Journal of Voice最新文献

Objectives: Lateral skull base surgeries pose a risk of injuring the lower cranial nerves, leading to potential postoperative complications such as dysphonia and dysphagia. Conservative treatments have shown limited efficacy in addressing these resultant voice and swallowing dysfunctions, significantly impacting patient quality of life. This study aims to evaluate the safety and effectiveness of a combined surgical approach involving autologous fat injection laryngoplasty (AFIL) and transcervical cricopharyngeal myotomy (TCPM) in patients suffering from severe dysphonia and dysphagia following lateral skull base surgery.

Methods: A retrospective analysis was conducted on 16 patients who underwent concurrent AFIL and TCPM to improve severe dysphonia and dysphagia following lateral skull base surgery. Preoperative and postoperative assessments of voice and swallowing functions were performed using the Voice Handicap Index-10 (VHI-10), GRBAS scale, maximum phonation time (MPT), the Chinese version of Swallow Quality-of-Life Questionnaire (CSWAL-QOL), and videofluoroscopic swallowing studies (VFSS).

Results: The results demonstrated notable improvements in voice quality and swallowing function. The VHI-10 score improved significantly from a preoperative mean of 32.06 ± 4.92 to a postoperative 9.06 ± 5.24. The results of the perceptual parameters of the GRBAS scale also improved significantly. The MPT increased from a preoperative average of 3.91 ± 1.00 seconds to 9.14 ± 2.44 seconds postoperatively. The CSWAL-QOL scores significantly improved from a preoperative score of 92.44 ± 17.75 to 130.19 ± 26.07 postoperatively. The VFSS-SWAL scores decreased from 6.63 ± 1.36 before surgery to 3.56 ± 1.58 after surgery. Similarly, the Penetration Aspiration Scale (PAS) scores significantly dropped from 6.38 ± 1.05 preoperatively to 2.93 ± 1.48 postoperatively. Nine out of 11 patients were able to have their gastric tubes successfully removed after surgery. There were no significant postoperative complications.

Conclusion: Concurrent AFIL and TCPM present a promising reconstructive method for patients experiencing severe dysphonia and dysphagia following lateral skull base surgery, highlighting its value in the postoperative management of complex lower cranial nerve injuries.

Islamic leadership is a diverse profession and previous research has highlighted the increased risk of voice problems among Islamic leaders. The prevalence and risk factors for voice problems among Malayalam-speaking Islamic religious orators have not been adequately investigated. This study aimed to assess the prevalence of self-reported voice problems among Islamic religious orators who recite the Adhaan and those who do not and to examine the impact of age and associated risk factors. This study employed a nonexperimental research design using survey research. The current findings report a high prevalence of voice problems among Islamic Adhaan reciters and suggest that age-related differences may influence the risk factors associated with voice problems in this population. Only two participants from the older group of Adhaan reciters had received voice therapy, suggesting that the majority of Islamic religious reciters lack knowledge about voice care and voice therapy. A limitation of the study is the lack of otorhinolaryngological examination, particularly laryngoscopy and voice analysis of Islamic religious orators. Further studies can investigate the effect of vocal hygiene training or similar voice management programs on Islamic religious orators' voices.

Background: Vocal hygiene (VH) is the practice of taking care of the voice and minimizing strain on it. This comprises avoiding smoking, alcohol, and other harmful substances, remaining hydrated, and practicing proper breathing techniques. This study intended to evaluate the level of knowledge and practices concerning VH.

Methodology: A cross-sectional study design was utilized to conduct the study among teachers in Greenland Higher Secondary School, Basundhara National Academy, and Nirmal Batika Academy using a self-administered structured questionnaire. A sample of 122 teachers was taken using a complete enumerative sampling technique. The data were collected from October 1 to October 16 and were edited, coded, and entered into the Statistical Package for Social Science for further analysis. Data were examined using descriptive (frequency, percentage mean, and standard deviation), inferential statistics (chi-square test), and Karl Pearson's test.

Findings: The study results presented that nearly half, 49.2% of the respondents, had a moderate level of knowledge, 31.1% had an inadequate level of knowledge, and 19.7% had an adequate level of knowledge regarding VH. The results discovered that 73% of the respondents had good practice, and 27% had poor practice regarding VH. There was a statistically significant association only between the level of knowledge regarding VH and the number of classes taken per week (P = 0.0053).

Value: The study showed that the majority of teachers have moderate knowledge about VH, whereas there is good practice among teachers. The results strongly recommend the need for VH training sessions for teachers.

