Journal of Voice最新文献

Objectives: Despite widespread industry knowledge regarding vocal health habits among singers, a paucity of research supports these beliefs, potentially undermining patient counseling. We sought to catalog attitudes of vocal healthcare providers regarding common vocal health practices to compare to vocalists.

Methods: An online survey was administered to fellowship-trained laryngologists and voice-specialized speech-language pathologists (SLPs) to assess attitudes regarding 82 factors frequently associated with vocal health. Respondents rated each item on the following scale: good in the long-term, good in the short-term, bad long-term, bad short-term, or no effect. Results were compared to previously collected data from an analogous survey completed by professional and amateur vocalists.

Results: Twenty-four vocal healthcare providers (15 SLPs and nine laryngologists) completed the survey. Consensus among vocal healthcare providers was found on all but six items, but differences between vocalists and providers were observed on 34 items. These items included factors seen as less harmful (eg dairy, whispering) or less beneficial (eg tea, Vitamin B12, jogging on performance day) by healthcare providers than singers. Several items were viewed more cautiously by providers (eg menthol, decongestants, spicy foods, breath-holding, and whiskey shots).

Conclusions: A substantial disconnect between vocal healthcare providers and singers was observed regarding habits conducive to vocal health. These data have significant implications for the counseling of voice users and demonstrate the importance of further study to understand the impact of vocalist habits on vocal health.

Level of evidence: Level 3.

Objective: To evaluate whether voice-derived acoustic and biomechanical features can serve as non-invasive biomarkers for mortality-risk prediction and survival stratification in patients with amyotrophic lateral sclerosis (ALS).

Methods: We conducted a retrospective study including 50 ALS patients evaluated in a phoniatrics consultation with available sustained vowel recordings, demographic data, and functional assessments. Nested logistic regression models were developed to predict clinical outcomes, progressively incorporating demographic variables, functional indices (Grade, Roughness, Breathiness, Asthenia, Strain, and Barthel), acoustic features (fundamental frequency, jitter, shimmer, harmonics-to-noise ratio), and biomechanical voice parameters (Pr1-Pr22). Model performance was assessed using receiver operating characteristic curves and area under the curve (AUC) comparisons via DeLong tests. Stepwise Akaike Information Criterion (StepAIC) was applied to optimize the final model. A Cox proportional hazards model was used to evaluate the association between voice parameters and survival time.

Results: The final StepAIC model, which included a subset of biomechanical features, achieved excellent predictive performance (AUC = 0.903, 95% confidence interval: 0.816-0.989), significantly outperforming baseline and acoustic-only models. Bootstrapping confirmed the model's robustness and generalizability. Cox regression analysis showed that the derived risk scores stratified patients into tertiles with significantly different survival probabilities (log-rank P < 0.0001; hazard ratio for high vs. low-risk group = 11.2).

Conclusion: Biomechanical voice features are strong predictors of mortality in ALS and outperform traditional clinical and acoustic indices. These findings support the integration of voice analysis into ALS monitoring protocols as a non-invasive, cost-effective, and scalable prognostic tool.

Objective: This study aimed to compare the characteristics of the voice handicap index-30 (VHI-30) and the vocal fatigue index (VFI) among patients with voice disorders across different occupational types and disease categories. Furthermore, this study aimed to analyze the correlations of the VHI-30 and VFI with factors such as sex and age to identify valuable assessment methods for clinical applications across varying intervention priorities.

Methods: A total of 263 patients with nonmalignant voice disorders treated at our hospital between October 1, 2023, and March 31, 2024, were enrolled. The patients were grouped on the basis of disorder type and occupation, and the differences in the VHI-30 and VFI scores across groups were compared. An analysis of differences in the two scales between males and females was subsequently conducted. Furthermore, the correlations of these scales with the duration of dysphonia at the time of consultation and age were examined.

Results: There were no significant differences in total VHI-30 scores or scores on the physiological, functional, or emotional subscales between professional voice users and nonprofessional voice users (P > 0.05). In contrast, there were significant differences in both the total and subscale scores of the VFI between the two groups (all P < 0.05). There were significant differences in total VHI-30 scores between disease categories (P < 0.05), but no significant differences in total VFI scores were observed (P > 0.05). Among nonprofessional voice users, VHI-30 scores varied significantly across disease types, unlike VFI scores. In contrast, among professional voice users, neither scale showed significant variation across disease categories. For the male and female groups, no significant difference was found in the VHI-30 scores, while the VFI scores significantly differed. Additionally, VHI-30 scores were not significantly correlated with age or dysphonia duration. In contrast, VFI scores were correlated with dysphonia duration but not with age at consultation.

