = 13) were investigated. Five /a/ vowels were manually extracted from stressed syllables in different positions. Voice fo (Hz), SPL (dBA), CPP (dB), and CPPS (dB) were computed using PRAAT. Statistical analysis included Linear Mixed Models with ANCOVA and Bonferroni post hoc tests.
Results
Voice SPL as single factor and combined with fo had a highly significant effect (P ≤ 0.001), while fo alone had no significant impact on both CPP and CPPS (P ≥ 0.77). Voice fo, SPL, CPP, and CPPS of the first vowel were all significantly lower than of the last vowel (P ≤ 0.03).
Conclusion
In vowel samples from connected speech of adults with voice disorders, we observed better CPP and CPPS in higher voice SPL alone and combined with higher fo. Further, the vowel position influenced the present results. A larger clinical study should confirm how prosody related SPL and fo and vowel position effects could be controlled for in connected speech samples.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressComparative Study of Increased Supraglottic Activity in Normal Individuals and those with Muscle Tension Dysphonia (MTD)
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Payman Dabirmoghaddam*,
Mahshid Aghajanzadeh
Correspondence information about the author Mahshid Aghajanzadeh†,Email the author Mahshid Aghajanzadeh, Reza Erfanian*,
Keyvan Aghazadeh*,
Saeed Sohrabpour*,
Mohamadreza Firouzifar*,
Saman Maroufizadeh‡,
Maryam Nikravesh§
Journal of Voice
Accepted: December 2, 2019; Published online: December 26, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.12.003
Publication stage: In Press Corrected Proof
Summary
Objectives
Excessive or disharmonious activity of internal and external laryngeal muscles causes a type of dysphonia known as muscle tension dysphonia (MTD). MTD is often diagnosed based on laryngoscopic findings and clinical history. Several diagnostic and classification systems have so far been proposed based on increased supraglottic activity to determine MTD. Various studies have shown that increased supraglottic activity may also be observed in those with normal voice. The present study aimed to precisely examine the incidence of abnormal muscle tension pattern (aMTP) in those with normal voice in comparison with those with MTD. The secondary goal of this study was comparative examination of acoustic parameters and maximum phonation time (MPT) in the group with MTD and normal individuals.
Material and Methods
Participants were 75 people with MTD (41 women and 34 men) and 50 individuals with normal voice and no history of dysphonia (20 women and 30 men). Laryngoscopic evaluation was performed for all participants by considering four types of aMTP. Acoustic analyses, including cepstral peak prominence, jitter, shimmer and NHR, as well as MPT examination were performed.
Results
A significant difference between the MTD group and control group was observed in all MTPs except for MTP 2 (lateral-to-medial approximation of the false vocal folds) (P = 0.367, χ2(1) = 0.81). In other MTPs, a significant difference existed between the control and MTD groups in terms of aMTP incidence (P < 0.05).
Conclusion
On the four aMTPs, results revealed that one must exercise caution in diagnosing MTD based on MTP 2 (medial compression of ventricular folds), and this must not be the sole criterion for diagnosis. Moreover, cepstral peak prominence and MPT analyses are of high clinical significance.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressAuditory Skills as a Predictor of Rater Reliability in the Evaluation of Vocal Quality
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Maxsuel Alves Avelino de Paiva*,
Marine Raquel Diniz da Rosa†,‡,
Ingrid Gielow§,
Itacely Marinho da Silva*,
Estevão Silvestre da Silva Sousa*,
Allan Carlos França da Silva*,
Priscila Oliveira Costa Silva†,
Leonardo Wanderley Lopes†,‡,1,
Correspondence information about the author Leonardo Wanderley LopesEmail the author Leonardo Wanderley LopesJournal of Voice
Accepted: November 26, 2019; Published online: December 23, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.11.020
Publication stage: In Press Corrected Proof
Summary
Objective
To determine whether an association exists between auditory skills and the reliability of judgments of the vocal deviation grade and the degrees of roughness and breathiness and to evaluate whether these skills are predictive of interrater reliability in auditory-perceptual evaluations.
Methods
The sample consisted of 20 speech-language pathology students without previous training in auditory-perceptual evaluation. The students underwent a basic audiological evaluation and a central auditory processing evaluation. They then participated in two auditory-perceptual evaluation sessions assessing the general grade (GG) and the degrees of roughness and breathiness of 44 samples of sustained vowel production with the presence or absence of dysphonia. For statistical analysis, the intraclass correlation coefficient (ICC) and a beta regression model were used.
Results
A difference was found in the average ICCs of the GG parameter between listeners with high and low temporal resolution and binaural interaction skills. Temporal resolution skills and binaural interaction affected the ICC of listeners in the GG evaluation, reducing the likelihood of reliability by 2.8 and 3.6 times, respectively.
