Voice Changes Research Articles

Comparison of Transoral and Transcutaneous Approaches for Gender-Affirming Thyroid Cartilage Reduction: A Case Series of 246 Patients.

Thyroid cartilage reduction (TCR) for gender-affirming neck surgery can reduce prominent thyroid notches and improve dysphoria. TCR can be performed with a transoral or transcutaneous approach. This study aims to review TCR approaches and outcomes. A retrospective chart review of all TCRs at a multi-institutional, integrated healthcare system from May 2016 to July 2024 was performed. Patient demographics, operative details, and post-operative complications were reviewed. Major complications included invasive interventions (corticosteroid injections for scars, fluid drainage, etc) or intraoperative complications. Minor complications included infections, hypertrophic scarring, and temporary voice changes. Chi square tests and Mann-Whitney U tests were performed to evaluate differences in postoperative outcomes by surgical approach. A total of 246 patients underwent TCR with 207 patients (84.1%) in the transcutaneous group and 39 patients (15.9%) in the transoral group. The median patient age was 30.7 years (interquartile range, IQR 24.9-39.0). Median BMI was 22.7 kg/m2 (IQR 20.6-25.5). There were no significant differences between transcutaneous and transoral groups, for median age (30.1 years vs 33.4 years, p=0.08) or median BMI (22.6 kg/m2 vs 23.7 kg/m2, p=0.28). Total major complication was 9.3% and minor complication was 10.6%. There were no significant differences between transcutaneous and transoral groups in rates of major (9.2% vs 10.3%, p=0.83) or minor (12.1% vs 2.6%, p=0.08) complications. TCR can be an effective treatment for neck dysphoria. Transoral approach avoids visible neck scars and is not associated with increased peri-operative complications. Further research is needed to determine the long-term outcomes of TCR.

A pilot study for speech assessment to detect the severity of Parkinson's disease: An ensemble approach.

Changes in voice are a symptom of Parkinson's disease and used to assess the progression of the condition. However, natural differences in the voices of people can make this challenging. Computerized binary speech classification can identify people with PD (PwPD), but its multiclass application to detect the severity of the disease remains difficult. This study investigated six diadochokinetic (DDK) tasks, four features (phonation, articulation, prosody, and their fusion), and three machine learning models for four severity levels of PwPD. The four binary classifications were: (i) Normal vs Not Normal, (ii) Slight vs Not Slight, (iii) Mild vs Not Mild and (iv) Moderate vs. Not Moderate. The best task and features for each class were identified and the models were ensembled to develop a multiclass model to distinguish between Normal vs. Slight vs. Mild vs. Moderate. For Normal vs Not-normal, logistic regression (LR) using the prosody from "ka-ka-ka" task, Random Forest (RF) using articulation from "petaka" for Slight vs Not Slight, RF for the fusion from "ka-ka-ka" for Mild vs Not Mild and Gradient Boosting (GB) using prosody from "ta-ta-ta" for Moderate vs Not Moderate gave the best results. Combining these using LR achieved an accuracy of 72%. Dividing the multiclass problem into four binary problems gives the optimum speech features for each class. This pilot study, conducted on a small public dataset, shows the potential of computerized speech analysis using DDK to evaluate the severity of Parkinson's disease voice symptoms.

Singing Voice Handicap Index-10 Minimal Clinically Important Difference: A Prospective Determination.

The Singing Voice Handicap Index-10 (SVHI-10) is a validated patient-reported outcome measure (PROM) that assesses patients' perception of handicap related to singing voice. A normative value has been established with a score ≥20 being abnormal. However, there is no defined minimal clinically important difference (MCID). This study prospectively determines the MCID of SVHI-10 among a diverse group of singers. 103 adult singers with and without voice complaints completed SVHI-10 twice, 30 days apart. MCID for the SVHI-10 was determined using distribution-based receiver-operating characteristic (ROC) curve analysis. Twenty-two men (1 transgender), 75 women (1 transgender), and 6 nonbinary individuals participated. The most frequently reported singing genres were classical (44.7%), musical theater (17.5%), and pop (10.7%). Mean initial SVHI-10 score was 13.05 (standard deviation 7.397), and mean follow-up SVHI-10 was 13.13 (7.994). There was a significant positive correlation between initial and follow-up SVHI-10 scores (r = 0.879, p < 0.001). SVHI-10 scores were significantly higher among participants who reported voice changes in the past year (p < 0.001) or sought voice treatment (p = 0.001) compared with participants who did not. SVHI-10 scores varied significantly based on singing type. The area under the ROC curve for SVHI-10 was 0.700 (p = 0.003). The SVHI-10 MCID was determined to be 9.5. An SVHI-10 score change ≥10 should be considered clinically meaningful. This definition has been missing from the literature and will improve understanding of patients' responses to treatment, which will help advance clinical care and track research outcomes. 4 Laryngoscope, 135:752-757, 2025.

