Journal of Voice最新文献

Background: In voice clinics, vocal effort is a prevalent complaint, with around 25% of clinicians citing it as the primary issue.

Aim: This study had two objectives. First, it sought to establish the prevalence of vocal effort, both as the primary and the only symptom, among patients receiving treatment from clinicians specializing in voice disorders in various countries across South and North America. Second, this study aimed to distinguish key factors, including country of clinical practice, clinicians' experience, and the instruments employed to assess effort, associated with the identification of vocal effort.

Methods: This cross-sectional study surveyed speech-language pathologists (SLPs) from North and South America on vocal effort in patients. The survey covered SLP demographics, caseload composition, patient challenges, and measures of vocal effort that were used. Statistical analysis assessed relationships between SLP demographics, caseload, and vocal effort factors.

Results and conclusion: The results suggest significant geographical variations in SLPs' experiences with vocal effort. Colombian clinicians report significantly fewer voice cases and a lower proportion of vocal effort in their caseload, while Argentinian clinicians were more likely to report vocal effort in their voice cases. Years of experience were identified as a significant predictor of a higher likelihood of a voice-dominant caseload and higher rates of vocal effort among patients. Interestingly, using the Vocal Fatigue Index during the assessments increased the likelihood of reporting vocal effort in the clinicians' caseload. These findings suggest a potential association between experience, outcome measure selection, and vocal effort caseload. These lead to suggestions that opportunities for additional voice disorder training beyond that which SLPs find in school are valuable.

Objective: To investigate the correlation between anxiety, depression, and self-perceived vocal handicap in Lebanese patients with voice disorders.

Study design: Prospective cohort.

Methods: All patients who presented to the voice clinic of a tertiary referral center with hoarseness between November 2023 and June 2024 were invited to participate in this prospective study. All patients were asked to complete the Voice Handicap Index-10 (VHI-10), the Generalized Anxiety Disorder scale-7 (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9).

Results: A total of 100 patients were enrolled in this study. The study group included 56 men and 44 women. The mean age of the participants was 46.03 ± 11.66 years. The mean VHI-10 score was 13.41 ± 6.39. Based on the GAD-7 score, 12 patients had minimal anxiety, 24 had mild anxiety, 43 had moderate anxiety, and 21 had severe anxiety. Patients with moderate or severe anxiety had a significantly higher VHI-10 score than those with minimal anxiety (P < 0.05). There was a mild positive correlation between level of anxiety and the VHI-10 score (r = 0.276). Based on the PHQ-9 score, 50 patients had minimal depression, 30 had mild depression, and 20 had moderate depression. Patients with moderate or mild depression had a significantly higher VHI-10 score than those with mild depression (P < 0.05). There was a mild positive correlation between level of depression and the VHI-10 score (r = 0.316).

Conclusions: Anxiety and depression are common in Lebanese patients with voice disorders. Self-perceived vocal handicap correlated positively with the level of anxiety and depression. A multidisciplinary approach is recommended to optimize treatment of patients with voice disorders and mental illnesses.

Objective: To explore different anesthesia techniques for medialization thyroplasty and determine how these anesthesia techniques may influence patient safety, patient experience, and surgical outcomes during medialization thyroplasty in adult patients.

Data sources: A comprehensive librarian-designed strategy was used to search EMBASE, MEDLINE, and Web of Science for English language studies from database inception to July 2023. The study was registered on Open Science Framework (10.17605/OSF.IO/R3BV2).

Review methods: Study selection was independently performed by two investigators for all English language studies of adult patients investigating anesthetic techniques for medialization thyroplasty with a minimum of five patients. Surgical outcomes (voice, perioperative complications, and swallowing), healthcare resource utilization metrics (operating time, length of stay), and patient-reported outcomes measures (PROMs) were analyzed. Study quality was assessed with the Oxford Levels of Evidence tool.

Results: From 354 articles, 28 studies were included. The most common anesthetic techniques were combined procedural sedation and local anesthesia (13/28 [46%]), local anesthesia alone (8/28 [29%]), and general anesthesia (GA) (7/28 [25%]). Six studies (21%) reported intraoperative complications (eg, desaturation), and eight (29%) studies reported postoperative complications (eg, airway obstruction). Voice outcomes were assessed in 14 (50%) studies. PROMs, including Voice Handicap Index (3/28 [11%]), were less commonly assessed. Intraoperative fiber-optic visualization was utilized in eight (29%) studies. Only one study assessed swallowing. Only two studies compared outcomes between anesthetic techniques. The median Oxford Level of Evidence was 4.

Conclusion: Medialization thyroplasty is performed under local anesthetic alone, with combined procedural sedation, and local anesthetic or with GA, with diverse approaches to airway management and minimal perioperative complications. Future research using standardized outcome measures is warranted due to the current paucity in the literature.

