Journal of Voice最新文献

Objective: To verify the self-assessment of gender in voice, the concept of an ideal voice, and voice satisfaction among people of different genders; and to compare these factors with the Auditory-Perceptual Assessment (APA) of gender in voice conducted by cisgender, transgender, and non-binary judges, as well as speech-language pathologists (SLPs) specializing in voice.

Methods: A cross-sectional study. In total, 47 individuals of different genders conducted a self-assessment of their voice's gender presentation (using a 100-point visual analog scale (VAS) ranging from very masculine to very feminine) based on two items: "My voice is" and "My ideal voice should sound." The same scale was used to measure voice satisfaction, ranging from "very dissatisfied" to "very satisfied." Subsequently, samples of connected speech (counting numbers) and expressive reading of a poem from these individuals were recorded and subjected to APA using the same VAS to evaluate gender presentation in voice. The APA was conducted by 101 cisgender judges (CJ), 70 transgender and non-binary judges (TNB), and 65 voice-specialized SLP. Descriptive and inferential analyses were performed (Friedman test, Durbin-Conover post hoc test, and Spearman correlation), considering P < 0.05 to compare the difference between the mean scores of the judges and the speakers' self-assessment and the correlation of APA with voice satisfaction.

Results: For the first item, "My voice is," there was a significant difference between the speakers' self-assessment and evaluations by all three groups of judges: CJ vs self-assessment (P = 0.013), SLP vs self-assessment (P = 0.016), and TNB vs self-assessment (P =< 0.001). Regarding the item "My ideal voice should sound," a significant difference was observed only between TNB vs Ideal voice (P = 0.032); CJ and SLP vs Self-assessment did not show statistically significant differences (P = 0.262 and P = 0.298, respectively). In terms of voice satisfaction, cisgender men showed a strong negative and significant correlation with self-perception (R = -0.761, P = 0.006).

Conclusion: The perceptions of cisgender, transgender, non-binary judges, and voice-specialized SLPs differed significantly from the speakers' self-perception regarding gender in voice. In the conception of an ideal voice, the perceptions of cisgender and SLP judges aligned with the speakers' expectations, possibly reflecting cultural influences that reinforce traditional gender norms. The correlation of voice satisfaction indicates that more satisfied cisgender men perceive their own voice as more masculine.

Purpose: This study aimed to compare the self-perception of voice at different times and the influence of age, number of infections, underlying diseases, and occupational voice use among individuals with Coronavirus Disease 2019 (COVID-19), with or without a history of hospitalization.

Methods: Data were collected from adults and older adults with COVID-19, treated at a Brazilian Military Hospital between April 2020 and May 2023. The questionnaire was sent by email and a messaging application. The data were analyzed by comparing self-perception of voice at different times and the study variables in the hospitalized and nonhospitalized groups.

Results: The sample comprised 101 individuals. Self-perception of voice quality worsened during COVID-19 in all three age groups, regardless of hospitalization history. Individuals with more than one infection had worse vocal self-perception during COVID-19, regardless of hospitalization. The worsening was greater among individuals with allergies and hearing loss. Arterial hypertension was associated with worsening after COVID-19 in the nonhospitalized group and with better self-perception before COVID-19 in hospitalized patients. Reflux was associated with hospitalized patients and worse self-perception of vocal quality at all times. Hospitalized occupational voice users had greater vocal quality improvement after COVID-19.

Conclusions: Regardless of hospitalization and age group, participants self-perceived voice worsening during COVID-19, with a greater decline among hospitalized patients, and a slower recovery among hospitalized older people. More than one infection negatively impacted voice self-perception during COVID-19, and having one infection and no hospitalization was more promising for the voice. Allergies, hearing loss, hypertension, and reflux had an impact on voice self-perception during and/or after COVID-19. Hospitalized occupational voice users had greater vocal quality improvement, whereas nonhospitalized occupational voice users improved more slowly.

Introduction: Voice abuse and misuse are the most common causes of benign vocal fold lesions (BVFL). Treatment may include a combination of voice therapy, singing sessions, or surgical resection. Otolaryngologists and speech language pathologists advocate for preoperative, as well as postoperative, voice therapy.

Objectives: To determine the efficacy of voice therapy in avoiding the need for surgery.

Methods: This study was a retrospective chart review of patients who were seen in the office at Philadelphia Ear, Nose and Throat Associates and were diagnosed with BVFL from January 1, 2010 to December 31, 2022. Information gathered from patient charts included past laryngeal medical/surgical history, BVFL pathology or subtype and description, voice intervention (type and dates of intervention), voice therapy outcomes, singing sessions, and voice surgery and characteristics of preoperative voice therapy, among other information. Data were then analyzed using statistics for relationships and significance.

