Folia Phoniatrica et Logopaedica最新文献

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.

Introduction: Children with malocclusion, combined with orofacial myofunctional disorders (OMDs), show increased risk of developing orthodontic problems and needs later in life. Speech-language therapists typically provide orofacial myofunctional therapy (OMT) after referral by dentists, orthodontists or ENT specialists. Interdisciplinary treatment is often advisable to prevent relapse after orthodontic treatment. OMDs and OMT are often found to be controversial topics by dentistry professionals. This study aimed to investigate self-reported knowledge and attitudes of Flemish dentists and orthodontists towards OMDs and OMT.

Methods: A survey containing 32 items on demographics, self-reported knowledge of OMDs and OMT, attitudes towards OMDs, OMT, and its use in clinical practice, and referral behaviour was filled out by 48 general dentists (48/79, 61%) and 31 orthodontists (31/79, 39%). The impact of specialization, degree of experience and educational programme was also evaluated.

Results: Fifty-six percent of all participants (44/79) reported insufficient to non-existent knowledge of OMT. Nevertheless, the general attitude towards the use of OMT was neutral (47%, 37/79) to (very) positive (48%, 38/79). Although they found correct, evidence-based knowledge on OMDs and OMT important, the majority indicated their formal training did not provide adequate information on OMDs (52%, 41/79) and OMT (62%, 49/79). Specialization showed significant effects, as orthodontists reported themselves knowledgeable on this topic significantly more often than general dentists (p < 0.001), and generally reported a more positive stance towards OMT (p = 0.022).

Conclusion: Dentists and orthodontists indicated a general interest in the topic of OMDs and OMT, alongside an overall lack of information provided by formal education. Current findings suggest the necessity of re-evaluating current curricula on OMDs and OMT.

Introduction: This paper aimed at observing the impact of dysphonic voice on children's reception of a linguistic message by evaluating their reaction times (RTs) to instructions given by functional dysphonic and control female schoolteachers (STs).

Methods: French minimal pairs such as /muʃ/ ("mouche" fly) versus /buʃ/ ("bouche" mouth) embedded in a carrier sentence "click on the drawing of…" were produced by two groups of 10 dysphonic and control female ST, matched in age and year of experience. The phonemical contrasts observed are voicing, nasality, consonantal place of articulation, vowel roundedness, and vowel place of articulation. The experimentation was presented in the form of a computer game to children from 7 to 10 years old. Two images illustrating the target words were presented, accompanied by the oral instructions recorded by ST. With a two-button box created for the experiment, children had to click as quickly as possible on the image corresponding to the instruction.

Results: Our results show that the RTs of all children are affected by the ST's dysphonia, regardless of their age and that they have significantly longer RT when discriminating minimal pairs contrasting in voicing when the instruction is given by a dysphonic speaker compared to the same instruction given by a control speaker.

Conclusion: These observations could be explained by the fact that functional dysphonia is associated with improper use of the vocal folds and thus an alteration of voicing.

Introduction: Acquired swallowing impairment is a major public health issue that often leads to increased morbidity and slower recovery. Speech and language therapists (SLTs) have taken the lead in the assessment and treatment of dysphagia, which is reflected in guidelines where early intervention is recommended. This is in addition to the central role that SLTs play in the management of acquired communication impairments since research indicates that patients with communication difficulties benefit from early and intensive therapy by SLTs. This increasing demand for SLTs is expected to cause conflicting pressures in their workload and, therefore, beneficial to consider workforce planning. The aim of this study was to examine real-world data in the UK to investigate this issue regarding changes in referral patterns of patients with dysphagia and/or communication disorders to SLTs over time, to assist with workforce planning.

Methods: We interrogated the Royal College of Speech and Language Therapists Online Outcome Tool, a national database, in this retrospective cohort study. We included patients evaluated between 2018 and 2022. We performed a subgroup analysis of patients aged ≥40 years who had a primary medical diagnosis of stroke. Data on age, primary diagnosis, time on caseload, primary Therapeutic Outcome Measure (TOM) scale and initial TOM score on impairment were examined.

Results: From the database of 44,444 referrals to speech and language therapy, 5,254 referrals were included in the stroke and overall subgroup analyses. Referrals were 55.1% male, with a median age of 71 years. More than half (56.1%) of these referrals were for dysphagia. Referrals decreased during the COVID-19 pandemic but began to recover from 2021 onwards. The time on the SLT caseload has increased over the years from a median of 14 days (interquartile range [IQR] 0-56) in 2018 to 20 days (IQR: 3-81) in 2022. While there were more referrals to SLT services for assessment and management of dysphagia than for communication in the overall population, in the stroke subgroup, referrals for communication disorders outnumbered referrals for dysphagia from 2020 onwards. Additionally, the severity of impairment on referral increased over the years.

Conclusion: Real-world data indicates that referrals to SLT services are changing over time to include more complex and severely impaired patients, with a demand for both swallowing and communication disorders. These findings should inform staff allocation and remodelling of education/training for SLTs to better meet clinical and public health needs. The retrospective nature of this study limits the strength and generalisability of these data, and this topic warrants further investigation.

Introduction: Many epidemiological studies of the disorder of stuttering have been conducted during the 20th century, continuing during the current one. Unfortunately, only a few were carried out in Japan. This study aimed at assessing (1) the incidence and prevalence of stuttering in 3-year-old children in multiple Japanese communities and (2) factors associated with the onset of stuttering among these children.

Methods: A questionnaire aimed at screening for the presence of stuttering was employed for 2,055 children aged 3 years, who underwent a standard nationwide health checkup. Positive responses were confirmed in several ways: (1) direct interviews and assessment of the child's speech, (2) confirmatory questionnaire, or (3) telephone interviews by licensed Speech Language Hearing Therapists.

Results: Approximately 6.5% of the children were found to exhibit stuttering at the time of their health checkup. This figure rose to 8.9% after including individuals who previously, but not currently, were reported to have exhibited stuttering. Among the putative risk factors, higher stuttering odds (odds ratio, OR = 3.27) were detected in those with a family history of stuttering, those whose guardians had concerns about their child's development (OR = 1.75), and those with diagnosed diseases or disabilities (OR = 2.13).

Discussion/conclusions: It was concluded that, in Japan, both the risk of stuttering incidence (8.9%) in children up to, and including, the age of 3 years, as well as its prevalence (6.5%) in this population, was similar to those reported by recent studies in other countries. Additionally, our findings also confirmed that an increased risk for stuttering at age 3 is associated with a family history of stuttering.