Journal of Voice最新文献

Background: Voice analysis has emerged as a potential biomarker for mood state detection and monitoring in bipolar disorder (BD). The systematic review aimed to summarize the evidence for voice analysis applications in BD, examining (1) the predictive validity of voice quality outcomes for mood state detection, and (2) the correlation between voice parameters and clinical symptom scales.

Methods: A PubMed, Scopus, and Cochrane Library search was carried out by two investigators for publications investigating voice quality in BD according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. Studies were assessed using the modified methodological index for non-randomized studies (MINORS).

Results: Of the 400 identified publications, 16 studies met the inclusion accounting for 575 BD patients. Machine learning approaches were implemented in 87.5% of studies, with classification accuracies ranging from 70.9% to 96.9%. Manic state detection showed the strongest predictive validity [area under the curve (AUC) up to 0.89], while depression detection demonstrated moderate performance (AUC: 0.66-0.78). Individual-specific models outperformed population-level approaches (correlation coefficients: 0.78 versus 0.44). Voice quality showed significant correlations with standardized clinical scales, particularly Young Mania Rating Scale and Hamilton Depression Rating Scale (normalized root mean square errors: 1.985 and 3.945, respectively). Prosodic features were examined in 81.25% of studies, with pitch consistently elevated during manic episodes. MINORS varied from 10 to 14, with notable limitations in sample size calculations and blinding procedures.

Conclusions: Voice quality is a promising biomarker in BD, particularly for manic state detection and individualized monitoring. While controlled settings showed strong performance, naturalistic applications yielded more modest results. Future research should focus on standardizing protocols across different environments and conducting large-scale longitudinal studies with robust methodological controls.

Objectives: To compare certain acoustic, aerodynamic, and perceptual parameters before and after an hour-long class to analyze vocal loading characteristics in female Bharatanatyam dance teachers.

Study design: Prospective study.

Method: The study included 52 female Bharatanatyam dance teachers aged 19 to 40years. A brief case history was taken to recruit the participants and document the essential details. Multiparametric voice assessment was done before and after an hour-long dance class for the parameters Mean Intensity, Mean Pitch, Pitch Standard Deviation, Harmonics to Noise Ratio, Jitter percentage, Shimmer, Cepstral Peak Prominence, Acoustic Voice Quality Index, s/z ratio, Maximum Phonation Time (MPT), GRBAS, and Voice-Related Quality of Life assessment.

Results: Acoustic Voice Quality Index values above 2.22 in 65.38% of participants before class, indicative of dysphonia. The mean Voice-Related Quality of Life score was 1.98±1.67. The Wilcoxon signed-rank test showed significant differences in mean intensity (P=0.00) and jitter percentage (P=0.012). The paired t test revealed significant differences in mean pitch (P=0.00), Cepstral Peak Prominence (P=0.027), and MPT (P=0.00). No significant difference was found in the GRBAS grade evaluation (P=0.439) before and after the class.

Conclusion: In the present study, significant changes in several acoustic parameters, MPT, and Acoustic Voice Quality Index indicating dysphonia, highlight the impact of vocal loading on the voice of female Bharatanatyam dance teachers.

Background: Methods to elicit the vital capacity (VC) include forced vital capacity (FVC) and slow vital capacity (SVC). Because the FVC maneuver can be affected by air trapping or inefficiencies in lung emptying vs. the SVC, the SVC-FVC difference may be substantial and diagnostically meaningful in elderly individuals and patients with respiratory obstruction. However, the degree of SVC-FVC difference in non-respiratory disordered individuals is unclear - some studies indicate a negligible difference, and other studies/guidelines suggest a mean difference in this target group up to 200 mL. This study examined the relationship between FVC vs. SVCs in a group of typical young adult speakers with three forms of measurement device (pneumotach-based; turbine flow meter; vortex whistle).

Methods: FVC and SVCs were collected from 66 non-respiratory disordered subjects (18-30 years) using three methods: a pneumotach system (KoKo Sx1000); a turbine flow spirometer (Micro Spirometer); and 3-D printed vortex whistles and analysis software. FVC and SVC measures were compared and correlated.

Results: The upper limit of the 95% CIs for the mean SVC-FVC difference were observed to be < 60-115 mL, depending upon the measurement system used. However, mean SVC-FVC differences were nonsignificant in all methods. Strong correlations between FVC vs. SVC were observed within each device (r's > 0.95), and both FVC and SVC measurements were highly correlated between devices (r's > 0.90).

Conclusion: Mean SVC tends to be slightly greater than mean FVC, though this difference is nonsignificant in typical young adult subjects, making VC measures from SVC vs. FVC essentially interchangeable in this target group. Any SVC vs. FVC differences are detectable via both pneumotach-based spirometry and lower-cost technologies. The SVC method has several benefits vs. FVC for speech-language pathologists who may be conducting VC testing with a large variety of patient groups in diverse (often non-medical) settings.

Introduction: Vocal symptoms are frequent in patients with coronavirus disease 2019 (COVID-19) and may occur during or after infection.