Conclusion
An association exists between temporal resolution skills and binaural interaction and the reliability of listeners in evaluations of vocal deviation severity. Listeners with low levels of these skills show less reliability in evaluations of the severity of vocal deviation. In addition, temporal resolution and binaural interaction are predictors and explain 42.7% of the variability in the reliability of evaluations of vocal deviation severity.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressRole of Peri- and Postoperative Antibiotics in Microscopic Laryngeal Surgery
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Luke J. Pasick*,
William L. Valentino†,
Hassan Paknezhad*,
Robert T. Sataloff‡,
Correspondence information about the author Robert T. SataloffEmail the author Robert T. SataloffJournal of Voice
Accepted: October 23, 2019; Published online: December 20, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.10.014
Publication stage: In Press Corrected Proof
SUMMARY
Objectives
There are no widely accepted guidelines for the use of peri- and postoperative antibiotics for microdirect laryngoscopy (MDL) to prevent postoperative surgical site infection (SSI). This study examines the incidence of not only SSI, but also respiratory and oropharyngeal infections among patients who underwent MDL.
Study Design
Retrospective cohort.
Methods
Medical records from a quaternary laryngology practice were reviewed retrospectively for patients who underwent MDL between October 2015 and December 2018. Adults who underwent MDL with excision of nonmalignant masses, vocal fold (VF) reconstruction with buccal graft, superficial VF injection, VF injection augmentation, use of carbon dioxide (CO2) or potassium titanyl phosphate (KTP) laser, and laryngeal dilation were included. Subjects were divided into three groups based on the use of antibiotics during the peri- or postoperative period. Group 1 did not receive peri- or postoperative antibiotics. Group 2 received perioperative antibiotics without postoperative antibiotics. Group 3 received both peri- and postoperative antibiotics. Antibiotic use was determined by surgeon policy, which changed over time, not by patient risk factors. Other data collected include demographics, medical comorbidities, surgical procedure, operative time, American Society of Anesthesiology class, incidence of SSI, respiratory or oropharyngeal infection, and postoperative antibiotic and steroid prescriptions for complications.
Results
190 surgeries met inclusion criteria. Groups 1, 2, and 3 consisted of 113, 57, and 20 subjects, respectively. No SSI were reported. Baseline characteristics of median age, American Society of Anesthesiology, wound class, and gender did not differ between groups. Groups were found to have differed in type of procedure performed, with a predominance of vocal fold excision and superficial injection in Group 1, injection laryngoplasty using autologous fat graft and laryngeal reconstruction in Group 3, and a combination of procedure types in Group 2. Laser treatment with CO2 and/or KTP was utilized in 35% of procedures. The mean operative times (total time in which the laryngoscope remained in the oral cavity) for Groups 1, 2, and 3 were 29 (SD = 13), 42 (SD = 23), and 73 minutes (SD = 78), respectively; this was significantly different among the three groups (P < 0.0001). By logistic regression models, operative time was not significantly associated with the overall use of antibiotics (Χ2 = 1.81, P = 0.18) or corticosteroid (Χ2 = .05, P = .82) prescriptions during follow-up. In Groups 1, 2, and 3, 11%, 14%, and 10% of patients, respectively, required a follow-up antibiotic prescription for non-SSI and 11%, 12%, and 0% of patients, respectively, required a follow-up corticosteroid prescription within 30 days postoperatively. There was no significant difference in patients with diabetes or pulmonary comorbidity and patients without comorbidity in use of postoperative antibiotic (P = .45) or corticosteroid (P > .99) prescription. Within 30 days of follow-up, patients in Group 1 experienced VF hemorrhage (defined as any subepithelial blood in the area of excision) at an incidence of 19%. Complications within 30 days of follow-up showed an incidence of substantial pain ranging between 2%-4% and respiratory or oropharyngeal infection between 10%-12%. Two patients in Group 2 reported emergency department visits for dyspnea. One patient in Group 3 was admitted for tongue and floor of mouth swelling secondary to prolonged suspension.