Implementation of RawNet3-Based Deep Voice Detector Resistant to Adversarial Fault Injection Attacks

Implementation of RawNet3-Based Deep Voice Detector Resistant to Adversarial Fault Injection Attacks

Successful Management of a Patient with Supraglottic Laryngeal Mass Causing Near Complete Airway Obstruction - A Case Report

Introduction: We describe the successful management of a huge supraglottic cyst involving the entire left side of the false vocal cord scheduled for microlaryngeal surgery. Case Report: A 45-year-old American Society of Anesthesiologists (ASA) 1 patient presented with a change of voice, dysphagia, and noisy breathing for three months. Indirect laryngoscopy (IDL) revealed a pedunculated cystic lesion 4x4 cm in the supraglottis, covering the entire glottic opening. Computed tomography (CT) of the neck showed a 2.7 x 2.5 x 2.3 cm cyst arising from the left aryepiglottic fold, covering the entire glottis. Awake FOB with airway blocks and local anesthesia of the nose and airway was performed by negotiating the FOB beyond the cyst, passing the scope into the esophagus, and then withdrawing it with anteflexion to enter the trachea. Videolaryngoscopy was used while railroading the ET tube to prevent rupture of the cyst. After surgery, smooth extubation was performed. Conclusion: Management of a difficult airway is a crucial aspect of patient safety, which can be accomplished by using a hybrid intubation technique (FOB + VL) with adequate preparation of the airway.

Comparative outcomes of ultrasound-guided radiofrequency ablation vs. microwave ablation for patients with T1N0M0 papillary thyroid carcinoma: a retrospective cohort study.

To compare the clinical outcomes between radiofrequency ablation (RFA) and microwave ablation (MWA) for the treatment of T1N0M0 papillary thyroid carcinoma (PTC) in a large cohort. This retrospective study included 1111 patients with solitary T1N0M0 PTC treated with RFA (n = 894) or MWA (n = 215) by experienced physicians. A propensity score matching was used to compare disease progression, including lymph node metastases (LNM), recurrent tumors and persistent tumors, recurrence-free survival (RFS), volume reduction ratio (VRR), and complications between the RFA and MWA groups. The subgroup outcomes of T1a and T1b tumors treated with RFA and MWA were also compared. During a mean follow-up period of 41.7 ± 12.6 months, the overall incidence rates of disease progression, LNM, recurrent tumors, and persistent tumors were 2.1%, 0.7%, 1.2%, and 0.2%, respectively. Eight patients (0.7%) experienced transient voice change and recovered within 3 months. After 1:1 matching, there were no significant differences in disease progression (3.3% vs. 3.7%, p = 0.793), LNM (1.4% vs. 1.9%, p = 1.000), recurrent tumor (1.4% vs. 1.9%, p = 1.000), persistent tumors (0.5% vs. 0%, p = 0.317), RFS rates (96.7% vs. 96.3%, p = 0.821), VRR (99.3 ± 3.0% vs. 98.3 ± 8.5%, p = 0.865), tumor disappearance rate (87.9% vs. 81.4%, p = 0.061) and complications (1.4% vs. 1.9%, p = 1.000) between the RFA and MWA groups. For T1a and T1b tumors, clinical outcomes were comparable between RFA and MWA. RFA and MWA did not show significant differences in clinical outcomes for T1N0M0 PTC. The choice between RFA and MWA could depend on physician expertise and resources of local center resources. A qualified and experienced physician with extensive knowledge of the modalities is recommended when thermal ablation is performed. Question With radiofrequency ablation (RFA) and microwave ablation (MWA) used worldwide for T1N0M0 papillary thyroid carcinoma (PTC), is one of them superior to the others? Findings There were no significant differences in disease progression, recurrence-free survival, volume reduction ratio, tumor disappearance, or complications between techniques for solitary T1N0M0 papillary thyroid carcinoma. Clinical relevance The choice between RFA and MWA could depend on physician expertise and resources of the local center resources. A qualified and experienced physician with extensive knowledge of the modalities is recommended when thermal ablation is performed.

Cross-trait multivariate GWAS confirms health implications of pubertal timing

Pubertal timing is highly variable and is associated with long-term health outcomes. Phenotypes associated with pubertal timing include age at menarche, age at voice break, age at first facial hair and growth spurt, and pubertal timing seems to have a shared genetic architecture between the sexes. However, puberty phenotypes have primarily been assessed separately, failing to account for shared genetics, which limits the reliability of the purported health implications. Here, we model the common genetic architecture for puberty timing using a multivariate GWAS, with an effective population of 514,750 European participants. We find 266 independent variants in 197 loci, including 18 novel variants. Transcriptomic, proteome imputation and fine-mapping analyses reveal genes causal for pubertal timing, including KDM4C, LEPR, CCNC, ACP1, and PCSK1. Linkage disequilibrium score regression and Mendelian randomisation analysis establish causal associations between earlier puberty and both accelerated ageing and the risk of developing cardiovascular disease and osteoporosis. We find that alanine aminotransferase, glycated haemoglobin, high-density lipoprotein cholesterol and Parabacteroides levels are mediators of these relationships, and establish that controlling oily fish and retinol intake may be beneficial for promoting healthy pubertal development.

