Journal of Voice最新文献

Objective: Different from normal or expiratory phonation (EP), inspiratory phonation (IP) involves the use of an ingressive airflow and it is frequently used in clinical voice assessment and treatment. The present study examined the voice quality and glottal vibratory characteristics associated with IP through acoustic (AC) and electroglottographic (EGG) analyses.

Methods: The AC and EGG signals of the vowel /i/ produced by 43 young, vocally healthy adults using IP and EP were simultaneously recorded and analyzed using Praat. Contact-related measures derived from EGG signals included contact quotient (CQ), CQ perturbation (CQP), contact index (CI), relative contact rise time (RT), amplitude of contact phase (Amp_con), slope of contacting phase (Slope_con), and slope of decontacting phase (Slope_decon). Additionally, fundamental frequency (F0), percent jitter (%Jitter), percent shimmer (%Shimmer), and harmonic-to-noise ratio (HNR) were extracted from both EGG and AC signals.

Results: CQP, CI, and RT increased and Amp_con and Slope_con decreased when using IP, but no significant differences in CQ and Slope_decon between EP and IP. F0_EGG, %Jitter_EGG, and %Shimmer_EGG increased during IP, while HNR_EGG decreased. Similarly, F0_AC, %Jitter_AC, and %Shimmer_AC increased during IP, with no significant difference between IP and EP for HNR_AC.

Conclusions: Marked differences in glottal vibration were identified for IP when compared with EP, with the latter having been studied more extensively. Given the clinical value of IP, further characterization is warranted to elucidate the specific role this maneuver may play in the differential diagnosis and treatment of laryngeal pathology.

Background: Presbylarynx refers to age-related changes in the larynx that can manifest clinically as presbyphonia. Several underlying mechanisms remain unclear.

Objectives: Perform a scoping review of the published literature on the mechanisms of presbyphonia in order to provide an adequate, comprehensive assessment of aging voice.

Methods and results: A scoping review on Medline, Cochrane, and Scopus included 188 published articles. Laryngeal aging results in calcifications of the hyaline cartilages, decreased vocal folds lubrication, decreased neuromotor transmission, decreased hyaluronic acid, increased lamina propria stiffness, and changes in the thyroarytenoid muscles. Concomitant aging of the respiratory system, collateral effects of age-related hormonal changes, concomitant presbycusis, and medical comorbidities interact with the presbylarynx to induce clinically detectable voice aging changes (a weak, breathy, or hoarse voice). Based on the results of our study, we proposed a comprehensive assessment of the aging voice, including all the factors involved.

Conclusion: This scoping review proposes a comprehensive assessment of presbyphonia based on the available data. We believe that this assessment will allow a more personalized approach to treatment.

Objectives: This study conducted a subjective 6-month follow-up to evaluate voice and swallowing changes after thyroid surgery in patients without clinical evidence of recurrent nerve injury.

Methods: In this prospective cohort study, voice and swallowing alterations were assessed in 56 adult patients who underwent thyroidectomy, compared to 59 patients with laryngeal conditions and 60 controls. Voice and swallowing changes were measured using auditory perceptual assessment, laryngoscopy, the Arabic Thyroidectomy‑related voice and symptom questionnaire (A-TVSQ), the Arabic VHI (A-VHI), and Swallowing Impairment Scores (SIS-6). For the thyroidectomy group, the A-TVSQ, A-VHI, and SIS-6 were recorded preoperatively, as well as at 2 weeks and 6 months postoperatively.

Results: Significant differences were found in the preoperative median A-TVSQ (voice, neck, and total score), A-VHI, and SIS-6 across the three groups (P < 0.001). In the thyroidectomy group, A-TVSQ (voice, neck, and total score), A-VHI, and SIS-6 increased 2 weeks after surgery but showed significant improvement by 6 months (P < 0.001, 0.009, and <0.001, respectively). The total A-TVSQ remained significantly different across the three times. Although A-VHI scores slightly increased 2 weeks postoperatively (P = 0.741), they showed significant improvement by 6 months (P < 0.001). Risk factors for worse A-TVSQ scores at 6 months postoperative included professional status, type of surgery, and baseline questionnaire scores.

Conclusions: Following thyroidectomy, voice and swallowing changes are common within the first 2 weeks but improve by the 6-month period. Nearly 48% of patients experience voice and neck discomfort despite no signs of recurrent laryngeal nerve injury. The findings highlight the importance of further research into the factors contributing to these symptoms. Patients should be counseled that even in the absence vocal cord injury, voice and swallowing problems may occur post-surgery and may take time to resolve.

Objective: To map the procedures and characterize the results of multidimensional voice assessment of individuals with sleep-related breathing disorders.

Method: This scoping review searched the MEDLINE, LILACS, Scopus, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, ProQuest, and MedRxiv databases, manually searched citations, grey literature, and consulted with experts. It included studies whose participants had sleep-related breathing disorders and underwent voice assessment. Two calibrated reviewers independently searched, selected, and extracted data on publication, sample, and assessment; disagreements were resolved by consensus. The data were analyzed descriptively.

