Folia Phoniatrica et Logopaedica最新文献

Introduction: The present study aimed to validate the Voice-Related Quality of Life (V-RQOL), vocal self-assessment questionnaire for Spanish.

Methods: The validation and psychometric properties were developed according to the criteria of the Scientific Advisory Committee of Medical Outcomes Trust (SAC). The Spanish translation for linguistic and cultural adaptation of the V-RQOL was used. The study involved 193 participants, including 90 vocally healthy individuals and 103 patients with voice disorders, to establish validity. To evaluate reliability, the protocol was applied to 40 participants with dysphonia, who answered it twice before the treatment. Then to determine response changes, the responses of 13 dysphonic participants to the V-RQOL for Spanish were analyzed after intervention and then compared to the initial ones. Clinicians contrasted subjects' V-RQOL results with a perceptual analysis of voice quality using the GRBAS scale. In order to determine sensitivity and specificity cut-off values, tools results were subjected to the receiver operating characteristic curve analysis. The sensitivity was obtained from the experimental group (dysphonic group) and the specificity from the control group (non-dysphonic group).

Results: This version of the V-RQOL questionnaire may be used as part of the standard assessment process of people with voice complaints and as an outcome of treatment efficacy in clinical trials.

Conclusion: A validation of the V-RQOL for Spanish in Chilean population was achieved.

Introduction: Training is an integral part of learning any skill. The vocal training helps singers attain proficiency as they are the most demanding vocal group of all professional voice users. Hence, it is necessary to evaluate the influence of training on the singer's voice. The current study objective was to investigate the influence of vocal training on voice measures (acoustic and aerodynamic) between male Carnatic singers with lower (6 months-5 years) and higher (6-10 years) training using novel task "mkaram" along with lyrical task.

Methods: Group 1 consisted of 30 trained male Carnatic singers with lower vocal training, and group 2, thirty trained male singers with higher training in the age of 18-45 years. The acoustic (frequency-related parameter, cepstral, spectral, perturbation, and noise) and aerodynamic measures (maximum phonation time and s/z ratio) of voice were obtained. The test-retest reliability was conducted on a sample of 10% of the population from each group, with a 2-week interval between the tests. Cross-sectional study design was applied.

Results: The statistical analysis revealed significantly decreased frequency-related parameters (semitones) such as the mean fundamental frequency, lowest fundamental frequency, highest fundamental frequency at the low register and the highest fundamental frequency at the middle register in group 2 during "mkaram" task (p ≤ 0.05). Similarly, one of the spectral-related measures 1st harmonic-2nd harmonic (dB) during lyrical task and one of the noise-related measure harmonic-to-noise ratio (dB) at the middle register during "mkaram" task showed a significant decrease in group 2 compared to group 1 (p ≤ 0.05). Test-retest reliability revealed that most of the parameters had "acceptable to excellent" internal consistency (Cronbach's α >0.7 to 1).

Conclusion: Few frequency and noise measures during "mkaram" task and a spectral measure during lyrical task showed to be sensitive in distinguishing the impact of vocal training on the voices of male Carnatic singers. The higher vocal training was found to help the singers to perform more efficiently with enhanced vocal range particularly in the low register and to some extent in the middle register. Indeed, the study highlighted the positive effects of vocal training on male Carnatic singers.

Introduction: This study investigated the effects of suspension pharyngeal flap surgery for velopharyngeal insufficiency (VPI) due to cleft palate.

Methods: Ten Filipino individuals (mean age = 20.63 years, range = 8.4-34.9 years) with a cleft palate who underwent suspension pharyngeal flap surgery for VPI were included in this study. Perceptual and instrumental speech assessments were conducted at two different time points: before surgery (data point 1) and after surgery (data point 2, range = 4-26 weeks postoperatively). Speech intelligibility in different contexts and satisfaction with speech were assessed by the participants themselves using a self-report questionnaire. Additionally, the risk for obstructive sleep apnea was assessed using the Berlin Questionnaire.

Results: Velopharyngeal gap size significantly decreased after the surgery. Additionally, significant improvements in speech understandability and acceptability were observed following the suspension pharyngeal flap procedure. Besides, a significant reduction in hypernasality, nasal emission, and the occurrence of passive articulation errors was seen. No difference in the occurrence of active articulation errors was observed when comparing data pre- and post-surgery. The ten individuals reported to be significantly more intelligible in different contexts after surgery.

Conclusion: Improved speech was observed in individuals who received the suspension pharyngeal flap procedure. This procedure also positively influences an individual's intelligibility in different contexts in daily life. In individuals with persisting active articulation errors, post-surgery speech therapy will still be necessary.

Introduction: The Speech Efficiency Score (SES) serves as an acoustic metric for assessing fluency in conversational speech within the temporal domain. This study leverages SES to investigate conversational speech efficiency among native speakers of American English (AE) compared to speakers of Mandarin-accented English (MAE).

