Journal of Voice最新文献

Objective: Despite anecdotal evidence highlighting the benefits of singing teacher involvement in voice rehabilitation for effective and sustainable biopsychosocial treatment of vocal injury, singing teachers working as singing voice rehabilitation specialists (SVRS) in the United Kingdom (UK) have often been criticized for working beyond their scope of practice. With limited empirical research into the role, concern and confusion has fueled challenges to its legitimacy. The lack of regulation raises questions around safeguarding, skills, and demarcation of roles within the multidiscipline team. Previous research into patient experiences in the voice clinic has suggested hierarchy and power imbalances between patients and clinicians are impeding development of rehabilitation practices and outcomes. The aim of this pilot study is to explore whether similar socioeconomic and epistemological structures are perceived as contributing to critique of SVRS involvement in rehabilitation and whether formal professionalization of the role may provide a solution to the debate.

Methods: To systematically explore the views and experiences of professionals working in the multidisciplinary voice clinic team in the UK, a deductive, qualitative methodology was adopted. Recognizing the majority female workforce in this context, MFST was applied to semistructured interviews with nine female-identifying participants: three Otolaryngologists, three SLTs, and three SVRS. Data were analyzed according to the themes and concepts of materialist feminism, using in vivo and embodied facial coding to capture verbal and non-verbal communication.

Results: Participants viewed the SVRS role as a positive addition to clinical practice. They indicate that in their experiences, some of the concepts found in materialist femininist analysis of organizations and women's role in the workplace hold true, and may be reasonably said to contribute to skepticism surrounding the SVRS role. They suggest there are challenges and benefits to professionaling the role. These relate to relationships, management and oversight; navigating and respecting professional identity; individual scope of practice, skills, and qualifications; establishing and managing shared ethical and economic values.

Conclusion: Overall, professionalization for SVRS was viewed positively, to enhance integration into existing workplace structures. Professional training, certification, and regulation was felt to be important for creating a shared language between clinicians and nonclinicians. It was noted, however, that there are challenges within the current medical paradigm, which would be less advantageous to pursue. The requirements of professionalization should be carefully negotiated alongside the current freedoms and creative practices employed by SVRSs.

Objectives: To assess depression and perception of vocal handicap in individuals with and without early-stage Alzheimer's disease (AD) using a self-report method.

Methods: It was conducted between April 2024 and June 2024 with individuals who visited the Internal Medicine Clinics of Çankırı State Hospital, including those with AD (study group: n = 41) and those without AD (with normal cognitive levels) (control group: n = 50). 41.46% (n = 17) of the study group were female, 53.54% (n = 24) were male. 56% (n = 28) of the control group were female, 54% (n = 22) were male. The Personal and Medical Characteristics Information Form, The Standardized Mini-Mental State Examination, the Geriatric Depression Scale (GDS), and the Voice Handicap Index-10 (VHI-10) were used. For the perception of vocal handicap, participants were asked to respond to the question, "How do you describe your voice at the moment?" by choosing one of two options: good or bad, to express their opinion.

Results: The study group scored significantly higher on the GDS than did the control group (t = (89) = 3.043, P = 0.03). Similar results were obtained in the VHI-10 scores of the two groups (t = (89) = 0.892, P > 0.05). The study group reported a worse perception in their responses to the question regarding perceived of vocal handicap (χ²(1) = 28.145, P < 0.001). A significant relationship was found between the GDS results of the study group and the perceived vocal handicap (χ²(2) = 20.246, P < 0.001). A moderate positive correlation was found between VHI-10 and GDS (r = 0.508, P = 0.001).

Conclusion: The voice is an important tool that individuals use for communication with their environment. While individuals with AD are at risk for depression, the current impact of the disease also affects their perception of vocal handicap. It is thought that broad-spectrum evaluations could be guiding for healthcare professionals working in geriatrics to better understand AD.

