Journal of Voice最新文献

Background: Parkinson's disease (PD) is a progressive neurological disorder frequently associated with hypokinetic dysarthria, characterized by impairments in voice, articulation, and prosody.

Aims: This study investigated speech and voice characteristics in Bosnian-speaking individuals with PD using objective acoustic and temporal measures derived from the speech signal.

Method: Participants with PD and age- and gender-matched healthy controls completed sustained vowel phonation, prolonged fricatives (/s/ and /z/), and diadochokinetic (DDK) syllable repetition tasks. All variables were obtained through acoustic analysis, including standard voice parameters, maximum phonation time, sustained /s/ and /z/ durations, the S/Z ratio, and speech timing measures derived from syllable durations, occlusion duration, and voice onset time (VOT).

Results: After correction for multiple comparisons using the false discovery rate (FDR), the most robust group differences were observed for speech timing measures, with participants with PD exhibiting significantly prolonged durations of DDK syllables as well as increased occlusion and VOTs, indicating slower speech timing. Maximum phonation time was also significantly reduced in the PD group. Differences in individual acoustic voice parameters were observed at the uncorrected level but did not remain significant after FDR correction, reflecting substantial interindividual variability.

Conclusions: The findings indicate that, in Bosnian-speaking individuals with PD, temporal aspects of speech production and sustained phonation duration provide the most sensitive acoustic markers of hypokinetic dysarthria. Within the phonological structure of Bosnian, characterized by a compact vowel system and unaspirated voiceless plosives, acoustic speech timing measures appear particularly informative for capturing PD-related speech impairment. These results support the use of acoustic and temporal assessment methods for clinically feasible evaluation of speech disorders in PD and contribute data from an underrepresented linguistic population.

Objectives: This study examined videolaryngostroboscopy (VLS) ratings from 9 speech-language pathologist (SLP) trainees and 8 experienced SLPs using 2 rating tools.

Methods: Participants rated 3 parameters (free edge, amplitude, mucosal wave) for 16 VLS exams using the Voice Vibratory Assessment of Laryngeal Imaging (VALI). They also rated deviance from "normal" for these parameters and rated overall severity using a 100 mm visual analog scale (VAS). Intrarater and interrater reliability were calculated. Average ratings were compared using independent t tests for scaled data.

Results: For the VALI, intrarater reliability for vibratory VLS parameters was variable for both groups (trainees: Spearman's rho (p) = 0.24-0.81; experienced (p) = 0.43-0.57), and intrarater agreement for free edge contour was moderate for both (trainees: Fleiss' 4 ϰ = 0.30-0.35; experienced = 0.37-0.42). Using the VAS, intrarater reliability for all parameters was high for trainees (Spearman's rho (p) = 0.77-0.95), and variable for experienced SLPs (Spearman's rho (p) = 0.46-0.83), whereas overall severity was similar for both groups (trainees: Spearman's rho (p) = 0.83; experienced (p) = 0.82). For the VALI, interrater reliability for vibratory VLS parameters (trainees: ICC = 0.82-0.93; experienced ICC = 0.76-0.91) and free edge contour (trainees: Fleiss' ϰ = 0.28-0.32; experienced: = 0.37-0.42) were similar. Using the VAS, interrater reliability for all VLS parameters was moderate to excellent for both groups (trainees: ICC = 0.85-0.94; experienced: = 0.79-0.94), and overall severity was excellent for both groups (ICC = 0.93-0.94). Using the VALI, trainees rated amplitude as higher than experienced SLPs (P < 0.05), but other differences were not significant. All VAS ratings were judged to be more deviant from "normal" by trainees versus experienced SLPs (P < 0.05).

Conclusions: Rater groups demonstrated similar interrater reliability using both rating tools. Trainees rated VLS parameters and overall severity as more severe than experienced SLPs.

Background: Technological advancements in healthcare offer the potential to improve patient outcomes, clinician productivity, and access to care. Evidence on their availability, clinical application, and long-term effectiveness in voice disorders remains unclear, highlighting the need for a comprehensive scoping review.

Aim: To map and describe existing evidence on the use of mobile health (mHealth) technologies for the early detection, assessment, and treatment of voice disorders.

Methods: A scoping review was conducted according to the Joanna Briggs Institute (JBI) framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist (PRISMA-ScR) to ensure a comprehensive and systematic approach.

