Journal of Voice最新文献

Objectives: Injection laryngoplasty (IL) is commonly performed for glottic insufficiency and has historically been performed under general anesthesia via direct laryngoscopy (DL), with an increasing number of procedures being performed in the office setting via flexible laryngoscopy (FL). Existing literature regarding complications of IL primarily addresses immediate peri-procedural complications and adverse reactions to the injection material. This is the first study utilizing a large multi-institutional database comparing complications of IL performed via DL versus FL.

Study design: Retrospective database study.

Methods: Patients who underwent IL were queried on the TriNetX Research platform from 2017 to 2024. Patients were stratified by injection approach (DL or FL). The two cohorts were balanced via propensity score matching for age at time of procedure, sex, race, and ethnicity. Diagnoses of dyspnea, stridor, dysphagia, odynophagia, persistent dysphonia, and laryngeal edema were compared between the two groups from the day of the procedure to three months postprocedure.

Results: A total of 6921 and 6832 patients underwent IL via DL and FL, respectively. Patients undergoing IL via DL had higher odds of experiencing dyspnea (OR = 1.375, P = 0.0014), stridor (OR = 4.443, P < 0.0001), and laryngeal edema (OR = 1.782, P < 0.0001), but had improved voice outcomes with lower odds of persistent dysphonia (OR = 0.568, P < 0.0001). Odds of developing dysphagia or odynophagia were comparable between the two cohorts.

Conclusion: IL procedures performed via DL were more likely to be associated with airway-related complications but had better voice outcomes up to three months after the procedure. Future study is needed to better determine the etiology of these complications to improve safety and efficacy.

Objectives: The Singing Voice Handicap Index (SVHI) was culturally adapted and validated in Greek to examine the impacts of voice problems on a singer's everyday life.

Methods: The translated version was administered to 120 singers in total, along with the translated version of the Voice Handicap Index (VHI), a sort voice history questionnaire, two Self-Rating Dysphonia Severity Scales (SRDSSs), and two visual analog scales. A week after the original completion of the Greek version of SVHI, a second copy of the SVHI was administered to 50% of the participants.

Results: The results showed high test-retest reliability (Pearson correlation coefficient (PCC): 0.859, P = 0.000) and excellent internal consistency (Cronbach's Alpha = 0.960). A significant difference between healthy and voice disordered singers emerged (18.01 ± 13.213, 43.26 ± 20.196; K-W: P = 0.000; ROC: Area = 0.863, Std. = 0.041, P = 0.000). Also, high concurrent (Spearman's rho 0.55, P = 0.000) and face (Spearman's rho: SRDSS₁ 0.481, P = 0.000; SRDSS₂ 0.504, P = 0.000) validity scores were observed. Regarding the relation of the demographic variables or habits that could relate to voice disorders, only the years of experience (PCC: -0.240, P = 0.008) and singing lessons (Spearman's rho: -0.286, P = 0.002) had a strong correlation with SVHI.

Conclusions: In conclusion, the Greek version of the SVHI questionnaire was validated successfully as a reliable tool with proper internal consistency. It will serve as a suitable and valuable instrument for self-evaluation of a vocal difficulty's effects on a singer's day-to-day life.

Introduction: Straw phonation therapy, a form of semi-occluded vocal tract (SOVT) exercise, is commonly used to help treat various voice disorders. Although straw phonation therapy has been studied extensively for decades, the impact of straw depth on vocal function remains unexplored. This study aims to quantify the effects of various straw vocal tract insertion depths (VTID) into the vocal tract on common aerodynamic parameters such as phonation threshold pressure (PTP), phonation threshold flow (PTF), and phonation threshold power (PTW) in an ex vivo canine model. It was hypothesized that increasing the VTID of the straw would reduce the PTP, PTF, and PTW.

Methods: Five excised canine larynges were mounted on a pseudolung apparatus and attached to a simulated vocal tract in an acoustic sound booth. Two straw depths (20.0 and 60.0 mm) were tested to determine the effect of VTID on ease of phonation as indicated by the aerodynamic parameters of PTP, PTF, and PTW. The control had no straw and a VTID of 0.0 mm. The straw diameter and length above the simulated vocal tract were consistent between the straws. Sustained phonation was achieved, and aerodynamic data was collected and analyzed.

Results: Both straw treatment groups exhibited significant reductions in PTP and PTW compared to the control. However, there were no significant differences between the 20.0 or 60.0 mm straw depths in PTP, PTF, or PTW.

Conclusion: The presence of a straw significantly reduced PTP and PTW, but VTID did not appear to influence these outcomes. This supports previous straw phonation therapy research suggesting that straw phonation therapy is beneficial primarily due to the presence of the straw rather than the depth of insertion. Future studies should explore the combined effects of varying straw diameters, lengths, and depths to optimize SOVT therapy for clinical use.

Objectives: The objectives of this study were to compare the auditory perceptual voice quality in young and older adults who had no self-reported voice complaints and to investigate the relationship of voice quality with age and gender in older adults.

Study design: This is a retrospective study.