Conclusion: The VFI demonstrated greater clinical value in terms of assessing vocal function between voice professionals and non-voice professionals, whereas the VHI-30 showed stronger correlations with disease categories. In clinical practice, assessment tools should be selected on the basis of specific circumstances.

Objectives: The present study aimed to empirically document the current clinical practices of speech language pathologists (SLPs) on assessment and management of unilateral vocal fold paralysis (UVFP) across India.

Method: The authors developed a questionnaire comprised of five sections, namely demographic details, experience with UVFP, voice assessment methods in UVFP, behavioral voice management strategies in UVFP, and clinical implications of electrical stimulation (ES) in UVFP. The final questionnaire, following content validation, comprised 53 questions. Using this questionnaire, an online survey was carried out among SLPs regarding the assessment and management of individuals with UVFP.

Result: Responses from 74 SLPs working with UVFP across India were analyzed. The participants reported that direct flexible laryngoscopy was the most commonly used procedure to diagnose individuals with UVFP, followed by videostroboscopy. Also, SLPs (90.54%) reported that auditory perceptual evaluation was the most common assessment option employed in clinical practice to evaluate individuals with UVFP. The majority of the participants were using multiparametric voice measures to document the improvement with voice therapy. Most of our study participants (68.92%) reported that voice therapy would be initiated within the first 4 weeks post-onset. Our respondents reported that frequently used voice therapy techniques for individuals with UVFP were breathing exercises, vocal hygiene, head turn, and vocal function exercises. Though most participants were aware of the use of ES for patients with UVFP, only 4.82% of the participants used it in day-to-day clinical activities.

Conclusion: Nearly half of the participants are using a multiparametric voice measure to assess individuals with UVFP in India. Also, there is a lack of uniformity in the selection of voice therapy techniques, duration, and frequency of sessions for the management of individuals with UVFP. The survey suggests the need for SLPs to update their knowledge regarding the recent literature and incorporate this knowledge to their day-to-day clinical practices.

Objective: To investigate the need for external laryngeal counter pressure during microlaryngeal surgery (MLS) and to present a new device that can be used for improved visualization of the larynx during surgery.

Methods: Patients who underwent MLS due to vocal fold pathology at Karolinska University Hospital in Sweden between January 1st, 2018, and December 31st, 2019, were retrospectively identified by their surgical classification code in the patient charts. Data regarding gender, age, diagnosis, the need for external pressure to the larynx, and complications were noted. A new innovative laryngoscope holder was created and produced in collaboration with the medical technology department at the Karolinska University Hospital.

Results: Among 452 surgical procedures in 382 individuals, external laryngeal pressure was needed in 34% of the cases to receive adequate exposure of the larynx. External pressure was more frequently needed among male patients (P = 0.007). Neither the location of the lesion on the vocal fold nor whether it was malignant or benign was significantly important (P = 0.798 and P = 0.073, respectively). A new laryngoscope holder is presented, which can provide stable external pressure on the laryngeal framework during MLS.

Conclusion: External laryngeal pressure was needed in 34% of the cases for full laryngeal exposure during MLS. To facilitate external pressure of the larynx during surgery, we present an innovative, adjustable laryngoscope holder that can be used in the laryngoscopy setting for improved visualization of the vocal folds. The device will be further investigated in prospective studies.

Level of evidence: 3:

Objectives: In everyday clinical and research practice, normative data of voice quality, such as fundamental frequency (Fo), serve as a reference standard for comparing individual voice assessments. To date, normative data in the Greek language have only been published for pediatric populations. This study aimed to provide normative data for adults, reporting the average Fo and cycle-to-cycle variation in the electroglottography (EGG) waveform (jitter) during sustained phonation, as well as the speaking time-varying Fo during reading, in a sample of native adult Greek speakers.

Study design: This is a cross-sectional study.

Methods: All participants were recruited at the Athens Naval Hospital and the Cyprus Institute for Neurology and Genetics. Candidates with neurological, musculoskeletal, cardiovascular, metabolic, and respiratory diseases were excluded. Additional exclusion criteria related to voice included the presence of a vocal disorder or a history of a laryngeal pathology. A combination of tasks (sustained phonation and reading of a standard text passage) was used to provide normative data on average Fo and jitter (%; sustained phonation), as well as speaking Fo (reading). In all participants, the voice was recorded and analyzed through EGG.

Results: One hundred forty-four native Greek speakers (77 females) aged between 20 and 86 years (mean 48.40 years) were included in the study. The Mann-Whitney U test showed significant differences in median average Fo in sustained phonation (U = 4638.50, P < 0.001) between males (139.12 Hz, n = 67) and females (207.43 Hz, n = 76). Along the same line, the speaking Fo during reading (DF x 1) was statistically different (U = 4820.00, P < 0.001) in males (124.55 Hz) compared to females (200.98 Hz). No differences were found in jitter (U = 2889.00, P > 0.05) between males and females. In males, speaking Fo showed a progressive lowering or relative stability until around age 60, followed by an increase in older age, whereas in females it progressively decreased with age.