Results: One hundred twenty-seven patients met inclusion criteria for this analysis. Seventy-nine patients were included in the nonsurgical intervention group, while 48 underwent voice therapy (defined as voice therapy or singing sessions) and progressed to surgery. Professional voice users between the two groups were similar, but a higher percentage of singers were present in the surgical group. Sex and lesion type agreed with previous literature for most lesions, with a higher number of polyps in females differing from literature. Patients in the non-surgical group had longer duration and number of voice therapy sessions.

Conclusions: Patients undergoing nonsurgical intervention (voice therapy or singing sessions) are less likely to have complete improvement as compared with their surgical counterparts, but the number of patients undergoing voice therapy over surgical options suggests voice therapy is still a valuable option for patients.

Objective: Chronic cough poses diagnostic and treatment challenges due to its often multifactorial nature. Chronic cough associated with laryngeal hypersensitivity is linked to sensory neuropathy of the superior laryngeal nerve and can be complex to manage. Superior laryngeal nerve (SLN) blocks are increasingly being utilized by laryngologists to treat refractory chronic cough with the intent of reducing inflammation and nerve hypersensitivity. This scoping review aims to provide an overview of the current literature examining the efficacy of SLN blocks for treatment of chronic cough, identify knowledge gaps, and guide future studies.

Methods: A search strategy was developed in collaboration with a medical librarian and run in Ovid Medline, Embase (Elsevier), Web of Science Core Collection (Clarivate), CINAHL Ultimate (Ebscohost), Cochrane, and Google Scholar (via Harzing's Publish or Perish). Search scope was from the inception of each database to March 5, 2024. Inclusion criteria were broad and focused on any study that utilized SLN block(s) for the treatment of chronic cough. The searches yielded 1264 articles that were loaded into Covidence systematic review software for deduplication and screening. Title and abstract and then full-text screening were performed.

Results: Twelve studies met inclusion criteria. Study designs varied, including retrospective reviews, case series, and one placebo-controlled trial. Outcome measures included validated patient-reported cough-specific quality of life measures and/or subjective patient reports. The number of blocks primarily ranged from an average of 2-4 per patient, with follow-up durations ranging anywhere from 2 weeks to 22.5 months. Adverse effects were minimal and primarily self-limiting. Other reported interventions included behavioral cough suppression therapy, used in conjunction with SLN blocks, and neuromodulators, which were often trialed prior to SLN therapy. All 12 studies reported improvement in cough, and while several studies reported significant improvements in patient-reported outcomes using Cough Severity Index and Leicester Cough Questionnaire questionnaires, only eight studies provided statistical testing with P values. The remaining studies did not perform statistical analyses or report confidence intervals, instead presenting descriptive or qualitative results.

Conclusions: Literature on the efficacy of SLN blocks for chronic cough reveals consistent positive outcomes. There is a need for randomized controlled trials, systematic studies with larger cohorts, longitudinal follow-up, and further comparison of ipsilateral versus bilateral blocks to determine the efficacy of SLN blocks for treatment of chronic cough.

Objective: To investigate the correlation between self-perceived vocal handicap, perceptual voice evaluation, and body mass index (BMI) in a cohort of patients presenting with hoarseness and to examine the correlation between perceptual voice evaluation and the Voice Handicap Index-10 (VHI-10) score in dysphonic patients with or without obesity.

Study design: Retrospective chart review.

Methods: The medical records of patients presenting with hoarseness to the voice clinic of a tertiary referral center between September 2023 and September 2024 were reviewed. Demographic data included age, gender, BMI, smoking, and clinical diagnosis of dysphonia. The VHI-10 questionnaire was used as a patient self-reported vocal handicap outcome measure and the GRB (grade, roughness, breathiness) rating scale was used for perceptual voice evaluation.

Results: The study included 120 dysphonic patients. The mean age was 53.5±15.1years. The most common diagnosis was Reinke's edema (20%) followed by vocal fold polyp (15.8%). Thirty-nine patients had a BMI <25kg/m² and 81 patients had a BMI ≥25kg/m². The mean VHI-10 score was 16.05±7.54 with no correlation between BMI and the VHI-10 score (r < 0.1). The mean grade of dysphonia was 1.62±0.76. The mean rate of roughness was 1.36±0.66. The mean rate of breathiness was 0.84±0.87 with no correlation between BMI and any of the GRB rating scores (r < 0.1). There was a moderate positive correlation between the VHI-10 score and the overall grade of dysphonia and rate of roughness (r=0.456, P<0.001 and r=0.258, P=0.012).

