Journal of Voice最新文献

Objective: To identify factors correlated with the effect of intracordal trafermin injection.

Study design: Retrospective cohort study.

Methods: Herein, 177 patients who received an intracordal trafermin injection at the Tokyo Voice Center for vocal fold paralysis were included. Medical records of patients were retrospectively reviewed. Information regarding age, sex, date of trafermin injection, date of vocal fold paralysis onset, and voice data indices [maximum phonation time (MPT), pitch range (PR), mean flow rate (MFR), and Voice Handicap Index (VHI)] was extracted. The primary endpoint was the rate of improvement in the VHI, defined as the difference in the VHI values before and after the injection.

Results: A total of 80 patients (49 men and 31 women; mean age, 61.6 years) were included. No correlations existed between the MPT (r = 0.05, P = 0.64), PR (r = 0.03, P = 0.77), or MFR (r = -0.09, P = 0.42) before injection and the rate of improvement in the VHI. Analyses of 74 cases with an interval of <1000 days between disease onset and injection revealed no correlation between the number of days from the onset to injection and the rate of improvement in the VHI. In 17 cases with an interval of <90 days, a moderate negative correlation existed between these parameters (r = -0.59, P < 0.01). In a univariate linear regression analysis, within 90 days, a 1-week delay in trafermin injection resulted in a 4.87 decrease in the VHI.

Conclusions: Intracordal trafermin injection may be an effective therapeutic strategy for severe vocal fold paralysis, with a particularly high efficacy when performed early after paralysis onset. In patients undergoing aortic surgery, intracordal trafermin injection post surgery and before extubation may prevent or reduce postoperative voice disorders caused by vocal fold paralysis due to recurrent nerve palsy and prevent postoperative pulmonary complications.

Objective: Voice disorders among children are quite common, probably due to the excessive and phonotraumatic voice use patterns. Global prevalence falls between 1.4% and 53.2%; however, no such prevalence studies are available in Indian literature. This study aimed to estimate the prevalence of perceptual dysphonia among school going children in the Dakshina Kannada district in Karnataka, India.

Study design: Cross sectional study.

Method: A total of 3005 school going children aged between 6 and 17 were recruited through voice screening camps conducted across 16 schools through cluster sampling. They were screened using an auditory perception tool-consensus auditory perceptual evaluation of voice (CAPE-V) and adapted The Quick Screen for Voice protocol.

Results: The prevalence of perceptual dysphonia was estimated to be 6.92% based on clinician rated CAPE-V ratings and The Quick Screen for Voice protocol. The measures of vocal tasks carried out as part of the protocol were grouped based on the age of the children.

Conclusion: The estimated prevalence highlighted the need for future epidemiological studies. Findings from such epidemiological studies will enable early identification, assessment, and treatment planning for pediatric voice disorders.

Phonation is the use of the laryngeal system, with the help of an air-stream provided by the respiratory system, to generate audible sounds. Humans are capable of generating voices of various phonation types (eg, breathy, neutral, and pressed), and these types are used both in singing and speaking. In this study, we propose to use features derived using the tunable Q-factor wavelet transform (TQWT) for classification of phonation types in the singing and speaking voice. In the proposed approach, the input voice signal is first decomposed into sub-bands using TQWT, and then the Shannon wavelet entropy of each sub-band is calculated. A feed forward neural network classifier is trained using the entropy values to discriminate three phonation types (breathy, neutral, and pressed). The results show that the proposed TQWT-based features outperformed six state-of-the-art features in the classification of phonation types, both in the singing and speaking voice. Furthermore, the TQWT features achieved the highest phonation classification accuracies of 91% and 82% for the singing and speaking voice, respectively.

Introduction: Parkinson's patients with dysarthria often suffer from multiple impairments in speech subsystems, including phonation. The Acoustic Voice Quality Index (AVQI) may be considered as a predictor of the onset and severity of Parkinson's disease.

Objective: Investigating the AVQI in Persian-speaking Parkinson's patients compared to healthy controls and its association with disease severity based on Unified Parkinson's Disease Rating Scale-Part III (UPDRS-III) and dysarthria severity.

Method: This is an epidemiological descriptive-analytical study with a sample size of 30 Parkinson's patients with hypokinetic dysarthria and 30 healthy controls. Disease severity was first assessed using the UPDRS-III, followed by speech sample recording (sustained vowel/a/phonation and reading of the text "grandfather") using a specialized microphone and dysarthria severity assessment. Finally, AVQI scores were extracted using the Praat software.

Results: An independent t test was used to compare mean AVQI between the healthy and patient groups. The mean voice quality index was higher in the patient group than in the healthy controls, and the difference between the two groups was significant (P value ≤ 0.001). Correlation analysis of AVQI with disease severity and dysarthria severity using Spearman's test showed that voice quality index was significantly positively correlated with disease severity (UPDRS-III) and dysarthria severity (P value ≤ 0.001).