Conclusions: This is the first study to provide normative EGG data on Fo and jitter in adult Greek speakers. Deviations from these norms may help clinicians in early diagnosis, monitoring disorder severity, and evaluating treatment effectiveness, thereby supporting timely adjustments in therapeutic plans.

The data obtained in the acoustical and physiological studies on the singing voice have been quite useful in understanding the relationship between a given musical genre and the vocal sound produced by the technique employed in that genre. However, in some of these studies, we see that authors have argued that a universally valid causal relationship exists between the perception of a sound as 'good' or 'beautiful' and the acoustic properties of that sound. This claim is fraught with epistemological problems. This study will address these problems, which are products of the positivist approach found in most experimental aesthetic studies. Within this framework, we will critically analyze an experimental study by Johan Sundberg in which these problems are clearly observed. In that work, he argued that there is a linear and causal relationship between the phenomenon known as the singer's formant, an acoustic component of the vocal sound produced by the technique used in opera singing, and the aesthetic value of the vocal production. In this study, it will be argued that the subjectivity of aesthetic experience invalidates from the outset the alleged causal relationship between the acoustic properties of a given sound and its aesthetic value. Studies in this field should take into account the impact of individuals' long-term exposure to and experience with a particular singing style, particularly through training, on their aesthetic expectations of what constitutes an ideal voice. The role of this prototypical voice in the evaluations made by those on the evaluation panels should not be overlooked.

Objective: Total laryngectomy (TL) is still considered the gold standard treatment for advanced laryngeal cancer. Despite its oncological efficacy, the procedure is invasive and leads to permanent voice loss, profoundly affecting patients' quality of life. While communicative and functional outcomes following standard TL have been widely studied, limited evidence is available regarding extended procedures that require reconstructive techniques. In particular, the potential impact of a pectoralis major flap on subsequent vocal rehabilitation remains unclear. The present study aimed to retrospectively evaluate and compare vocal outcomes in patients who underwent TL with primary tracheoesophageal puncture (TEP) and voice prosthesis (VP) placement, either with pectoralis major flap reconstruction (Pec Maj reconstruction group) or without reconstruction (Primary closure group).

Methods: Vocal assessments were performed during scheduled follow-up visits by a speech and language therapist. The evaluation included both subjective and objective measures. Acceptance and adaptation to tracheoesophageal (TE) speech were assessed using the Italian version of the Self-Evaluation of Communication Experiences after Laryngeal Cancer. Perceptual voice quality was analyzed through the Impression, Noise, Fluency, Voicing scale, while acoustic parameters were obtained using Praat software. Aerodynamic performance was measured with maximum phonation time. Group comparisons were carried out to identify possible differences and correlations among outcomes.

Results: The statistical analysis showed no significant differences between the two groups. Comparable levels of acceptance and adaptation to TE speech were observed, along with similar perceptual, acoustic, and aerodynamic results.

Conclusions: These findings suggest that pectoralis major flap reconstruction does not negatively influence vocal rehabilitation when primary TEP with VP placement is performed. TE speech, therefore, remains a reliable and effective method of voice restoration, regardless of reconstructive requirements. Patient-related factors, rather than surgical variables, appear to be the main determinants influencing candidacy for primary TEP and successful VP rehabilitation.

Objective: To assess the alignment of Chat Generative Pre-trained Transformer (ChatGPT), based on Generative Pre-trained Transformer 4 (GPT-4) with the 2018 Clinical Practice Guideline on Hoarseness (Dysphonia), using a structured three-rater evaluation involving an otolaryngologist, an audiologist, and ChatGPT.

Methods: Thirteen guideline statements were converted into 15 open-ended clinical questions and independently answered by ChatGPT. Responses were assessed for consistency with the guideline using a three-point scale (consistent, partially consistent, inconsistent). Evaluations were performed by an otolaryngologist, an audiologist, and ChatGPT itself, with final adjudication by a senior otolaryngologist.

Results: Of 15 items, 13 responses (86.7%) were rated as fully consistent by all three raters. Two responses (13.3%) were rated as partially consistent by one evaluator each. No responses were deemed inconsistent. Overall agreement across raters was 97.8%.

Conclusion: ChatGPT's responses showed high concordance with expert recommendations in the evaluation and management of hoarseness. These findings support the potential of large language models as adjunctive tools for patient education and clinical decision-making in voice disorders, when used under expert oversight.