Conclusion: The results of this investigation indicate no correlation between BMI, VHI-10 score and GRB rating in patients presenting with hoarseness. The results also showed a poor to moderate correlation between the VHI-10 score, the grade of dysphonia and roughness in the study group.

Purpose: Blood lactate concentration is commonly used to assess metabolic demand and skeletal muscle training response. The objective of the pilot study was to investigate if a change in blood lactate was detectable in an anaerobically designed vocal demand task vocal capacity anaerobic task (VCAT⁶⁰) and determine if the developed vocal demand task may assess the anaerobic capacity of the voice musculature, like anaerobic power tests commonly used in applied exercise science.

Methods: A prospective repeated measures study quantified blood lactate concentration preVCAT and postVCAT⁶⁰ in vocally healthy adults. The secondary outcomes included determining correlations and predictors of the change in lactate including aerodynamic, leg anaerobic capacity and anthropometric measures as well as participant reported vocal fatigue.

Results: A significant positive change in lactate pre and post VCAT⁶⁰ was observed (P = 0.003). Regression analyses showed that Body mass index (P = 0.003) was a predictor of the lactate concentration shift. There was no evidence of additional measured variables or their interactions being predictors of the blood lactate concentration levels detected via the vocal demand task.

Conclusions: Evidence supports the hypothesis that blood lactate may be an effective metabolic biomarker in investigating voice physiology in vivo. The VCAT⁶⁰, via the shift in systemic blood lactate concentration, may provide a means from which to understand metabolic adaptations that occur in the peripheral muscles of the voice mechanism during behavioral voice intervention. Further investigations are needed to determine the clinical significance of the measured blood lactate as well as to refine the proposed anaerobic vocal demand task.

Objective: To analyze acoustic measures of speech and vowel samples from individuals of different genders and to correlate these acoustic measures with vocal satisfaction. This study aims to provide additional data on acoustic measures, serving as references for clinicians while emphasizing the importance of moving beyond cisgender norms. Additionally, it addresses a gap in the Brazilian context by exploring correlations between acoustic measures and self-perceived vocal satisfaction across diverse gender groups.

Methods: Cross-sectional study. Speech segments and sustained vowel emissions from 47 individuals (11 cisgender women-CW, 11 transgender women-TW, 11 cisgender men-CM, seven transgender men-TM, and seven non-binary individuals-NB) were recorded, and 14 acoustic measures of noise, perturbation, spectral, and cepstral parameters were extracted. Vocal satisfaction was measured using a visual analog scale. Descriptive and inferential analyses were performed using Kruskal-Wallis, Dwass-Steel-Critchlow-Fligner, and Spearman correlation tests, considering P < 0.05.

Results: Significant differences were observed in various acoustic measures, such as the average fundamental frequency (f_o) between CW and CM (P < 0.001), TM (P = 0.015), and TW (P = 0.050); minimum f_o between CW and CM (P = 0.002) and TW (P = 0.050); Jitter between CW and CM (P = 0.013); H1-H2 between CW and CM (P = 0.002); Shimmer between CW and CM (P = 0.046); Acoustic Breathiness Index (ABI) SCORE between CW and CM (P = 0.024); median f_o in speech between CW and CM (P < 0.001), TM (P = 0.009), and TW (P = 0.011); minimum f_o in speech between CW and CM (P = 0.014) and TW (P = 0.031); and maximum f_o in speech between CW and TW (P = 0.050). The measures that correlated with vocal satisfaction were strong positive correlation for spectral emphasis in CW (R = 0.608; P = 0.047) and noise-to-harmonic ratio in TW (R = 0.724; P = 0.012); very strong positive correlation for smoothed cepstral peak prominence in TM (R = 0.847; P = 0.016); and strong negative correlation for coefficient of variation of intensity in NB (R = -0.775; P = 0.041).

Conclusion: Acoustic measures differ according to the speaker's gender in the studied sample. Significant differences were observed in fundamental frequency between CM and cisgender and TW, as well as between cisgender and TW. Differences in fundamental frequency, Jitter, Shimmer, the difference between the first two harmonics, and the were identified across gender groups. The measures correlated with vocal satisfaction differed among the groups. However, these correlations should be interpreted cautiously, as they suggest a relationship but do not imply causation, and their clinical significance requires further investigation.

Objective: The Mandarin Chinese version of the Vocal Performance Questionnaire (VPQ-CM) for evaluating vocal performance.

