Journal of Voice最新文献

Objectives: To quantify characteristics of laryngeal electromyography with the laryngeal motor conduction study (LMCS) for evaluating laryngeal nerve injury.

Methods: This study included 809 patients with unilateral vocal fold paralysis. Quantitative parameters were measured on abnormal spontaneous activity, motor unit potential (MUP), recruitment patterns, and synkinesis of the affected thyroarytenoid (TA), posterior cricoid (PCA), and cricothyroid (CT) muscles. The proportion of recorded compound muscle action potential in LMCS was calculated to further divide muscles into LMCS+ and LMCS- groups, between which cut-off values for recruitment patterns were determined.

Results: In laryngeal muscles, amplitudes of fibrillation potentials were 90-100 μV and durations were 2.2-2.4 milliseconds, which were of 80-90 μV and durations of 4.8-5.0 milliseconds in positive sharp waves. Amplitudes of abnormal MUP showed increased amplitude compared to the normal, with prolonged durations of 6.16 ± 1.02 milliseconds, 6.57 ± 1.32 milliseconds, and 6.19 ± 1.19 milliseconds (P < 0.01). The amplitude and turns of abnormal recruitment were significantly smaller than those of normal laryngeal muscles (P < 0.01), with turns in the mixed and simple pattern being 30% and 20-25% of the full interference pattern, respectively. In mixed patterns, the LMCS- group exhibited smaller amplitudes, with cut-off values at 298.50 μV, 355.00 μV and 379.50 μV for TA, PCA and CT muscles.

Conclusions: Amplitude and duration are critical parameters for identifying abnormal spontaneous activity and MUP in laryngeal muscles, with duration being of higher specificity. Combined with LMCS-derived cut-off values for amplitude, the reduced turns can help distinguish recruitment patterns to assess the degree of laryngeal nerve injury.

Background: Subjective assessment of voice and speech disorders, often based on hoarseness or breathiness, suffers from limited interrater reliability. Objective, composite metrics-such as the acoustic voice quality index (AVQI) and the acoustic breathiness index (ABI)-offer more consistent and reproducible alternatives for diagnosis and monitoring, although they show some sensitivity to recording conditions.

Aim: The aim of this study is to analyze the contributions and dependencies of individual acoustic parameters to composite metrics. Building on this, the influence of room acoustics on objective measures and their parameters is systematically investigated.

Methods: Using close-microphone recordings with negligible reverberation, the contribution of individual parameters to the composite measures was determined through variance and value range analyses. In 35 speech and language therapy (SLT) rooms, acoustic parameters such as reverberation time, impulse response, and background noise were measured. Their influence on objective measures from real voice samples was analyzed using mixed linear regression.

Results: Variance analyses show that, in particular, smoothed cepstral peak prominence (CPPS) substantially contributes to the predictive power of the composite measures and has a dominant influence on the investigated voice quality metrics. The results also demonstrate a strong impact of room acoustics on measurement accuracy - especially for mildly pathological voices and for reverberant speech recordings. Reverberation time and clarity measures were found to be crucial influencing factors and predictors.

Conclusions: The investigated voice quality measures are largely determined by CPPS. However, CPPS is heavily influenced by room acoustic properties, which can cause unreliable prediction with indices such as AVQI and ABI. Despite these limitations, CPPS remains a strong predictor of perceptual grading and breathiness. For reliable use of objective voice quality metrics in clinical settings, standardization or optimization of recording conditions, or development of more robust analytical methods, is essential. These findings support the refinement of objective voice diagnostics and promote evidence-based approaches in SLT.

Objectives: Tonsillar hypertrophy can alter the vocal tract; however, the potential effects of partial and total tonsillectomy on pediatric voice characteristics have been relatively understudied compared to their impact on sleep-related problems and the management of tonsillitis. This study aimed to compare the effects of partial and total tonsillectomy on voice characteristics in pediatric patients over the first three postoperative months.

Methods: Forty-four children (4-12 years) undergoing total (n = 22) and partial (n = 22) tonsillectomy were evaluated preoperatively and at 1 and 3 months postoperatively. Voice outcomes were assessed using both subjective (Pediatric Voice Handicap Index [pVHI]) and objective measures, including Multi-Dimensional Voice Program parameters, cepstral analyses, and formant frequency evaluations.

