Journal of Voice最新文献

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.