Parkinson's disease (PD) is a neurodegenerative disorder affecting motor and non-motor functions, including speech. This study evaluates the effectiveness of the audio spectrogram transformer (AST) model in detecting PD through vocal biomarkers, hypothesizing that its self-attention mechanism would better capture PD related speech impairments compared to traditional deep learning approaches. Speech recordings from 150 participants (100 from PC-GITA: 50 PD, 50 healthy controls (HC); 50 from Italian Parkinson's voice and speech (ITA): 28 PD, 22 HC) were analyzed using the AST model and compared against established architectures including VGG16, VGG19, ResNet18, ResNet34, vision transformer, and swin transformer. Audio preprocessing included sampling rate standardization to 16 kHz and amplitude normalization. The AST model achieved superior classification performance across all datasets: 97.14% accuracy on ITA, 91.67% on Parkinson's Colombian - Grupo de Investigación en Telecomunicaciones Aplicadas (PC-GITA), and 92.73% on the combined dataset. Performance remained consistent across different speech tasks, with particularly strong results in sustained vowel analysis (precision: 0.97 ± 0.03, recall: 0.96 ± 0.03). The model demonstrated robust cross-lingual generalization, outperforming traditional architectures by 5%-10% in accuracy. These results suggest that the AST model provides a reliable, non-invasive method for PD detection through voice analysis, with strong performance across different languages and speech tasks. The model's success in cross-lingual generalization indicates potential for broader clinical application, though validation across more diverse populations is needed for clinical implementation.

Objectives/hypothesis: Assess the impact of the infraglottal medialization technique on acoustics and the vertical stiffness gradient of the vocal fold using excised canine larynges.

Methods: Seven ex vivo canine larynges were tested in three states: 1) no implant, 2) medialized using a glottal implant, and 3) medialized fold using an infraglottal implant. Outcome measures were vocal efficiency and stiffness of the fold. Stiffness was measured using the indentation technique in three height levels of the fold to assess the vertical stiffness gradient.

Results: Infraglottal medialization improved vocal efficiency in all larynges tested and was superior to the improved efficiency seen with glottal medialization. Infraglottal medialization increases the vertical stiffness gradient of the vocal fold. While glottal medialization increased overall vocal fold stiffness, it did not enhance the vertical stiffness gradient.

Conclusion: Infraglottal medialization improves vocal efficiency and vertical stiffness gradient. Stiffness gradient might be the mechanism behind the creation of the glottal divergent angle by infraglottal medialization, a finding that was observed in a previous study. These results provide valuable guidance to clinicians in selecting implant location and medialization techniques, offering the prospect of enhanced vocal outcomes. In addition, it sheds light on some principles in vocal fold vibration mechanics.

Level of evidence: NA.

Objective: To verify changes in acoustic parameters, namely jitter, shimmer, and standard deviation of the fundamental frequency (dp f_o), through the life span of vocally healthy Brazilian Portuguese speakers.

Method: In total, 526 voice recordings of subjects without complaints and without vocal disorders, aged between 5 and 93 years old, were included. The recordings were divided into 12 age groups (5 to 7, 8 to 9, 10 to 11, 12, 13 to 15, 16 to 18, 19 to 29, 30 to 39, 40 to 49, 50 to 59, 60 to 69, and 70 to 93 years old). Acoustic analysis was carried out, based on the sustained emission of the vowel /a/, extracting the parameters jitter, shimmer, and dp f_o, using the Multi-Dimensional Voice Program software. The two-way ANOVAtest was used to investigate possible differences between age groups, followed by the Sidak Post-Hoc test.

Results: Related to jitter, children present higher values compared with the elderly. In adults and the elderly, the jitter measurement does not reflect the changes resulting from aging in both sexes. Women have a higher jitter value compared with men. As for the shimmer, this measurement is high in the child population with stability during adulthood and, in the elderly, it was observed that the shimmer was sensitive to indicate vocal changes in the male population. In general, there are no sex differences on this measurement. Finally, for dp f_o, the study found higher values in the child population, with a reduction with aging until stabilizing in adults and the elderly. Higher values were observed for females compared with males.

Conclusion: Jitter, shimmer, and dp f_o changed through the life span, being elevated for the child population, remaining stable in the adult population, and with smaller changes during aging.

Objective: Serial intralesional steroid injections (SILSI) are increasingly used in the treatment of idiopathic subglottic stenosis (iSGS) and auto-immune related subglottic stenosis (SGS), which are both known for their high rate of recurrences. SILSI could potentially prolong the time to re-intervention. We evaluated the effects of adjuvant SILSI in iSGS and auto-immune related SGS-patients on time to reintervention and spirometry results.

