Journal of Voice最新文献

Background: Studies on treatment efficacy in unilateral vocal fold paralysis (UVFP) often lack a predetermined treatment protocol, and little is known about the effects of specific vocal techniques on vocal outcomes and quality of life in UVFP patients. The purpose of this preliminary proof-of-concept study is to investigate the effects and feasibility of two intensive treatment protocols based on water-resistance therapy (WRT) and vocal function exercises (VFE).

Methods: Ten participants with acute or chronic UVFP/paresis were recruited in the study and randomly assigned to the WRT or VFE group. Three of these participants presented with aphonia and could not complete the program as prescribed. The remaining participants completed an intensive therapy program with the assigned vocal technique. Before, during, and after the program, a multidimensional voice assessment was performed. Maximum phonation time, acoustic, perceptual, and patient-reported outcome measures (PROMs) were obtained.

Results: WRT and VFE had positive clinical effects on instrumental and auditory-perceptual voice quality, glottal closure, and PROMs, but interindividual variability was high. Studies with larger sample sizes are necessary to confirm or refute these findings.

Conclusion: The WRT- and VFE-based therapy programs are both feasible and seem to elicit positive clinical changes in UVFP patients. Suggestions on how to improve the programs are provided, as well as considerations for implementation in clinical practice. Follow-up research is needed to examine the efficacy of both programs on group level.

Background: Previous research has examined the correlation between certain personality traits and specific voice disorders. These studies indicated that a predictive relationship exists between an individual's personality and their likelihood of experiencing certain types of voice disorders. The personality type classified as "extravert" was most commonly correlated with voice problems associated with high vocal use such as inflammation or nodules.

Aim: The purpose of this study was to determine if a relationship exists between self-reported vocal fatigue, demographic characteristics, such as assigned sex at birth and age, perception of current voice condition, aerodynamic measures, and voice acoustic parameters with any of the five personality traits measured by the Big Five Personality Index: Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness. We hypothesized that vocal fatigue scores and spirometry measurements may be good predictors of specific personality traits, and therefore, can be useful measures to complement vocal assessment.

Methods: Participants in this cross-sectional correlational study included 73 full-time elementary and middle school teachers. Participants completed the Vocal Fatigue Index (VFI) and the Big Five Inventory (BFI)-10 personality index; further, microphone recordings were collected from a battery of voice tasks in addition to spirometry. Descriptive analyzes of the dependent variables (BFI personality traits) and independent variables (demographics, acoustics, spirometry, and VFI total score) were performed, calculating frequency values. Kruskal-Wallis tests were conducted to evaluate independent variables' differences across the scores of the five BFI personality traits. The association between the independent and dependent variables was then investigated using a Generalized Estimating Equations multinomial logit model. The level of significance was defined at 0.05, and the associations are expressed as betas and standard error.

Results and conclusion: The results suggest that high scores for the traits of extraversion and agreeableness were both predicted by lower scores on the VFI (P ≤ 0.05), indicating that individuals with lower perception of vocal fatigue may be more likely to be identified as extraverted and/or agreeable personalities. These results support previous study's conclusion as well as add additional insights that could be translated into screening protocols and additional supportive care of occupational voice users.

Speech features have been investigated as novel digital biomarkers for many psychiatric and neurocognitive diseases. Microphones are the most used devices for speech recording but inevitably suffering from several disadvantages such as privacy leakage and environmental noises, limiting their clinical applications particularly for long-term ambulatory monitoring. The aim of the present study is therefore to explore the feasibility of extracting speech features from the acceleration recorded on the sternum. Ten healthy subjects volunteered in our study. Two speech tasks, that is, repeating one sentence 20 times and reading 20 different sentences, were performed by each subject, with each task repeated eight times under different speech rate and loudness. Voice signals and speech-caused chest vibrations were simultaneously recorded by a microphone and an accelerometer placed on the sternum. Forty-two acoustic features and six time-related prosodic features were extracted from both signals using a standard toolbox, and then compared by a linear fit and correlation analysis. Good agreement between the acceleration features and microphone features is observed in all six time-related prosodic features for both tasks, but only in 19 and 17 acoustic features for task 1 and 2, respectively, with most of them loudness- or pitch-related. Our results suggest the sternum acceleration to track time-related speech prosody, loudness, and pitch very well, demonstrating the feasibility of deriving digital biomarkers from the acceleration signal for diseases strongly related to time-related prosodic and loudness features.

Objectives: The aim of this study was to validate the Acoustic Voice Quality Index (AVQI) version 3.01 in the Turkish-speaking population.

Materials and methods: Concatenated voice samples of the sustained vowel [a:] and continuous speech were collected from 127 dysphonic and 128 normophonic participants. The auditory-perceptual evaluation was performed by five experienced raters using the Grade parameter of the Grade, Roughness, Breathiness, Asthenia, Strain scale. Rater reliability, concurrent validity, diagnostic accuracy, and differences between normophonic and dysphonic groups were analyzed for the AVQI version 3.01.