Methods: A total of 120 participants with vocal disorders and 120 healthy participants completed this study. Investigators translated the original VPQ into the VPQ-CM, and participants completed the questionnaire fill it. Investigators assessed the reliability by internal consistency and test-retest. And investigators evaluated content validity through expert consensus by the Delphi method, measured structural validity by factor analysis, and assessed criterion validity by analyzing the correlation between VPQ-CM and Voice Handicap Index-10 (VHI-10). Discriminant validity was evaluated by comparing the scores of participants with vocal disorders and healthy participants for significant differences. Receiver Operating Characteristic curve analysis was utilized to identify the cutoff score to distinguish participants with or without vocal disorders.

Results: VPQ-CM demonstrated internal consistency (Cronbach's α = 0.882) and test-retest reliability (intra-class correlation coefficient: 0.954). The expert committee unanimously agreed that the questionnaire had good content validity (expert authority level Cr = 0.767-0.967, coefficient of variation Cv = 5.23%-16.64%). The loading values of each item in the described common factors of the VPQ-CM were greater than 0.4, indicating good structural validity. There was a significant correlation between the VPQ-CM and VHI-10 (r = 0.608-0.761, P < 0.001), demonstrating good criterion validity of the questionnaire. Significant differences were observed in the VPQ-CM scores between participants with and without vocal disorders (P < 0.001), indicating good discriminant validity of the VPQ-CM.

Conclusion: The VPQ-CM demonstrated good reliability and validity and can be utilized for clinical measurement of vocal performance in patients with vocal disorders.

Level of evidence: 2a.

Background: With an increasing prevalence of frailty among older adults, effective classification and management strategies for frailty have become imperative. Voice biomarkers, offering insights into the overall health status of older adults, hold promise for enhancing the management of this multifaceted geriatric syndrome.

Objectives: This scoping review aims to consolidate existing knowledge regarding the relationship between frailty and voice biomarkers.

Methods: A systematic search was conducted following the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews guidelines across multiple databases: PubMed, Embase, Proquest, Scopus, and Web of Science. The results were synthesized through information extraction and are presented in tables.

Results: A total of 11 studies met the inclusion criteria. The majority (63.6%) employed a cross-sectional design. Voice biomarkers encompassed acoustic parameters, such as the peak/average volume ratio, and linguistic parameters, such as verbal fluency. Nine articles reported significant associations between frailty and acoustic parameters. Three articles included linguistic parameters in their analyses. Only one demonstrated associations between frailty and both acoustic and linguistic parameters.

Conclusion: Despite the relatively small sample sizes in the included studies, the findings underscore a significant connection between voice biomarkers and frailty among older adults, suggesting the potential utility of vocal characteristics as non-invasive indicators for identifying and managing frailty. Integrating voice biomarkers into routine geriatric assessments could substantially improve the precision and efficiency of frailty management, facilitating personalized healthcare interventions tailored to the needs of older adults.

Purpose: The present study aims at exploring the effect of pitch, loudness, vowel, and voice condition on supraglottic activity among female participants with voice disorders and among female participants with normal voices.

Methods: Forty-four volunteers were recruited. Inclusion criteria for the dysphonic group were: 1) age between 20 and 50 years, 2) reporting at least 1 year-long history of voice problems, 3) moderate or severe dysphonia. Inclusion criteria for normal-voice group were: 1) age between 20 and 50 years, 2) no history of voice problems during at least one year prior to enrollment in the study, and 3) perceptually normal voice. Flexible and rigid laryngeal endoscopic examinations were conducted to assess supraglottic activity during speech-based phonatory tasks. Two laryngologists (blinded judges) were asked to assess laryngoscopic video samples using a visual analog scale. They assessed 4 laryngoscopic variables: medial laryngeal compression, anterior-posterior laryngeal compression, vertical laryngeal position (VLP), and pharyngeal compression. Groups, loudness levels, and pitch were compared.

Results: Degree of loudness, pitch, and type of vowel were significantly linked to higher scores on most supraglottic activity measures. No significant differences between dysphonic and normal participants were found on any laryngoscopic dependent variables, except for VLP in vowel [u:].

Conclusion: Degree of supraglottic activity should not be necessarily greater in female patients with functional dysphonia compared to normal-voice female participants. Loudness level, pitch, and vowel have a clear impact on the degree of tissue displacement of supraglottic structures in both normal and people with voice disorders. Thus, loudness, pitch, and vowel should be controlled when performing laryngoscopic examination in both clinic and research; otherwise conclusions may not be completely reliable.