Purpose: Literature highlights the efficacy of prolonged use of straw phonation for vocally healthy individuals. Nevertheless, minimal studies have examined the prolonged use of single treatment in hyperfunctional voice disorders (HFVD), as straw phonation is used as physiological training to improve voice quality in these individuals. The present study aimed to investigate the long-term intensive training effect of straw phonation exercise in air (SPEA) for HFVD.

Method: In a time series design, seven females with HFVD (mean age 42.28years) participated in SPEA for 12 long sessions (30 minutes/session) intensively trained for 3weeks (4days/week). The participant-recorded voice samples were analyzed for aerodynamic measures Aerodynamic Subglottic Pressure (ASP), Airflow Rate (AFR), glottal behavior measures Contact Quotient (CQ), Contact Quotient Range (CQR), acoustic measure Acoustic Voice Quality Index (AVQI), auditory-perceptual Consensus Auditory Perceptual Evaluation of Voice - Kannada (CAPE-V-K), and self-perceptual measure Voice Handicap Index - Kannada (VHI-K) at pre-therapy, mid-therapy, post therapy, and 1-month follow-up timelines. Related Friedman's two-way analysis of variance and post hoc Wilcoxon signed-rank test were used to analyze the change in outcome measures across therapy timelines.

Results: Significant reduction in ASP, CQR, AVQI, CAPE-V-K, and VHI-K measures from pre-therapy to post-therapy and follow-up timelines was observed. Although there was a decrease in AFR and CQ measures from pre therapy to post therapy and follow-up, no significant differences were observed. No significant changes were observed from pre therapy to mid-therapy in any outcome measures, indicating the need for extended therapy duration and regular practice.

Conclusion: These findings provide preliminary evidence of implementing the long-term intensive training of SPEA for HFVD with the support of significant outcome measures at various therapy timelines.

Background: Voice rest (VR) is widely recommended after microlaryngeal surgery to facilitate recovery and improve voice outcomes. Our study is the first systematic review and meta-analysis summarizing the impact of postoperative absolute voice rest (AVR) and no voice rest (NVR) instructions on voice outcomes.

Methods: PubMed, Embase, and Cochrane Library databases were searched using "voice rest laryngeal surgery" and "postoperative voice rest" for articles published before December 2022. Risk of bias was assessed using ROBINS-I and RoB2 tools. Meta-analysis using a random effects model was performed for studies comparing Voice Handicap Index (VHI-10) outcomes between NVR and AVR. Analysis was performed in R Studio.

Results: In total, 255 articles were reviewed, 24 underwent full-text screening, and nine met inclusion criteria. Four randomized control trials (RCT) and one retrospective review compared AVR durations (range: 2-10days). Four studies (two cohort, one cross-sectional, and one RCT) compared AVR to NVR. All studies had risk of bias (ROBINS-I: two moderate, two serious; RoB2: five with concerns). Comparing AVR durations, two found no difference between short and long duration, while two reported improved outcomes for the short cohort. In studies comparing AVR to NVR, all concluded no significant difference in outcomes. Pooled analysis of three studies (355 patients) comparing NVR and AVR demonstrated no significant differences in pre- and postoperative VHI-10 change (mean difference=-0.87; 95% CI, -2.51 to 0.77; P = 0.27).

Conclusion: Systematic review findings indicate postoperative VR may not lead to improved voice outcomes, and a meta-analysis demonstrated no difference in VHI-10 outcomes between AVR and NVR.

Level of evidence: 2:

Objectives: The study aims to classify normal and pathological voices by leveraging the wav2vec 2.0 model as a feature extraction method in conjunction with machine learning classifiers.

Methods: Voice recordings were sourced from the publicly accessible VOICED database. The data underwent preprocessing, including normalization and data augmentation, before being input into the wav2vec 2.0 model for feature extraction. The extracted features were then used to train four machine learning models-Support Vector Machine (SVM), K-Nearest Neighbors, Decision Tree (DT), and Random Forest (RF)-which were evaluated using Stratified K-Fold cross-validation. Performance metrics such as accuracy, precision, recall, F1-score, macro average, micro average, receiver-operating characteristic (ROC) curve, and confusion matrix were utilized to assess model performance.