Results: Eighty-four studies were included, predominantly published between 2016 and 2025 and conducted in mostly high-income countries. Most focused on adult populations (67%) and the use of smartphones (51%) or telehealth platforms (19%). The mHealth solutions primarily targeted neurological (27%) and functional voice disorders (20%) and have demonstrated feasibility, accessibility, and potential for early detection, monitoring, and treatment. Most studies (31%) relied on acoustic assessments, while only 4% used gold-standard laryngeal imaging techniques, such as stroboscopy or endoscopy.

Conclusion: mHealth technologies have the potential to enhance accessibility, equity, and cost-effectiveness in voice disorder care, particularly in underserved regions. Further research is needed to expand applications in early detection, diagnosis, and treatment, especially incorporating laryngeal imaging, as these solutions could potentially transform care into a preventative and globally sustainable model.

Speech-language pathologists who work with transgender and nonbinary individuals are often concerned about introducing vocal hyperfunction (VH) while supporting the use of a more gender-congruent voice. The current study examined the effects of volitionally altering fundamental frequency (f_o) on measures associated with VH. Forty (20 female, 20 male) speakers with no vocal complaints and who did not identify as transgender were recruited. Speakers were recorded in two conditions: habitual f_o and altered f_o. In the altered f_o condition, speakers volitionally altered their f_o by two semitones in the stereotypical direction desired by transgender and nonbinary speakers with the same vocal anatomy: females lowered their f_o and males raised their f_o. A total of 13 acoustic, aerodynamic, videostroboscopic, and perceptual (self- and other) measures were assessed. Of the 13 measures, 7 were statistically affected by the two-way interaction between sex and f_o condition. Only three measures had medium or larger effect sizes. Compared to using a habitual f_o, females used longer vocal tract lengths, and higher smoothed cepstral peak prominences (CPPS) and low to high (L/H) ratios when lowering f_o and males used shorter vocal tract lengths and lower L/H ratios when raising f_o. In general, vocalizations produced with a volitionally altered f_o were more consistent with those in speakers with VH than vocalizations produced with a habitual f_o. In response to altering f_o, females had more measures that differed than males. This is counter to expectations given that males raised their f_o and using a higher f_o is associated with increased laryngeal tension. That being said, many of the changes reflected the physiological adjustments required to achieve an externally specified f_o target.

Objectives: Several options exist allowing for phonation with a tracheotomy tube including use of a one-way speaking valve and finger occlusion. In 2021, new Shiley™ tracheotomy tubes were introduced including a redesigned inner cannula with a "duckbill" configuration that locks into place. When using this model, the discontinuity of the inner cannula at 12 and 6 o'clock positions results in air leak during attempted phonation with finger occlusion. We aim to discuss a method of overcoming this challenge.

Methods: We present a technique that has been developed by one of our patients to continue using finger occlusion for phonation with the new Shiley™ tracheotomy tube. One to two layers of 1/4 in. wide paper surgical tape is wrapped circumferentially around the outer edge of the inner cannula to recreate a complete circle.

Results: With this modification, air no longer escapes through the sides of the inner cannula during finger occlusion with the new Shiley™ tracheotomy tube. This is an inexpensive and simple modification that improves patient communication, safety, and quality of life. Often patients who prefer finger occlusion phonation have opted to clean and reuse the discontinued model of Shiley™ tracheotomy tubes or they simply leave out the inner cannula entirely. The former action increases risk of infection by encouraging biofilm formation over time while the latter risks complete obstruction of the tracheotomy tube which can be life threatening.

Conclusions: Phonation with finger occlusion using the new Shiley™ inner cannulas is challenging for the patient. Applying the 1/4 in. paper surgical tape wrapping technique offers a solution to this problem that is easy to adopt by patients and clinicians alike. We would like to share this simple modification with the tracheotomy community and to propose consideration for a redesign of the inner cannulas with the new Shiley™ tracheotomy tubes.

Level of evidence: Level 5.

Background: Voice disorders are a common occupational risk for teachers, usually resulting from extended voice usage in vocally demanding and frequently inadequate situations.

Objective: This study is the inaugural investigation in Tamil-speaking areas to comparatively assess voice fatigue and dysphonia across four diverse teaching specialties, employing both subjective and objective methodologies. The objective is to identify high-risk populations and provide specific occupational voice health initiatives METHODS: A cross-sectional study was performed using 420 school teachers in Tamil Nadu, evenly distributed throughout four categories: elementary, secondary, special education, and physical education. Voice fatigue was evaluated utilizing the Tamil-adapted vocal fatigue index (VFI-T), whilst the acoustic voice quality index (AVQI) was employed for the objective assessment of dysphonia.