Methods: SES, speaking rate, articulation rate, and vocabulary diversity were measured and compared between two groups: native AE speakers and MAE speakers. The study utilized conversational speech samples collected from both groups to analyze these metrics.

Results: Findings indicate a disparity in speaking rate and articulation rate between the AE and MAE groups, with the AE group exhibiting significantly faster speech. However, no significant differences were observed in SES and vocabulary diversity between the two groups.

Conclusion: The results are discussed in the context of the interplay between speaking rate, speech fluency, and vocabulary diversity. These findings shed light on the maintenance of speech efficiency among bilingual speakers, suggesting that despite differences in speaking rate and articulation rate, SES and vocabulary diversity remain comparable between native AE speakers and MAE speakers.

Introduction: Consistency of liquid food plays an important role in managing patients with dysphagia, which can be objectively evaluated by using IDDSI Flow Test and consistometry. The present study established the relationship between IDDSI Flow Test and consistometric measures, and examined the measurement limitations of each test associated with thickened liquids prepared using starch-based and xanthan gum-based thickening agents.

Methods: Thirteen thickened liquid samples of consistency ranging from IDDSI Level 1 (mildly thick) to Level 3 (moderately thick) were prepared using starch-based and xanthan gum-based thickeners. IDDSI Flow Test and consistometric measures were obtained and analyzed using correlation and regression.

Results: A strong correlation was observed between both tests. Regression analyses revealed a linear and a quadratic relationship between IDDSI Flow Test and consistometric measurements, respectively.

Conclusion: Starch-based and xanthan gum-based thickeners exhibited different relationships between IDDSI Flow Test and consistometric measurements. Findings allow easy conversion and adaptation of consistometric measures to the IDDSI framework, which renders the use of consistometry in the clinical settings as a complementary quantitative measurement of liquid consistency to IDDSI Flow Test.

Introduction: Benign and malignant vocal fold lesions (VFLs) are growths that occur on the vocal folds. However, the treatments for these two types of lesions differ significantly. Therefore, it is imperative to use a multidisciplinary approach to properly recognize suspicious lesions. This study aimed to determine the important acoustic characteristics specific to benign and malignant VFLs.

Methods: The acoustic model of voice quality was utilized to measure various acoustic parameters in 157 participants, including individuals with normal, benign, and malignant conditions. The study comprised 62 female and 95 male participants (43 ± 10 years). Voice samples were collected at the Shanghai Eye, Ear, Nose, and Throat Hospital of Fudan University between May 2020 and July 2021. The acoustic variables of the participants were analyzed using Principal Component Analysis (PCA) to present important acoustic characteristics that are specific to normal vocal folds, benign VFLs, and malignant VFLs. The similarities and differences in acoustic factors were also studied for benign conditions including Reinke's edema, polyps, cysts, and leukoplakia.

Results: Using the PCA method, the components that accounted for the variation in the data were identified, highlighting acoustic characteristics in the normal, benign, and malignant groups. The analysis indicated that coefficients of variation in root mean square energy were observed solely within the normal group. Coefficients of variation in pitch (F0) were found to be significant only in benign voices, while higher formant frequencies and their variability were identified as contributors to the acoustic variance within the malignant group. The presence of formant dispersion (FD) as a weighted factor in PCA was exclusively noted in individuals with Reinke's edema. The amplitude ratio between subharmonics and harmonics (SHR) and its coefficients of variation were evident exclusively in the polyps group. In the case of voices with cysts, both pitch (F0) and coefficients of variation for FD were observed to contribute to variations. Additionally, higher formant frequencies and their coefficients of variation played a role in the acoustic variance among voices of patients with leukoplakia.

Conclusion: Experimental evidence demonstrates the utility of the PCA method in the identification of vibrational alterations in the acoustic characteristics of voice affected by lesions. Furthermore, the PCA analysis has highlighted underlying acoustic differences between various conditions such as Reinke's edema, polyps, cysts, and leukoplakia. These findings can be used in the future to develop an automated malignant voice analysis algorithm, which will facilitate timely intervention and management of vocal fold conditions.

Introduction: This study explores the quality of life among patients with recurrent respiratory papillomatosis (RRP) after vocal fold surgery as measured by the outcome scores of the Voice Handicap Index (VHI) and the Distress Thermometer and Problem List in Patients with Recurrent Respiratory Papillomatosis (DT&PL). Differences in quality of life were explored within the independent variables age, surgical frequency, weeks since last vocal fold operation, gender, HPV type, surgical location, vaccination with Gardasil©, and a patient's request to speak with a speech-language pathologist.

Methods: A single-center, observational cohort study was conducted using VHI and DT&PL scores and demographic and clinical data obtained from patient files. Inclusion criteria were a confirmed HPV type, age 18 years or older, the ability to fill in both questionnaires in Dutch, and having undergone at least one surgical procedure to remove laryngeal papilloma. Relationships of the independent variables with VHI and Distress Thermometer (DT) scores were explored using univariable and multivariable regressions and linear regression models.