Results: The number of syllables for the standardized reading text with the concatenation of the voiced parts lasting around 3 seconds (mean = 3.84 seconds) was 36. The intraclass correlation coefficient (ICC) values of intra-rater reliability of G scores of five raters were excellent (mean ICC = 0.934), and of inter-rater reliability, they varied between moderate and excellent (mean ICC = 0.786). AVQIv3 demonstrated a high diagnostic accuracy with area under receiver-operating characteristic curve = 0.906 in identifying disrupted versus normal voice quality. With sensitivity of 80% and specificity of 94%, AVQIv3 = 2.345 was the cutoff point that differentiated most accurately between normophonic and dysphonic voices in Turkish.

Conclusion: AVQIv3 is an ecologically valid tool for objective differentiation between dysphonic and normal voices in the Turkish language.

Objectives: This study aims to examine the association between voice experience and levels of depression, anxiety, and stage of gender affirmation in transgender women.

Study design: A cross-sectional study.

Methods: Adult transgender women attending a tertiary referral center were recruited between April 2022 and January 2023. They filled in a demographic and health survey, the Hebrew Trans Woman Voice Questionnaire (H-TWVQ), the Hebrew Patient Health Questionnaire, and the Hebrew version of the Generalized Anxiety Disorder Screener. Descriptive statistics and data regarding the associations between voice experience, grades of anxiety and depression, and stage of gender affirmation were compiled.

Results: Sixty-seven transgender women were included (mean age 26.7 ± 7.78 years, mean time of presenting socially as a woman 5.2 ± 5.2 years). The median H-TWVQ score was 71 (maximal score 120). Most participants reported mild anxiety and mild depression levels. Those who reported a more positive voice experience (H-TWVQ score ≤71) had lower median depression and anxiety scores than participants with a less-positive voice experience (H-TWVQ score >71) (P = 0.028 vs P = 0.044, respectively), complained less of hoarseness (2.9% vs 19.4%, P = 0.045,) and more were employed (78.8% vs 41.9%, P = 0.003). No association was found between voice experience and cross-sex hormone treatment, affirmation surgery undertaken, or number of years presenting socially as a woman.

Conclusions: We observed a potential association between better voice experience and lower anxiety and depression levels among transgender women. No association was found between voice experience and the stage of gender affirmation. Physicians treating this population should be aware of these associations and consider therapeutic means for voice adjustment.

Background: Teachers rely heavily on their voices, making them susceptible to voice disorders affecting their teaching efficacy and well-being. This study explores the role of voice as a working tool for teachers and its impact on their professional lives, a necessary step in designing intervention points.

Methods: Using a phenomenological approach, we conducted qualitative interviews with 18 teachers (13 females, 5 males) from diverse backgrounds. They represented diverse teaching areas, grade levels, and school districts. Data were analyzed through content analysis. In this process, 52 codes were identified, totaling 753 code references.

Findings: This study uncovered insights into the role of voice as a working tool for teachers and its impact on their professional lives. In-depth analysis of the interviews with 18 teachers resulted in 6 key themes: (1) Voice is a crucial occupational tool for teachers for instruction, engagement, and classroom management; (2) working conditions significantly impact teachers' vocal health, with environmental factors and vocal load contributing to voice problems; (3) vocal health concerns are frequently reported by teachers, emphasizing the need for comprehensive health management strategies; (4) there are notable best practices and gaps in vocal care, with teachers expressing the need for more resources and formal training; (5) amplification devices play a significant role in sustaining teachers' vocal health, although access to and use of these tools is inconsistent; and (6) voice-related problems have a significant emotional and psychosocial impact on teachers, affecting their self-perception, professional identity, and well-being.

Discussion: This study highlights the critical role of vocal health in teachers' professional lives, revealing its impact on teaching efficacy, well-being, and professional identity. The findings highlight the need for comprehensive support systems, including vocal health programs, resources like amplification devices, and counseling for emotional impacts. The six identified themes emphasize the necessity of holistic interventions to enhance teachers' well-being and effectiveness.

Objectives: Comparative histoanatomy regarding the evolution of epiglottis and preepiglottic space (PES) of primate larynx as the supralaryngeal vocal tract (SVT) is acquired was investigated.

Methods: Two lemur, one galago, two macaque, two gorilla, and two chimpanzee normal larynges were investigated and compared with human larynges using the whole-organ serial section technique.

Results: Nonhuman primates with the limited pharyngeal space of SVT (lemurs, galago, and macaques, phyletic distant relative of humans) did not have PES. Their epiglottis was composed of cartilage that is not very flexible. Nonhuman primates with the lengthened pharyngeal space of SVT (gorillas and chimpanzees, hominids, phyletic close relative of humans) had PES. Furthermore, the PES of chimpanzees (phyletic closest relative of humans) existed astride the epiglottis similar to the human PES. The hominid epiglottises were composed of elastic cartilage, which is flexible, and play the role of retroflection. These histoanatomical structures of the epiglottis and PES reflect the fact that those features evolved as the pharyngeal space of SVT was lengthened.

