Journal of Voice最新文献

Background: School teachers are known to be at risk for dysphonia. However, they do not always get the benefits that are guaranteed to people with occupational diseases. Objective parameters attempting to quantify the condition are a requirement. Based on an earlier smaller study done in a single district of Kerala, a highly literate State in south India, the present study was envisaged as a Statewide survey of the problem.

Objectives: The aim was to check the possibility of designating voice problem (dysphonia) in school teachers as a distinct occupational health issue. The primary objective was to document the prevalence of subjective dysphonia. Second, the study sought to look for possible associations between known risk factors and dysphonia.

Methods: A cross-sectional, questionnaire-based survey was conducted. The tool was developed from an earlier version, with the addition of risk factor questions and subjective handicap scoring. Three categories of dysphonia were obtained. Statistical analyses were done for all variables, with P value <0.05 considered statistically significant. Odds ratios (OR) with 95% confidence limits were calculated for four of the risk factors.

Results: Completed responses were obtained from 4014 school teachers. Of these, 1885 (46.96%) had dysphonia at the time of responding, 1922 (47.88%) in the last 1year, and 2650 (66.02%) at some point during their career. Most risk factors had statistically significant association with dysphonia. OR calculation showed greater risk for teachers in government-managed or -aided schools, those teaching in secondary (5th- to 12th-grade) schools, those in the job for more than 20years, and teaching social science subject.

Conclusions: There is a high prevalence of dysphonia in school teachers in a Statewide survey of Kerala. Several risk factors have been identified, some peculiar to the region. There is enough numerical evidence to designate dysphonia in school teachers as an occupational health issue.

Objective: Phonotrauma has been hypothesized to be associated with prolonged and/or accumulated biomechanical stress on vocal fold tissue. This hypothesis can be tested using ambulatory monitoring of vocal fold dissipated power, which requires a reliable method for its noninvasive estimation during the activity of daily living. The first aim of this study was to show that a laboratory-based estimate of vocal fold dissipated power computed from intraoral pressure (IOP) has significant discriminative power in individuals with phonotraumatic vocal hyperfunction (PVH). Considering that estimation of subglottal pressure from IOP is not practical for ambulatory applications, an alternative approach should be used. The second aim of this study was to test the impact of two alternative methods for the estimation of subglottal pressure on the discriminative power of vocal fold dissipated power in individuals with PVH and, hence, to provide an evidence-based recommendation for future ambulatory monitoring studies of vocal fold dissipated power.

Method: Four groups of adult females were included in this study: 16 individuals with PVH, 16 individuals with nonphonotraumatic vocal hyperfunction (NPVH), and two groups of vocally typical controls matched to the participants in each patient group in terms of age and occupation. Each participant produced strings of five consecutive /pae/ syllables while wearing a pneumotachograph mask with an IOP tube. Neck-surface accelerometer and acoustic signals were recorded simultaneously using an ambulatory voice monitor and a head-mounted microphone, respectively. IOP was used to estimate subglottal pressure and subject-specific calibration factors were determined for the estimation of subglottal pressure from the accelerometer signal.

Results: (1) Individuals with PVH had significantly higher dissipated power than controls (P = 0.001, Cohen's D=1.31) when the intraoral estimate of subglottal pressure was used in the computation of dissipated power. (2) The difference between the dissipated power of individuals with NPVH and their matched controls was not significant. (3) When microphone-based sound pressure levels was used for the estimation of subglottal pressure, the difference between individuals with PVH and their matched controls vanished (P = 0.23). (4) When subject-specific estimation of subglottal pressure from the accelerometer was used, the discriminative power returned with a very large effect size (P = 0.001, D=1.38).

Conclusion: Increased dissipated power is sensitive and specific to individuals with PVH among individuals with hyperfunctional voice disorders. The results provide evidence that accelerometer-based estimate of energy dissipation dose (power integrated over time) during daily life could be clinically useful.

Objective: Our study aims to determine the presence of voice disorder in religious officials and to examine the differences in temperament and personality traits between religious officials with and without voice disorder.

