Hoarseness Research Articles

Clinical evaluation of pediatric patients with recurrent respiratory papillomatosis.: A longitudinal study at a Saudi Arabian tertiary care center.

To study the clinical evaluation of recurrent respiratory papillomatosis (RRP) patients and the factors associated with the improvement in the Derkay's score as a measure of disease severity. A retrospective cohort that included all juvenile RRP patients who were admitted to King Abdulaziz University Hospital, Riyadh, Saudi Arabia, between September 2015 and June 2022 and underwent surgical debulking. A total of 16 patients were eligible to join our study. Among them, 7 patients were males. Hoarseness of voice was the most frequent symptom. The median period of the follow-up was 56 months. Complete remission was achieved in 31.3%. The univariate linear regression model revealed that the cidofovir-treated patients had a significant reduction in the change value of Derkay's score compared to those without treatment (regression coefficient= -5.83, 95% confidence interval [CI]: [-11.5 to -0.143], p=0.045). Also, the increased first Derkay's score decreased the change value and subsequently increased the improvement chance of the disease (regression coefficient= -0.424, 95% CI: [-0.764 to -0.083], p=0.018). However, in the multivariate regression model, both variables showed non-significant results. cidofovir treatment and higher Derkay's scores affected the disease improvement.

A comparative study of endotracheal tube cuff pressure changes in patients undergoing open abdominal and laparoscopic surgeries

Background: Laparoscopic surgeries are routinely performed because it’s minimally invasive and early recovery for patients. The preferred mode of anesthesia is general anesthesia with an endotracheal tube (ETT). The creation of the pneumoperitoneum and various positions cause cuff pressure (CP) changes. Aims and Objectives: We aim to study the CP changes and post-operative complications related to it. The secondary objective was to observe the post-operative complications such as sore throat, hoarseness of voice, and blood-streaked expectoration after extubation at 12 h, and at the time of discharge from the post-anesthesia care unit. Materials and Methods: One hundred and fifty patients undergoing elective open abdominal and laparoscopic surgeries were enrolled. Three groups (open abdominal [group A], n=50; lap head up [group B], n=50; and lap head down [group C], n=50) were compared for CP changes before and after pneumoperitoneum and position change. CP changes and post-operative complications were recorded and analyzed with Statistical Package for the Social Sciences version 19. Results: Mean differences in CP after intubation at 5 min were similar in all three groups. At 45 min onward, the mean CP in group C was found to be elevated and continued to increase till the end of surgery. However, at 90 min, group B also showed some increase in CP. There was a mild increase in CP in groups B and A. The mean difference between groups was found to be remarkable. During the post-operative period, there were 0.7% and 3.3% of cases with throat pain in group B and group C, and 2% of patients in group C had blood streak expectoration. Conclusion: In laparoscopic surgery, especially in a head-down position, a considerable increase in CP is associated with postoperative complications.

Dysphonia as a Speech Disorder

Oral communication is one of the most important forms of communication. It is through which the speaker directly delivers the content of the verbal message to the addressee. Usually, the existence of any defect or disorder in the speaker’s vocal cords may result in not delivering the message properly. One of the problems that cause such improper delivery of a verbal message is voice disorders, especially voice hoarseness (Dysphonia). Thus, this paper is entitled (Dysphonia as a Speech Disorder), which refers to the changes occurring in the speaker’s voice that are marked as disorders compared to the normal patterns. Such disorder occurs due to a defect in the elements needed for the process of voice production in a healthy person. This disorder is not confined to a specific age group. It can occur at any age, from childhood onwards, and it may be a temporary or chronic disorder.
 Speech disorders and their treatment methods are often approached in the domain of applied linguistics, and dysphonia is one of those voice disorders that have not received ample attention from researchers in general, and speech pathologists in particular, despite the steady increase in the number of cases day after day due to several factors including the noise pollution and crowdedness in cities, and some everyday duties that cause injury, which then can be an effective factor for this disorder to occur.
 Hence, this study is determined to introduce the most important modern trends in rehabilitating voice disorders and presenting methods for curing them.

An Unusual Case of Hoarseness of Voice and Dysphagia in Multiple Myeloma with Amyloidosis.

