Journal of Voice最新文献

Background: This study aims to evaluate the outcomes of Wendler glottoplasty combined with postoperative voice therapy in transgender women, focusing on improvements in voice acoustics and quality of life after surgery.

Study design: Retrospective observational study.

Methods: This retrospective study reviewed medical records of 138 transgender women who underwent Wendler glottoplasty between January 2020 and January 2024, performed by a single surgeon. Among them, 52.2% (n = 72) underwent concurrent chondrolaryngoplasty. Speech samples, dysphonia assessment, trans woman voice questionnaire (TWVQ), and a visual analog scale (VAS) for neck aesthetic satisfaction were collected preoperatively and one year postoperatively. All patients completed at least 12 postoperative voice therapy sessions. Statistical analysis used paired t tests and effect-size calculations to assess changes across key parameters.

Results: Significant improvements were observed in both vocal and aesthetic parameters. The mean fundamental frequency (F₀, sustained /e/) increased from 138.73 Hz to 207.82 Hz (Δ = +69.09 Hz or +7.00 semitones (ST); P < 0.0001; 95% confidence interval [CI], 64.18-74.00 Hz; Cohen's d = 5.27), while the mean speaking F₀ rose from 140.38 Hz to 209.24 Hz (Δ = +68.86 Hz or +6.91 ST; P < 0.0001; 95% CI, 65.12-72.60 Hz; Cohen's d = 4.96). Quality of life also improved significantly, with TWVQ decreasing from 99.06 to 56.18 (P = 0.008; 95% CI, 37.54-47.22; Cohen's d = 3.05). Among those who underwent chondrolaryngoplasty, aesthetic satisfaction markedly increased: the mean preoperative VAS score (0-10 scale) rose from 1.03 ± 0.71 to 9.83 ± 0.18 at 12 months postoperatively (P < 0.0001, Wilcoxon test).

Conclusion: Wendler glottoplasty combined with voice therapy significantly enhances fundamental and speaking frequencies in transgender women, while concurrent chondrolaryngoplasty contributes to substantial improvement in aesthetic satisfaction with the neck contour.

Objectives: (1) To determine whether acoustic glottal stop production (GSP) measures from two sentence-embedded glottal stops (GS) differed between patients with unilateral vocal fold paresis/paralysis (pUVFP) and normal controls (NCs), and if so, their diagnostic accuracy; (2) to examine context specificity by correlating within-speaker GSP measures from sentence-embedded GS with repeated [i] and [isi] tokens; and (3) to test whether GSP measures differed depending on speaker perception as pUVFP or NC.

Method: Sixty-two pUVFP and eight NCs produced "We eat eggs every Easter," containing two potential GS: GS1 (we eat) and GS2 (every Easter). Averages were calculated for four GSP measures (offset and onset intensity differences and slopes) obtained by 2 assessors using a customized Praat script. Group comparisons were analyzed using Mann-Whitney U tests, and diagnostic accuracy by receiver operating characteristics and Youden's Index for combined and separate contexts. Pearson product-moment coefficients were used to assess within-speaker correlations across contexts. Kruskal-Wallis tests assessed differences between GSP measures based on perceptual classifications of the sentence.

Results: Intensity differences were significantly smaller and slopes shallower (P < 0.05) between pUVFP and NCs for both environments combined and for GS2 individually. Diagnostic accuracy was perfect for GS2 measures, but poor for GS1. Significant within-speaker correlations (P < 0.05) were found for GSP measures from most contexts. Significantly greater intensity differences and steeper slopes (P < 0.05) were found from sentences that both listeners perceived as produced by an NC compared to those produced by a pUVFP.

Conclusion: Acoustic GSP measures, regardless of phonetic context, show generalizability in distinguishing between pUVFP and NCs. However, repeated [i] may be more valid because acoustic GSP measures are significantly correlated with measures from other contexts; better diagnostic accuracy, and include one more variable, the number of voicing cessations, already shown to be important in recovery.

Purpose: Treatment for voice and upper airway disorders often includes a behavioral program to reduce laryngopharyngeal reflux (LPR), a recognized irritant for voice and upper airway diagnoses. The purpose of this systematic review was to develop an evidence-based behavioral guideline for nonphysician voice professionals who counsel clients on optimal vocal hygiene, which could include nonmedical management of LPR.

