Journal of Voice最新文献

Background/objectives: The coronavirus disease (COVID-19) pandemic has significantly impacted global health, with Malaysia reporting over 5 million cases as of May 2024. While symptoms like fatigue and breathlessness are commonly reported among COVID-19 patients, limited research exists on the vocal and pulmonary conditions of individuals with long COVID symptoms. This study aims to assess vocal impairments and pulmonary function differences between long COVID patients and healthy controls, addressing gaps in understanding how long COVID affects vocal and respiratory health. Additionally, it seeks to identify gender-specific differences to inform targeted rehabilitation programs.

Methods: The study included 140 participants, divided into two groups: an experimental group (long COVID patients) and a control group (healthy individuals). Participants completed questionnaires and underwent acoustic voice and pulmonary/lung function measurements in a controlled environment at Universiti Putra Malaysia (UPM). Vocal parameters measured were F0, F0SD, jitter, shimmer, harmonic-to-noise ratio, cepstral peak prominence (CPP), H1-H2, maximum phonation time (MPT), and number of voice break (NVB), while pulmonary function was assessed using forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and the FEV1/FVC ratio.

Results: Significant differences were found between the long COVID and control groups in several vocal acoustic parameters (F0, jitter, shimmer, CPP, MPT, and H1-H2) and pulmonary function measures (FEV1, FEV1/FVC ratio). Gender-specific differences included males showing significant differences in shimmer, CPP, H1-H2, MPT, and FVC (combined obstructive and restrictive conditions), while females showed differences in F0, jitter, shimmer, and H1-H2. Both genders exhibited obstructive lung conditions.

Conclusion: The study investigated vocal and pulmonary function impairments in individuals experiencing long COVID symptoms compared with healthy controls. Significant differences in vocal acoustic and pulmonary parameters were observed between the two groups. This study identified changes in vocal acoustic and pulmonary parameters associated with long COVID, highlighting the need for targeted rehabilitation programs to support recovery in affected patients, providing insights into potential rehabilitation programs for long COVID patients.

Purpose: Parkinson disease (PD) is a progressive neurodegenerative disease. The aim of this study is to investigate the association between acoustic and cortical brain features in Parkinson's disease patients.

Methods: We recruited 19 (eight females, 11 males) Parkinson's disease patients and 19 (eight females, 11 males) healthy subjects to participate in the experiment. Speech samples of three vowels (/i/, /a/, /u/), six plosives (/p/, /pʰ/, /t/, /tʰ/, /k/, /kʰ/), and three voiced consonants (/l/, /m/, /n/) were collected for the experiment, and the acoustic parameters were extracted for fundamental frequency (F0), voice onset time (VOT), voicing onset-vocalic voicing onset (VO-VVO), first formant (F1), second formant (F2), third formant (F3), first bandwidth (B1), second bandwidth (B2), third bandwidth (B3), Jitter, Shimmer, and Harmonics-to-noise ratio (HNR). We also used Ingenia CX 3.0 T to complete the cranial magnetic resonance scanning and did image processing based on the Desikan-Killiany-Tourville Atlas. We assessed the differences in acoustic and neuroimaging parameters between the PD and healthy controls (HCs) groups using the Levene's test (LT), two-sample independent t test (TT), and Mann-Whitney U test (MWUT), and calculated Spearman's bias correlations for acoustic and neuroimaging parameters in the PD and HC groups, respectively.

Results: The results showed that in acoustic features, based on the results of the TT, it can be seen that the F3 of the PD group regarding the vowel /i/ is significantly smaller than that of the HC group. The jitter on the vowel /u/ was significantly higher in the male PD group than in the male HC group. For other acoustic measures, there were no statistically significant differences between the two groups. In the cortical features, the thickness, area, and volume of the cortex were reduced in the vast majority of the brains of the PD patients, however, there is also a small portion of the cortex that appears to be thickened. In the correlation analysis between cortical and acoustic features, F0, F1, F2, F3, B2, B3, VO-VVO, Jitter, HNR, and VOT acoustic parameters showed significant and strong correlation with thickness, area, and volume of cortical sites such as frontal, temporal, entorhinal, fusiform, and precuneus in PD patients, whereas no significant correlation was found in HC group.