How to cite this article: Dash S, Pandalanghat S, Kumar Y. An Unusual Case of Hoarseness of Voice and Dysphagia in Multiple Myeloma with Amyloidosis. Indian J Crit Care Med 2024;28(2):175-176.

Assessment of quality of voice after 3D conformal hypofractionated radical radiotherapy in early-stage glottic cancer: A prospective study

ABSTRACT Purpose: The purpose of this study was to evaluate the short-term outcomes in terms of oncological outcomes, toxicities, and impact of quality of voice on livability of early glottic cancer (EGC) (T1) patients after hypofractionated radiotherapy. Material and Methods: 30 patients of early glottic carcinoma, staged cT1a-T1bN0M0 with Eastern Cooperative Oncology Performance Status (ECOG PS ≤ 2). Exclusion criteria included ECOG PS > 2, T2–T4 disease, and any other head and neck malignancy. Voice Handicap Index-10 (VHI-10) was used to score voice outcomes of patient’s pre- and post-radiation. Results: All the subjects were predominantly smokers (80%) having hoarseness of voice as the most common presenting complaint (76.7%) followed by dry cough (13.3%) and foreign body sensation (10%). On posttreatment response assessment, there has been a significant reduction in VHI-10 scores from pre-radiotherapy (RT) to 6, 12, and 24 weeks post-radiation completion in all three domains (functional, emotional, and physical), as well as total scores, with a significant P value (<0.05) being observed. Conclusion: The use of modest hypofractionated regimen (63 Gy in 28 fractions) in patients of early glottic disease (T1a and T1b) posttreatment completion provides good oncological outcomes with better quality of voice being observed.

Automated Acoustic Evaluation of Voice Disorders: A Comprehensive Study on Parameter Analysis Using ANN

Voice analysis serves as a crucial tool in diagnosing voice abnormalities, offering a non-invasive alternative to intrusive procedures. This research digs into a comprehensive study of voice disorder assessment methodologies, focusing on acoustic analysis and classification. The study employs various parameters such as Jitter, Shimmer, and Harmonic-to-Noise Ratio (HNR) alongside an Artificial Neural Network (ANN) classifier. Utilizing the Saarbruecken Voice Database the research aims to distinguish between healthy and dysphonic voices across genders. Principal Component Analysis (PCA) aids in feature selection, enhancing model accuracy. The results exhibit distinct precision levels in male and female groups, showcasing the effectiveness of specific parameters in classification.

Detection of recurrent phosphaturic mesenchymal tumors by using Ga-68 DOTATATE PET/CT

Phosphaturic mesenchymal tumor is a rare clinical condition and often causes osteomalacia due to tumor. Its diagnosis is often significantly delayed due to its rare occurrence in addition to the generalized and vague symptoms of their presentation. A 19-year-old female with a history of left facial nerve palsy, generalized weakness and hoarseness of voice revealed a dense mass in her brain. In this case, we reported successful application of a Ga-68 labeled DOTATATE PET/CT scan to identify the primary site and distant metastases of phosphaturic mesenchymal tumors and show the diagnostic value of Ga-68 labeled DOTATATE PET/CT imaging for the rare tumors.

Effect of Akson Therapy on Acoustic Parameters in Patients with Functional Dysphonia.

Functional dysphonia can impair the language expression ability and adversely affect the career development of some patients. Therefore, an active exploration of effective treatment options is imperative. This study investigated the effect of Akson therapy on acoustic parameters in patients with functional dysphonia. In this retrospective analysis, 79 patients with functional dysphonia who received conventional voice correction training from June 2020 to June 2021 were included in the reference group (RG). Our hospital has implemented Akson therapy since July 2021. Correspondingly, 72 patients with functional dysphonia who underwent Akson therapy from July 2021 to July 2022 were enrolled in the observation group (OG). The acoustic parameters such as fundamental frequency (F0), jitter, shimmer, and normalized noise energy (NNE); the aerodynamic parameters including maximum phonation time (MPT), mean airflow rate (MFR), and Voice Handicap Index-10 (VHI-10) score; and the Grade, Roughness, Breathiness, Asthenia, and Strain scale (GRBAS) score were measured before and after treatment and compared between the two groups. The F0, jitter, shimmer, NNE, MPT, and MFR values as well as the VHI-10 score and the grade (G), roughness (R), and breathiness (B) scores on the GRBAS did not significantly differ between the two groups before treatment (P > 0.05). However, significantly lower F0, jitter, shimmer, NNE, and MFR values and higher MPT levels were found in the OG compared to the RG after treatment (P < 0.001). Furthermore, the VHI-10 score and the G, R, and B scores were significantly lower in the OG than in the RG after treatment (P < 0.001), whereas the asthenia (A) and strain (S) scores remained at 0 before and after treatment. Akson therapy can improve the acoustic parameters of patients with functional dysphonia to a certain extent, indicating its potential application value.