Methods: A systematic review was conducted and is reported following the Preferred Reporting Items for Systematic Review and Meta-analyses guideline. The search was limited to human intervention studies that targeted the reduction in LPR symptoms published in English. Databases included Medline through the Ovid platform, EMBASE, and Web of Science.

Results: Database searches yielded 1621 items, 1162 after removal of duplicates. The authors screened 1162 at the title and abstract stage, eliminating 1098. Including citation review sources, 71 sources were retrieved for full-text review. After elimination of noneligible sources, data were extracted from 21. Evidence was identified to support the most commonly advised dietary and behavioral methods to reduce LPR, except for chocolate and carbonated beverages. Acacia gum, alkaline water, and a body positioning device were unexpected evidence-supported recommendations.

Conclusion: Most commonly recommended dietary and behavioral interventions to reduce LPR have evidence to support their use; however, most investigations combined approaches, making it difficult to understand the clinical impact of each individual recommendation. A combination approach appears to be best when nonphysician voice care professionals advise students and clients on behavioral management of LPR symptoms.

Objective: To describe the self-reported voice handicap and type of voice disorders in waterpipe smokers presenting with hoarseness, and to compare these outcome measures with those of cigarette smokers and nonsmokers.

Methods: The medical records of all patients who presented with a history of hoarseness between June 2022 and June 2025 were reviewed. Patients with a history of waterpipe smoking (WPS) were included in this study. Two groups, cigarette smokers and nonsmokers, frequency matched by age and gender, were also included. Two voice outcome measures were used, The voice handicap index-10 (VHI-10) and voice diagnosis, which was categorized as structural, neurologic, or functional.

Results: Fifty-one waterpipe smokers, 51 cigarette smokers, and 51 nonsmokers were included. The most commonly reported symptoms in the whole study population were hoarseness, vocal fatigue, and loss of range. There was no statistically significant difference in the prevalence of these vocal symptoms among the three subgroups. The mean VHI-10 score in waterpipe smokers was 8.27 ± 8.58 compared to 7.59 ± 8.11 in nonsmokers, and 8.35 ± 9.69 in cigarette smokers (P = 0.911). Waterpipe smokers had the largest percentage of abnormal VHI-10 score compared to cigarette smokers and nonsmokers (33.3% vs. 29.4% vs. 27.5%, respectively), but the difference was not statistically significant. Regression analysis accounting for age, gender, reflux, and allergy showed no association between type of smoking and abnormal VHI-10 scores (VHI ≥ 11). The most common voice diagnosis in all subgroups was structural voice disorders, followed by functional voice disorders. Analysis of vocal fold pathologies showed a significant difference in the prevalence of Reinke's edema (RE), leukoplakia, and granuloma across the three subgroups (P = 0.039, P = 0.043, P = 0.026, respectively). The prevalence of RE and leukoplakia was highest in cigarette smokers compared to WPS and nonsmokers. The most common vocal fold pathology in waterpipe smokers was vocal fold polyp, accounting for 19.4% of structural voice disorders, followed by RE and leukoplakia in 13.9%. Waterpipe smokers were 2.6 times more likely to have RE (odds ratio [OR] = 2.6; 95% confidence interval [CI] [0.49-14.4]), and 1.27 times more likely to have leukoplakia compared to nonsmokers (OR = 1.27; 95% CI [0.32-5.05]). Regression analysis revealed no significant association between the type of smoking, VHI-10 score, and type of voice disorder.

Conclusion: There was no significant difference in self-perceived voice handicap nor in the type of voice disorder between waterpipe smokers, cigarette smokers, and nonsmokers presenting with hoarseness. A future study on a larger cohort of waterpipe smokers is warranted.

Objective: This study aimed to translate, culturally adapt, and validate the voice care knowledge questionnaire (VCKQ) and to evaluate the effectiveness of a structured educational intervention on voice care knowledge among parents and medical students.

Methods: A three-phase design was employed. Phase 1 involved forward-backward translation, expert review, and cultural adaptation of the VCKQ. Phase 2 included validation through expert review and pilot testing with parents. Phase 3 evaluated the effect of a structured educational intervention using a quasi-experimental, pre-post design among parents (n = 133) and third-year medical students (n = 112). The intervention consisted of two standardized sessions delivered in-person (students) or online (parents). Knowledge scores were compared before and two months after the educational intervention.

