Journal of Voice最新文献

Background: The Voice Disability Coping Questionnaire (VDCQ) is a valuable tool for assessing coping strategies in individuals with voice disorders. The scarcity of evidence on coping strategies for voice-related problems globally highlights the need to establish the validity and reliability of the VDCQ in specific populations and languages. Cross-cultural adaptation is necessary to ensure the tool's linguistic and cultural relevance for Tamil-speaking individuals with dysphonia.

Objectives: This study aimed to cross-culturally adapt the VDCQ into Tamil (VDCQ-T) and evaluate its validity and reliability for use in Tamil-speaking populations with voice disorders.

Method: The study followed a standardized process for translation and cultural adaptation, involving forward translation, expert panel review, back-translation, and pilot testing. Content validity was assessed by a panel of five speech-language pathologists, three Tamil language experts, and feedback from participants. The VDCQ-T was administered to 150 participants (75 with voice disorders and 75 controls). Principal component analysis (PCA) was performed to extract factors, and the questionnaire's reliability was evaluated using Cronbach's alpha and test-retest reliability with the intraclass correlation coefficient (ICC).

Results: PCA revealed four distinct factors: social support (factor I), passive coping (factor II), avoidance (factor III), and information seeking (factor IV). The questionnaire demonstrated high internal consistency with a Cronbach's alpha of 0.909, and test-retest reliability showed an ICC of 0.782. The VDCQ-T showed significant differences between the voice disorder group and the control group, confirming its construct validity. Although subgroup analysis for specific voice disorders was limited, the results suggest that the tool is broadly applicable to individuals with dysphonia.

Conclusions: VDCQ-T is a valid and reliable instrument for assessing coping strategies in Tamil-speaking individuals with voice disorders. The findings emphasize the importance of social support in managing dysphonia. Future studies should explore subgroup differences and include a more diverse sample to enhance generalizability.

Objective: To map the procedures used by Brazilian speech-language pathologists (SLPs) in vocal assessment and gender-affirming voice therapy of transgender women.

Methods: The survey included 52 SLPs, with a mean age of 39.50 years, who worked with voice in Brazilewing method, vowel-only reading, and who had treated transgender women in the previous 12 months. They were recruited through social media and answered a digital form via Google Forms, with questions about their professional profile, the care provided to transgender women, and the procedures and strategies used in vocal assessment and gender-affirming voice therapy. Data were collected between August 2022 and March 2023.

Results: Most SLPs were cisgender women specializing in voice, with a mean experience of 15.67 years. Transgender women seen by SLP were predominantly adults. Multidimensional vocal assessments are most common, but they do not necessarily include aerodynamic assessments. Gender-affirming voice therapy sessions were primarily individualized. The SLPs' most used therapeutic strategies were diaphagmatic-abdominal breathing, fricative sounds, tongue or lip trill, humming, resonance tube phonation in water-low resistance, chewing technique, jaw opening exercise, tongue mobility exercise, tongue rotation in the oral vestibule with humming, tongue snap with humming, yawn-sigh technique, auditory repetition, in-ear monitors, pitch and loudness modulation, overarticulation, chant speech, chewing method, vowel-only reading, guidance, awareness and proprioception, supportive approach, and vocal hygiene. There was good satisfaction among SLPs with the therapeutic strategies used in gender-affirming voice therapy, except for respiratory level, where satisfaction was average.

Conclusion: The most used assessment procedures, satisfaction, and therapeutic strategies are related to the main vocal characteristics that contribute to gender identification through the voice.

Voice is a critical tool for communication, and diagnosing voice disorders poses significant challenges, particularly when using high-speed video (HSV) endoscopy. The primary difficulty with HSV lies in the need for clinical experts to manually analyze and interpret large volumes of HSV frames. To address these challenges, kymography has been introduced as an effective clinical decision-support tool. In this study, a deep learning-based approach for classifying kymographic images is proposed to automate the analysis by training models to detect subtle and intricate variations in pathological vibratory patterns. We used high-speed recordings from the Benchmark for Automatic Glottis Segmentation (BAGLS) dataset to generate kymographic images, which were then used for binary and tertiary classifications employing deep learning models. We evaluated the performance of five widely used pretrained models: AlexNet, DenseNet121, Xception, Inceptionv3, and ResNet50v2. Our experimental results demonstrate that DenseNet121 can automatically classify voice disorders with higher accuracy and better performance across different model evaluation indicators, outperforming existing methods. With further research, the deep learning classifier has the potential to become a valuable diagnostic assistance tool for clinicians.