Conclusion: The AVQI can differentiate between the presence of voice disorders in Persian-speaking Parkinson's patients with hypokinetic dysarthria and healthy controls. This index showed a positive correlation with Parkinson's disease severity and dysarthria severity in Persian. It is recommended that this correlation be investigated in other languages as well.

Background: It is not clear to what extent patients with thyroid disease are knowledgeable about voice health. This study investigated patients' awareness and practices concerning voice disorders post-thyroidectomy and their willingness for further education.

Methods: This study was a cross-sectional observational survey conducted at the Department of Thyroid Surgery, West China Tian Fu Hospital, between February and May in 2024. The questionnaire consists of four sections; descriptive analysis, correlation analysis, and logistic analysis were used for statistical analysis.

Results: A total of 248 participants were included, with 94% of participants reporting no dysphonia at present but expressing concern about postoperative voice change (with an average anxiety level of 6.43 out of 10). Among all participants, 53.2% were aware of postoperative voice change as a complication before hospitalization, and this percentage increased to 85.5% after surgery. A total of 77.8% of them reported that undergoing an examination before surgery was "absolutely necessary" or "necessary." Participants have limited understanding of the symptoms of voice disorders, methods of voice assessment, and causes of postoperative voice disorders. The most common source of knowledge was preoperative conversations with surgeons (63.3%). However, participants exhibited a positive attitude toward the treatment of voice disorders after thyroid surgery (87.5%) and were willing to receive knowledge on vocal hygiene (91.9%).

Conclusions: In this study, participants displayed inadequate knowledge about voice disorders following thyroid surgery but took proactive steps to manage it. They generally preferred conservative treatment options for postoperative voice disorders. Additionally, the results revealed a strong interest among patients in receiving further education on managing voice disorders after surgery. Therefore, enhancing education can help facilitate timely medical consultations for patients with postoperative voice disorders and improve their overall postoperative quality of life.

Objective: Laser treatment of the anterior commissure (AC) poses a potential risk of anterior glottic web (AGW) formation. Effectively addressing and mitigating this potential complication is vital for procedure safety and efficacy. This study evaluates the incidence of AGW following TruBlue laser treatment in patients undergoing AC laryngeal surgery.

Study design: Retrospective case series.

Methods: A retrospective analysis was conducted on a cohort of nine patients who underwent TruBlue laser ablation under general anesthesia between August 2020 and February 2024. All lesions were superficial and involved the AC. Laser parameters were set at 10 W, with 30 ms on-time and 300 ms off-time. The AC was thoroughly cleared of abnormal tissue in a single, non-staged operation. Laryngoscopic evaluations were performed at regular intervals.

Results: Underlying pathologies included moderate dysplasia (11%), high-grade dysplasia/carcinoma in situ (55.5%), and squamous cell carcinoma (33%). Among the study participants, only one (11%) developed AGW post TruBlue laser treatment, which was subjectively insignificant. No other adverse events were observed. The stroboscopic findings and patient-reported assessments demonstrated considerable variability.

Conclusions: This study suggests TruBlue laser ablation is a promising treatment for AC premalignant and malignant lesions, with a low incidence (11%) of AGW. Our protocol involved a single non-staged procedure that ablated both sides of the vocal folds and the AC, resulting in favorable outcomes compared to CO₂ laser surgery and potentially improved results compared to other photoangiolytic lasers. The study marks an important stride toward alternative therapies for AC lesions, suggesting that the TruBlue laser could be a viable alternative to radiotherapy.

Objective: Acquired anterior glottic webs are the result of trauma, iatrogenic, radiation, or inflammation to the anterior commissure, resulting in narrowing of the airway and elevated pitch. They are very challenging to treat, and contemporary management strategies typically involve repeat procedures under general anesthesia with high rates of web recurrence. We aim to describe a novel treatment for anterior glottic webs with potassium titanyl phosphate (KTP) laser treatment that are performed in-office under topical anesthesia.

Methods: This is a retrospective chart review of six patients with an anterior glottic web who were managed in an office setting with KTP laser between the years 2019 and 2023. Demographic data, patient reported outcome measures, and treatment details were collected. Preprocedure and postprocedure video laryngoscopy was collected, and representative images were evaluated by blinded laryngologists. The reviewer, blinded to treatment status, was asked to measure the length of the vocal fold from vocal process to current anterior commissure and in addition, measure vocal process to expected ideal anterior commissure. The percentage change in length of the anterior glottic web is then calculated and reported.

Results: Six patients were included in the study, all tolerated the procedure well, and no adverse events. Patient follow up was on average 7 months (5 weeks to 3.1 years), with three of six patients having approximately 3 years follow up. All patients had a reduction in the length of the anterior glottic web, with an average pretreatment web length 40.4%, falling to 15.4% postKTP; t(6) = 3.43, 95%CI [6.29-43.71], P < 0.05. There were no significant change in VHI-10 scores post treatment t(3) = 1.73, 95% CI [-2.93-9.93].