Methods: A total of 16 consecutive subjects undergoing SILSI from 07/2018 were included in this consecutive case-series. All patients were treated with surgical endoscopic dilatation (ED) followed by SILSI (ED + SILSI). A subgroup of patients (no. 7/16) were previously also treated with solely ED. In this subgroup, outcome measures could be compared before and after adding SILSI within the same patient. Outcome measures included time to reintervention, side effects, and spirometry results expressed in Δarea under the curve_total/forced vital capicity (AUC).

Results: Of all patients, 8/16 (50%) underwent at least one reintervention post ED + SILSI after a mean time of 14 months. In the subgroup, the median of the mean time to reintervention improved from 12 (interquartile range = 6) months post ED to 18 months (IQR = 8) post ED + SILSI. The median difference in AUC was 1.27 (P = 0.022; 95% CI: 0.51-3.05). No patients developed serious side effects during SILSI.

Conclusion: Adjuvant SILSI after ED potentially prolongs time to reintervention in iSGS and auto-immune SGS patients. It is, however, still unclear which patients benefit most. The decision to incorporate this adjuvant treatment should be made in shared decision making between surgeon and patient.

Level of evidence: 4:

Objectives: In voice production, interactions occur between the oscillating vocal folds, the respiratory system, and the vocal tract. However, it is not yet sufficiently understood how the respiratory system could affect the vocal tract configuration. It is hypothesized that a reduction in tracheal pull, caused by decreasing lung volume, along with shifts in dominant exhalation forces (from inspiratory to expiratory muscles), leads to a larynx elevation with shortening of the vocal tract tube, and consecutively, articulatory adjustments to preserve consistent sound quality.

Methods: Seventeen professional operatic singers performed a maximum phonation time task on comfortable pitch while being recorded with dynamic 2D-magnetic resonance imaging (MRI) (25 fps, pixel resolution of 1.6 x 1.6 mm²) including simultaneous audio recording. From the MRI footage, articulatory movements were calculated for vertical larynx position, pharynx width at the narrowest point, lip opening, jaw opening, and jaw protrusion. Spectral data were extracted from the audio signals after noise reduction.

Results: The larynx moved in cranial direction in 5 of 9 female and 3 of 8 male participants during the phonatory exhalation. Such movement was directly counteracted by other articulators in four cases. In 12 of the subjects, articulatory and/or spectral events in the form of adaptions or twitches occurred around and after 50% of the phonation time. Most subjects exhibited changes in articulator positioning as well as adjustments to the subsequently sustained fundamental frequency during the first and last 10% of the sustained phonation.

Conclusions: The articulatory movements during the task were non-systematic. Sudden events/adaptations in the second half of the phonatory exhalation could potentially mark a passage of the REL. The cranial movement of the larynx could be attributed to the decreasing tracheal pull; however, this was not evident in all subjects, suggesting a high degree of individuality in the regulation of respiratory movement in relation to vertical larynx position. Overall, the data indicate that it is important to consider continuous and sudden articulatory movements during sustained measurements.

Objective: To investigate the laryngopharyngeal reflux disease (LPRD) features in singers.

Methods: According to the PRISMA statements, two investigators searched the literature related to the prevalence of symptoms, findings, and clinical therapeutic outcomes of reflux in singers through a PubMed, Scopus, and Cochrane Library systematic review.

Results: Of the 91 identified studies, 18 publications met the inclusion criteria, accounting for 2288 singers and 1398 controls, respectively. There were 1243 (54.3%) professional singers, 450 (19.7%) amateurs, 329 (14.4%) singing students, and 102 (4.5%) singing teachers. The LPRD diagnosis and findings were based on objective evaluations in 2/18 studies. According to validated and unvalidated patient-reported outcome questionnaires, reflux symptoms have been found in 25.0% to 65% of singers, with a RSI > 13 in 25.0%-33.9% of cases. The prevalence of LPRD signs ranged from 18.1% to 73.4% of singers without voice complaints and 18.1%-73.4% of singers with voice complaints at the time of the evaluation. No study investigated the pretreatment to post treatment changes in symptoms, findings, and voice outcome. Substantial heterogeneity was found between studies for reflux diagnosis, symptom and sign evaluations, singer profiles (musical styles, voice range), and association outcomes.