Results: Both groups demonstrated a significant reduction in pVHI scores (P < 0.001) and mean fundamental frequency (F0) values (P = 0.037 for total, P = 0.006 for partial tonsillectomy), while jitter, shimmer, noise-to-harmonic ratio, and cepstral measures showed no significant postoperative changes. Formant frequency shifts, particularly in F1 and F2 of /i/, were more pronounced after total tonsillectomy, indicating subtle resonance alterations.

Conclusion: Tonsillectomy influences vocal output by reducing vocal tract resistance and lowering F0, even without direct vocal fold involvement. Preoperative counseling is recommended, particularly for children or parents concerned about potential resonance changes, as total tonsillectomy may cause subtle alterations in vocal tract resonance despite the absence of direct vocal fold involvement.

Introduction: There is evidence to suggest physiological impacts of seasonal allergic rhinitis (SAR) on the singing voice. Yet there is limited evidence surrounding the subsequent impact on perceived singing vocal quality from the perspective of singers.

Objectives: To investigate the impacts of SAR on the perceived vocal quality of adult choral/choir singers in Australia.

Study design: Quantitative cohort study design.

Methods: An anonymous online questionnaire was administered to professional and amateur singers in choral or choir contexts, with participant recruitment realized through active snowballing.

Results: A total of 32 participants completed the surveys: five (16%) professional singers, three (9%) teachers or instructors, three (9%) music students and 21 (66%) amateur choir/singing group singers. Twenty-six participants were identified as having SAR. Participants with SAR reported a greater frequency of negative vocal experiences impacting personal vocal performance and reported more severe challenges presented in their ability to sing than those without SAR symptoms. No significant difference was exhibited between male and female participants. Of the 26 participants with SAR, 13 (50%) reported using medication to treat symptoms. No difference was exhibited between participants who medicate for SAR and those who do not.

Conclusions: This study indicates a correlation between SAR-related vocal pathologies and the perceived impact on vocal performance and quality of life. Further research is needed to consider the impact of medication on a singer's vocal performance and ability to sing.

Background: Primary muscle tension dysphonia (MTD) is a functional voice disorder characterized by excessive laryngeal muscle tension, resulting in various voice quality impairments and associated symptoms. While voice therapy is recognized as the primary treatment approach, there remains limited evidence regarding the multidimensional effects of eclectic therapeutic interventions combining multiple evidence-based techniques.

Aim: To investigate the effectiveness of eclectic voice therapy on acoustic, aerodynamic, auditory-perceptual, and self-assessment voice parameters in patients diagnosed with primary MTD.

Method and procedures: Thirty patients (17 males, 13 females) diagnosed with primary MTD participated in this prospective cohort study. All participants underwent multidimensional pre- and post-therapy evaluations, including acoustic analysis (fundamental frequency, jitter, shimmer, noise-to-harmonics ratio [NHR], voice turbulence index, soft phonation index), respiratory and phonotary efficiency (maximum phonation time [MPT], s/z ratio), auditory-perceptual evaluation (Grade, Roughness, Breathiness, Asthenia, Strain [GRBAS]), and self-assessment scales (voice handicap index-10 [VHI-10], vocal fatigue index [VFI], vocal tract discomfort scale [VTDS]). The intervention consisted of eclectic voice therapy incorporating vocal hygiene education, head-neck relaxation exercises, tongue-out phonation, yawn-sigh technique, voice production with body movements, resonant voice therapy, and laryngeal manual therapy over eight weekly sessions.

Outcomes and results: Significant improvements were observed in acoustic parameters, including jitter (P = 0.009), shimmer (P < 0.001), and NHR (P = 0.022). MPT increased significantly from 11.03 seconds to 16.47 seconds (P < 0.001). All GRBAS parameters demonstrated significant improvements (P < 0.05). Self-assessment measures showed substantial reductions: VHI-10 scores decreased from 25.5 to 9.2 (P < 0.001). VFI total scores reduced from 44.9 to 18.47 (P < 0.001), and VTDS frequency and severity scores decreased significantly from 17.8 to 6.4 and 17.45 to 6.66, respectively (P < 0.001).

Conclusion and implications: Eclectic voice therapy demonstrated significant effectiveness across multidimensional voice parameters in patients with primary MTD. These findings support the clinical efficacy of combined therapeutic approaches that systematically integrate multiple evidence-based techniques in the management of primary MTD.

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.