Objective: This study aimed to assess the prevalence and analyze characteristics and symptoms of non-infectious sore-throat in teachers.

Study design and methods: Adult persons employed as teachers were screened for non-infectious sore throat. A cross-sectional study was performed in patients with non-infectious sore throat confirmed based on clinical examination.

Results: Out of 1008 teachers who participated in the screening, non-infectious sore throat was found in 70 respondents (6.9%). Most of the participants with non-infectious sore throat were women with a mean age of 45.5 years and a mean length of service 18.1 years. A small number of participants (n = 7, 10%) often visited a medical doctor because of throat problems. Over 80% of participants commonly used throat therapeutic agents. The most common symptoms were dry throat, tickling, and scratching in the throat. The oropharyngeal mucosa in most subjects was slightly red to red, the tonsils were normal, and there was no oropharyngeal enanthema. The median subjective assessments using the visual analog scale from zero to ten were four (interquartile range (IQR) 0-5) for pain, four (IQR 1-5) for difficulty in swallowing, and two (IQR 0-4) for swelling of the pharynx back wall. Of the analyzed risk factors, the highest percentages of participants were using air conditioning and consuming chilled and carbonated drinks, 21.4% were smokers and 10% of participants had a confirmed respiratory allergy.

Conclusions: The prevalence of non-infectious sore throat was 6.9% with the most common symptoms being dry throat, tickling, and scratching in the throat. While a small percentage of participants often visited a medical doctor because of throat problems, the majority of them used throat therapeutic agents. Additional multicentric prospective studies are needed to increase our knowledge about symptoms and therapeutic strategies for non-infectious sore throat and voice disorders in general.

Aim: To review the epidemiology, presentation, and outcomes of benign laryngeal nerve sheath tumors treated at our center.

Methods: We retrospectively analyzed the demographic data (age and sex), clinical profile, imaging, management, and follow-up of histopathologically confirmed benign solitary nerve sheath tumors of the larynx from January 2016 to August 2023.

Results: There were a total of 10 cases, 80% were schwannomas, and 20% were neurofibromas, all being sporadic with none associated with neurofibromatosis or schwannomatosis. There was no gender predilection. Schwannomas were predominantly found in the 6th to 7th decade of life, mostly located in the supraglottis, and presented with dysphonia. Neurofibromas were primarily glottic and found in the 7th decade of life. All tumors were excised by microlaryngoscopy; 80% with cold steel and 20% with transoral laser surgery. Postoperative vocal cord palsy was seen in three of the schwannomas excised, of which two recovered fully. There was one recurrence in each tumor type, which was managed by repeat transoral microlaryngeal surgery with no further recurrences. No vocal or swallowing dysfunctions were reported post-excision (VHI-10 and EAT-10 scores).

Conclusion: Peripheral nerve sheath tumors are rare but important differentials for mucosa-covered lesions of the larynx. Schwannomas are predominantly supraglottic, while neurofibromas may involve the glottis; both present with dysphonia as the primary symptom. Surgical excision, preferably transoral microlaryngoscopic resection, is the treatment of choice with good success and minimal complications.

Objective: Investigating the effect of semi-occluded vocal tract training with a free-end tube on acoustic characteristics and glottal performance in dysphonic adults.

Study design: A systematic review.

Methods: This systematic review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was guided by the population, intervention, comparison, results and study design framework. Adults with dysphonia were included, while studies with psychiatric, cognitive, or cancer-related conditions were excluded. The intervention involved semi-occluded vocal tract training (SVOT) with a free-end straw, and outcomes included acoustic parameters (eg, jitter, shimmer, HNR, CPP, and F0) and contact quotient. A comprehensive search across multiple databases identified studies, and two independent reviewers screened and assessed them for inclusion. Bias was evaluated using the Cochrane RoB-2 tool, with results visualized via Robvis.

Results: This section outlines the inclusion of three studies with 127 participants from an initial pool of 5752 records. The studies varied in their methodologies, with one utilizing electroglottography evaluation and two employing acoustic assessments, while all reported different durations of vocal training. The Cochrane Risk of Bias-2 tool indicated a high risk of bias across the studies, primarily due to missing outcome data and randomization issues.