Results: A total of 51.4% of individuals indicated vocal fatigue, while 50.2% demonstrated dysphonia (AVQI > 2.8). Primary school educators had the greatest incidence of vocal fatigue (60.0%) and dysphonia (64.8%), markedly surpassing secondary educators, who reported 40.0% and 28.6%, respectively. A robust positive connection was identified between VFI-T and AVQI scores (r = 0.62, P < 0.001).

Conclusion: Voice problems are common among school instructors in Tamil Nadu, with elementary and special educators being more vulnerable. The results underscore the necessity for proactive occupational voice health initiatives and regular screening protocols in educational environments.

Purpose: Vagal reflex (VR) is a common and potentially critical complication during suspension laryngoscopy. This study aimed to identify anatomical predictors for VR and to evaluate the efficacy of a standardized, heart rate-based stepwise management protocol.

Methods: A prospective cohort of 371 patients undergoing suspension laryngoscopy was enrolled. Preoperative neck anatomical parameters, including thyromental distance (TMD), sternomental distance (SMD), and thyromental angle (TMA), were measured. The occurrence and severity of intraoperative VR, categorized by heart rate (≤40, 40-50, >50 bpm), were recorded. Spearman's correlation analysis was employed to assess relationships between anatomical parameters and VR. All VR events were managed according to the corresponding level of the stepwise protocol initiated based on real-time heart rate.

Results: VR occurred in 118 patients (31.8%). Significant negative correlations were found between VR occurrence and TMD (P = 0.0003), SMD (P = 0.004), and TMA (P = 0.03). For all VR cases, initial management involved immediate cessation of manipulation and withdrawal of the laryngoscope. This alone sufficed to restore stable heart rate in 32 patients (27.1%). The remaining 86 patients (72.9%) required additional intravenous atropine; this subgroup included 5 cases of cardiac arrest, all of whom were successfully resuscitated. The stepwise management protocol was ultimately effective in all cases, with complete heart rate recovery.

Conclusion: Reduced TMD, SMD, and TMA are significant anatomical predictors of VR during suspension laryngoscopy. A real-time heart rate-based stepwise management protocol, ranging from procedural cessation to pharmacologic intervention and advanced life support, proved to be a safe and effective strategy, providing a critical framework for perioperative risk management.

Objective: This study aimed to analyze the voice quality of patients with vocal fold polyps and laryngopharyngeal reflux (LPR) and to explore the effect of LPR on voice quality in these patients.

Methods: A total of 89 adult patients with vocal fold polyps were retrospectively selected between 1 August 2020 and 30 April 2025 using convenience sampling. The reflux finding score (RFS) and the reflux symptom index (RSI) were assessed after vocal fold polypectomy. Patients with an RFS > 7 and an RSI > 13 or with a previous diagnosis of LPR comprised the reflux group, whereas patients with vocal fold polyps but without evidence of LPR comprised the control group. Both groups underwent voice assessment using the Voice Handicap Index-10 (VHI-10) and fiber optic nasopharyngoscopy to evaluate vocal fold morphology. The Voice-Related Quality of Life (V-RQOL) questionnaire and the grade-roughness-breathiness-asthenia-strain (GRBAS grade) scale were also used. Differences in the above indicators between the two groups were compared.

Results: The mean VHI-10 score (18.59 ± 8.956 vs 13.51 ± 7.354, P = 0.012) and the GRBAS grade (2.28 ± 0.615 vs 1.91 ± 0.626, P = 0.032) in the reflux group were higher than those in the control group, whereas the V-RQOL score (57.98 ± 20.13 vs 74.12 ± 18.69, P = 0.019) in the reflux group was lower than that in the control group; the differences were statistically significant. The incidence of broad-based vocal fold polyps (72.9% vs 20.8%, P = 0.032) and bilateral vocal fold polyps (78.4% vs 45.8%, P = 0.017) in the reflux group was higher than that in the control group, and these differences were statistically significant.