Objective: To conduct a descriptive review on the topic "dysphonia and COVID-19" in order to alert specialists to these symptoms associated with the virus and sequelae.

Methodology: A literature review was carried out in the main databases: Web of Science, PubMed, Google Scholar, and Scopus, between April 2020 and April 2024 using descriptors that related COVID-19 or severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) to voice disorders.

Results: In total, 41 studies, 13 case reports, 6 retrospective, and 22 prospective, 5139 patients (2131 M, 2991 F), mean age of 51 years. The prevalence of dysphonia ranged from 0.39% to 79%. The most prevalent vocal symptoms were hoarseness, cough, dry throat, sore throat, reflux, aphonia, phonasthenia, stridor, and hypersecretion. Videolaryngoscopic findings: unilateral paralysis (145), bilateral paralysis (16), erythema (84), benign lesions (56), muscle tension dysphonia (54), granulomas (33), edema (31), stenosis (22), atrophy (19), incomplete glottal closure (12), and ventricular hypertrophy (6). Auditory-perceptual analyses identified mild/moderate vocal impairment in infected patients and persistence of changes in the long-COVID period. Acoustic analyses indicated significant changes in Jitter, Shimmer, harmonic-to-noise ratio (NHR), and maximum phonation time in patients with COVID-19.

Conclusion: Dysphonia caused by COVID-19 infection is common, both in the acute and chronic phases of the disease. The main causes include vocal fold paralysis, inflammatory laryngitis, and muscle tension dysphonia. All patients who present vocal symptoms after COVID-19 infection should undergo videolaryngoscopy and subjective and acoustic vocal analyses to identify sequelae of the disease.

Background: Vocal fatigue involves self-perceived vocal symptoms and reduced physiological capacity. This study aimed to adapt and validate the Vocal Fatigue Index (VFI), a tool originally designed to distinguish between patients with vocal fatigue and vocally healthy individuals, for Italian speakers.

Method: A four-step translation and validation process was employed. First, four bilingual clinicians specializing in voice disorders translated the English VFI into Italian. An expert committee of six bilingual Italian-English voice disorder specialists then reviewed and refined these translations, leading to a preliminary Italian version. This version was then back-translated into English by one of the authors, ensuring semantic equivalence with the original. Finally, the resulting Italian VFI (VFI-I) was pretested in a study involving 669 participants (386 normal voices and 283 disordered voices) from diverse regions.

Results: Nonparametric tests showed significantly higher VFI-I scores for all factors among participants with voice disorders compared with participants with healthy voices. The VFI-I showed good internal consistency and reliability, with Cronbach alpha coefficients ranging from 0.92 to 0.97. Treatment-induced changes were captured, showing a significant decrease in Factor-1 scores post therapy. Convergent validity analysis indicated moderate correlations between VFI-I factors and VHI-I subscales. Multivariate analysis confirmed the association of VFI-I factors with diagnosed voice disorders.

Conclusion: This study established the VFI-I as a reliable and valid tool for identifying Italian speakers with vocal fatigue, with good sensitivity to clinical diagnosis, and the ability to track treatment progress highlighting its potential for improving voice care in Italian-speaking populations.

Objective: To investigate the risk of obstructive sleep apnea (OSA) in patients with muscle tension dysphonia (MTD) in comparison to subjects with no dysphonia.

Study design: Prospective cohort study.

Methods: Patients who were diagnosed with MTD at a tertiary referral center between October 2022 and October 2023 were invited to participate in this study, alongside a healthy control group matched by age and gender, with no history of dysphonia. The risk of OSA was evaluated using the STOP-BANG and Epworth Sleepiness Scale (ESS) questionnaires. Demographic data included age, gender, history of smoking, history of allergy, and history of reflux disease.

Results: A total of 55 patients who had filled the STOP-BANG and ESS questionnaires were enrolled in this study, including 31 patients diagnosed with MTD and 24 healthy subjects. Using the STOP-BANG, two-thirds of the study group had an intermediate-to-high risk of having OSA as compared to 25% of the control group (P = 0.002). The odds of having OSA was 6.3 times among patients with MTD in comparison to controls (OR = 6.3; 95% CI [1.91-20.75]. When using the ESS, nine patients of the study group (29%) exhibited excessive daytime sleepiness compared to none in the control group (P = 0.007).

Conclusion: The results of this investigation indicate that the risk of OSA is significantly higher in patients with MTD vs. controls. Patients with MTD were 6.3 times more likely to have an increased risk of OSA in comparison to subjects with no dysphonia. A longitudinal study using objective tests for OSA is needed to establish a cause-effect relationship between OSA and MTD.

The assessment of vocal function plays an important role in the diagnosis of voice disorders. With the continuous development of voice medicine in China, the evaluation, diagnosis, and treatment of voice disorders are gradually professionalized and standardized. Experts of the Subspecialty Group of Voice, Society of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association; Subspecialty Group of Laryngopharyngology, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery reached the expert consensus through clinical research, literature search, and quality evaluation, as well as two meetings and two rounds of questionnaire voting. It includes the baseline information of patients, subjective and objective assessment of voice quality, voice-related quality of life assessment, laryngoscopy and vocal fold vibration evaluation, aerodynamic analysis, laryngeal neuromuscular electrophysiological function evaluation, and many other aspects. This is the first expert consensus on vocal function assessment in China and provides appropriate guidance recommendations to voice specialists, otolaryngologists, and primary care practitioners in China.

