Journal of Voice最新文献

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.

Voice is a highly salient and complex signal that people use to categorize another's gender. For transmasculine individuals seeking to align their gender expression with their gender identity, vocal presentation is a major concern. Voice-gender incongruence, where one's voice does not match their gender identity, can lead to vocal strain, fatigue, emotional distress, and increased risk of suicidality. Testosterone therapy, which uses exogenous testosterone to masculinize or androgynize the voice and other secondary sexual characteristics in individuals assigned female at birth, is one method to address this issue. However, many individuals remain dissatisfied with their voice post therapy, indicating that hormonal voice modification is a complex process not fully understood. In the present study, we use unmodified voice samples from 30 transmasculine individuals undergoing testosterone therapy and utilized multivariate analysis to determine the relative and combined effects of four acoustic parameters on two measures of gender perception. The results show that transmasculine individuals' speech is perceived as equally "masculine" as that of cisgender males, with both groups being statistically categorized as male at similar rates. Although mean fundamental frequency and formant-estimated vocal tract length together account for a significant portion of the variance in gender perceptions, a substantial amount of variance in gender perception remains unexplained. Understanding the acoustic and sociolinguistic factors that contribute to masculine voice presentation can lead to more informed and individualized care for transmasculine individuals experiencing voice-gender incongruence and considering testosterone therapy. For this population, addressing voice-gender incongruence has important implications for life satisfaction, quality of life, and self-esteem.

Aim: This study aimed (i) to extract videostrobokymograms (VSK) and measure the objective metrics of vocal fold vibration from stroboscopic footage with unsteady laryngeal positions using a customized approach that utilized the Lucas-Kanade optical flow method-alongside other preprocessing methods and kymogram extraction techniques and (ii) to juxtapose the readings of Electroglottography (EGG) with the extracted VSK metrics.

Method: Sixty-three tokens of videostroboscopy and EGG were obtained from 21 phononormals. The videostroboscopic samples were then subjected to pre-processing for optimization. From the preprocessed samples, VSK were extracted at three lines of interest, ie, anterior, middle, and posterior region of the vocal folds, using a customized approach. Further, closed quotient was computed from the extracted VSK (VSK CQ) and contact quotient from the EGG waveform (EGG CQ). Wilcoxon signed-rank test and Bland-Altman plot analysis were performed to compare and determine the agreements between VSK and EGG values.

Results and discussion: VSK obtained in this study were visually similar to the VSK reported in the literature. Mean and SD of EGG CQ was (0.45 ± 0.01), and VSK CQ was (0.46 ± 0.02). The values of VSK CQ differed from the anterior to the posterior portion of the vocal folds, demonstrating variations in movement along its length. Wilcoxon signed-rank test revealed no statistically significant differences between the VSK and EGG measurements. Bland-Altman plot analysis used to compare the agreements between two measurements suggested that VSK values were in agreements with the EGG measurements.

Conclusion: The present work offers preliminary evidence that quantifiable objective measures can be calculated even from videostroboscopic footage with unsteady laryngeal positions by tailoring the VSK technique. However, assessing the clinical value of this approach is mandatory.

Objectives: This study aimed to evaluate the efficacy of injection laryngoplasty (IL) in improving voice quality in patients with unilateral vocal fold paralysis (UVFP), as measured by acoustic parameters.

Methods: A cohort of 177 patients with UVFP underwent preIL and postIL assessment using maximum phonation time (MPT), Acoustic Voice Quality Index (AVQI), and Acoustic Breathiness Index (ABI), in conjunction with auditory-perceptual (A-P) ratings and the Voice Handicap Index-10 (VHI-10).

Results: Significant improvements were observed across all acoustic and perceptual measures following IL. MPT, AVQI, and ABI, as analyzed using Praat, provided comprehensive quantification of voice recovery. All three measures showed high diagnostic accuracy, with area under the curve values of ≥ 0.73. Receiver-operating characteristic analysis identified effective cutoff values for MPT, AVQI, and ABI, confirming their predictive value for voice recovery.

Conclusion: The findings of this study support the integration of MPT, AVQI, and ABI in clinical practice for a more precise assessment of IL outcomes in patients with UVFP. Future research should involve larger sample sizes to investigate cause-specific recovery rates and the role of postIL voice therapy.

Objectives: To assess the prevalence, lifetime prevalence of voice disorders, and its association with psychosocial work factors and psychological distress among secondary school teachers.

Study design: Cross-sectional study.

Methods: Secondary data from the CLUSTer study were analyzed, which included sociodemographics, psychosocial work factors (Job Content Questionnaire-22), psychological distress (Depression Anxiety and Stress Scale-21), and outcome measure of voice (Voice Handicap Index-10).

Results: A total of 1216 teachers were included in this study. Majority of them were females (81.0%), of Malays ethnicity (63.9%), and were married (83.3%). Almost one-third of the participants experienced high occupational stress. Less than one-third of them were having depression (27.9%) and stress (21.8%). More than half had anxiety (53.9%). The prevalence of voice disorders was 11.2% [95% confidence interval (CI): 8.9, 14.1], and the lifetime prevalence of voice disorders was 52.4% (95% CI: 48.8, 56.0). Participants with depression (aOR = 2.50, 95% CI: 1.48, 4.22), anxiety (aOR = 2.08, 95% CI: 1.05, 4.13), and stress (aOR = 1.94, 95% CI: 1.11, 3.40) were associated with voice disorders. Psychosocial work factors such as occupational stress, supervisor support, and coworker support were not associated with voice disorders.

Conclusion: Psychological distress is associated with the prevalence of voice disorders among secondary school teachers. These findings can be utilized in developing, designing, and implementing interventions or programs to reduce voice disorders for school teachers.