Journal of Voice最新文献

Objective: To develop a multiparametric index based on machine learning (ML) to predict and classify the overall degree of vocal deviation (GG).

Method: The sample consisted of 300 dysphonic and non-dysphonic participants of both sexes. Two speech tasks were sustained vowel [a] and connected speech (counting numbers from 1 to 10). Five speech-language pathologists performed the auditory-perceptual judgment (APJ) of the GG and the degrees of roughness (GR), breathiness (GB), instability (GI), and strain (GS). We extracted 47 acoustic measurements from these tasks. The APJ result and the acoustic measurements were used to develop the multiparametric index. We used mean absolute error, root mean square error, and coefficient of determination (R²) to select the best model of ML to predict GG and feature importance to select the best set of variables for the index. After classifying the GG between nondysphonic, mild, moderate, and severe, the final model was validated using accuracy, sensitivity, specificity, predictive values, likelihood ratios, F1-Score, and weighted kappa.

Results: The gradient boost model showed the best performance among the ML models. Eight features were selected in the model, including four acoustic measures (jitterLoc, smoothed cepstral peak prominenc, mean harmonic-to-noise ratio (HNRmean), and correlation) and four APJ measures (GR, GB, GS, and GI). The final model correctly classified 93.75% of participants and obtained a weighted kappa index of 0.9374, demonstrating the model's excellent performance.

Conclusion: The Integrated Vocal Deviation Index includes four acoustic measures and four auditory-perceptual measures and showed excellent performance in classifying voices according to GG.

Objective: To validate the Evaluation of the Ability to Sing Easily (EASE) scale for Brazilian Portuguese.

Methods: A total of 391 singers participated in the study-192 females and 198 males, with a mean age of 33 years. Validation was performed according to the criteria recommended by the COnsensus-based Standards for the selection of health Measurement INstruments, evaluating the following domains, properties, and measurement: reliability (reliability and internal consistency), construct validity (transcultural validity and structural validity), and criterion validity (concurrent criterion validity). Hence, participants responded to the EASE for Brazil (EASE-BR), the Voice Symptoms Scale (VoiSS), the list of signs and symptoms (LSS), and a vocal self-assessment. The EASE-BR was answered a second time 2-15 days after the first application.

Results: The Brazilian version of the EASE scale, called EASE-BR, was found to have adequate cross-cultural validity. In construct validity, the 22-item, three-factor model had its structure validated in confirmatory factor analysis with an standardized root mean square residual of 0.066; internal consistency with a high Cronbach's coefficient between 0.902 and 0.779; test-retest reliability with an ICC between 0.72 and 0.52; and concurrent criterion validity significantly correlated with the VoiSS, LSS, and vocal self-assessment (P < 0.05). The cutoff values that differentiated individuals with and without risk for voice changes were 10.5 points for the total, 4.5 for vocal fatigue, 5.5 for the vocal risk index, and 1.5 for vocal concern.

Conclusions: The EASE-BR proved to be a valid and reliable vocal self-assessment instrument in its structure with 22 items and three factors.

Objectives: The Evaluation of the Ability to Sing Easily (EASE) is used to assess the singer's perceptions of the current singing voice status. The purpose of this research was to culturally adapt the Turkish version of the EASE (EASE-TR) and investigate its validity and reliability.

Methods: According to the Professional Society for Health Economics and Outcomes Research recommendations, the original version of the EASE was translated and culturally adapted into Turkish. One hundred amateur or professional choir members completed the EASE-TR and the Vocal Tract Discomfort Scale (VTDS) before and after the singing performance. EASE-TR scores before and after performance were compared for construct validity. "Known Groups Validity" was used according to variables of singing experience, voice training status, and current voice complaints. As part of the criterion validity assessment, the correlation between the after-performance EASE-TR scores and the VTDS scores was evaluated. Cronbach's alpha was calculated for internal consistency. EASE-TR was applied twice to 35 participants to measure test-retest reliability.

Results: Statistically significant (P < 0.001) differences were found between the before and after performance scores in all subscales and the total score of the EASE-TR. A moderate positive correlation (r = 0.664) was observed between EASE-TR and VTDS. There was a significant difference in the EASE-TR scores between the group with vocal complaints and the group without complaints. The Cronbach alpha value of the EASE-TR was found to be 0.894. EASE-TR was found to have a good degree of test-retest reliability.

Conclusion: EASE-TR is a valid and reliable self-reported tool for singers to measure current singing voice function. Our findings indicate that EASE-TR is a sensitive tool that can measure the positive effect of voice training, experience, and vocal warm-up and even can detect voice complaints in participants who are not actively seeking treatment.

Clinical trial: ClinicalTrials.gov identifier NCT05999045.

