Journal of Voice最新文献

Objectives/hypothesis: Vocal fold (VF) injury and chronic inflammation can progress to scarring, which is notoriously difficult to treat. Human amniotic fluid (AF) has potential for VF wound healing in a rabbit model, and we hypothesized that AF would demonstrate wound healing properties superior to hyaluronic acid (HA) over time.

Study design: Randomized, controlled trial.

Methods: In this pilot study, 60 New Zealand white rabbits (10 rabbits in each of six groups) received unilateral VF biopsy and immediate injection treatment of AF, HA, or saline (SA). The contralateral VF served as an uninjured control. Rabbits were sacrificed and VFs removed at 4 or 10 weeks postinjury. Rheology and reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) were employed to assess viscoelastic properties and inflammation, respectively.

Results: Rheology differences were seen between four and 10 weeks postinjury in treatment groups but not in controls. Values for the AF treatment group differed from the SA and HA groups at week 10 (elastic P = 0.0002, viscous P < 0.0001). RT-qPCR: AF and HA had higher levels of inflammatory cytokines than SA at week 4 [TNFα: SA4 < HA4 (P = 0.0086), SA4 < AF4 (P = 0.0112)]. Presumptive inflammation was still present at 10 weeks in all treatment groups [IL-1β: AF control < AF (P = 0.0002), SA control < SA (P = 0.0212); IL-6: HA control < HA (P = 0.0312)]. AF demonstrated reduced inflammation at 10 weeks compared with SA [IL-6: SA > AF (P = 0.0141)]. AF was the only treatment group that had significant reductions in inflammation at 10 versus 4 weeks [IL-1β: AF4 > AF10 (P = 0.0249)].

Conclusions: The main finding from this pilot study was that AF demonstrated wound healing effects over time compared with HA and SA by reducing inflammation and improving VF viscoelastic properties. Continued research to further investigate the use of AF in VF wound healing over longer periods of time is necessary before translation to human VFs.

Introduction: Patients with primary muscle tension dysphonia (pMTD) commonly report symptoms of vocal effort, fatigue, discomfort, odynophonia, and aberrant vocal quality (eg, vocal strain, hoarseness). However, voice symptoms most salient to pMTD have not been identified. Furthermore, how standard vocal fatigue and vocal tract discomfort indices that capture persistent symptoms-like the Vocal Fatigue Index (VFI) and Vocal Tract Discomfort Scale (VTDS)-relate to acute symptoms experienced at the time of the voice evaluation is unclear. Finally, correlations between voice symptoms and acoustic vocal quality are poorly understood. As such, the objectives of this study were to: (1) identify the most salient pMTD symptoms, (2) correlate the VFI and VTDS with acute voice symptom severity, and (3) better understand relationships between voice symptom experiences and vocal acoustics.

Methods: Thirty subjects (15 pMTD, 15 controls) rated their vocal effort, vocal fatigue, vocal tract discomfort, odynophonia, and vocal quality on separate 100 mm visual analog scales (VAS) and completed the VFI-Part1 and VTDS. Cepstral peak prominences (CPP) were obtained from voice recordings of sustained /i/ and the all-voiced consensus of auditory-perceptual evaluation of voice (CAPE-V) sentence.

Results: Patients with pMTD reported significantly higher severities of vocal effort (P < 0.0001), fatigue (P = 0.001), and discomfort (P = 0.0008) and scored significantly higher on both vocal indices (VFI-Part1: P < 0.0001; VTDS: P = 0.0056) compared to vocally healthy controls. Both indices had medium-to-high correlations with acute symptom severities in both groups. However, there were no significant differences between groups on odynophonia severity (P = 0.349), acoustic vocal quality (/i/: P = 1.00, CAPE-V: P = 0.228) or self-perceptual vocal quality (P = 0.141). There were also no significant relationships between vocal acoustics and patient symptoms or between vocal acoustics and standard vocal fatigue and vocal tract discomfort indices (P's > 0.05).

Conclusion: Somatosensory symptoms of vocal effort, vocal fatigue, and vocal tract discomfort are the most salient clinical features in patients with pMTD. Standard voice indices that capture more chronic symptoms can also reliably capture symptoms experienced at the time of the voice evaluation in patients with pMTD. Although odynophonia and aberrant acoustic vocal quality may be present in some patients with pMTD, they do not appear to be symptoms central to the condition. Because somatosensory experiences are more salient than vocal quality and vocal acoustics in pMTD, somatosensory symptoms of vocal effort, fatigue, and discomfort should hold more weight during the voice evaluation when pMTD is suspected.

Objectives: This study investigates the use of sustained phonations recorded during high-speed videoendoscopy (HSV) for machine learning-based assessment of hoarseness severity (H). The performance of this approach is compared with conventional recordings obtained during voice therapy to evaluate key differences and limitations of HSV-derived acoustic recordings.

Methods: A database of 617 voice recordings with a duration of 250 ms was gathered during HSV examination (HS). Two databases comprising 809 vowels recorded during voice therapy were used for comparison, examining recording durations of 1 second (VT-1) and 250 ms (VT-2). A total of 490 features were extracted, including perturbation and noise characteristics, spectral and cepstral coefficients, as well as features based on modulation spectrum, nonlinear dynamic analysis, entropy, and empirical mode decomposition. Model development focused on selecting a minimal-optimal feature subset and suitable classification algorithms. Recordings were classified into two groups of hoarseness based on auditory-perceptual ratings by experts, yielding a continuous hoarseness score yˆ. Model performance was evaluated based on classification accuracy, correlation between predicted scores yˆ∈[0,1] and subjective ratings H∈{0,1,2,3}, and correlation between the relative change in quantitative and subjective ratings.

Results: Logistic regression combined with five acoustic features achieved a classification accuracy of 0.863 (VT-1), 0.847 (VT-2), and 0.742 (HS) on the test sets. A correlation of 0.797 (VT-1), 0.763 (VT-2), and 0.637 (HS) was obtained between yˆ and H, respectively. For 21 test subjects with two recordings, the model yielded a correlation of 0.592 (VT-1), 0.486 (VT-2), and 0.088 (HS) between ∆yˆ and ∆H.

Conclusion: While acoustic signals recorded during HSV show potential for quantitative hoarseness assessment, they are less reliable than voice therapy recordings due to practical challenges associated with oral laryngeal examination. Addressing these limitations, for example, through the use of flexible nasal endoscopy, could improve the quality of HSV-derived acoustic recordings and voice assessments.