Methods and procedures: A total of 87 religious officials between the ages of 18 and 65 were included in the study. For the objective evaluation of the voice of all individuals, a videolaryngostroboscopic examination was performed by a specialist Ear Nose Throat physician using a rigid endoscope. For temperament and personality assessments, each participant completed the TEMPS-A Temperament Rating Scale Turkish version and the Big Five-50 Personality Test Turkish Form (B5KT-50-Tr). All individuals were divided into groups according to the presence of voice disorder.

Results: Sixty-five of 87 individuals were found to have normal voice health, and 22 individuals were diagnosed with voice disorder. While there was a significant difference between the groups with and without voice disorder in terms of extraversion and emotional stability scores on the B5KT-50-Tr scale (P < 0.05), there was no significant difference in TEMPS-A temperament scale scores.

Conclusions: There was no discernible disparity in the temperament traits of religious officials with and without voice disorders. It should be emphasized that religious officials who suffer from voice disorders exhibit personality traits such as low extroversion and emotional stability. The improvement of more effective intervention strategies can be boosted by considering the temperament and personality traits of these individuals while planning the voice assessment and therapy processes of these religious officials.

Objectives: Laryngeal fractures are rare but potentially life-threatening traumas. Complications, such as airway obstruction and disrupted laryngeal anatomy, associate with significant morbidity. Early identification of at-risk patients and optimal management remain crucial for improved outcomes. Recently, machine learning (ML) has attained great attention as a unique and novel technique for evaluating complex nonlinear relationships between multiple observations to create a predictive model with greater accuracy. This study aimed to demonstrate the potential of ML in predicting airway and surgical management of laryngeal fracture patients and identify key contributing parameters for the predictive performance of the ML models.

Methods: The ML models were developed using a patient series managed at the Helsinki University Hospital during 2005-2019. The developed models were further evaluated independently using a different cohort collected from the same institution between 1995 and 2004.

Results: The ML showed a weighted area under curve (AUC) of 0.93 and accuracy of 0.86 following training for airway management. Likewise, for treatment approach, weighted AUC was 0.85 and accuracy 0.78. Injury type, Schaefer-Fuhrman grade (SF gr), age at incident, cause of injury, and fracture of the cricoid, in decreasing order of significance, were the most prominent features for the model's predictive performance for airway management. Similarly, our model identified SF gr, fracture of the cricoid, injury type, age at incident, and cause of injury as the most significant predictors for surgical treatment approach.

Conclusions: The proposed prediction of management approach by an ML technique can provide accurate predictions and thus aid clinicians in administering early and personalized interventions. The model may serve as a supporting tool in recognizing at-risk patients and in timely decision-making. Further independent external validation is warranted for model generalizability.

Objective: Height has the strongest correlation with esophageal length among the external anthropometric indices. Based on the association between laryngopharyngeal reflux (LPR) and the upper esophageal sphincter, this study aimed to investigate the relationship between height and LPR.

Methods: Retrospective chart analysis of patients who visited an outpatient clinic with symptoms of LPR and underwent a 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH (24-hr HEMII-pH) monitoring. The study analyzed the relationship between height and LPR by (1) in total of 219 patients, (2) in males and females, and (3) in patients under age 60 and over age 60.

Results: The relationship between height and LPR was analyzed for a total of 219 patients. There was no statistical significance between the number of pharyngeal reflux episodes and the height of subjects. When same analysis was done according to gender, the number of pharyngeal reflux episodes decreased as height increased in males, which was statistically significant, but not in females. Further analysis was done according to age in male and female, respectively. In male under age 60, there was statistical significance between the number of pharyngeal reflux episodes and the height of subjects, but not in over age 60. Also, in female under age 60 and over age 60, there was no statistical significance between the number of pharyngeal reflux episodes and the height of subjects.

Conclusions: This study suggests a correlation between height and pharyngeal reflux events in males and individuals under 60 years old tested with the 24-hr HEMII-pH monitoring.

Objective: Ambulatory phonation monitoring (APM) has a long evolving history. Current devices mostly use a contact microphone or accelerometer over the anterior neck, limiting its general acceptance outside of academic purposes. This study applied wireless Bluetooth earphones to receive voice signals. We also designed a mobile App with personalized AI model to identify phonation segments.