Conclusion
There were no incidents of SSI in this cohort. The need for follow-up antibiotic and/or corticosteroid prescription did not differ in relation to use or non-use of perioperative antibiotics, and neither did the incidence of respiratory or oropharyngeal infection. Longer operative time was associated with both peri- and postoperative antibiotic use, but there is no evidence yet that antibiotic use was necessary. These findings suggest that avoidance of routine perioperative and/or postoperative antibiotics may be appropriate; and further research should be encouraged.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressRelationship Between Sleep Quality and Stress with Voice Functioning among College Professors: A Systematic Review and Meta-analysis
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Andrés Carrillo-Gonzalez*,
Maryluz Camargo-Mendoza†,
Lady Catherine Cantor-Cutiva*,
Correspondence information about the author Lady Catherine Cantor-CutivaEmail the author Lady Catherine Cantor-CutivaJournal of Voice
Accepted: November 4, 2019; Published online: December 20, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.11.001
Publication stage: In Press Corrected Proof
Summary
Background
Sleeping is the most critical stage in the psychological and somatic recovery process. Sleep deficiency can lead to changes in the breath pattern that might contribute to the appearance and development of voice disorders. Sleep can also compromise the individual's communicative competence. Work-related stress is a risk factor for serious health and mental issues, including voice and sleep disorders. Recovery from stress is fundamental in order to preserve health, wellbeing, and work performance. No systematic review of the literature or meta-analysis concerning this relationship has been performed yet.
Objective
To define the association of voice disorders with sleep quality and stress among teachers.
Methods
A systematic review of literature and meta-analysis were performed. Three computerized databases were used to characterize the relationship between voice disorders among teachers with sleep quality and stress. Information such as year of publication, study population, sample size, stress/sleep exposure, voice outcome, and prevalence were extracted from each paper. All the included articles were measured in terms of their methodological quality.
Results
In total, 10 publications met the criteria for inclusion. The point prevalence of voice disorders ranged widely for both sleep quality (12% to 81%), and for stress (17% to 81%). Teachers who reported stress at work were more likely to report voice disorders. Additionally, teachers who reported having slept more than 6 hours per day were less likely to report a voice disorder.
Conclusion
This study provides evidence about the relationship between sleep quality and work-related stress with voice functioning. Although, included studies had low quality and the number of studies was low, our results suggest that the increased occurrence of voice disorders among teachers with high stress and work and less than 6 hours/day of sleep. Future investigation should aim to identify how sleep quality and stress interact in relation to voice functioning.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressAnalysis Method for Laryngeal High-Speed Videoendoscopy: Development of the Criteria for the Measurement Input
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Khairy Anuar Mohd Khairuddin*,†,
Correspondence information about the author Khairy Anuar Mohd KhairuddinEmail the author Khairy Anuar Mohd Khairuddin, Kartini Ahmad*,
Hasherah Mohd Ibrahim*,
Yuling Yan‡
Journal of Voice
Accepted: December 3, 2019; Published online: December 19, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.12.005
Publication stage: In Press Corrected Proof
Summary
Despite its clear advantages, laryngeal high-speed videoendoscopy (LHSV) has not yet been accepted as a routine imaging tool for the evaluation of vocal fold vibration due to the unavailability of methods to effectively analyze the huge number of images from the LHSV recording. Recently, a promising LHSV-based analysis method has been introduced. The ability of this analysis method in studying the vocal fold vibratory behaviors had been substantially demonstrated. However, some practical aspects of its clinical applications still require further attention. Most fundamental is that the criteria for the measurement input ie, a segment of interest (SOI), which has not been fully defined. Particularly, the length of the SOI and the location along the sample, where it needs to be selected require further confirmation. Meanwhile, the analysis using any options of a well-delineated glottal area demands verification. Without clear criteria for the SOI, it is difficult to demonstrate the relevance of this analysis method in clinical voice assessment. Therefore, the aim of the present study is to establish the criteria for the SOI, which involved the investigations on the length of the SOI and the location along the sample, where it needs to be selected, as well as the use of any options of a well-delineated glottal area for analysis. The participants in the present study consisted of 36 young normophonic females. The methods involved LHSV recording of the images of the vibrating vocal folds. The captured images were then analyzed using the method. The LHSV-based measures from the analyses were compared according to the specified procedures of each investigation. Results indicated that 2000 frames should be used as the SOI length. The SOI could be selected at any location along the sample as long as well-delineated glottal areas were observed. With the current findings, a more conclusive measurement protocol is available to ensure reliable LHSV-based measures. The findings further support this analysis method for clinical application, which in turn promote LHSV as a reliable laryngeal imaging tool in clinical setting.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressEffects of Vocal Intensity and Fundamental Frequency on Cepstral Peak Prominence in Patients with Voice Disorders and Vocally Healthy Controls
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Meike Brockmann-Bauser*,†,1,
Correspondence information about the author Meike Brockmann-BauserEmail the author Meike Brockmann-Bauser, Jarrad H. Van Stan‡,§,
Marilia Carvalho Sampaio*,†,║,
Joerg E. Bohlender*,†,
Robert E. Hillman‡,
Daryush D. Mehta‡
Journal of Voice
Accepted: November 21, 2019; Published online: December 19, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.11.015
Publication stage: In Press Corrected Proof
Summary
Objective
Cepstrum-based voice measures, such as smoothed cepstral peak prominence (CPPS), are influenced by voice sound pressure level (SPL) in vocally healthy adults. Since it is unclear if similar effects hold in voice disordered adults and how these interact with natural fundamental frequency (fo) changes, this study examines voice SPL and fo effects on CPPS in women with vocal hyperfunction and vocally healthy controls.