Conclusion: The prevalence of symptoms and findings attributed to LPRD can be high in singer populations. However, the nonspecificity of symptoms and findings, the lack of objective reflux testing, and the heterogeneity in the singer profile limit the drawing of valid conclusions for the prevalence of LPRD. Based on the findings collected in this systematic review, the authors proposed a semistructured questionnaire, including key points for primary singer evaluation.

Aim: To investigate the occurrence of auditory impairments in individuals with dysphonia and to describe the results of behavioral and electrophysiological audiological assessments in this population.

Study design: A scoping review.

Method: A scoping review following the guidelines of the Joanna Briggs Institute Manual for Evidence Synthesis for Scoping Reviews and PRISMA-ScR. A search was carried out using the electronic databases PubMed, Scielo, and Lilacs, as well as the gray literature via Google Scholar. Using the Rayyan platform, the selection and extraction of data from the studies was carried out independently and blindly by two reviewers, with excellent agreement. The studies included in the review were subjected to extraction of the following information for analysis: authors, year of publication, objective, sample characteristics, dysphonia classification, audiological assessment procedure, and conclusion.

Results: About 100 studies were found, and 13 eligible studies were included in the analysis. Of the studies included, 92.3% (n = 12) adopted cross-sectional designs, 76.9% (n = 10) investigated auditory functions in individuals with behavioral dysphonia, and 23.1% (n = 3) with organic dysphonia. The samples consisted of children in 53.8% (n = 7) of the studies and adults in 46.2% (n = 6), both with dysphonia. Around 53.80% (n = 7) of the studies included control groups without dysphonia. As for audiological assessment methods, 53.8% (n = 7) used behavioral tests of central auditory processing, 15.4% (n = 2) electrophysiological assessment, and 30.8% (n = 4) a combination of both.

Conclusion-: Individuals with dysphonia, especially of the behavioral type, may have deficits in auditory function. The main impairments refer to central auditory processing, especially in skills involving temporal processing, figure-ground skills, and auditory closure. Electrophysiological assessment does not show any significant differences between individuals with and without behavioral dysphonia. However, the frequency of follow-up response has a potential for greater impairment in this population. In cases of organic dysphonia, small and inconsistent impairments have been found, such as prolonged latencies of auditory potentials.

Objectives: There is no Azerbaijani-Turkish scale for assessing voice-related quality of life (V-RQOL). This study aimed to adapt the V-RQOL questionnaire to Azerbaijani-Turkish and evaluate its validity and reliability through cross-cultural adaptation.

Study design: A cross-sectional and prospective validation design was adopted.

Methods: The V-RQOL was translated and culturally adapted into the Azerbaijani-Turkish language according to the methodology of standard forward-backward translations to obtain semantic, idiomatic, and conceptual equivalence. The study included 160 participants, with 80 having voice disorders and 80 not having voice disorders. Content validity with four experts through cognitive interviewing and face validity and the pilot study with 10 voice patients was performed. The construct validity was calculated by comparing the total score of the Azerbaijani-Turkish version of V-RQOL (AT-VRQOL) with the self-assessment results. The internal consistency of V-RQOL was examined using Cronbach's alpha coefficient. To calculate the test-retest reliability coefficient, the AT-VRQOL was completed twice by 30 participants, including 20 with voice disorders and 10 without voice disorders, at intervals of 2 weeks.

Results: Differences in the V-RQOL scores between participants with and without voice disorders were statistically significant (P < 0.001). The construct validity results showed that the total score of V-RQOL with the self-assessment results is correlated (r = 0.88, P < 0.001). The area under the curve value from the receiver operating characteristic curve was 100. The optimal cut-off point was 21.25, with a sensitivity of 80% and a specificity of 100%. The AT-VRQOL had high internal consistency, indicating excellent reliability (Cronbach's alpha coefficient = 0.98). The total V-RQOL scores obtained from the two administrations of the test-retest reliability were examined. It was found that there was a high degree of correlation between the scores obtained in the two administrations (r = 0.99, P < 0.001).

Conclusions: The AT-VRQOL is a valid and reliable scale that can assess patients with voice disorders in a simple, easy, rapid way to apply and not time-consuming.