Conclusion: Laryngopharyngeal reflux may cause patients with vocal cord polyps to be more prone to sessile vocal cord polyps and bilateral vocal cord polyps, which in turn aggravates the hoarseness of the patient 's voice; laryngopharyngeal reflux may also affect the physiological, psychological and quality of life of patients with vocal cord polyps. Anti-reflux therapy is recommended for patients with vocal cord polyps with LPR after surgery.

Background: Thyroidectomy frequently leads to transient or persistent voice, swallowing, and throat or neck-related symptoms that can substantially affect patients' quality of life. Patient-reported outcome measures (PROMs) are essential to capture these subjective experiences, yet no validated French-language instrument specifically targets thyroidectomy-related voice and symptom complaints.

Objectives: This study aimed to translate, culturally adapt, and preliminarily validate a French version of the Thyroidectomy-related Voice and Symptom Questionnaire (TVSQ-FR) for use in French-speaking clinical and research settings.

Methods: Translation and cultural adaptation followed internationally recognized guidelines (WHO, ISPOR, and Cruchinho et al). Two independent forward translations were synthesized through a Delphi consensus process involving otorhinolaryngologists, speech-language pathologists, and a psychometrician, followed by independent back-translation. The prefinal version was pretested in 30 adult French-speaking patients undergoing thyroidectomy, assessed preoperatively and 2 to 4 weeks postoperatively. Quantitative analyses included internal consistency (Cronbach's α), item-total correlations, and sensitivity to postoperative change (Wilcoxon signed-rank tests). Qualitative data from open-ended questions and semistructured cognitive interviews explored comprehensibility, cultural relevance, and acceptability.

Results: Internal consistency was excellent for the Voice subscale (α = 0.90) and total score (α = 0.92), and good for the Throat and Neck subscale (α = 0.87). Item-total correlations were moderate to strong across both domains. Significant postoperative changes were observed primarily in the Voice subscale, supporting the instrument's sensitivity to early postoperative symptoms. Qualitative analyses confirmed high comprehensibility, cultural adequacy, and clinical relevance, with patients describing the questionnaire as clear, accessible, and reflective of their postoperative experience.

Conclusions: The TVSQ-FR demonstrates strong linguistic and cultural equivalence with the original instrument and shows good preliminary psychometric properties. It provides a brief, patient-centered tool for assessing voice-related and throat or neck-related symptoms after thyroidectomy in French-speaking populations. Further studies with larger samples are warranted to confirm structural validity, test-retest reliability, and convergent validity, and to establish reference values for score interpretation.

Aim: This study investigated the relationship between subjective (patient-based and clinician-based) and objective (acoustic) voice evaluation parameters in Persian elderly speakers.

Study design: A cross-sectional study was conducted to explore the abovementioned relationships.

Methods: Ninety-two elderly participants (50 females, 42 males; aged 60 years and above) were recruited. The Persian version of the Aging Voice Index (AVI) was used for patient-reported assessment. Acoustic measures, including jitter, shimmer, harmonic-to-noise ratio (HNR), and cepstral peak prominence (CPP) were analyzed using Praat software. The auditory-perceptual evaluation was conducted using the GRBAS scale by skilled, experienced clinicians.

Results: Based on GRBAS ratings, 41.9% of voices were normal, 51.6% mild, and 6.5% moderate dysphonia. CPP significantly differed across severity groups for both /i/ (P = 0.019) and /a/ (P = 0.006), with lower CPP corresponding to greater dysphonia. AVI also varied across groups (P = 0.020), with values increasing in mild dysphonia and decreasing in moderate dysphonia. AVI showed weak and nonsignificant correlations with CPP (|r| < 0.23, P > 0.22) and acoustic measures (|r| < 0.20, P > 0.08). Female speakers demonstrated lower jitter and shimmer and higher HNR for /a/ (P = 0.044, P = 0.013, and P = 0.028, respectively), while F0 was significantly higher in females for both vowels (P < 0.001). AVI did not differ by gender (P = 0.807). Age showed a significant positive correlation with shimmer for /a/ (r = 0.211, P = 0.043), with stronger age-related increases in shimmer and decreases in HNR among males (P ≤ 0.008).

Conclusion: The findings reveal a complex relationship between the subjective and objective voice measures in elderly speakers. While GRBAS ratings correlated moderately with acoustic parameters, patient-reported AVI scores showed no significant relationship with objective measures. These results emphasize the importance of using multiple assessment tools for the comprehensive evaluation of voice disorders in aging populations.