Study Design
Retrospective matched case-control study.
Methods
Fifty-eight women with vocal hyperfunction were individually matched with 58 vocally healthy women for occupation and approximate age. The patient group comprised women exhibiting phonotraumatic vocal hyperfunction associated with vocal fold nodules (n = 39) or polyps (n = 5), and nonphonotraumatic vocal hyperfunction associated with primary muscle tension dysphonia (n = 14). All participants sustained the vowel /a/ at soft, comfortable, and loud loudness conditions. Voice SPL, fo, and CPPS (dB) were computed from acoustic voice recordings using Praat. The effects of loudness condition, measured voice SPL, and fo on CPPS were assessed with linear mixed models. Pairwise correlations among voice SPL, fo, and CPPS were assessed using multiple regression analysis.
Results
Increasing voice SPL correlated significantly (P < 0.001) with higher CPPS in both patient (r2 = 0.53) and normative groups (r2 = 0.45). fo had statistically significant effects on CPPS (P < 0.001), but with a weak relation for the patient (r2 = 0.02) and control groups (r2 = 0.05).
Conclusions
In women with and without voice disorder, CPPS is highly affected by the individual's voice SPL in vowel phonation. Future studies could investigate how these effects should be controlled for to improve the diagnostic value of acoustic-based cepstral measures.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressLong-Term Effects of a Voice Training Program for Teachers on Vocal and Mental Health
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Manfred Nusseck*,1,
Correspondence information about the author Manfred NusseckEmail the author Manfred Nusseck, Anna Immerz*,
Claudia Spahn*,
Matthias Echternach†,
Bernhard Richter*
Journal of Voice
Accepted: November 21, 2019; Published online: December 18, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.11.016
Publication stage: In Press Corrected Proof
Summary
Objectives
The voice is an important occupational tool for teachers. Voice training programs have been shown to help strengthen the voice health and endurance. However, longitudinal studies on voice trainings are sparse. In this study, long-term effects nearly 2 years after a voice training program have been investigated.
Methods
The acoustic voice quality (Dysphonia Severity Index [DSI]), the voice self-concept (Fragebogen zur Erfassung des Stimmlichen Selbstkonzepts), and the health-related quality of life (SF-12) of 55 teachers who participated in a prior voice training program of ten 90 minutes sessions were compared to 33 teachers without voice training. The participants were measured at three times: in a pre- and a post-training survey and in a 2-years follow-up survey.
Results
The trained teachers increased in DSI over all three surveys while the nontrained teachers decreased in DSI with a significant interaction effect. Also the trained teachers significantly increased the awareness of voice use and their mental health compared to the nontrained group.
Conclusions
The positive effects of the voice training, which have been found between pre- and post-training and in comparison with the control group, clearly sustained in long-term 2 years after the end of the training. This finding emphasizes the importance of voice training for teachers as a long-term investment for a voice-related healthy working life.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressThe Use of Inhaled N-Acetylcysteine for Laryngopharyngeal Reflux Disease: A Randomized Controlled Trial
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Yong Seok Jo,
Ick Soo Choi,
Yoon Kyoung So
Correspondence information about the author Yoon Kyoung SoEmail the author Yoon Kyoung SoDepartment of Otorhinolaryngology-Head and Neck Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
Journal of Voice
Accepted: October 2, 2019; Published online: December 14, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.11.017
Publication stage: In Press Corrected Proof
Summary
Objectives
Proton pump inhibitors (PPIs) are the mainstay of the medical treatment for laryngopharyngeal reflux disease (LPRD). However, extraesophageal symptoms of LPRD, such as globus, are often refractory to PPI treatment. Many kinds of adjunctive medications have been attempted to address those refractory cases. We aimed to study whether inhaled N-acetylcysteine (NAC), a mucolytic agent, has additive effects for the treatment of LPRD when used in conjunction with PPIs.
Methods
Patients with reflux symptom index (RSI) greater than 13 and reflux finding scores (RFS) greater than 7 were prospectively enrolled and were randomly assigned to control or study group. Patients were treated with oral rabeprazole in the control group and with oral rabeprazole and inhaled NAC in the study group. Patients were followed once a month for 2 months with questionnaires and stroboscopic examination. At every follow-up, RSI and RFS were checked. The extent of improvements of RSI and RFS were evaluated and compared between two groups.