Results: The Arabic VCKQ demonstrated excellent psychometric properties, including high content validity index (I-CVI = 0.80-1.00; S-CVI/Ave = 0.99) and strong internal consistency (Cronbach's α = 0.922). Baseline knowledge of vocal hygiene was limited in both groups, with no major differences between parents and students. Following the intervention, mean total knowledge scores improved significantly for parents (11.05 ± 3.2 to 25.42 ± 2.0, P < 0.001) and students (10.99 ± 3.4 to 25.88 ± 1.9, P < 0.001), with large effect sizes (Cohen's d = 2.9-3.1). Misconceptions about whispering, throat clearing, and caffeine consumption showed the greatest improvements. Non-smoking parents demonstrated significantly higher gains than smoking parents did (P = 0.027).

Conclusions: The Arabic VCKQ is a valid and reliable instrument for assessing voice care knowledge in Arabic-speaking populations. A structured educational intervention significantly enhanced evidence-based understanding of vocal hygiene among both parents and medical students. Integration of such educational programs into medical training and community education may reduce preventable voice disorders and promote healthier communication practices.

Objective: This study examined the immediate effects of the Finger Kazoo (FK) exercise, with and without intentional oropharyngeal enlargement, on acoustic, self-perceptual, and auditory-perceptual parameters of the operatic singing voice.

Methods: Fifteen classically trained singers screened using the Singing Voice Handicap Index-10 performed two randomized conditions: FK without oropharyngeal enlargement (Condition A) and FK with oropharyngeal enlargement (Condition B). Assessments included: (1) self-perception using the Evaluation Auditory-Perceptual Instrument for Operatic Singing Voice-EAI Scale; (2) acoustic analysis of maximum phonation time (MPT) for vowels /a/ and /i/, examining fundamental frequency (F₀), jitter, and shimmer; and (3) blinded auditory-perceptual ratings of aria excerpts by a 15-member expert panel. Statistical procedures comprised paired and nonparametric tests (t, Wilcoxon, and Friedman), robust analyses, and Bayes factors, with Holm-adjusted P values and effect sizes (Cohen's d, r).

Results: Both interventions significantly improved MPT and reduced jitter and shimmer (all p <.05), with very large effect sizes (Cohen's d > 0.8). Mean MPT increased by 12-15%, jitter decreased by 13-16%, and shimmer by 18-20%. F₀ remained stable across vowels and conditions (P > 0.59), indicating enhanced phonatory control without pitch alteration. Self-perception scores increased from baseline (38.5 ± 6.3) to post intervention (51.6 ± 13.6 in A; 53.9 ± 8.4 in B; P < 0.001). Auditory-perceptual ratings confirmed significant improvements across all eight EAI parameters-most notably Resonance Balance, Ring, Vibrato, and Pitch Accuracy-while Strain showed smaller but consistent reductions. No statistically detectable differences were found between Conditions A and B, with Bayesian analyses supporting equivalence (BF₁₀ < 1/3).

Conclusions: The FK exercise produced immediate, robust, and clinically meaningful improvements in resonance, stability, and efficiency of the operatic singing voice. Both versions-performed with and without oropharyngeal enlargement-were comparably effective, underscoring the versatility of this semioccluded vocal tract technique as an evidence-based tool for singers, pedagogues, and clinicians.

Background: Recurrent respiratory papillomatosis (RRP) is a rare, benign epithelial tumor primarily caused by low-risk human papillomavirus (HPV) types 6 and 11. Although p16 is widely used as a surrogate marker of high-risk HPV infections in other HPV-related malignancies, its role in RRP remains unclear.

Objective: This study aimed to investigate the immunohistochemical expression of p16 in Adult-Onset RRP (AORRP) patients with RRP and evaluate its association with clinical recurrence.

Methods: We retrospectively reviewed 64 adult patients primarily with AORRP who underwent surgical treatment for RRP at the Nihon University Hospital between January 2008 and March 2022. p16 expression was assessed using a standardized scoring system based on the staining intensity and proportion of positive cells. The patients were categorized into four groups: negative, low, intermediate, and high expression. Recurrence was defined as the need for additional surgical intervention after the initial treatment. Statistical analyses were performed using the Chi-square test.

Results: p16 positivity (score ≥1) was observed in 51 (51/64:80%) cases. The high expression group (Score 5-6) demonstrated significantly higher recurrence rates than the negative group (P = 0.0036). All the patients in the high-expression group experienced recurrence. However, no significant difference was observed in the recurrence among the other groups.