Objectives: This review aims to explore potential associations between immunological biomarkers and phonotraumatic vocal fold lesions.

Study design: Scoping review.

Methods: Ovid MEDLINE, CINAHL, PubMed, Proquest Theses and Dissertations, Scopus, and Web of Science were searched using the terms "vocal fold" and "inflammatory marker" initially, and later "development" and "phonotraumatic lesion." Papers were included for review if they were published in the last 20 years in English language, used human cell lines or biological samples, and outcomes were measured objectively using immunological biomarkers.

Results: In total, 4107 papers were identified for screening. The automation tools EndNote and Covidence removed 1257 duplicates. A further 2687 papers were excluded by reviewers at the title and abstract screening stage. The remaining 62 papers underwent full-text screening and 28 publications were ultimately included in the review.

Conclusions: Research concerning the possible association between immunological biomarkers and phonotraumatic lesions is still in its early stages, largely due to difficulty obtaining biological vocal fold samples in a safe and noninvasive manner, and challenges in identifying laboratory techniques that are sensitive enough to detect concentrations of biomarkers in small volumes of vocal fold samples. Signaling molecules are likely the most promising biomarkers to investigate the role of voice use patterns in the development of phonotraumatic lesions due to relatively rapid shifts in response to host conditions. Future research would benefit from control of potential systemic contributions to laryngeal manifestations of inflammation.

Objective: This study examines the demographic makeup of composers in Western classical art song anthologies and reference materials.

Design: Generalized (noncomposer or demographic-specific) musical anthologies (n = 379) and reference books (n = 29) were collected through commercial search engines, publisher websites, academic libraries, and private collections. Each composer's gender, race, sexuality, birth nationality, approximate musical period, and number of compositions were collated and categorized from each resource.

Methods: Definitions for demographic information were adapted from the United States Census Bureau and Human Rights Campaign to center the lens of a contemporary user's experience engaging with these texts. Basic statistics calculated using the composer's demographic information were multiplied by their total number of compositions to capture an aggregate understanding of what identities are likely to be encountered in such a resource.

Results: Data collection yielded 12,321 composers (unique n = 3971) and 56,847 songs with repetition. Generalized resources tend to contain the music of specific composer demographics. Included works were composed by primarily straight (n = 43,795, 77.0%), White (n = 55,661, 97.9%), or male (n = 53,864, 94.8%) composers. Z-test results showed significance when comparing musical resources with population estimates in all categories. Man, White, and Queer are significantly higher, while Woman, Black, Indigenous, People of Color (BIPOC), and Straight are lower in the aggregate data than in general population estimates. Man/White/Straight and Man/White/Queer are higher in the data, and all other groups are lower in the aggregate data than general population estimates.

Conclusions: The widespread use of art song resources representing a select portion of the available repertoire with unknown editorial impartiality could reinforce canonic ideology by limiting exposure to diverse repertoires. A "French Song" anthology is unlikely to have any women, BIPOC, or queer representation unless designed as a "Women in French Song," "BIPOC French Composers," or "Art Song by Queer French Composers" resource instead.

Purpose: Due to the elevated vocal risks of university professors and the possible relationship between auditory-motor integration and voice disorders, the current study was designed to explore the effects of altered auditory feedback via bone conduction on voice production measures in university professors.

Methods: A total of 43 hours of voice recordings across 32 university classes were collected from two vocally healthy college professors through voice dosimetry. During their classes, the professors experienced either the real-time altered auditory feedback or a condition without altered auditory feedback. The voice dosimetry recordings from all classes were processed to calculate the sound pressure level values, fundamental frequency values, and the time dose. The effects of the altered auditory feedback conditions on these voice acoustic parameters were analyzed and compared with the conditions without altered auditory feedback.

Results: The altered auditory feedback conditions resulted in significantly decreased sound pressure level values and time dose for both professors when comparing the altered auditory feedback conditions to the conditions without altered auditory feedback. The altered auditory feedback effects were larger for the male professor compared with the female professor. Additionally, the male professor demonstrated significantly decreased fundamental frequency values when comparing the altered auditory feedback conditions to the conditions without altered auditory feedback, while the female professor did not.

Conclusions: This study provides evidence that altered auditory feedback provided via bone conduction through an altered auditory feedback device resulted in statistically significant improvements in the voices of two college professors.

Objective: To evaluate whether Robotic or Laparoscopic Nissen Fundoplication (LNF) improves voice outcomes and symptoms in patients with Laryngopharyngeal Reflux (LPR) compared to patients who were candidates for surgery but elected to receive treatment with antireflux medical management alone.

Study design: Retrospective chart review.

Methods: A retrospective chart review was conducted of patients who visited the office of the senior author, received a diagnosis of LPR, and were candidates for LNF. Patients were categorized into two groups: those who received LNF surgery (Nissen-received, n = 50) and those who declined surgery (Nissen-declined, n = 54). Reflux Finding Scores (RFS) collected pre- and post-treatment were compared between groups. 24-hour pH-impedance results also were evaluated pre- and post-treatment.