Results
With treatment, the mean RSI changed from 21.0 to 7.6 (P < 0.001) in control group and from 19.7 to 4.5 (P < 0.001) in study group. The mean RFS also changed from 12.9 to 7.1 (P < 0.001) in control group and from 13.5 to 6.9 (P < 0.001) in study group. For both RSI and RFS, the extents of improvement were not significantly different between two groups. In patients whose RSI improved less than nine at the first follow-up (poor early responders), RSI became significantly lower in the study group (4.6 ± 2.0) than in the control group (9.5 ± 4.6) at second follow-up (P = 0.019). In good early responders, however, RSI was not significantly different between the two groups in the second follow-up.
Conclusions
In this study, there were no significant differences in the overall outcome between patients treated with inhaled NAC and PPI and those with PPI alone. Interestingly, some additional therapeutic effect of NAC appeared late for the patients with poor early response. Further studies are required to investigate the underlying mechanism for this.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressDoes the Reflux Symptom Index Predict Increased Pharyngeal Events on HEMII-pH Testing and Correlate with General Quality of Life?
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Elliana Kirsh DeVore*,
Walter W. Chan†,
Jennifer J. Shin*,1,
Thomas L. Carroll
Correspondence information about the author Thomas L. CarrollEmail the author Thomas L. CarrollJournal of Voice
Accepted: September 14, 2019; Published online: December 14, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.11.019
Publication stage: In Press Corrected Proof
Summary
Objectives
To determine the ability of the reflux symptom index (RSI) to predict objective impedance and pH-probe testing, and to examine the relationship between disease-specific and general health status in patients diagnosed with laryngopharyngeal reflux (LPR).
Methods
Adults presenting to a tertiary care academic center with a primary voice complaint completed the RSI and the Patient-Reported Outcomes Measurement Information System 10-item global health instrument (PROMIS). An RSI score ≥13 was considered abnormal. Objective testing for LPR was performed using hypopharyngeal-esophageal multichannel intraluminal impedance catheter with dual pH (HEMII-pH) testing; a positive test was defined as more than one pharyngeal impedance events over 24 hours. Spearman rho analyses were applied, and the sensitivity and specificity of the RSI to detect HEMII-pH findings were determined.
Results
One hundred four patients underwent HEMII-pH testing. Mean scores were 16.7 (95%CI 15.1–18.3) for RSI. Sixty-three (60.6%) patients were diagnosed with LPR by HEMII-pH testing. RSI scores were moderately correlated with PROMIS physical (Spearman rho 0.43, P < 0.0001), social (Spearman rho 0.33, P < 0.0001) and mental health (Spearman rho 0.33, P < 0.0001) scores. The RSI has a sensitivity and specificity of 66.7% and 31.7%, respectively, for detecting pharyngeal events on HEMII-pH testing.
Conclusions
There is moderate sensitivity and lack of specificity of the RSI for detecting increased pharyngeal reflux events. Reflux-specific and general health status instruments are correlated. Further investigation could assess the diagnostic ability of RSI compared proximal reflux events on HEMII-pH, as well as whether health status instruments can be used to detect clinically meaningful change in the LPR population.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressEffect of Phonation on Perception of Femininity/Masculinity in Transgender and Cisgender Speakers
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Nichole Houle
Correspondence information about the author Nichole HouleEmail the author Nichole Houle, Susannah V. Levi
Department of Communicative Sciences and Disorders, New York University, New York, New York
Journal of Voice
Accepted: October 18, 2019; Published online: December 14, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.10.011
Publication stage: In Press Corrected Proof
Abstract
Many transwomen seek voice and communication therapy to support their transition from their gender assigned at birth to their gender identity. This has led to an increased need to examine the perception of gender and femininity/masculinity to develop evidence-based intervention practices. In this study, we explore the auditory perception of femininity/masculinity in normally phonated and whispered speech. Transwomen, ciswomen, and cismen were recorded producing /hVd/ words. Naïve listeners rated femininity/masculinity of a speaker's voice using a visual analog scale, rather than completing a binary gender identification task. The results revealed that listeners rated speakers more ambiguously in whispered speech than normally phonated speech. An analysis of speaker and token characteristics revealed that in the normally phonated condition listeners consistently use f0 to rate femininity/masculinity. In addition, some evidence was found for possible contributions of formant frequencies, particularly F2, and duration. Taken together, this provides additional evidence for the salience of f0 and F2 for voice and communication intervention among transwomen.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressImpact of Vocal Hygiene Training on Teachers’ Willingness to Change Vocal Behaviors
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Connie K. Porcaro*,1,
Correspondence information about the author Connie K. PorcaroEmail the author Connie K. Porcaro, Stephanie Howery*,
Amanda Suhandron*,
Thomas Gollery†
Journal of Voice
Accepted: November 15, 2019; Published online: December 13, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.11.011
Publication stage: In Press Corrected Proof
SUMMARY
There is a high incidence of dysphonia reported in teachers, which has been shown to indicate the teacher's ability to instruct as well as students’ ability to comprehend. Factors such as extra vocal load, poor classroom acoustics, and health issues may increase a teacher's risk of acquiring a voice disorder that impacts his or her career. A common approach to treating or preventing voice disorders is the use of vocal hygiene training. Many studies have addressed different types of voice training with mixed results due to lengthy training programs, poor implementation, and other factors related to teacher motivation. The purpose of this study was to determine whether education on vocal hygiene practices would impact teachers’ willingness to modify vocal behaviors. A group of 26 teachers from preschool to high school was sent pre- and post-training surveys to determine demographics, daily vocal use, and history of voice issues. The survey also assessed participants’ likelihood to modify their behaviors to incorporate vocal hygiene practices into their daily lives. Between the pre- and post-training surveys, teachers received a one-hour training on vocal hygiene practices. This training consisted of basic information regarding the anatomy and physiology of the voice, healthy, and unhealthy vocal behaviors and the impact of phonotrauma behaviors, and positive effects of vocal hygiene techniques.