Results: The RF model achieved the highest accuracy (0.98 ± 0.02), alongside strong recall (0.97 ± 0.04), F1-score (0.95 ± 0.05), and consistently high area under the curve (AUC) values approaching 1.00, indicating superior classification performance. The DT model also demonstrated excellent performance, particularly in precision (0.97 ± 0.02) and F1-score (0.96 ± 0.02), with AUC values ranging from 0.86 to 1.00. Macro-averaged and micro-averaged analyses showed that the DT model provided the most balanced and consistent performance across all classes, while RF model exhibited robust performance across multiple metrics. Additionally, data augmentation significantly enhanced the performance of all models, with marked improvements in accuracy, recall, F1-score, and AUC values, especially notable in the RF and DT models. ROC curve analysis further confirms the consistency and reliability of the RF and SVM models across different folds, while confusion matrix analysis revealed that RF and SVM models had the fewest misclassifications in distinguishing "Normal" and "Pathological" samples. Consequently, RF and DT models emerged as the most robust performers, making them particularly well-suited for the voice classification task in this study.

Conclusions: The method of wav2vec 2.0 combining machine learning models proved highly effective in classifying normal and pathological voices, achieving exceptional accuracy and robustness across various machine evaluation metrics.

Objective: To report the long-term data of the Triple procedure (medialization laryngoplasty, adduction arytenopexy, and cricothyroid subluxation) regarding complications and revisions in a large cohort of patients.

Study design: Retrospective case series.

Methods: This study included patients who underwent ≥1 components of the Triple procedure between January 2000 and July 2019. Demographic data, etiology of paralysis, duration of follow-up, complications, revision surgeries, and touch-up injections were noted from retrospective chart review.

Results: Of the 222 patients who underwent ≥1 of the Triple procedure components, 86 underwent medialization laryngoplasty alone and were excluded from the study. The remaining 136 underwent ≥1 components of the Triple procedure other than medialization laryngoplasty alone. The overall surgical complication rate was 7.3% (10/136) and no intraoperative complications were noted. Of the 10 complications, four were implant extrusions, four were hematoma, and two were rupture of the arytenoid fixation suture. In all, 20 of the 136 cases subsequently required revision surgery (14.7%) at a mean of 57.3months after the initial surgery.

Conclusion: The present findings show that the Triple procedure, or its subcomponents, can be performed with few complications and acceptable revision rates.

Ear, nose, and throat (ENT) physicians, speech and language pathologists (SLPs), and singing instructors play complementary roles in the assessment and remediation of voice disorders in performing artists. Given that there are differences among these groups in the training they receive, and that there may be further differences due to their occupational settings and goals, it is unknown whether and to what extent these different disciplines diverge in their perceptions and evaluations of voice quality. Against this background, the present study compared perceptual evaluation of pathological voice by these voice-related disciplines. Using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scale, five ENT physicians, five SLPs, and five singing instructors evaluated voice samples recorded from 10 people with pathological voice. The participant groups' scores for each CAPE-V parameter were compared. It was found that the ENT physicians and SLPs were similar in their evaluations, whereas the singing instructors gave higher scores than the ENT physicians and SLPs on several CAPE-V parameters, suggesting that the singing instructors tended to rate the patients' voice quality as more severe on average than ENT physicians and SLPs. These findings highlight the similarities between ENT physicians and SLPs in their perceptual evaluations of pathological voice and suggest that singing instructors may show a more sensitive and heightened perceptual response to pathological voice than the other professional groups, possibly due to differences in occupational experiences and expectations among these voice-related disciplines.

Crying is one of the primary means by which infants communicate with their environment in the early stages of life. These cries can be triggered by physiological factors such as hunger or sleepiness, or by pathological factors such as illness or discomfort. Therefore, analyzing infant cries can assist inexperienced parents in better caring for their babies. Most studies have predominantly utilized a single-speech feature, such as Mel Frequency Cepstral Coefficients (MFCC), for classifying infant cries, while other speech features, such as Mel Spectrogram and Tonnetz, are often overlooked. In this study, we manually designed a hybrid feature set, MMT (including MFCC, Mel Spectrogram, and Tonnetz), and explored its application in infant cry classification. Additionally, we proposed a convolutional neural network based on residual connections and long short-term memory (LSTM) networks, termed ResLSTM. We compared the performance of different deep learning models using the hybrid feature set MMT and the single MFCC feature. This study utilized the Baby Crying, Dunstan Baby Language, and Donate a Cry datasets. The results indicate that the hybrid feature set MMT outperforms the single MFCC feature. The MMT combined with the ResLSTM method achieved the best performance, obtaining accuracy rates of 94.15%, 92.92%, and 95.98% on the three datasets, respectively.