Conclusions: The results of this study are consistent with the hypothesis that, in the process of evolution, the histoanatomical structures of epiglottis and PES changed and allowed the larynx to descend and the pharyngeal space of the SVT to be lengthened. This may facilitate speech production in humans. Moreover, the distribution of the human PES allows the epiglottis to more effectively play the role of retroflection during swallowing in order to prevent aspiration, which may have been derived from primate swallowing physiology.

Objective: This study aims to validate, cross-culturally, and linguistically adapt the Vocal Fatigue Index (VFI) into Arabic.

Study design: Cross-sectional study.

Methods: The VFI was translated into Arabic, reverse translated, and content validated. To assess its psychometric properties, 398 patients with voice disorders (199 males, 199 females, mean age=46.2 ± 15.0years) and 121 vocally healthy controls (57 males, 64 females, mean age=42.1 ± 6.9years) completed the VFI-Arabic. We calculated internal consistency and test-retest reliability using Cronbach's alpha and intraclass correlation (ICC) coefficients. Independent sample t tests determined mean factor score differences between groups, while receiver operator characteristic curves analyzed sensitivity, specificity, and cut-off scores for the three factors.

Results: The overall Cronbach's alpha was 0.95, across all factors combined, it was 0.68; and for factors 1, 2, and 3, it was 0.95, 0.91, and 0.91, respectively. Test-retest reliability for the subscales was excellent (ICC: 0.97, 0.91, 0.82 for factors 1, 2, and 3). Mean subscale scores were significantly higher in the voice-disordered group than in controls. The area under the curve for factors 1, 2, and 3 was 0.824, 0.759, and 0.646, respectively. Best cut-off scores were ≥14.5 (69.8% sensitivity, 83.1% specificity) for factor 1, ≥3.5 (66.3% sensitivity, 74.4% specificity) for factor 2, and ≥5.5 (60.1% sensitivity, 64.5% specificity) for factor 3.

Conclusion: The VFI-Arabic is a valid and reliable tool for identifying and quantifying vocal fatigue symptoms in Arabic speakers.

Objective: To evaluate the inter-rater reliability and internal consistency of the Reflux Sign Assessment-10 (RSA-10) among otolaryngologists and speech therapists with various experiences.

Methods: Six experts (2 otolaryngologists, 2 speech-therapists, and 2 speech-therapist students) rated 300 clinical images of oral, laryngeal, and pharyngeal signs from patients with laryngopharyngeal reflux disease diagnosis at the 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring. Inter-rater reliability and internal consistency were evaluated with Intraclass Correlation (ICC) and Cronbach-α. The severity of scores was compared between judges. The intra-rater (test-retest) reliability was evaluated with the Spearman correlation coefficient.

Results: The pictures of 40 patients were included. There were 18 females and 22 males. The mean age was 52.6 ± 13.9 years. The Cronbach-α was 0.854, which indicates a high internal consistency between judges. The overall ICC was 0.787 (95% CI: 0.715-0.845; P = 0.001). The ICC varied among judges with the highest value for students (ICC = 0.960) and SLP seniors versus students (ICC = 0.805). The severity of RSA-10 rating scores was influenced by the number of reflux patients seen (r_s =-0.941; P = 0.001) and the number of fiberscope examinations performed (r_s =-0.812; P = 0.049). The RSA-10 was more severely scored by speech therapists with the least experience compared to otolaryngologists with the most experience in fiberscope/reflux patient assessment.

Conclusion: The RSA-10 demonstrated adequate global ICC and internal consistency among otolaryngologists and speech therapists with various degrees of experience. The assessment of RSA was influenced by the fibroscopy experience, and the number of reflux patients seen.

Purpose: Health content has been presented and accessed freely on social networks and can generate misinformation; hence, this study aimed to analyze the voice guidance in videos available on YouTube.

Method: This observational cross-sectional research selected the 45 most-viewed videos on YouTube in 2022, produced by professional voice users with guidance on vocal hygiene and well-being. The content was described and compared with the scientific literature on the topic, analyzing which category of professional voice users produced the most scientifically based content.

Results: Altogether, 38 topics were found in the videos, distributed in nine blocks, identified from A to I. Block A (foods with a positive effect on the voice) was the only one that had no citations in scientific articles, whereas block D (negative habits for the voice) had the highest mean number of articles in relation to the others. The most publicized guidelines were mainly related to actions and/or behaviors and resources considered positive for the voice. Eight professional categories were found who produced these videos. Singing teachers who also worked as singers produced the most scientifically based content.

Conclusion: The study showed that not all the information in the videos was scientifically based, which means that people with voice problems have easy access to information that could even harm them if used in their professions.