Results showed that the impact of vocal hygiene training on teachers’ willingness to incorporate vocally hygienic behaviors was statistically significant (d ≥ 0.80). Increases in study participant perceived desire to engage in vocal hygiene behaviors by virtue of vocal hygiene training was manifested in nearly 90% of the targeted vocal hygiene behaviors. In conclusion, teachers appear to benefit from receiving education on voice use and vocal hygiene techniques and show willingness to incorporate these techniques into their repertoires.
Published by Elsevier Inc.
Article in PressA Preliminary Exploration of Vocal Usage in Prospective Professional Voice Users (PPVUs): Students of the Alimah Course
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T. Jayakumar*,
H. Mohamed Yasin†,1,
Correspondence information about the author H. Mohamed YasinEmail the author H. Mohamed YasinJournal of Voice
Accepted: November 15, 2019; Published online: December 13, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.11.012
Publication stage: In Press Corrected Proof
Summary
Background
Students of the Alimah degree are Prospective Professional Voice Users whose career involves teaching, preaching, and conducting religious activities. For them, a cultured and efficient voice is an important prerequisite for a successful career. This study aimed to explore vocal usage and knowledge of voice care among students pursuing the Alimah course.
Objectives
To check the period prevalence of voice problems among the students during the Alimah course, understand communication, and voice usage in daily situations, understand their lifestyle, assess their knowledge about voice and voice care through a self-reporting questionnaire.
Method
The data were obtained from 150 undergraduate students pursuing the Alimah degree in and around Nagapattinam and Thanjavur districts of Tamil Nadu, India, through a self-reporting questionnaire.
Results
The students pursuing the course were at a high risk for developing voice problems, with a period prevalence of 70%. Excessive vocal load, inappropriate diet, phonotraumatic behaviours and limited knowledge of voice care were found to be the threats to voice problems among the population.
Conclusion
This population with a high prevalence rate of voice problems should be studied further. The authors suggest including lessons on vocal enhancement methods and voice care in the course curriculum of the Alimah degree.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressA Case of Nervus Laryngeus Superior Paresis Treated With Novafon Local Vibration Voice Therapy
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Ben Barsties v. Latoszek*,†,
Correspondence information about the author Ben Barsties v. LatoszekEmail the author Ben Barsties v. Latoszek, Christopher R. Watts‡
Journal of Voice
Accepted: October 23, 2019; Published online: December 06, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.10.013
Publication stage: In Press Corrected Proof
Summary
Objective
The aim of the study is to present a case of chronic idiopathic superior laryngeal nerve paresis (SLNp) treated with a novel voice therapy approach called Novafon Local Vibration Voice Therapy (NLVVT).
Methods
Outcome measurements including acoustics, aerodynamics, and self-perception of voice handicap were acquired before intervention (i.e., NLVVT) and after intervention (i.e.,follow-up). The use of NLVVT was modified from previous reports of use in functional voice disorders for application to a neurological voice disorder (SLNp).
Results
The results showed that NLVVT had meaningful improvements in Voice Range Profile boundaries, an increase in speaking fundamental frequency, and improved acoustic indices of voice quality in a case of SLNp. The follow-up after NLVVT intervention revealed maintenance of the post-treatment improvements at a 1-month measurement interval.