Conclusions: This systematic review highlights the beneficial effects of SVOT using a free-end tube in improving acoustic characteristics and glottal performance in dysphonic adults. The technique enhances vocal fold coordination, reduces tension, and promotes efficient phonation. Further research is recommended to explore its long-term effects and efficacy across various dysphonia subtypes.

Objectives: This study investigates how the production of three different phones ([a], [o], [r]), as well as breathing, coughing, and individual characteristics, influences respiratory particle emission.

Design: Experimental study.

Methods: Particle size distribution and sound pressure levels (SPL) were measured in 41 infection-free participants under controlled conditions. The measurement instruments, condensation particle counter (3775, TSI Inc.), and aerodynamic particle sizer (APS 3321, TSI Inc.), covered the size range of 0.004-10 µm. Exhaled flow rates were calculated from CO₂ concentrations measured with LI-840A NDIR gas analyzer (LI-COR Environmental).

Results: Production of [o] generated more particles than production of [a] across all size fractions. The alveolar trill [r] generated more small particles than did the vowels. SPL had a consistent positive effect on particle generation but did not fully explain the differences. Exhaled flow rates showed no statistical differences between the phones. Higher age was associated with elevated particle emission in breathing. Higher exhaled flow rate and higher body mass index (BMI) were associated with higher particle emission in coughing. No systematic connection between peak expiratory flow (PEF) or sex and particle emission was observed.

Conclusions: Understanding respiratory aerosol generation, in different situations and individuals, is critical for advancing knowledge of airborne transmission of diseases. Our findings corroborate prior evidence of an association between SPL and particle emission in voiced activities. Particle production also varies systematically across different phones, irrespective of SPL. The predominance of small particles in the phonation of [r] suggests the production of satellite particles from the tongue vibration. The higher particle generation in the phonation of [o] compared with [a] suggests the oral opening may contribute to the number of emitted particles. None of the individual characteristics-age, sex, BMI, or PEF-was a systematic predictor of particle production across all respiratory activities.

Objective: To validate the Trans Woman Voice Questionnaire (TWVQ) in Brazilian Portuguese for measuring vocal self-perception in transgender women.

Method: This is a quantitative, methodological study. The validation process included steps for assessing validity, reliability, and responsiveness. The sample had five voice specialists, 85 transgender women, and 40 cisgender women. The voice specialists evaluated the TWVQ items using the Content Validity Index (CVI). Target population participants completed the TWVQ three times: initially, after 2-14 days, and following a voice intervention from a speech-language-hearing pathologist.

Results: The overall CVI in the content validation phase was 0.89. For the Item CVI (I-CVI), 13 out of 30 items scored below the expected threshold (<0.8) and were revised by the authors. The full protocol was administered to 20 participants from the target population, and 14 items required adjustments. Following item revision, the protocol was readministered to the target population, and all items were deemed adequate. The second validation phase involved 65 transgender women, administering the instrument at three moments: initial application (test), reapplication after 7-14 days (retest), and a third application after the voice intervention (responsiveness). For the final TWVQ version, items 1 ("People have trouble hearing me when I speak in noisy places") and 26 ("People who don't know me find my voice unusual") were excluded due to low communality. Confirmatory Factor Analysis validated the three-factor, 28-item TWVQ-Br model: Factor 1 with 15 items (voice-gender congruence), Factor 2 with 11 items (voice production and impact), and Factor 3 with 2 items (vocal restriction). Reliability was found for the internal consistency of the TWVQ-Br and test-retest reliability. Responsiveness indicated a significant change in construct scores following the voice intervention, with lower TWVQ-Br scores postintervention. The TWVQ-Br distinguished transgender and cisgender women across all factors and total scores (P < 0.001 for all).

Conclusion: The TWVQ's validation in Brazilian Portuguese led to significant adjustments to enhance alignment with the experiences of Brazilian transgender women. Certain items that did not contribute to the instrument's objectives were removed, and three factors were extracted. The final instrument had high reliability in test-retest analysis, high sensitivity with score changes postintervention, and the capacity to differentiate between transgender and cisgender women based on protocol scores, indicating that it specifically meets transgender women's needs.