Study design: Proof of concept study.

Setting: Acoustic laboratory.

Methods: The materials comprised 1-hour audio files from seven teachers recorded in the classroom. The first 5minutes were used to train the personalized SpeechDetection models using deep neural networks. Another six segments (30 seconds each) were selected for assessing the accuracy of this APM system using two parameters: (1) speech intensity, which was compared to the gold standard measured by CLIO 12, a professional system for voice recording, and (2) phonation segments, which was compared with manual labeling.

Results: The training accuracy of the SpeechDetection model ranged from 91.2% to 98.5%, with a mean of 95.4%. The testing accuracy for detecting phonation segments ranged from 88.4% to 97.0% (mean: 91.5%). The Kappa value of consistency ranged from 0.710 to 0.931 (mean: 0.813, P < 0.001 for all seven participants). After linear calibration, the accuracy of measuring speech intensity ranged from 0.846 to 0.927 (mean: 0.885, P < 0.001, Pearson correlation coefficient).

Conclusions: The study results demonstrated that a novel APM system using wireless earphones with mobile apps can accurately measure phonation segments and speech intensity for teachers in the classrooms. Further experiments under different environments with more participants are mandatory before extrapolating this system to real-world use cases.

Level of evidence: N/A.

Objective: Laryngeal myasthenia gravis (MG) is a focal manifestation of MG, and most patients are seronegative for antibodies against the acetylcholine receptor (AChR) and muscle-specific kinase (MuSK). The purpose of this study was to determine the incidence of anti-AChR and anti-Musk antibodies in voice patients and to characterize the clinical and neuromuscular profiles of these patients in order to guide the diagnosis of laryngeal MG.

Study design: This was a retrospective case-control study that included patients over the age of 18 who underwent laryngeal electromyography (LEMG) as part of their evaluation for neuromuscular junction dysfunction.

Methods: Cases and controls were evaluated serologically, for the anti-AChR, anti-MuSK, and anti-striational muscle antibodies, and neuromuscularly using the Tensilon test in some patients, repetitive nerve stimulation (RNS) test, and a treatment trial of pyridostigmine bromide. Cases were defined as either (1) positive anti-AChR or anti-MuSK, or (2) a positive Tensilon test or positive pyridostigmine bromide trial.

Results: Two hundred and eleven patients were screened; 61 (29%) patients were identified with laryngeal MG, and 77 (36%) patients were selected as controls. All case and control patients were seronegative for the anti-AChR and anti-MuSK antibodies with no significant difference between case and control status for seropositivity for anti-striational muscle antibodies. Of the case patients with an electrically positive Tensilon test (80.6%) who completed a treatment trial, 100% had symptom improvement. Of the case patients with a symptomatically positive Tensilon test (16.1%), only 60% of patients had improvement with a treatment trial. The RNS was more likely to be positive in case patients than control patients, and cases had a higher severity of paresis in all laryngeal muscles with LEMG evaluation.

Conclusions: Laryngeal MG is an underrecognized condition in the otolaryngology community owing in part to its seronegative presentation. Electrical improvement with a Tensilon test, or electrical or substantial symptomatic improvement with pyridostigmine bromide represents the most robust diagnostic criteria in these patients.

The feasibility of using acoustic parameters to predict presbyphagia has been preliminarily confirmed. Considering that age and gender can influence the results of acoustic parameters, this study aimed to further explore the specific effects of age and gender on acoustic parameter analysis of the elderly population over 60 years old with presbyphagia. A total of 45 participants were enrolled and divided into three groups (60-69 years old, 70-79 years old, and 80-89 years old). Acoustic parameters, including maximum phonation time, first to third formant frequencies (F1-F3) of /a/, /i/, and /u/, oral diadochokinesis, the acoustic vowel space, and laryngeal diadochokinesis (LDDK), were extracted and calculated. Two-way analysis of variance was used to analyze the correlations between acoustic parameters and age and gender. The result indicates that /hʌ/ LDDK rate had significant differences in age groups, presenting the 80-89 age group being significantly slower than the 60-69 age group. F1/a/, F2/a/, F2/i/, F3/i/, and F2i/F2u differed systematically between genders, with males being lower and smaller than females. Changes that were consistent with /hʌ/ LDDK regularity, confirmed by greater regularity in females. No significant differences were observed for other acoustic parameters. No significant interactions were revealed. According to the preliminary data, we hypothesized that respiratory capacity and control during vocal fold abduction weaken with aging. This highlights the importance of continuously monitoring the respiratory impact on swallowing function in elderly individuals. Additionally, gender influenced several acoustic parameters, indicating the necessity to differentiate between genders when assessing presbyphagia using acoustic parameters, especially focusing on swallowing function in elderly males in Ningbo.