Conclusion
The NLVVT program may have potential to improve voice quality and vocal function in a case of SLNp. Further research is necessary to test a potential effectiveness for NLVVT applied to vocal fold immobility due to paresis in both larger numbers of patients and more well-designed, controlled experiments.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressLateralization of the Vocal Fold: Results of an Exclusive Transoral Approach
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Christol Fabre*,
Nathalie Henrich Bernardoni†,
Marie-Pierre Aboussouan‡,
Paul F. Castellanos§,1,
Ihab Atallah*,║,
Correspondence information about the author Ihab Atallah1,Email the author Ihab AtallahJournal of Voice
Accepted: November 14, 2019; Published online: December 04, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.11.009
Publication stage: In Press Corrected Proof
Summary
Objective
Vocal fold paralysis in adduction can result in dyspnea. The authors have previously described an original vocal fold lateralization technique performed exclusively through an endoscopic approach. In this work, we studied long and short-term results of this procedure on dyspnea, phonation, and swallowing.
Study Design
Retrospective cohort study through data from medical records and operative notes. Patients with unilateral or bilateral vocal fold paralysis in adduction who underwent transoral lateralization were included.
Methods
In all patients, under laryngosuspension, a supraglottic laryngotomy was performed with CO2 laser and a lateralization suture was passed through the thyroid cartilage to the vocal process of the vocal fold with the desired tension allowing lateralization of the arytenoid and corresponding vocal fold. We studied evolution of breathing, phonation, and swallowing in all patients who underwent lateralization suture. We tried to correlate symptoms to preoperative and postoperative glottic area, inter-arytenoid distance, and anterior glottic angle.
Results
Eighteen patients were included in the study. Three patients were tracheostomy-dependent and were successfully decannulated. All other cases presented short and long-term significant improvement of their dyspnea index score (P < 0.001) in correlation with glottic area enlargement (P < 0.001). There was no statistical difference between preoperative and postoperative voice and swallowing parameters.
Conclusion
Our transoral lateralization technique allows enlargement of the glottic aperture in case of laryngeal dyspnea secondary to vocal fold paralysis in adduction. This technique optimally preserves laryngeal structures, especially the mucosa. It is reproducible and reliable for all laryngologists experienced in reconstructive transoral laser microsurgery.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressAcoustic Psychometric Severity Index of Dysphonia (APSID): Development and Clinical Application
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Seung Jin Lee*,†,1,
Correspondence information about the author Seung Jin LeeEmail the author Seung Jin Lee, Hong-Shik Choi*,
HyangHee Kim†,‡
Journal of Voice
Accepted: November 12, 2019; Published online: December 04, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.11.006
Publication stage: In Press Corrected Proof
Summary
Objectives/Hypothesis
The purpose of this study was to explore the predictability of the Korean version of the Voice Activity and Participation Profile (K-VAPP) scores and acoustic measures for perceived severity of voice disorders. Furthermore, usefulness of the index derived from the multivariate formula as a screening tool for voice disorders was explored and compared with that of the Cepstral Spectral Index of Dysphonia (CSID).
Methods
A total of 150 patients with various voice disorders (42 males and 108 females, age = 45.15 ± 15.15 years) and matched 50 normal controls (14 males and 36 females, age = 44.78 ± 13.70 years), participated in the study. Correlates of perceived overall severity were explored by a stepwise regression analysis with regards to demographic information (age, gender, and professional voice use), jitter, shimmer, and noise-to-harmonic ratio of vowel samples, cepstral peak prominence (CPP), L/H spectral ratio, and their standard deviations of sentence and vowel samples, and psychometric measures of the K-VAPP. Using the ROC curve analysis, the area under curve (AUC) of the novel index derived from the regression equation and the CSID were compared and the cut-off score of the index was obtained.
Results
A significant portion (adjusted R square = 79.0%) of the overall severity perceived by clinicians was predicted by five parameters: CPP of the sentence and vowel production, the self-perceived severity subscale score of the K-VAPP, σCPP of the vowel production, and gender. The AUC of the novel index was 0.935 (95% confidence interval 0.891–0.965) and significantly higher than that of the CSID of vowel samples (AUC = 0.832). The cutoff score with the highest Youden J Index (0.7612) was >22.257617 (sensitivity = 82.12%, specificity = 94.00%).
Conclusion
The current data showed the possibility that a novel index reflecting both acoustic and psychometric correlates of auditory-perceptual estimates for dysphonia severity could be suggested and possibly named as the “Acoustic Psychometric Severity Index of Dysphonia (APSID).” Further studies pertaining to the follow-up of various voice disorders are needed to extend its clinical usefulness.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressIncidence of Common Mental Disorders in Teachers: Is There a Relationship with Voice Disorders?