The conventional transoral microscopic approach for cricoarytenoid joint (CAJ) injections is well-established but requires general anesthesia and operating room facilities. Recent studies suggest that transcutaneous approaches might offer a more accessible alternative. This study compares the anatomical precision of two transcutaneous injection techniques: the cricothyroid membrane (CTM) and the thyrohyoid membrane (THM) approaches. To determine the most effective and precise method for transcutaneous access to the CAJ using CTM and THM approaches in cadaveric larynges. This anatomical study was conducted on 22 adult cadaver larynges (seven female, 15 male). Two injection approaches were tested: 1) the THM approach, with measurements of entry point distances, needle length, and angles, and 2) the CTM approach, similarly measured. The precision of needle placement was assessed by visual guidance and direct measurement. Statistical analysis was performed. THM Approach: The needle was inserted 1.92 ± 1.68 mm lateral to the midline and 11.6 ± 2.45 mm below the horizontal line, with a 25.1 ± 1.47 mm depth. The sagittal angle was 141° ± 1.82° (males) and 105° ± 12.4° (females), while the coronal angle was 17.2° ± 8.59° (males) and 16.5° ± 7.43° (females). Significant differences were found between genders in horizontal distance and sagittal angle (P < 0.05). CTM Approach: The needle was inserted 2.85 ± 1.1 mm lateral to the midline and advanced 28.34 ± 3.64 mm. The sagittal angle was 43.3° ± 11.1° (males) and 56.6° ± 12.9° (females), and the coronal angle was 138.9° ± 14.5° (males) and 147.1° ± 27.0° (females). This study enhances understanding of anatomical landmarks and technical considerations for CAJ injections. The THM and CTM approaches are effective and reliable, with potential implications for improving outpatient laryngeal interventions. Further research and clinical trials are necessary to validate these findings and optimize injection techniques.

Objectives: With increasing reliance on online platforms for health information, ensuring the accuracy, accessibility, and reliability of content is essential. To date, no studies have evaluated the quality of laryngoplasty content on YouTube. Assessing quality will (1) Reveal deficits in existing content to help providers facilitate patient education prior to laryngoplasty and (2) Provide a framework for institutions to produce better laryngoplasty content in the future.

Methods: A search of YouTube videos was performed using the keyword "laryngoplasty." The first three pages of results were filtered for videos from hospitals and universities under 20 minutes long. Transcripts were created based on YouTube's autogenerated transcripts that were edited by one author (N Weiss). Content was assessed with the DISCERN instrument, Flesch Readability Ease Score (FRES), and Flesch-Kincaid Grade Level (FKGL). Videos were grouped by DISCERN scores: good (DISCERN > 3), moderate (DISCERN = 3), and poor (DISCERN < 3). Engagement metrics were collected. Variables were summarized using mean and standard deviation.

Results: Eleven videos met inclusion criteria. Good videos (36.3%) scored 4.25 (0.5) on DISCERN, 10.97 (1.54) on FKGL, and 51.94 (7.37) on FRES. Engagement averaged 114.25 likes and 16 325 views. Duration averaged 3:05 minutes. Moderate videos (36.3%) scored 3 (0) on DISCERN, 7.61 (1.79) on FKGL, and 66.36 (5.29) on FRES. Engagement averaged 389 likes and 269 107 views. Duration averaged 1:44 minutes. Poor videos (27.2%) scored 1.33 (0.58) on DISCERN, 7.54 (0.64) on FKGL, and 69.11 (3.78) on FRES. Engagement averaged 294.3 likes and 59 621 views. Duration averaged 13:52 minutes.

Conclusion: Good videos exhibited high FKGL (10.97) and low FRES (51.94), indicating that they are difficult for patients to understand. Moderate/poor videos had higher engagement (269 107 and 59 621 views, respectively) than good videos (16 325 views), indicating that patients are more often watching lower-quality content. Disparities seen in these data underscore the importance of providing thorough patient education in preparation for laryngoplasty and reveal a need to develop higher-quality, accessible laryngoplasty education on YouTube.

Educational objectives: 1-Provide information for institutions to create accessible and reliable laryngoplasty videos 2-Evaluate the accuracy and quality of information available on YouTube 3-Facilitate patient cooperation and education for laryngoplasty procedure.