Objectives: Modern Chinese folk singing is developed by fusing regionally specific traditional Chinese singing with Western scientific training techniques. The purpose of this research is to contribute to the exploration of the acoustic characteristics of Chinese folk songs and the efficient resonance space for the performance.

Method: Seven tenors and seven sopranos were invited to sing three songs and read the lyrics in an anechoic chamber. The vocal outputs were meticulously recorded and subjected to a comprehensive acoustic analysis. Overall equivalent sound level, long-term average spectrum (LTAS), gain factors, and other acoustic parameters were analyzed for different vocal efforts (soft, normal, and loud), genders, and vocal modes (singing and speaking).

Results: Male singers have singer's formant at 3 kHz in LTAS, a characteristic not found in other country singers or Chinese opera singers, but slightly higher than the frequency of Western Classical singers. Female singers do not have singer's formant and their LTAS curves are much flatter. The α, spectral balance, and singing power ratio all increased with increasing vocal effort, and they are higher for singing than for speaking. Finally, there is a significant gain factor at 3 kHz, with a maximum value of 1.85 for men and 1.68 for women.

Conclusions: Male singers in Chinese folk singing have a singer's formant, a phenomenon not consistently observed in their female singers. The intricate acoustic characteristics of this singing style have been extensively examined and can contribute to the existing literature on the spectral properties of diverse vocal genres. Furthermore, this analysis offers foundational data essential for the optimization of room acoustics tailored to vocal performance.

Objective: The objective of this study was to demonstrate the long-term oncologic efficacy of flexible endoscopic laryngeal surgery (FELS) in treating T1-T2 glottic carcinoma.

Methods: From 134 patients who underwent FELS, 90 patients (males-82, females-8), aged 18-83 (mean-56.9 ± 10.7) with early glottic carcinoma (T1a-27, T1b-24, and T2-39) were included in the study. Fifty-seven patients (63.3%) underwent FELS under local anesthesia with spontaneous ventilation, the rest of the patients were operated on under general anesthesia with superimposed high-frequency jet ventilation (SHFJV). Tumor ablation by Nd:YAG laser was performed in all the cases, preceded by diathermy snare excision in one-third of cases. In 20 of the T2 cases, adjuvant radiotherapy (RT) was performed.

Results: Five-year overall survival and ultimate disease control, including salvage treatment, was obtained in 82/90 patients (91.1%), cure with larynx preservation-in 88.9% of cases, disease-free survival-in 83.3% of cases, and ultimate local control with FELS alone-in 86.7% of cases. The best 5-year oncological results were obtained in the T1a group of treated patients, all the patients being alive and free of disease with the preserved larynx due to FELS alone. There was no evidence of better oncological results by FELS under general anesthesia with SHFJV over FELS under local anesthesia with spontaneous ventilation. Anterior commissure (AC) involvement worsened the treatment results. Adjuvant RT did not demonstrate an improvement of oncological results in the T2 group of patients.

Conclusions: FELS demonstrates oncological outcomes that are comparable to RT and transoral laser microsurgery and can be considered an oncologically efficient method of treatment of T1-T2 glottic carcinoma. Awake FELS is not inferior to FELS under general anesthesia with SHFJV concerning oncological efficacy. More studies on a bigger clinical material are necessary for definitive conclusions concerning the impact of AC affection and adjuvant RT on the oncological results.