Multitask and Transfer Learning Approach for Joint Classification and Severity Estimation of Dysphonia.

Despite speech being the primary communication medium, it carries valuable information about a speaker's health, emotions, and identity. Various conditions can affect the vocal organs, leading to speech difficulties. Extensive research has been conducted by voice clinicians and academia in speech analysis. Previous approaches primarily focused on one particular task, such as differentiating between normal and dysphonic speech, classifying different voice disorders, or estimating the severity of voice disorders. This study proposes an approach that combines transfer learning and multitask learning (MTL) to simultaneously perform dysphonia classification and severity estimation. Both tasks use a shared representation; network is learned from these shared features. We employed five computer vision models and changed their architecture to support multitask learning. Additionally, we conducted binary 'healthy vs. dysphonia' and multiclass 'healthy vs. organic and functional dysphonia' classification using multitask learning, with the speaker's sex as an auxiliary task. The proposed method achieved improved performance across all classification metrics compared to single-task learning (STL), which only performs classification or severity estimation. Specifically, the model achieved F1 scores of 93% and 90% in MTL and STL, respectively. Moreover, we observed considerable improvements in both classification tasks by evaluating beta values associated with the weight assigned to the sex-predicting auxiliary task. MTL achieved an accuracy of 77% compared to the STL score of 73.2%. However, the performance of severity estimation in MTL was comparable to STL. Our goal is to improve how voice pathologists and clinicians understand patients' conditions, make it easier to track their progress, and enhance the monitoring of vocal quality and treatment procedures. Clinical and Translational Impact Statement: By integrating both classification and severity estimation of dysphonia using multitask learning, we aim to enable clinicians to gain a better understanding of the patient's situation, effectively monitor their progress and voice quality.

Transient Voice Loss after Spinal Anaesthesia for Lower Limb Surgery: A Case Report

Transient Voice Loss after Spinal Anaesthesia for Lower Limb Surgery: A Case Report

Silenced by heart – Ortner’s syndrome (cardio-vocal hoarseness) – An unusual manifestation of a distant dreadful disease: A cross-sectional observational study

ABSTRACT Aims and Objectives: This study aims to explore the pathogenesis of hoarseness of voice resulting from cardiovascular disorders that affect the left recurrent laryngeal nerve (LRLN), supported by a review of the existing literature. Materials and Methods: This is a cross-sectional observational study conducted over a 3-year period, spanning from May 2019 to May 2022. The study involved the evaluation of 720 cases of hoarseness of voice through video-laryngoscopy. Within this cohort, we scrutinized eight distinct cases of Ortner’s syndrome, each attributed to various underlying causes. All patients with LRLN paralysis underwent a comprehensive clinical assessment, which encompassed chest X-rays, echocardiography, and chest computed tomography scans. Results: Out of the eight Ortner’s syndrome cases, six were associated with dilated pulmonary arteries, stemming from various etiologies such as rheumatic heart disease, mitral valve prolapse, pulmonary embolism, interstitial lung disease, portopulmonary hypertension, and patent ductus arteriosus. One case presented with pericardial effusion and pulmonary hypertension, while another case featured a dilated aorta secondary to severe aortic regurgitation. Among these cases, three patients underwent valve replacement, one underwent pericardiocentesis, and the remaining cases were managed conservatively. Only one case that underwent mitral valve replacement showed partial improvement in voice, while there was no significant improvement in the other cases. All cases remained under follow-up. Conclusion: Although cardiovascular-related hoarseness is an unusual presentation, it should be kept in mind for all cases of altered voice with underlying cardiac disease. Indirect laryngoscopy should be routinely performed in all cases of cardiac illness having hoarseness of voice.