Objectives: Patients with unilateral vocal fold paresis and unfavorable posterior cricoarytenoid (PCA) muscle synkinesis can be challenging to treat with medialization procedures alone. Arytenoid repositioning procedures are generally considered contraindicated in mobile vocal folds. We present two cases of persistent dysphonia following type I thyroplasty for vocal fold paresis that improved after botulinum toxin-A (BTX-A) injection into the PCA muscle. We aim to highlight the use and outcomes of BTX-A as an intervention for unfavorable PCA muscle synkinesis in unilateral vocal fold paresis.

Study design: Retrospective case series.

Methods: Two patients with long-standing unilateral left vocal fold hypomobility are described. Both patients underwent type 1 thyroplasty with partial improvement but with persistent posterior glottic insufficiency and dysphonia. BTX-A chemodenervation of the ipsilateral PCA muscle was performed to address residual respiratory glottal insufficiency. Injection was done percutaneously under electromyographic guidance with favorable voice improvement. Patient outcomes were based on laryngeal videostroboscopy, perceptual voice analysis, and patient-reported measures.

Results: Both patients achieved similar results following PCA muscle BTX-A injections. Their dysphonia was markedly improved within 2 weeks after injection, and their voice had nearly returned to nearly normal with adequate projection and endurance. Laryngeal videostroboscopy examinations showed an improved glottal closure pattern. Both patients experienced improvements in dysphonia.

Conclusion: BTX-A chemodenervation of the PCA muscle may be considered in the management of unilateral vocal fold paresis with residual posterior glottal insufficiency.

Although emesis is a relatively common event that bathes the larynx in low pH and irritative enzymes, prolonged laryngeal consequences of emesis are atypical. We present three cases of laryngeal injury of unusual severity and duration from periprocedural emesis and discuss predisposing factors, acute management, and mitigation of sequalae.

Background: Vocal fold leukoplakia (VFL) has a risk of malignant transformation, and the underlying mechanisms remain defined. It was assumed that laryngopharyngeal reflux (LPR) may contribute to the occurrence of VFL. Studies showed that sphingosine kinase 1 (Sphk1) was highly expressed in the gastroesophageal reflux-related gastrointestinal tumors. This study aimed to investigate the effects of Sphk1 on the transformation of VFL in LPR patients.

Materials and methods: Fifteen VFL patients with or without LPR were enrolled in this cohort study based on the results of pathology, reflux finding score (RFS)/reflux symptom index (RSI), and a Pepsin test. VFL lesion diagnosis from surgery or biopsy tissues was confirmed by clinical pathologists. The clinical characteristics of LPR and nonLPR groups were compared. Levels of Sphk1/sphingosine-1-phosphate (S1P)/sphingosine-1-phosphate receptor 1 (S1PR1), inflammatory markers, and cell-proliferative protein were measured using immunohistochemistry (IHC) and quantitative polymerase chain reactions (qPCR). Cell proliferation pathway-related proteins phosphorylated AKT (p-AKT) and phosphorylated ERK (p-ERK) were detected by western blot.

Results: There were no significant differences in age, sex, smoking, alcohol consumption, and the underlying diseases between patients with LPR and without LPR. RFS/RSI values of patients with LPR were significantly higher than those without LPR. SphK1 messenger RNA (mRNA) and protein expressions were increased with elevated levels of inflammatory-responsive biomarkers in the VFL tissues of patients with LPR. S1P and S1PR1 consecutively initiated the intracellular AKT and ERK signaling cascades, the latter of which is closely related to cell proliferation.

Conclusion: The proliferation of VFL patients with LPR was significantly higher than those without LPR. SphK1/S1P/S1PR1 signaling pathway molecules of VFL patients with LPR were dramatically elevated compared with patients without LPR. Sphk1 may promote malignant transformation of VFL in patients with LPR.

Objective: This study aims to identify sensitive respiratory, laryngeal, and self-perceptual measures for assessing vocal fatigue and to determine tasks that effectively elicit the experience of vocal fatigue.

Methods: A scoping review was conducted using Cochrane, Medscape, PubMed, and Google Scholar databases. A total of 17 studies met the inclusion criteria and were reviewed in full and summarized. The studies were analyzed to extract relevant data on respiratory, laryngeal, and self-perceptual measures used to assess vocal fatigue, as well as the tasks employed to elicit vocal fatigue.

Results: Of the 17 articles, 14 studies involved vocally healthy individuals, while three studies included participants with vocal fatigue. Phonation threshold pressure (PTP) was the most used and most consistent indirect respiratory measure in detecting vocal fatigue; however, only five studies included direct measurements of respiratory patterns and only two included ventilatory data. Laryngeal measures demonstrated inconsistent response to a vocal demand task, except mean fundamental frequency among vocally healthy participants, but not in those with complaints of vocal fatigue. Short-duration vowel tasks were found to be capable of eliciting vocal fatigue similar to prolonged reading tasks.