Objectives/hypothesis: Speech rate is deemed as one of the contributing factors in dysphonia. This study sought out if dysphonic patients speak faster than their normal counterparts. Also, the effects of dysphonia subtype (organic, functional, and neurologic), sex, and age on speech rate were investigated.

Study design: An analytical cross-sectional study.

Methods: Reading and connected speech samples of 188 participants (128 dysphonic patients and 60 normal controls) were transcribed and their speech rates while eliminating the voiceless parts and pauses by freeware Praat were calculated in syllable/word per minute.

Results: The results indicated that dysphonic patients significantly speak faster than normal controls in connected speech with moderate to large strength of effect size (P < 0.05) and this pattern was mostly not affected by sex. The speech rate did not differ significantly between subgroups of dysphonic patients (P > 0.05), except for speech rate in connected speech and average speech rate of reading and connected speech tasks between organic, functional, and neurological dysphonic patients with normal controls (P < 0.05). Also, there was no correlation between speech rate and age (P > 0.05).

Conclusions: According to the preliminary outcomes, the increased rate of speech may be a contributing factor to dysphonia. Additional research is required to clarify the role of speech rate in clinical settings.

Objectives: This in vitro study investigated the interaction between human vocal fold fibroblasts (hVFF) and macrophages under the influence of cigarette smoke extract (CSE) and vibration as potential regulators of vocal fold (VF) inflammation.

Study design: Experimental in vitro pilot study.

Methods: Immortalized hVFF were cultured in flexible-bottomed cell culture plates, treated with CSE, and subjected to static or dynamic conditions in a phonomimetic bioreactor. For coculture, unstimulated or lipopolysaccharide/IFNγ-stimulated THP-1 (human leukemia monocytic cell line) macrophages were added in inserts for a final 24 hours of vibration period. We measured messenger ribonucleic acid (mRNA) (quantitative polymerase chain reaction [qPCR]) and protein levels (Western Blot, ELISA, and LUMINEX®) of hVFF and analyzed the results using two- and three-way ANOVA with post hoc tests.

Results: Under inflammatory stimulation, we observed a reduction of collagen (COL) type 1A1, 1A2, and 3A1, and increased gene expression of COL4A1, matrix metallopeptidase 2, and vascular endothelial growth factor A in hVFF. Additionally, the pro-inflammatory markers cyclooxygenase (COX) 1 and 2, interleukin (IL) 1β, IL-6, and IL-8 were upregulated. CSE increased COX1 and COX2 levels, whereas vibration reduced CSE-induced increases of COL4A1 and COX2 in pro-inflammatory stimulated hVFF.

Conclusion: This study indicates that vibration may mitigate CSE-induced inflammatory damage in the hVFF, thereby offering new insights into the cellular crosstalk that underlies the pathophysiology of VF inflammation in smoking-related voice disorders.

Background: Laryngeal respiratory dystonia (LRD) is diagnosed based on clinical presentation, patient history, and physical examination. Key indicators include dyspnea, desynchronized breathing patterns, and laryngoscopic findings that reveal vocal fold adduction during inspiration. Treatment for LRD remains controversial and often yields limited effectiveness. While botulinum toxin type A (BtxA) is commonly injected into the thyroarytenoid-lateral cricothyroid (TA-LCA) muscle complex, there are cases where injections into the interarytenoid (IA) muscle have also proven beneficial. DaxibotulinumtoxinA (DAXI) is an emerging therapy that has shown promising effectiveness and safety across various conditions, including cervical dystonia. In this report, we present the first documented use of DAXI specifically for LRD, highlighting the significant benefits experienced by the patient compared to previous treatments with BtxA.

Case: A 77-year-old man presented with a 1-year history of significant shortness of breath. Laryngeal endoscopy demonstrated inappropriate adduction of the patient's vocal folds during respiration, suggestive of LRD. The patient received their first Botox (BtxA) injection in May 2018 and has since undergone a total of 40 injections. The patient had a variable response to BtxA injection into his TA-LCA muscle complex, experiencing general improvement in breathing but frequent negative impact on voice and swallowing function. In November of 2021, electromyography-guided BtxA injection into the patient's IA muscle was performed with significant improvement in results. The patient described near-complete resolution of his LRD breathing symptoms with minimal voice changes and a duration of benefit of ~50 days. In November of 2023, DAXI injection into the patient's IA muscle was performed. The patient self-reported a complete resolution of his symptoms for a total duration of benefit of 91 days. Subsequent injections with DAXI in February and May of 2024 had near identical responses.

Conclusion: DAXI appears to provide ~80% better duration than the patient's average BtxA injection and a 57% improvement than his best BtxA injection. DAXI is a safe and realistic alternative to BtxA injection in patients with LRD.