Results: 24-hour pH-impedance testing from patients in the Nissen-received group showed a statistically significant decrease in six recording categories at the proximal sensor and five at the distal sensor, pre- to post-Nissen fundoplication. Proximal sensor categories included: (1) total reflux, (2) supine reflux, (3) acidic reflux, (4) weakly acidic reflux, (5) upright reflux, and (6) total postprandial reflux. Distal sensor categories included: (1) total reflux, (2) weakly acidic reflux, (3) supine reflux, (4) upright reflux, and (5) upright weakly acidic reflux. There were statistically significant differences in the changes from pre- to post-intervention when comparing between the Nissen-received and Nissen-declined groups at three proximal and three distal recordings. The proximal recording categories were (1) total reflux, (2) upright reflux, and (3) upright weakly acidic reflux, and the distal sensor categories were (1) upright reflux, (2) upright weakly acidic reflux, and (3) weakly acidic reflux. The Nissen-received group demonstrated statistically significant improvements in total RFS score, as well as the subcategory score of erythema, from pre- to post-Nissen fundoplication. There were statistically significant differences in the subcategory scores of erythema and diffuse laryngeal edema when comparing the changes from pre- to post-intervention between the Nissen-received and Nissen-declined groups.

Conclusion: LNF provides improved LPR control compared with treatment with antireflux medication alone.

Objective: To verify the likelihood of dysphonia in firefighters and its relationship with individual and occupational factors and mental health.

Method: This cross-sectional observational study with 442 firefighters collected data on sociodemographic, occupational, and lifestyle aspects and screening for common mental disorders (CMD). Individuals were divided into two groups: those slightly likely and those moderately/highly likely to have dysphonia, according to the Brazilian Dysphonia Screening Tool. The questionnaire's items addressed their sex, age, race, marital status, education, work schedule, administrative or field activity, alcohol consumption, smoking, and CMD. Those who answered "yes" to the question about having a hoarse voice were considered to have dysphonia with an indication for clinical voice assessment. The suspicion of a CMD was measured with the SRQ-20 Self Report Questionnaire. Data were subjected to descriptive and association analysis. Statistical tests were performed assuming a significance level of 5%.

Results: The moderate/high likelihood of dysphonia was 6.12%. Most firefighters were males (90.31%), aged over 30 (52.47%), multiracial (44.39%), living with a partner (61.39%), and with a bachelor's or higher degree (42.35%). Individuals self-declared as Black or multiracial had a higher percentage of dysphonia (8.10%). Black and multiracial individuals were approximately 2.5 times more likely to pass the dysphonia screening than Whites and other races. Individuals with symptoms of CMD were also 2.7 times as likely to have dysphonia.

Conclusion: The results of the study show that Black and multiracial firefighters and those with symptoms of CMD were moderately/highly likely to have dysphonia. Firefighters with the highest likelihood of having dysphonia are indicated for clinical voice assessment to confirm the diagnosis.

Objective: One challenge in voice therapy is that mastering new vocal techniques is inherently cognitively effortful. While effort is critical for learning, it can also lead to frustration and reduced patient engagement. The purpose of this study was to investigate the relationship between patient-perception of voice handicap and mental effort in voice therapy, and to determine if different therapy approaches and stimuli elicit different perceptions of mental effort.

Methods: A nonexperimental, prospective investigation was conducted with adult patients receiving voice therapy. Prior to therapy initiation, patients completed the Voice Handicap Index-10 (VHI-10) to quantify perceived severity of their voice disorders. To assess mental effort, a Borg mental effort scale and the NASA Task Load Index (NASA-TLX) were administered following each therapy session. Therapy type and treatment stimulus/level of treatment hierarchy were documented for each session. Kruskal-Wallis H-test was used to compare differences in baseline VHI-10 and mental effort among voice disorder diagnoses. Pairwise comparisons, linear random-intercept mixed-effects model, and generalized estimating equation method were used to determine correlation between VHI-10 and mental effort, and therapy type, stimulus, and effort.

Results: Twenty-seven participants (89% female, 60% white) completed the study. There was no significant difference in VHI-10 or baseline perceptions of mental effort between races or among voice disorder diagnoses. There was a significant positive correlation between VHI-10 scores and session 1 mental effort. There was no significant difference in effort ratings among therapy types, but effort was rated as significantly greater for therapy stimuli that involved connected speech practice than other stimuli. Perceived mental effort significantly decreased over time.

Discussion: Voice therapy imposes a cognitive load on the patient, and is particularly challenging for individuals with more severely perceived voice disorders. Further, patients think voice treatment approaches that utilize connected speech stimuli are more effortful than those that use simple stimuli, regardless of treatment target (eg, resonance, flow).