Materials and methods: This study included 114 participants. The study group comprised 57 older adults (24 men, 33 women) with a mean age of 72.6 ± 0.76 years, while the control group included 57 young adults matched by gender. All participants reported no voice complaints and scored less than 19 points on the Voice Handicap Index. Clinicians applied the GRBAS (Grade, Roughness, Breathiness, Asthenia, and Strain) auditory perceptual assessment protocol to evaluate the voice quality of the participants of the study and control groups.

Results: More than half of the study group (50.9%) were rated as having mild voice abnormality (G1) based on the GRBAS auditory perceptual assessment protocol, while 21.1% exhibited moderate (G2). In contrast, only 19.3% of the control group participants had mild voice abnormality. The study group demonstrated statistically worse voice quality compared to the control group. Furthermore, participants over 75 years of age had statistically higher G ratings compared to those under 75. No significant difference was found between the G category and gender in older adults.

Conclusions: The present study's findings indicate that compared to younger adults, older adults perceive voice quality deviation less than clinicians do. Furthermore, it is found that the deviation in voice quality among older adults was influenced by age but not by gender. This study highlights the need for screening and early identification/prevention of voice disorders in older adults.

Objective(s): To assess the prevalence of Helicobacter pylori in Reinke's edema patients. To evaluate and compare the disease severity of patients who are H. pylori positive with those who are H. pylori negative.

Methods: In this prospective study, subjects were recruited at the time of Reinke's edema diagnosis using flexible laryngoscopy between March of 2022 through August of 2022. Participants completed a Voice Handicap Index (VHI-10) survey and then underwent a H. pylori IgG blood test to identify infection. The severity of Reinke's edema, grade, and type were determined by a fellowship trained laryngologist.

Results: Thirty one patients participated. The cohort was 19% male. 38.7% of the cohort had a positive H. pylori test. Men had significantly greater smoking exposure in pack years than women (P = 0.003). Interestingly, the total VHI-10 score was significantly greater in patients negative for H. pylori (P = 0.05). This was also true for four of the VHI-10 domains. Patients positive for H. pylori had significantly more severe Reinke's edema in terms of type (P = 0.03) and grade (P = 0.01).

Conclusions: There is a significant relationship between H. pylori status and the severity of Reinke's edema, with patients H. pylori positive having a greater grade and type of Reinke's edema. There is also a significant inverse relationship between H. pylori status and dysphonia, a subjective Reinke's symptom.

Level of evidence: III.

Objectives: The purpose of this study was to analyze cepstral changes following intensive voice-focused treatment in Spanish speakers with Parkinson's disease (PD). A secondary aim of the study was to explore the relationship between cepstral values across time and perceptual data across speech subsystems.

Study design/methods: This study followed a one-group pretest-post test design. The smoothed cepstral peak prominence (CPPS) of conversational sentences was analyzed pretreatment and post treatment and at a 1-month follow-up session in 15 Spanish-speaking individuals with PD. A secondary data analysis was then conducted to examine CPPS values relative to perceptual changes in voice quality (VQ), ease of understanding, articulatory precision, resonance (RES), and prosody across time points.

Results: A significant difference in CPPS was established between speakers with mild and moderate dysarthria at pre treatment only. No significant differences were observed between groups at post treatment or follow-up. Within groups, both sets of speakers evidenced significant increases in CPPS post treatment as well as from pre treatment to follow-up. A positive and statistically significant correlation was observed between CPPS scores and the perceptual values for VQ and RES, irrespective of the stage of treatment.

Conclusions: Intensive voice-focused treatment may lead to improved VQ, as measured by the CPPS, in ecologically valid contexts, such as those involving conversations, with gains maintained in the short-term. Additionally, this type of treatment may result in a positive distribution of effects involving not just perceived VQ but also improved perception of RES.

Background: The neck, and specifically the prominence of the thyroid cartilage, can be considered a marker of male gender, which is often unwanted by transgender women. Chondrolaryngoplasty is traditionally performed using an open transcervical approach, which, while effective, leaves visible scars that can compromise patient satisfaction. Recent advancements, such as the transoral endoscopic vestibular approach (TOEVA), have emerged as promising alternatives, eliminating external scars and improving esthetic outcomes.

Methods: Endoscope-guided transoral buccal dissections of five human cadavers' necks were performed to visualize and expose the thyroid cartilage, followed by the chondrolaryngoplasty procedure by the same route. The technique involved three oral vestibule incisions for trocar placement, subplatysmal dissection, and resection of the thyroid cartilage prominence using laparoscopic instruments. A specially designed endoscopic rasp was utilized to refine cartilage contours.

Results: Chondrolaryngoplasty using a transoral approach proved feasible, allowing the thyroid prominence to be reduced without an apparent scar. Visualization and instrument manipulation were successful in three cases, with adaptations required in two cases due to rigor mortis altering anatomical positioning. Complications included two minor skin perforations and instrument breakage in a case with calcified cartilage, necessitating alternative tools. There were some complications related to cadaveric phenomena.