Conclusions: KTP is a novel in-office treatment that offers promising and potentially durable results in the management of anterior glottic web.

Level of evidence: Level 4 - Case series study design.

Objectives/hypothesis: To design low-cost smartphone adapters for recording otolaryngology trainee and physician extender endoscopies and evaluate their image quality and usability in the inpatient and emergency room (ER) settings.

Study design: Prospective mixed-methods study, including device design, quantitative, and qualitative surveys.

Methods: 3D-printed adapters for rigid and flexible fiberoptic endoscopy were iteratively developed. Three versions of the adapters were provided to otolaryngology trainees, faculty, and physician extenders: phone adapters +/- telescope magnification and tablet/laptop adapters featuring a universal serial bus camera. Surveys including the System Usability Scale (SUS) and questions on image quality, ease of use, and impact on patient care were administered. Images from the adapters and existing recording methods were compared using the Blind/Referenceless Image Spatial Quality Evaluator (BRISQUE) image quality metric.

Results: 20 otolaryngology staff completed the survey (nine residents, one physician assistant, nine attendings, one fellow). SUS scores were excellent with a mean of 77.5 (SD 9.7). There were no significant differences in BRISQUE scores when comparing the smartphone adapters with single-use distal-chip nasopharyngolaryngoscopes and clinic fiberoptic systems (F = 0.7, df = 4, P = 0.5890). The cost to fabricate the phone adapter with/without a telescope and the tablet/laptop adapter was $1.28, $39.38, and $93.84, respectively. Responses to semi-structured questions highlighted positive impact on supervision and collaboration.

Conclusions: There are limited options for recording and supervising otolaryngology trainee endoscopic exams in the inpatient and ER settings. Endoscopic phone adapters designed by 3D printing can generate sufficient image quality and usability for clinical supervision.

The laryngopharyngeal reflux disease (LPRD) treatment remains controversial due to the poor effectiveness of proton pump inhibitors (PPIs). In this paper, the author reviewed the current primary treatments used in clinical studies for managing LPRD and discussed the pharmacological, biological, and physiological properties of medication for providing clinical relevance for otolaryngological practice. A comprehensive review of the PubMed, Cochrane Library, and Scopus literature was conducted to document and analyze the medical treatments of LPRD in the largest case series published in the past 20 years. Fifty-five studies met the inclusion criteria, revealing that 67 different therapeutic regimens were used in the LPRD studies in the past 20 years with nine different therapeutic durations. PPIs have been used as a single therapy in 70.1% of cases. PPIs were combined with another drug in 23.9% of cases. Alginates and antacids were used as single therapy or in association with other drugs in 10.5% and 3.0% of cases, respectively. There was an important variability of molecules, doses, and regimens. There is an important gap between current therapeutic practice and the recent advancements in the pathophysiology of LPRD. The pharmacological and physiological findings of this review can reasonably support the notion that alternative gastroesophageal reflux disease therapies (alginate, antacids) could take a significant place in the treatment of primary or recalcitrant LPRD. Future studies are needed to confirm the stability of the LPRD profile at the hypopharyngeal-esophageal multichannel intraluminal impedance-pH and the role of digestive enzymes in the development of upper aerodigestive tract mucosa inflammation and symptoms.

Objective: To examine the rate of abidance and adherence to voice therapy (VT) in a group of Lebanese patients with voice disorders, and to analyze the correlation between the rate of abidance, adherence, and socioeconomic factors in addition to patient- and disease-related factors.

Study design: Retrospective chart review.

Methods: The medical records of patients with voice disorders who presented to the voice unit in a tertiary referral center between January 2022 and December 2023 were reviewed. All patients referred to voice therapy selected were included in this study. Patients were stratified into those who abided to voice therapy and those who did not. Patients who abided to voice therapy were further divided into two subgroups: those who adhered to VT and those who did not.

Results: A total of 236 patients with voice disorders were referred to VT, with only 51 attending VT, resulting in a 21.6% abidance rate. Of the 51 patients who attended VT, only 25 completed the therapy sessions, yielding a 55.6% adherence rate. Younger age and higher education level were positively correlated with adherence (r = 0.382, P = 0.01 and r = 0.506, P < 0.001, respectively). Disease-related factors showed a moderate negative correlation between high Voice Handicap Index-10 (VHI-10) scores and adherence (r = -0.687, P < 0.001). Functional voice disorders were associated with higher adherence rates compared with structural or neurologic voice disorders (P = 0.014).

Conclusion: The results of this study indicate that the rate of abidance to VT in a group of Lebanese patients with dysphonia is low. Otolaryngologists referring dysphonic patients to VT should take into account the main factors affecting this low rate and account for alternative treatment plan in case one or more of these deterring factors are present.