Results: Of 271 RRP patients, 100 met the inclusion criteria and responded to requests to fill in both questionnaires with a minimum of 12 weeks after their last operation. Our study showed a statistically significant negative relationship between age and VHI scores (p = 0.02) in the univariable, and multiple linear regressions (p = 0.01), indicating that patients experienced fewer self-perceived functional voice disabilities with each increase in age. A parallel negative relationship is seen between the variables age (p = 0.03) and DT scores. Our results showed a statistically significant positive relationship between the number of vocal fold surgeries and DT scores (p = 0.03).

Conclusion: The results of this study show a significant relationship between age, surgical frequency, and quality of life in patients with RRP. Older patients have lower Voice Handicap Index (VHI) and Distress Thermometer (DT) scores, indicating fewer self-perceived voice and disease-related quality of life problems. Conversely, a rise in surgical frequency is significantly associated with higher DT scores, reflecting greater disease-related distress.

Introduction: The predominant alterations in voice of patients with multiple sclerosis (MS) are phonatory instability, vocal asthenia and roughness, shortness of breath, hypophonia, and hypernasality. However, research on alterations of acoustic parameters has few studies and disparate results. The objective of this study was to investigate voice disturbances in patients with MS, both with objective measures (analysis of biomechanical) and subjective measures (scales and questionnaires).

Methods: This is an experimental study with a total of 20 participants with MS. Voice samples were collected, and biomechanical correlates were analyzed through the Clinical Voice Systems program, Online Lab App. The VHI-30 (Voice Handicap Index) questionnaire, the GRBAS (grade, roughness, breathiness, asthenia, strain) scale, and the Hospital Anxiety and Depression Scale were used as subjective measures.

Results: Ninety-five percentages of participants feel and describe dysphonic difficulties. Self-perception of vocal disability correlated with auditory vocal perceptual analysis in the sample of women.

Conclusion: The biomechanical parameters showed alterations in the strength of the glottic closure, the efficiency index, and the structural imbalance index.

Introduction: Flamenco is a traditional music originally from Andalusia in southern Spain. Some of the vocal resources used in Flamenco have components of voice distortion and other voice qualities that could sound like hyperfunctional voice productions. The present study aimed at observing supraglottic activity in flamenco singers while engaged in singing at various degrees of pitch and loudness and while engaged in realizing phonatory tasks.

Methods: A total of eighteen flamenco singers with at least 5 years of voice training were recruited. Flexible endoscopic voice evaluations were recorded and edited to provide samples of different pitches, loudness levels, and phonatory tasks. Sound was removed from video samples. Two blinded laryngologists were asked to assess antero-posterior compression, medial compression, pharyngeal compression, and VLP for every sample, using a visual analog scale.

Results: Significantly higher values were found for medial compression, anterior-posterior compression, VLP and pharyngeal compression during high loudness levels when compared to medium and low loudness. Overall, medial compression was lower than anterior-posterior compression.

Conclusion: Supraglottic activity is present in flamenco singing in the four laryngoscopic variables. It seems to be that supraglottic activity increases with loudness level and pitch. This behavior could be a natural and necessary aspect of flamenco singing present during both sustained vowels and song.

Introduction: This study proposes a revised version of the Reflux Symptom Index (R-RSI), a seventeen-item questionnaire that was revised to increase the suspicion of laryngopharyngeal reflux disease (LPRD).

Methods: Internal validation involved 213 participants, comprising 160 subjects without a previous LPRD diagnosis and 53 subjects with a self-reported previous diagnosis of LPRD with or without gastroesophageal reflux disease (GERD). Test-retest reliability and internal consistency were calculated. For the external validation, 56 patients (independent from the previous cohort) were enrolled to explore the R-RSI screening properties and determine a cutoff using 24-h MII-pH as the gold standard.

Results: R-RSI test-retest reliability was high, both for the total score (ICC: 0.970) and for each item (ranging from 0.876 to 0.980). Cronbach's alpha was 0.910, indicating excellent internal consistency of the questionnaire. Participants with a previous self-reported diagnosis scored significantly higher (mean 24.94 ± 7.4; median 26, IQR 20-29) than those without a previous diagnosis (mean 4.66 ± 5.3; median 4, IQR 1-6) (p value <0.0001). Participants with both previous LPRD and GERD diagnoses had higher scores (27.20 ± 7.8) compared to those with only LPRD (21.77 ± 5.5) (p value = 0.003). Using 24-h MII-pH diagnosis as a gold standard, the optimal R-RSI cutoff point was determined to be 18, with a sensitivity of 84.5% and a specificity of 81.8%, positive predictive value of 95%, and negative predictive value of 60%.

Conclusions: Our results suggest that the R-RSI may be useful to suspect LPRD, with or without GERD. The R-RSI is a self-administered patient-reported outcome questionnaire that demonstrates excellent reliability and high screening properties. Employing a cutoff of ≥18 in the R-RSI can assist in diagnosing and monitoring LPRD.