Results: The search found 1089 studies, of which 32 were selected. The sample comprised one study on catathrenia and 31 on obstructive sleep apnea. Acoustic analysis was the most used voice assessment procedure for sleep-related breathing disorders. The most frequent measures and instruments were jitter and fundamental frequency in acoustic analysis; maximum phonation time in aerodynamic assessment; GRBAS in auditory-perceptual judgment; Vocal Handicap Index-10 in vocal self-assessment; and videolaryngostroboscopy in laryngeal imaging. Shimmer and jitter were the measures most used to distinguish individuals with and without sleep-related breathing disorders and most verified as abnormal in individuals affected by such conditions.

Conclusion: Obstructive sleep apnea is the most studied sleep-related breathing disorder in the voice clinic. Acoustic analysis was the most used method to assess sleep-related breathing disorders, with disturbance measures being the most altered, and the most used to differentiate individuals with and without sleep-related breathing disorders.

Objective: To review the current literature about surgical management and postoperative outcomes of posterior glottic stenosis (PGS).

Data sources: PubMED, Scopus, and Cochrane Library.

Methods: Three investigators conducted a comprehensive review of the literature related to the epidemiology, etiologies, and management of adult patients with PGS through the PRISMA statements.

Results: Twenty-eight retrospective studies met our inclusion criteria, accounting for 502 patients. Prolonged intubation (51.8%) was the most prevalent etiology. PGS required immediate tracheotomy in 57.6% of the cases. The mean postsurgery decannulation mean rate was 79.6%, ranging from 61.5% to 100% regarding procedures. There was a myriad of procedures used, the most common including postcricoid mucosa advancement flap, arytenoidectomy, and synechia incision. Voice, swallowing, and airway outcomes significantly improved in most studies following surgery. There was a substantial heterogeneity between studies in the PGS diagnosis, the procedure definition and technical features, and the postoperative outcomes. A few studies used objective airway and voice quality measurements to investigate the procedure effectiveness.

Conclusion: The management of PGS is associated with satisfactory decannulation rates and subjective improvements in voice and swallowing across various surgical procedures. However, this review highlights significant limitations, including the lack of controlled studies comparing these techniques and the overall low evidence level of existing research. Future consensus guidelines are needed for defining surgical procedures and determining the primary postoperative outcomes to evaluate in PGS.

Partial deafness (PD) is a hearing impairment that presents with normal hearing thresholds at low frequencies (up to 1 kHz), and deep hypoacusis at high frequencies. For many years, this type of hypoacusis has not been treated with typical hearing aids because of a low level of speech understanding improvement. Since the first worldwide PD cochlear implantation conducted in 2002, this type of hearing impairment became a subject of research also in the aspect of its influence on the patient's voice.

Purpose: This study aimed to examine whether voice disorders accompanying postlingual PD in adults present gender differences.

Methods: The study group involved 30 patients with post lingual PD (15 females and 15 males) in whom pre existing voice disorders were excluded. Voice samples were recorded and analyzed using Multi-dimensional Voice Program by Kay Pentax.

Conclusions: The study showed that adults with PD develop voice dysfunctions; however, no major differences between females and males were found.

Purpose: This study aimed to examine whether voice disorders accompanying postlingual PD in adults present gender differences. The word gender in the paper is understood as a set of biological attributes associated with physical and physiological features; therefore, is used as the equivalent of sex.

Introduction: The main goal of voice therapy is to reestablish the balance of the vocal system through myoelastic and aerodynamic forces. Therefore, the therapeutic method must focus on vocal physiology as a way of reversing the pathology and also be easy for the patient to internalize it. Water resistance therapy (WRT) can meet this demand. In addition, the use of sensorimotor learning (SML) principles can benefit the rehabilitation process. Then, the objectives of this study are to propose a therapeutic program based on the physiological approach and the principles of SML and to verify its effects on individuals diagnosed with behavioral dysphonia.

Methods: Experimental, prospective, and analytical study. Participants in this study were 11 volunteers, aged between 18 and 50 years, with vocal complaints and changes, which constituted a diagnosis of behavioral dysphonia. The volunteers underwent intervention with the WRT Program (with a silicone tube submerged in water), consisting of eight sessions lasting 30 minutes. The following SML principles were adopted: prepractice, practice amount, practice distribution, practice variability, practice schedule, attentional focus, and target complexity. To analyze the effect of the WRT Program, vocal economy and its components, cepstral peak prominence-smoothed (CPPs), alpha ratio, L1-L0, and the vocal and laryngopharyngeal symptoms intensity, the Vocal Fatigue Index (VFI) and the Voice Symptom Scale (VoiSS) were measured before and after the interventions. Data were analyzed using the paired t test and Wilcoxon Test (P < 0.05).