Conclusions: This suggests that Parkinson's disease does have an effect on the acoustic and cortical features of the patient's brain, and that there is a correlation between the two features.

Objectives: This study aims to validate and assess the reliability of the Arabic version of the Voice Handicap Index-Throat (VHI-T_A), as a self-reported questionnaire for patients with throat difficulties.

Study design: A prospective, observational, cross-sectional, and descriptive study was performed in the ear, nose, and throat department of Kafr El-Sheikh University hospitals from October 2023 to July 2024.

Methods: The preliminary VHI-T_A was obtained through forward and backward translation. All participants were asked to fill out the Arabic version of VHI-T twice, 2 weeks apart, to test reliability. We tested the Arabic version for internal consistency, reliability, validity, sensitivity, and specificity to produce an Arabic-validated patient questionnaire. The questionnaire's internal consistency was assessed using Cronbach's alpha coefficient. Cronbach's alpha coefficient was calculated for each of the 10 items and for the total score to assess the reliability.

Results: Cronbach's alpha coefficient ranged from 0.961 to 0.986 for the 10 items (acceptable to excellent internal consistency) and 0.997 for total score (excellent internal consistency). The corrected item-total correlation values varied between 0.951 and 0.978. There was a significant difference between all domains and the total score of the VHI-T_A tool (significantly higher among case group).

Conclusion: Our results showed that the VHI-T_A is a trustworthy and valid questionnaire for estimating self-perceived throat issues. In clinical practice, the VHI-T_A is anticipated to identify a group of throat discomforts that are prevalent in our patients and that are only tangentially addressed by other instruments.

Objectives: To analyze the prevalence of pediatric voice disorders.

Study design: Systematic review (SR) and meta-analysis.

Methods: The research question of this SR was "What is the prevalence of dysphonia in children?" An electronic search was performed using the Medical Literature Analysis and Retrieval System online (Medline), Literatura Latino-Americana e do Caribe em Ciências da Saúde, EMBASE, Web of Science, and SCOPUS database. A manual search was performed in gray literature (ProQuest and Banco Digital de Teses e Dissertações) and through the mapping of references. Studies that analyzed the prevalence of dysphonia in children with outcomes such as the overall degree of vocal deviation, laryngeal endoscopic imaging, acoustic analysis, and vocal self-assessments in the global context were included. The risk of bias was verified using a checklist of prevalence studies. A meta-analysis was performed using proportion analysis, and statistical heterogeneity was calculated using I² and t².

Results: The initial search identified 796 articles, and 16 were selected. The risk of bias analysis showed that 62.5% (n = 10) of the articles had low methodological quality. The total prevalence of dysphonia was 15% based on the overall degree of vocal deviation, 29% based on laryngeal endoscopic imaging, 10% based on vocal self-assessment, and 19% regardless of the type of assessment performed. High heterogeneity was observed for all evaluation forms.

Conclusion: Children have a high prevalence of dysphonia. Studies on the prevalence of pediatric voice disorders have low methodological quality, and the prevalence rates obtained in these studies are heterogeneous, thus compromising the validity and generalization of the results.

Objective: The purpose of this study is to examine the effects of a short-term (30 minutes) vocal loading task (VLT) on the objective and subjective parameters of voice and determine the restorative strategies of three different vocal exercises performed after the VLT.

Methods: The sample of the study included 30 normophonic women. The protocols that were applied in the study were carried out on three consecutive days. In each protocol, right after the VLT based on 30 minutes of phonation at 80-85 dBA_30 cm, a randomly selected strategy from among the three different therapeutic strategies was performed for 10 minutes. The therapeutic strategies consisted of the water resistance therapy (tube submerged depth 3-cm) (WRT protocol), the voiced oral high-frequency oscillation (VOHFO) technique performed using the Acapella Duet (Smith Medical, USA) (VOHFO protocol), and the semi-occluded nasal tract exercise (SONTE) (SONTE protocol). The analyses were conducted based on acoustic, electroglottographic, and perceived vocal exertion (Borg CR-100) measurements made at different time points.