Ease of endotracheal intubation with the conventional polyvinyl chloride endotracheal tube versus wire-reinforced flexometallic tube through the intubating laryngeal mask airway: A comparative study.

The aim of our study was to compare the ease of intubation when using conventional PVC tubes versus the wire-reinforced flexometallic tubes with the ILMA-FastrachTM. The number of attempts, time taken and additional maneuvers were noted. Intra-operative hemodynamic changes, post-operative sore throat, bleeding and hoarseness of voice was recorded over a period of 24 hours. After informed consent, 60 ASA I-II patients undergoing elective surgeries under general anesthesia were allocated to undergo blind intubation with the PVC tube or the wire-reinforced flexometallic tube. More attempts were required for successful intubation using the wire-reinforced tube than the PVC tube with 76.7% passing in the first attempt in the PVC, and 53.3% passing in the first attempt in the flexometallic group. (P = 0.4). Average time for intubation in the PVC group: 28.24 ± 7.22 seconds. Average time for intubation in the flexometallic tube: 45.8 ± 15.78 sec. Occurrence of post-operative sore throat was 13.3% in the PVC group and 26.6% in the flexometallic group, with minimal hoarseness of voice 3.3% in the PVC group and 10% in the flexometallic group. There was also a slightly higher hemodynamic response in those who were intubated with the flexometallic tube than a PVC tube. Intubating via the ILMA-Fastrach with the PVC tube offered better intubating conditions with regards to lesser time taken, lesser attempts, less manipulation, and less hemodynamic variations as compared to the patients who were intubated using the wire-reinforced tube.

Effects of an 11-week vibro-tactile stimulation treatment on voice symptoms in laryngeal dystonia.

Laryngeal dystonia is a task-specific focal dystonia of laryngeal muscles that impairs speech and voice production. At present, there is no cure for LD. The most common therapeutic option for patients with LD involves Botulinum neurotoxin injections. Provide empirical evidence that non-invasive vibro-tactile stimulation (VTS) of the skin over the voice box can provide symptom relief to those affected by LD. Single-group 11-week randomized controlled trial with a crossover between two dosages (20 min of VTS once or 3 times per week) self-administered in-home in two 4-week blocks. Acute effects of VTS on voice and speech were assessed in-lab at weeks 1, 6 and 11. Participants were randomized to receive either 40 Hz or 100 Hz VTS. Primary: smoothed cepstral peak prominence (CPPS) of the voice signal to quantify voice and speech abnormalities, and perceived speech effort (PSE) ranked by participants as a measure of voice effort (scale 1-10). Secondary: number of voice breaks during continuous speech, the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) inventory as a measure of overall disease severity and the Voice Handicap Index 30-item self report. Thirty-nine people with a confirmed diagnosis of adductor-type LD (mean [SD] age, 60.3 [11.3] years; 18 women and 21 men) completed the study. A single application of VTS improved voice quality (median CPPS increase: 0.41 dB, 95% CI [0.20, 0.61]) and/or reduced voice effort (PSE) by at least 30% in up to 57% of participants across the three study visits. Effects lasted from less than 30 min to several days. There was no effect of dosage and no evidence that the acute therapeutic effects of VTS increased or decreased longitudinally over the 11-week study period. Both 100 and 40 Hz VTS induced measurable improvements in voice quality and speech effort. VTS induced an additional benefit to those receiving Botulinum toxin. Participants, not receiving Botulinum treatment also responded to VTS. This study provides the first systematic empirical evidence that the prolonged use of laryngeal VTS can induce repeatable acute improvements in voice quality and reductions of voice effort in LD. ClinicalTrials.gov ID: NCT03746509.