Results: The WRT Program showed an increase in the vocal economy (P = 0.004) and a reduction in the glottal contact quotient (P > 0.001). About acoustic measurements, they did not show statistically significant changes. However, concerning the vocal and laryngopharyngeal symptoms intensity, there was a decrease in "breaking voice" (P = 0.019), "hoarseness" (P = 0.003), "pain when speaking" (P = 0.021), and "strained speaking" (P = 0.005). Furthermore, there was a reduction in VoiSS (P = 0.001) as well as VFI in its total value (P = 0.001) and its subscale "physical discomfort associated with the voice" (P = 0.06).

Conclusion: The WRT Program, as proposed, has positive effects on voice economy and vocal comfort.

Recent research on schizophrenia seeks to identify objective biomarkers of the disease. The voice, and in particular the fundamental frequency (F0), could be one of them.

Methodology: We conducted a cross-sectional and descriptive study with a sample of 154 people. Of these, 46 were diagnosed with schizophrenia, 41 were at substance abuse, and 67 formed the control group, matched in variables of sex, age, and educational level, but without substance use compared with the high-risk group.

Results: The biomechanical analyses of the voice indicated significant differences between the groups, differentiated by gender: in men (F = 5.316; P = 0.006) and in women (F = 4.13; P = 0.004). The greatest differences between groups were observed in the group of vulnerable individuals, with some stability of the F0 in people with schizophrenia. Furthermore, we found correlations between positive symptoms and decreased F0 (r = -0.353; P = 0.016).

Conclusions: Our study shows that schizophrenia is associated with decreased F0 in both men and women, and that medication could stabilize this decrease. These findings have important implications for the objective monitoring and diagnosis of schizophrenia.

Transcranial direct current stimulation (tDCS) can be used to temporarily and reversibly modulate brain functions and is an increasingly utilized tool to investigate the relationships between brain and behavior. This study aimed to identify the brain area where tDCS has the greatest effect on vocal quality, vocal range, neuromotor functioning of the larynx, and self-reported vocal effort in vocally healthy individuals. Sixteen adults, non-singers, with a mean age of 22.5 (±1.9) years and no vocal symptoms or brain dysfunction, participated in this double-blinded randomized crossover clinical trial. The participants underwent four anodal tDCS session (20 minutes; 2 mA) in targeting different areas-cerebellum, primary motor cortex (M1), primary somatosensory cortex (S1), and dorsolateral prefrontal cortex (DLPFC)-with a 7-day washout period between sessions. Volunteers were evaluated for vocal performance before and after each tDCS session. Voice recordings were taken to assess the following vocal parameters: vocal range profile (VRP) at weak and strong intensities; vocal quality (jitter, shimmer, irregularity, glottal-to-noise excitation ratio, and dysphonia acoustic index) at weak, habitual, and strong intensities; laryngeal diadochokinesis, and self-reported vocal effort using the adapted Borg CR10 scale. M1 stimulation enhanced the VRP by increasing maximum intensity and improving vocal quality, particularly at habitual and strong intensities. Similarly, S1 stimulation improved vocal quality at strong intensities but reduced the VRP by lowering the maximum fundamental frequency. Cerebellum stimulation enhanced neuromuscular control and coordination of the larynx without affecting vocal quality. Additionally, self-reported vocal effort decreased across all stimulated areas following tDCS. Our findings indicate that tDCS applied to different brain areas produces varying effects on vocal parameters.

Many common voice disorders are associated with vocal hyperfunction (VH), with subtypes including phonotraumatic VH (leading to organic vocal fold lesions such as nodules and/or polyps) and nonphonotraumatic VH (often diagnosed as primary muscle tension dysphonia). VH has been hypothesized to influence baseline vocal fold tension during phonation, and the relative fundamental frequency (RFF) during onset and offset cycles of phonation has been related to vocal fold tension and has been shown to differentiate typical voices from patients with VH in laboratory settings. In this study, we investigated whether the laboratory sensitivity of RFF to the presence of VH found in the laboratory is preserved in naturalistic, in-field settings and whether ecological momentary assessment of RFF during daily life could be a correlate of self-reported vocal effort. RFF analysis was carried out after performing smartphone-based monitoring of anterior neck-surface vibration with accelerometer sensors in both laboratory and in-field settings. Supervised machine learning was applied to combine multiple RFF values to discriminate and classify patients with VH from vocally typical speakers. Results showed that RFF-based classification of VH can be preserved in the naturalistic environments for patients with phonotraumatic (81.3% accuracy) and nonphonotraumatic (62.5% accuracy) VH. Additionally, we used explainability techniques to understand which RFF features were clinically relevant in the classification tasks. No direct relationship was observed between RFF and self-reported vocal effort. Overall, this study advances our understanding about RFF as a potential biomarker of VH as individuals go about their daily life. Machine learning algorithms can be implemented within a monitoring device for proactive screening or in biofeedback-based voice therapy paradigms.