Results: After the VLT, increased fundamental frequency (F_o) and cepstral peak prominence (CPP) values, and decreased electroglottography (EGG)-contact quotient (CQ) and nasalance score values were observed. In comparison to the values measured before the performance of the exercises, during all three exercises, EGG-CQ values decreased, and EGG-average (Avg.) jitter values increased. Among the three included exercises, the lowest Borg CR-100 scores were obtained after the SONTE protocol. Only the EGG-CQ values obtained after the SONTE and VOHFO protocols were lower than those obtained after the VLT.

Conclusions: The short-term (30 minutes) VLT (80-85 dBA_30 cm) performed in this study led to differences in the subjective and objective parameters that were measured, and it was considered to be an effective VLT. All three exercises that were used immediately after the VLT as restoration strategies were observed to be effective in reducing perceptual vocal effort scores, and similar vocal fold movement patterns were observed during the exercises according to the EGG results. According to the increased acoustic-CPP and reduced EGG-CQ and EGG-Avg. jitter parameter values after the exercises, the SONTE and VOHFO protocols were more successful than the WRT protocol in stabilising the negative effects of vocal loading.

Objective: To compare the vocal symptomatology of professors from a federal university who engaged in distance, hybrid, and face-to-face teaching during and after the Coronavirus Disease 2019 (COVID-19) pandemic period.

Method: The study included 40 university professors, 20 men and 20 women, whose symptomatology was monitored at three time points: during the distance teaching period due to social isolation caused by COVID-19, in hybrid teaching (partial return), and upon returning to face-to-face teaching, which required the use of face masks and posed contamination risks.

Results: The hybrid phase presented the highest absence of vocal complaints/discomfort, and most participants did not need to be reassigned due to vocal problems. Although the hybrid phase showed the highest number of responses with no vocal complaints, the transition back to face-to-face teaching revealed a significant increase in vocal issues, possibly due to prolonged mask usage and the ongoing risk of COVID-19.

Conclusion: The perception of vocal problems was higher during the return to face-to-face teaching. The main symptoms reported during this phase were shoulder pain and tension, hoarseness, burning sensation, and voice failures.

Objective: The care of patients with dysphonia will change due to the growing shortage of specialists, demographic change, and digitalization. To counteract the associated problems in patient care, the LAOLA app demonstrator is to be developed. In the future, patients will receive exercise videos for their training from their treating speech and language pathologist (SLP) via LAOLA. During the training, they will receive real-time biofeedback on visual (eg, posture) and auditory (eg, volume) criteria using machine learning. This study aimed to analyze the needs and requirements of SLPs and patients with dysphonia for an innovative mobile health application. It was determined how LAOLA can motivate regular training and what other functions are desired.

Materials and methods: An online survey (19 SLPs), a guideline-based focus group (10 SLPs), a reflection session (five SLPs), and individual interviews with six patients with dysphonia took place, which were evaluated according to the qualitative content analysis according to Kuckartz and Rädiker, which structured the content.

Results: Of the seven main categories and (up to seven each) subcategories, the main category "LAOLA components regarding the training part" was the most revealing. The results were presented using the Technology Acceptance Model 2. From the user's point of view, LAOLA is innovative as a digital assistance system and would be used in everyday life. Maintaining motivation is just as important as avoiding control and pressure to perform. It is also important that LAOLA is not intended to replace treatment, but to complement it. Various specific functions, for example, an overview of services, were requested. The results are an important basis for the user-oriented development of the app.

Conclusion: Digitization creates new treatment options and enables individual patients to control their health more closely. LAOLA is intended to allow better monitoring of dysphonia and cost reduction in the healthcare sector, with data protection having a high priority. Since the smartphone is usually always present, voice training can be reminded at any time.

Objectives: Suspension laryngoscopy can trigger vagal reflexes, leading to a decrease in heart rate, a phenomenon that is more common in patients with a high body mass index (BMI). This study aims to systematically evaluate the effect of BMI on heart rate during suspension laryngoscopy (SL-HR) in patients with laryngeal lesions.

Methods: We employed univariate generalized linear regression and stratified analyses to assess the relationship between BMI and changes in SLHR, adjusting for confounders such as age, gender, intubation type, and depth. A generalized additive model with spline smoothing was utilized to evaluate the BMI-HR relationship, with piecewise linear regression to identify specific cutoff points.