Conclusion: High p16 expression may serve as a potential prognostic marker for AORRP recurrence. Given the simplicity and accessibility of immunohistochemical staining, p16 scoring may be considered a valuable tool for the risk stratification and long-term disease management of AORRP.

Objective: The aim of this study was to evaluate the temporal changes in perceptual, acoustic, and cepstral voice parameters following expansion sphincter pharyngoplasty (ESP) in patients with moderate-severe obstructive sleep apnea syndrome (OSAS).

Method: In this prospective, nonrandomized clinical study, ESP was performed on 27 adult patients with moderate-severe OSAS. Voice assessments were conducted preoperatively, at 1 week postoperatively, and at 3 months postoperatively using the Turkish Voice Handicap Index-10, Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scale, acoustic parameters (fundamental frequency, jitter %, shimmer %, and noise-to-harmonic ratio [NHR]), formant frequencies (F1-F4), and cepstral measurements (cepstral peak prominence [CPP], smoothed cepstral peak prominence [CPPS]) during sustained /a/ phonation and connected speech. Statistical analyses were performed using the Friedman test and Analysis of Variance (ANOVA).

Results: Regarding perceptual evaluation, although Friedman tests indicated statistical variance in Grade (P = 0.016) and Roughness (P = 0.005), conservative post hoc analyses revealed no statistically significant pairwise differences, suggesting perceptual stability. Objective acoustic analysis demonstrated a significant increase in Shimmer (P = 0.020) and a decrease in NHR (P = 0.011) by the third postoperative month. Cepstral analysis revealed a significant decrease in sustained /a/ CPP (P = 0.007) and CPPS (P = 0.010), reflecting reduced signal periodicity, while connected speech CPP showed significant variance (P = 0.020).

Conclusion: ESP characterizes as a functionally safe and resonance-sparing intervention. Although the procedure induces subclinical acoustic perturbations manifesting as reduced signal periodicity, it maintains perceptual stability and does not compromise functional communication. Preoperative counseling regarding these subtle acoustic changes is recommended, particularly for professional voice users.

Introduction: The spatial characteristics of voice radiation represent an important yet still insufficiently explored dimension of vocal performance and pedagogy. While previous studies have focused on spectral and glottal correlates of vocal modes, less attention has been given to how these modes shape the directional distribution of sound energy in space. Building on prior work on complete vocal technique (CVT), this study explores how the perceptual parameters of metal and density may influence voice directivity patterns across vocal modes and stylistic contexts.

Methods: A double-case study was conducted involving two professional singers (M1-AMAB, F1-AFAB) performing sustained phonation across four CVT vocal modes, each modified in terms of metal (neutral, reduced, and full) and density (reduced, full) for Neutral, Overdrive, and Edge. A total of 1088 samples were recorded using a hemispherical microphone array in an anechoic chamber. Directional sound radiation was analyzed across absolute and relative domains and evaluated using front-back ratios, spectral tilt, and directivity indices. Factor analysis was employed to reduce spatial dimensionality and explore consistent radiation patterns. Correlations were tested between radiation factor scores and directivity and acoustic.

Results: Across the two singers, we observed singer-specific differences in spatial radiation patterns that appeared to relate to variations in metal and density. Full metallic and full density for Overdrive and Edge conditions tended to show more forward-focused radiation, particularly in the 2-5-kHz band. Classical productions showed a tendency toward broader radiation patterns in the 0-2-kHz band, whereas contemporary conditions appeared more directional. Factor scores suggested the presence of structured directional components, and correlations with directivity parameters indicated recurring tendencies across metal levels and, in some cases, density. In these two singers, differences in radiation could not be attributed solely to sound pressure level or fundamental frequency, which may point to the contribution of coordinated vocal tract shaping.

Conclusion: In this double-case study, variations in metal-and to some extent density in Overdrive and Edge-were associated with singer-specific changes in three-dimensional radiation, beyond what could be explained by pitch and loudness alone. These preliminary observations suggest that spatial acoustics may provide a useful extension of the CVT framework and may hold relevance for pedagogical and technological relevance of controlling vocal directivity. The study introduces novel parameters for quantifying radiation and proposes their integration into applied settings such as voice training, performance acoustics, and immersive audio systems.