Journal of Voice最新文献

Objective: Early life adversity and related social determinants of health (SDOHs) are risk factors for trauma, learning and regulation difficulties, and poor adult health outcomes, such as functional voice disorders (FVDs). It is unknown if learning new voice techniques is confounded by a history of adverse experiences. The purpose of this study was to investigate the relationship between SDOHs and cognitive effort in voice therapy.

Methods: Patients referred for voice therapy at the Emory Voice Center in Atlanta, GA were recruited to participate in a non-experimental prospective study using an event-based ecological momentary assessment (EMA) methodology. At therapy initiation, patients completed the Trauma Symptoms of Discrimination Scale (TSDS), the Adverse Childhood Experiences (ACEs) questionnaire, and the Voice Handicap Index-10 (VHI-10). To assess mental effort and frustration for voice therapy, the NASA Task Load Index (NASA-TLX) was administered following each therapy session. Statistical tests were applied to examine differences in ratings among races and voice disorder diagnosis. Pairwise comparisons and generalized estimating equations were used to determine correlations between different outcome measures.

Results: Twenty-seven participants (89% female, 60% white) completed the study. No significant differences in baseline perceptions of voice handicap, mental effort, frustration, trauma symptoms, or early adversity were observed among different groups. Elevated and clinically significant TSDS scores (M=46.18, SD=23.82) were observed among patients with FVDs. Statistically significant and positive correlations were observed between TSDS and mental effort and frustration scores (r=0.51, adjusted p=0.0296). Participants' mental-effort scores decreased significantly after therapy visits when considering the effects of confounders, but frustration scores did not.

Discussion: Results indicate that patients reporting more trauma symptoms were also more likely to report greater cognitive effort and frustration during voice therapy than those reporting fewer trauma symptoms. While mental effort decreased from session to session during therapy, frustration did not. Findings underscore the need for the universal practice of trauma-informed care that includes equipping patients with resources that encourage positive emotions and resilience for the purpose of sustaining mental effort throughout the course of voice therapy.

Purpose: This study aims to evaluate the effect of obesity on phonation quality by examining changes in voice parameters in obese individuals who experienced weight loss after bariatric surgery, and to reveal the reflections of anatomical and physiological changes due to weight loss on voice characteristics.

Study design: Prospective study.

Methods: Fifteen female patients who underwent bariatric surgery were included in the study. The voice parameters of the participants were evaluated preoperatively and at the 3rd postoperative month. Demographic data were recorded during the evaluation; the Voice Handicap Index (VHI-10) and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scales were used for perceptual analysis. Voice recordings were obtained according to determined phonation and speech tasks; acoustic analyses were performed using MDVP software. Additionally, cepstral analyses were conducted using ADSV software. Aerodynamic evaluations were performed via maximum phonation time (MPT) measurement.

Results: At the 3rd month after sleeve gastrectomy, the mean body weight of the participants decreased from 104.60 ± 10.84 kg preoperatively to 81.73 ± 12.29 kg postoperatively; BMI decreased from 41.26 to 31.11 (p=0.001). Improvements in GRBAS and VHI-10 scores (p=0.003, p=0.041), and increases in SPI and MPT values (p=0.041, p<0.001) were detected. In cepstral analysis, significant changes were observed in CPP F0, CPP, and L/H Ratio SD parameters in certain sentence types (p<0.05).

Conclusion: Weight loss associated with bariatric surgery may lead to improvement in voice outcomes; however, the mechanisms underlying this improvement have not been fully elucidated. The findings suggest that physiological changes due to weight loss may strengthen respiration-phonation coordination, increase MPT, and improve certain aspects of vocal harmonic regularity. However, the limited change in fundamental acoustic parameters suggests that this effect may be multidimensional and individual-specific.

Objectives: The aim of the study is to characterize the sociodemographic profile and describe the diagnoses of patients who consult for dysphonia at a voice unit in a University healthcare network in Chile.

Methods: We evaluated 1079 patients with dysphonia who attended the Voice Unit of a University Hospital. Parameters assessed were age, gender assigned at birth, occupation, smoking history, laryngeal diagnoses, patient-reported outcome measures scores, and Grade, Roughness, Breathiness, Asthenia, Strain, and Instability perceptual ratings.

Results: Of the 1079 patients with dysphonia who were included in this study, 418 were male (38.7%), and 661 were female (61.3%). The age groups were as follows: under 18 years (n = 68); 19-40 years (n = 353); 41-60 years (n = 383); and >60 years (n = 162). The predominant professions of the patients were teachers, retired individuals, and students. Smoking was reported by 17.7% patients. With regard to the etiology of dysphonia, in children (1-17 years old), cysts (n = 23;33,8%), nodules (n = 20;29,4%). In adults (18-60 years old), polyps (n = 142;19.3%), muscle tension dysphonia (MTD) (n = 107;14.5%), and vocal paralysis (n = 67;9.1%) predominated. In patients >60 years, vocal paralysis (n = 47;17%), presbylarynx (n = 30;10.9%), and vocal fold (VF) neoplasm (n = 22;8%) predominated. Based on videolaryngoscopic findings, the sample group was divided into functional dysphonia (n = 174), organic dysphonia (n = 679), and movement disorders (n = 226). The most frequently laryngeal pathologies were polyps, MTD, and VF paralysis. Organic dysphonia was more common in all age groups, and movement disorders dysphonia presented a worse voice quality and voice-related quality of life.

Conclusions: In this population of 1079 patients with dysphonia, adults and women were predominant. Dysphonia had different etiologies in the different age groups studied. Cysts and nodules predominating in children, polyps and MTD in adults, and paralysis in the elderly. This is the first study in Chile that finds the prevalence in a large number of patients of all ages that consult for dysphonia in a Voice Unit in an Otolaryngology Department.

Introduction: Nonlinear energy difference ratio (NEDR) and voice type component profile (VTCP) are reliable acoustic metrics for voice classification; however, their performance under varying vocal intensities, speech sounds, and recording environments has not been thoroughly established. This study examined the effectiveness of these measures under real-world variability with different phonemes, sound intensities, and environments to help determine their clinical diagnostic potential.

Methods: Thirty-one normophonic adults produced sustained vowels (/a/, /i/, /u/) and fricatives (/s/, /z/) at five nominal sound pressure levels from very soft (L1), soft (L2), baseline (L3), loud (L4), and very loud (L5). The vowel /a/ was also recorded in sound-attenuated and noise-masked environments to elucidate the environmental effects on reliability. Trimmed 0.75-second samples were analyzed in MATLAB to compute NEDR and VTCP values. Repeated-measures analysis of variances tested the effects of intensity, sound type, and environment for NEDR and VTCP.

Results: NEDR remained stable across vowels and voiced fricatives, with deviations limited to very soft phonation (L1) and the voiceless fricative /s/. VTCP was more sensitive to changes, particularly at low intensities and in noisy environments, with voice types 3 and 4 frequently misclassifying healthy phonations as disordered. Across environments, NEDR showed greater robustness than VTCP.

Conclusion: NEDR demonstrates relative stability across vocal intensity, phoneme type, and recording environment, supporting its potential clinical utility, including in telepractice and nonsoundproof settings. Its susceptibility to very low intensities and voiceless fricatives highlights the need for cautious interpretation and further validation in disordered populations.