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Luise Marques da Rocha*,
Paulinia Leal do Amaral*,
Correspondence information about the author Paulinia Leal do AmaralEmail the author Paulinia Leal do Amaral, Suelen de Lima Bach*,
Mara Behlau†,
Luciano Dias de Mattos Souza‡,§
Journal of Voice
Accepted: October 16, 2019; Published online: December 02, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.10.009
Publication stage: In Press Corrected Proof
Summary
Objective
This study aims to evaluate the risk factors associated with the incidence of common mental disorders (CMD) in teachers, particularly the possible relationship with voice disorders.
Material and Methods
A longitudinal quantitative study of 469 teachers of the municipal schools of Pelotas in Brazil was conducted over three years after a baseline interview. The symptoms of CMD were assessed with the Self-Reporting Questionnaire 20 items (SRQ-20 scale) and the voice disorder was assessed with the Voice Handicap Index Protocol with cutoff of 19 points. A bivariate analysis was performed using Poisson regression to verify the difference in proportion of the incidence of CMD in the different categories of independent variables.
Results
The incidence of CMD was 18% (N = 265). In the bivariate analysis, the risk for CMD was 77% higher for teachers who presented with a voice disorder (RR 1.77 95% CI 1.04 to 3.03).
Conclusions
Teachers who reported a voice disorder had an increased risk of developing a CMD.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in PressImpact of Pregnancy and Glucocorticoid Treatment on NF-κB and MUC5AC in Mucosa of Rat Larynx
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Burak Ulkumen*,
Correspondence information about the author Burak UlkumenEmail the author Burak Ulkumen, Burcu Artunc Ulkumen†,
Muhammet Burak Batir‡,
Halil Gursoy Pala§,
Seda Vatansever¶,
Sirri Cam‡
Journal of Voice
Accepted: November 13, 2019; Published online: December 02, 2019
DOI: https://doi.org/10.1016/j.jvoice.2019.11.008
Publication stage: In Press Corrected Proof
SUMMARY
Objective
The aim of this study is to reveal physiological expression and distribution of nuclear factor-kappa B (NF-κB) and MUC 5 subtype AC (MUC5AC) in rat laryngeal mucosa and to find out the effect of pregnancy and glucocorticoid treatment on these biomolecules.
Methods
This animal experiment was done in Experimental Animals Research and Application Center of Manisa Celal Bayar University in accordance with the accepted policy on the use of animals. A total of 30 young, adult Wister albino female rats were randomized into a control group (group A), a pregnant group (group B), and a steroid administered group (group C). Sacrification was done by injection of sodium-pentobarbitone (400 mg/kg) solution via intraperitoneal route in all groups. Serum estradiole (E2) and progesterone (PG) were determined by enzyme-linked immunosorbent assay. The relative expression and distribution of NF-κB and MUC5AC in laryngeal mucosa was studied both by immunohistochemistry (IHC) and polymerase chain reaction testing. Expression and immunohistochemical localization of NF-κB and MUC5AC was evaluated by light microscopy (Olympus BX41). In statistical analyses; relative expression of NF-κB and MUC5AC were compared on group basis. The effect of E2 and PG levels on these biomolecules was also evaluated.
Results
NF-κB was found to be significantly low both in group B (P < 0.05) and C (P < 0.001) when compared with group A, while MUC5AC was found to be significantly high both in group B (P < 0.05) and group C (P < 0.05) when compared with group A. Concerning IHC; NF-κB was found to be expressed in epithelium and lamina propria. MUC5AC was found to be expressed particularly in the epithelial layer in all groups. Statistically significant negative correlation between PG and NF-κB expression (P = 0.048), but no correlation between PG and MUC5AC expression (P = 0.487) were revealed. On the other hand, no correlation was found between E2 and the expression of relevant biomolecules (NF-κB [P = 0.270], MUC5AC [P = 0.829]). We also did found a significant negative correlation between the expression of NF-κB and MUC5AC (P = 0.031).
Conclusions
In this study, the physiological expression of NF-κB and MUC5AC in rat laryngeal mucosa was shown for the first time both by polymerase chain reaction and IHC. The impact of pregnancy and glucocorticoid treatment on the expression and distribution of these biomolecules was also revealed. The expression of NF-κB was found to be decreased while the expression of MUC5AC was found to be increased both by pregnancy and glucocorticoid treatment. The inhibitory effect of serum PG on NF-κB expression in rat laryngeal mucosa was also shown for the first time. The expression of MUC5AC was found to be increased both in pregnant and glucocorticoid administered group. Negative correlation between NF-κB and MUC5AC expression was also revealed in rat larynx for the first time. These findings may partially unclose the histochemical background of voice changes caused by pregnancy and as well as by glucocorticoid treatment.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
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