Results: We conducted a prospective study of 205 patients who underwent general anesthesia for suspension laryngoscopy. Multivariate linear regression analysis indicated that, after adjusting for covariates, each one-unit increase in BMI was associated with a decrease of 1.04 beats per minute in SL-HR (β = -1.04 [95% CI, -1.85 to -0.23]). Curve fitting revealed a gradual decline in SL-HR with increasing BMI, plateauing at around 60 beats per minute. The decrease in SL-HR became more pronounced as BMI approached 30 kg/m², with further analysis revealing an inflection point at a BMI of 28.8 kg/m², where each additional unit of BMI correlated with a 6.5 beats per minute decrease in heart rate (β = -6.5 [95% CI, -10.1 to -2.8], P < 0.001).

Conclusions: Patients with high BMI are more prone to vagal reflexes during suspension laryngoscopy, resulting in significant reductions in heart rate, especially when BMI exceeds 28.8 kg/m². Therefore, close monitoring of heart rate changes is crucial in this patient demographic, along with considering prophylactic anticholinergic agents to mitigate vagal reflex effects.

Objectives/hypothesis: Given the complex pathology underlying unilateral vocal fold paralysis (UVFP), there has been limited systematic exploration of curative treatments in humans. Central to the investigation of experimental therapies includes establishing a reliable and analogous large animal model. The study goal was to create a standardized porcine model of UVFP by establishing characteristic pathophysiology and functional outcomes.

Methods: Four female Yucatan minipigs underwent transection of the right recurrent laryngeal nerve (R-RLN). Measurements of acoustic vocalization data, bilateral nerve conduction studies, and laryngeal adductor pressure (LAP) were obtained prior to transection (baseline) and 7weeks after transection. Laryngeal adductor muscle complex volume was analyzed via 3D ultrasound. Histological analysis with myofiber diameter measurement of bilateral thyroarytenoid muscles was conducted at study conclusion.

Results: Stimulation of the R-RLN 7weeks after transection demonstrated reduction of motor unit action potentials. In addition, there was a statistically significant reduction in LAP compared to preinjury when stimulating the R-RLN. Voice analysis notably revealed decreased intensity and frequency ranges at 7weeks postinjury, and statistically lower average intensity and frequency of glottic phonations. Denervated right-sided laryngeal muscle volume was statistically lower compared to noninjured side. Morphological changes consistent with denervation, including smaller myofibril diameters and decreased nerve-to-muscle contact, were observed in right thyroarytenoid muscle and associated neuromuscular junctions.

Conclusions: Given that our porcine model yielded histopathological and functional changes consistent with human UVFP, it has potential to serve as a viable model for systematic and controlled studies of potential treatments for UVFP.

Level of evidence: NA.

Objectives: This study aimed to translate and evaluate the psychometric properties of the Children's Voice Handicap Index-10 for Parents (CVHI-10-P) in Persian for assessing voice-related quality of life in Persian-speaking children.

Methods: The CVHI-10-P was translated into Persian and assessed for face and content validity by a panel of speech-language pathologists. The questionnaire was administered to 141 children aged 6-11 years, including 35 with voice disorders and 106 without. Reliability was measured using Cronbach's alpha, Spearman-Brown, and Guttman coefficients. Validity was evaluated through sensitivity, specificity, accuracy, precision, F-score metrics, and correlations with the Persian version of the Pediatric Voice Handicap Index (PVHI).

Results: The translated CVHI-10-P demonstrated high reliability, with a Cronbach's alpha of 0.944 for the total score. Significant differences in CVHI scores between children with and without voice disorders confirmed the questionnaire's ability to distinguish between these groups. Receiver operating characteristic (ROC) curve analysis revealed an area under the curve (AUC) of 0.974, indicating excellent diagnostic accuracy. Pearson's correlation showed strong associations between CVHI and PVHI scores across all dimensions.

Conclusion: The Persian version of the CVHI-10-P is a reliable and valid tool for assessing the impact of voice disorders on the quality of life in Persian-speaking children. It offers a concise and effective means for parents to report their children's voice-related challenges.