Histopathology of a polyploid laryngeal growth revealing disseminated histoplasmosis

Abstract Any polyploid growth in the laryngeal region may be mistaken for a malignant condition. Histoplasmosis of the larynx rarely causes laryngitis; it often masquerades as malignancy or tuberculosis. The other name of this condition is “Cave’s disease” and is caused by the fungus, Histoplasma capsulatum. Here, we report a 54-year-old diabetic male who presented with a history of progressive hoarseness of voice for 6 months. The patient was a chronic smoker for 15 years. A biopsy of the growth was done, and a histopathological examination of the tissue clinched the diagnosis of laryngeal histoplasmosis. The patient was managed with intravenous liposomal amphotericin B and oral itraconazole with complete resolution of symptoms.

A case series on conversion aphonia – A diagnostic enigma

Conversion aphonia otherwise known as psychogenic aphonia which is a type of conversion disorder is typically a diagnostic enigma for many practitioners due to its varying presentation. After ruling out organic causes, many such cases are referred to psychiatry for further management. Here, in this case series, we present three such cases of sudden loss of voice and its successful management. After ethical committee clearance, three consenting patients of sudden loss of voice are reported in this study. Conversion aphonia is a challenging case not only because of its peculiar presentation but also because after ruling out all organic causes this diagnosis can be made.

Seeing Again, Seeing Anew: Documentary Reenactments in Contemporary Israeli Cinema

Abstract: This article examines the various forms of reenactment in contemporary Israeli documentary cinema. It argues that current documentary reenactments challenge—along the axes of nationalism, gender, class, and ethnicity—the traditional distinctions between past and present, documentary and fiction, reference and representation. They offer the possibility of bringing the past into the present, and simultaneously awarding a new aesthetic form to the historical event appearing on the screen for the first time. The reenactments give presence to the past, while at the same time showing the impossibility of returning to it in its entirety. They put into question the very borders of documentary cinema as well as raising ethical issues about the ontological status of documentary "truth." Moreover, through reenactments, contemporary documentaries aspire to retrieve lost voices and bodies, forgotten testimonies and histories of Israeli society's Others, and to give them new visual form so that they can find new listeners.

Lost voices of science journalism

Writing for Their Lives: America’s Pioneering Female Science Journalists, Marcel Chotkowski LaFollette

A Case of Pulmonary Tuberculosis Misconceived as Functional Dysphonia

Functional dysphonia (FD) refers to a voice disorder without any anatomical or neurologic pathology affecting the larynx. The beginning of a diagnosis of FD is to differentiate the patient’s voice symptoms from other organic voice disorders and other functional voice problems. Pulmonary tuberculosis initially presented by voice change is very rare. This atypical presentation might cause some confusion due to other more common diseases. We report a case of pulmonary tuberculosis as initial presentation of dysphonia in a 16-year-old girl. The patient was referred to our hospital with a gradually worsening dysphonia for 6 months. At first, it was misdiagnosed as FD because there was no specific finding on stroboscopy. One month later, she was finally diagnosed as pulmonary tuberculosis due to fever and pleuritic pain. After antituberculous therapy, her symptoms and voice have improved.

Prólogo: Voces perdidas, voces olvidadas, de Maribel Castro y Roberto J. Martín por Aurora Gámez Enríquez

Lost voices, forgotten voices contribute to valuing the roots of the female intelligentsia, mythical, historical and literary biographies, what Saron Keefe Ugalde, in his study En voz denominates the matrilineal inheritance so invisible throughout history. In this book, Lost Voices, Forgotten Voices, 36 biographies of writers, women possessing knowledge, knowledge or exceptional powers are recovered. The fascinating study of the authors and authors of these works has been recovered the biographies and works of these writers. They overcame the difficulties of a patriarchal and androcentric culture, becoming publishers and full-fledged authors.

Giant Subclavian Artery Aneurysm

Subclavian artery aneurysms are rare peripheral aneurysms. A giant subclavian artery aneurysm can lead to compression of the trachea or brachial plexus, erosion of the lung causing hemoptysis, hoarseness of voice, dysphagia, Horner’s syndrome, and upper extremity deep vein thrombosis. Compression of the trachea and inability to ventilate the patient can be a real challenge for the anesthesiologist and must be anticipated. Computed tomographic angiography is a useful imaging modality for its diagnosis and to rule out additional aneurysms in the body.