Conclusion: Performing the procedure on cadavers presented some limitations related to cadaveric phenomena, such as skin stiffness and loss of elasticity, as well as difficulties with mobility, making the surgical procedure difficult. Despite these challenges, the procedure achieved satisfactory esthetic outcomes, with precise cartilage reduction and no visible scars. The procedure proved to be viable, achieving the goal of reducing the prominence of the thyroid cartilage while avoiding an apparent scar. Further clinical studies are suggested.

Objectives: As professional voice users, speech and language pathologists (SLPs) follow vocal hygiene behaviors both in the rehabilitation of voice disorders and in preventive interventions to reduce the risk among healthy users. However, it is curious to what extent SLPs adhere to vocal hygiene and healthy vocal behaviors and how this affects vocal fatigue. This study aims to investigate the extent to which SLPs perform vocal hygiene behaviors, their levels of vocal hygiene, and vocal fatigue.

Method: An online survey with 22 questions was developed to assess participants' healthy vocal behavior. In addition, the Voice Fatigue Index was employed to determine participants' levels of vocal fatigue. These two data collection tools were sent online to intern speech and language therapy students and professionals in Türkiye. Including student and professional SLPs, a total of 120 individuals partook in the study. The data were analyzed through SPSS 23.0. Descriptive statistics, Mann-Whitney U test, Kruskal-Wallis test, ANOVA, pearson correlation, and Tukey post hoc test.

Results: Almost half of the participants (40.8%) stated they were careful about vocal health. No significant difference was concluded between the student and professional SLPs in terms of compliance with the vocal hygiene behaviors. Vocal Fatigue Index scores of both groups were high, but significantly high for the professionals (P < 0.05).

Conclusion: SLPs, an intern or not, seem to find it difficult to fully practice what they preach, leading to concerning fatigue levels. SLPs should regulate their living conditions to comply more with appropriate vocal hygiene behaviors.

Introduction: Patient-reported outcome measures (PROMs) represent an important part of a comprehensive voice assessment for clinical care and research. Access to multilingual PROMs enables inclusion of information from diverse patient populations. This review compares available translated and validated PROMs for adult dysphonia.

Methods: A comprehensive review of Cochrane Library, PubMed, and OnBase was performed for PROMs evaluating adult dysphonia in all languages. References were additionally queried. PROM development process, available languages, and study group demographics were compared between PROMs available in at least one language other than English. Cultural validation for each PROM was assessed against Beaton et al's six-stage cross-cultural adaptation guidelines.

Results: Of 21 PROMs assessing adult dysphonia, 13 (62%) were available in one or more language other than English, and nine (43%) were available in seven or more. Voice Handicap Index (VHI) and VHI-10 were the most widely available translated questionnaires (n = 29, n = 15) followed by Vocal Fatigue Index (VFI), Singing-VHI (S-VHI), and Voice-Related Quality of Life (V-RQOL) (n = 11). Identified questionnaires were available in English (n = 21), Persian (n = 9), Kannada (n = 8), and Turkish (n = 7) as the most common languages. Females averaged 60% (range 13%-81%) of dysphonic subject groups and 59% of non-dysphonic subject groups (range 20%-88%). Of the 113 articles that reported cultural validation techniques, 16 (14%) adequately fulfilled the cross-cultural adaptation guidelines used.

Conclusion: Multilingual PROMs for dysphonia are widely available, but linguistic representation varied. VHI, VFI, S-VHI, and V-RQOL are the most widely translated. The most represented languages were Persian, Kannada, and Turkish. Few studies adequately followed cross-cultural adaptation standards. Efforts to translate and validate questionnaires into different languages may allow more diverse assessment and comparison of larger populations with dysphonia. This review identifies translated PROMs for dysphonia and analyzes their level of cultural validation for future use.

Objective: To systematically assess the current state of speech-language-hearing (SLH) practices in health services addressing vocal care for transgender individuals, aiming to identify key themes and gaps in the existing body of knowledge.

Methods: This scoping review was based on the Joanna Briggs Institute manual and followed the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses-Extension for Scoping Reviews. It was registered with the Open Science Framework Open Source 10.17605/OSF.IO/BUCRG.

Results: Altogether, 1517 studies were found. After excluding duplicates and applying the eligibility criteria, 103 articles were chosen for the review. The studies addressed topics such as vocal training, case/experience reports, barriers to access services, SLH pathologists' and students' perception and knowledge about the transgender voice, evaluation of programs and services, transgender people's perception and knowledge about their own voice and SLH care, acoustic/auditory-perceptual evaluation, protocols, instruments, impacts of voice on quality of life, verbal and nonverbal communication, and hormone therapy and surgeries.

Conclusions: The summary of the studies reflects the diversity of methods applied in research on transgender people's communication and voice, as well as the variety of topics. Despite the increasing publications on vocal care for transgender people, it is necessary to ensure the dissemination of evidence to support effective practices that recognize and enhance the diversity of this population. Literature data have promising SLH procedures and useful protocols to assess this population. However, they do not clearly indicate what the transgender population actually wants and needs. Furthermore, the study types have not progressed in a coherent order-that is, from preliminary studies to those with more robust methods. Thus, such knowledge may lack consolidation. Many answers to questions in both clinical and academic practices are still not entirely clear. However, it is believed that the advancement of studies will clarify them.