Conclusion: Phonation threshold pressure (PTP) consistently captured vocal fatigue and can serve as an indirect respiratory measure. Measures of respiratory patterning and ventilation require further study. Fundamental frequency shows potential as a laryngeal measure of vocal fatigue in vocally healthy individuals but requires further investigation in those with vocal fatigue. Short-duration tasks elicit vocal fatigue and need to be investigated in future study protocols. These findings highlight the need to develop systematic protocols for ongoing assessment and monitoring of vocal fatigue to enhance both clinical practice and research methodologies.

Introduction: The Vocal Fatigue Index (VFI) is a widely used self-report questionnaire that is reliable for research and clinical purposes. Several studies have adapted and validated the VFI versions in different languages using various approaches. This study evaluated the translation process, validity, and reliability of various VFI versions across different languages.

Method: This systematic review involved the authors searching the PubMed, Scopus, Web of Science, and Google Scholar databases to gather relevant data. The articles were extracted from English studies published between 2015 and 2024. After screening, the paper that met the study eligibility criteria was included. Two authors used the Critical Appraisal Skills Programme to evaluate the methodology of the papers. The review included versions of VFI that were adapted and validated for linguistic or cultural variations.

Results: The initial database contained 3294 search results. After removing duplicates, 1285 articles were analyzed. Nineteen studies were chosen following a review of their titles and abstracts. After eliminating five studies, 14 versions were selected for the final evaluation.

Discussion/conclusion: This review comprehensively understood the challenges encountered during cross-cultural adaptation and psychometric evaluation. Due to the advantageous characteristics of VFI, it has been rapidly translated into various languages since its publication. Research indicates that there was no preferred method for translation, as each study employed a distinct approach. The strong validation properties observed in various languages support the applicability of the translated versions of the VFI across diverse populations.

Objective: Creak is an acoustic feature found to discriminate speakers with adductor laryngeal dystonia (AdLD) from typical speakers with outstanding diagnostic accuracy. Yet creak is also used by typical speakers as a phrase-boundary marker. This study aims to compare the prevalence of creak across estimated breath groups in speakers with AdLD and controls to delineate physiological mechanisms underlying creak in AdLD.

Methods: Thirty-four speakers read aloud the first paragraph of the Rainbow Passage (17 diagnosed with AdLD and 17 with no history of voice complaints). "Breath-like" pauses were defined as any in which technicians audibly heard a pause and all pauses >500 ms. For each phoneme, the time preceding the next breath-like pause was calculated, and the probability of creak occurrence was calculated. A generalized linear mixed-effects model was performed to determine the relationship between creak and time preceding a breath-like pause.

Results: Inter-rater and intrarater reliability of technicians were excellent. There was a statistically greater probability of creak in the AdLD group compared to controls (22% vs. 5%) and a statistically greater probability of creak as speakers approached a breath-like pause in both groups. The interaction between the time preceding a breath-like pause and group was significant, with a stronger relationship between the time preceding a breath-like pause and creak for control speakers (P < 0.001).

Conclusions: Creak is more prevalent in speakers with AdLD and may not only be related to respiratory phrasing but possibly in response to or because of the hyperadduction of the vocal folds during a laryngeal spasm.

Lay summary: The probability of creak occurring was greater towards the end of estimated breath groups in speakers with and without AdLD; however, for speakers with AdLD, creak was more prominent across the entire breath group.

Level of evidence: 3:

Objectives: This study aimed to investigate the knowledge, attitude, and practice (KAP) of patients regarding vocal cord polyps.

Study design: Cross-sectional survey-based study.

Methods: A cross-sectional survey was conducted from November 2022 to May 2023 at Jinhua Central Hospital, involving 564 patients diagnosed with vocal cord polyps. The survey utilized a validated questionnaire to assess KAP. Structural equation modeling (SEM) was employed to examine the relationships among knowledge, attitudes, and practices, considering both direct and indirect effects.

Results: Among the 564 patients surveyed, 69.86% were female, and 40.25% were over 50 years of age. The mean scores for KAP were 7.05 ± 2.56, 20.04 ± 1.92, and 22.02 ± 4.61 out of 12, 30, and 30, respectively, indicating a need for improvement in all domains. SEM results demonstrated that a history of surgery negatively influenced attitudes and practices, while higher knowledge positively impacted both. Direct effects revealed that knowledge positively shaped attitudes and practices, and attitudes further improved practices.

Conclusions: The findings highlight gaps in patients' knowledge and suboptimal attitudes towards vocal cord polyps, underscoring the necessity for targeted education to enhance understanding, promote proactive health-seeking behaviors, and improve patient outcomes.