Acute disseminated multiple encephalomyelitis

The article presents a clinical observation of acute disseminated encephalomyelitis in a 45-year-old female patient. The onset of the disease began with speech disturbances, changes in voice, weakness in the right leg, and periodic twitching in the right arm. Magnetic resonance imaging revealed lesions in the white matter of the brain. A complication of the disease was occlusive thrombosis of the left internal jugular vein, the lower jugular vein, and the subclavian vein. This case highlights the importance of physicians’ awareness—specifically general practitioners and neurologists—about rare diseases such as acute disseminated encephalomyelitis, its early manifestations, potential long-term complications, and modern treatment approaches

Long-term Prospective Comparative Analysis of Ototoxic and Survival Outcomes of Sequential Boost and Simultaneous Integrated Boost of Volumetric Modulated Arc Therapy for Head-Neck Carcinomas.

To compare the ototoxicity and survival in head and neck carcinoma patients treated with sequential (SEQ) and simultaneous integrated boost (SIB) of volumetric modulated arc therapy (VMAT). This long-term prospective study enrolled patients with histologically confirmed head and neck carcinoma, all receiving VMAT treatment. Audiological assessments were done using various tests at baseline, two weeks, treatment completion, six months, and 12 months. The changes in bone conduction pure tone thresholds were correlated with cochlear dose, comparing SEQ and SIB plans. We also investigated other significant late toxicities that led to dysphagia, voice changes, and xerostomia. Survival was assessed with the Kaplan-Meier analysis. The study included 93 patients (186 ears), 40 receiving radiation alone and 53 undergoing chemoradiation. Baseline hearing levels for the right and left ears were 13.3±2.3 dB and 14.2±1.5 dB. After 12 months of radiation, levels were 18.5±2.4 dB and 19.11±1.9 dB, respectively. No significant changes were observed between SEQ and SIB plans, but high-frequency shifts occurred. The cochlea tolerated up to 28 Gy without hearing loss in the radiation-alone group but showed loss at 9 Gy when combined with cisplatin chemotherapy. The maximum dose (Dmax) and the mean dose (Dmean) of pharyngeal constrictor muscles predicted dysphagia. No significant SEQ vs. SIB differences were found in late toxicity or survival outcomes. Modern radiotherapy techniques like VMAT adhere to cochlear dose limits. No significant differences were found between SEQ and SIB plans in sensorineural hearing loss, late toxicity, or survival, making both suitable for head and neck carcinoma treatment.

Disposition of emergency department patients presenting with angiotensin-converting enzyme inhibitor-induced angioedema

BackgroundAngiotensin-converting enzyme inhibitors (ACEI) are the most common cause of drug-induced angioedema in the United States. Our primary objective was to provide descriptive evidence regarding emergency department (ED) disposition of ACEI-induced angioedema patients. Our secondary objective was to evaluate unique patterns in those with ACEI-induced angioedema at a tertiary referral center, including demographics, details of those requiring intubation, length of inpatient stay, and allergy documentation.MethodsThis was a retrospective study evaluating all cases of ACEI-induced angioedema at a large, regional academic medical center. We performed a medical record review to identify patients with ACEI-induced angioedema who presented to the ED from January 1, 2016, to December 31, 2022. A structured data abstraction process was utilized to select patients of interest, followed by descriptive statistics, chi-square tests and odds ratios for categorical data, and Kruskal Wallis tests for continuous data.ResultsA total of 637 unique patient encounters met potential inclusion. After a substantial, standardized review, 94 patients met inclusion. During the study period, there were 94 patients presenting to the ED who were diagnosed as having angioedema secondary to an ACEI (90 patients) or angiotensin receptor blocker (ARB) (4 patients). Overall, 53 patients (56.38%) improved during their ED stay, and of those, 32 patients (60.38%) were discharged home. None of the 12 patients that worsened were sent home from the ED. Those who were discharged from the ED with a median stay of 4 h had no increased risk of return to the ED versus those who were admitted. The only treatment found to have statistical association with disposition was intramuscular epinephrine. Only 13 of 43 ED discharged patients (23.64%) had their ACEI/ARB documented in their allergy listings compared to 42 of 51 patients (76.36%) of admitted patients, odds ratio of failure to document was 0.0929 (95% CI, 0.0352 to 0.24512). Only one patient out of the total 94 returned to the ED due to recurrent angioedema symptoms during our study period and was subsequently discharged.ConclusionOur results indicated that at a large, tertiary care referral center, patients with ACEI-angioedema who did not exhibit severe symptoms were safely discharged home with low risk of early return visit to the ED. Severe symptoms were found to be any throat symptoms, voice change, drooling, worsening swelling, or complaints of dyspnea. Further, among those admitted, patients in our study had a short inpatient stay and were safely discharged with no documented early return visit to the ED.

Pubertal timing, depressive symptoms, and depression in adolescent males: a prospective cohort study.

Early pubertal timing is associated with depressive symptoms in girls, but studies in boys are limited and have yielded conflicting results. N=4,664 male participants from a UK birth cohort (Avon Longitudinal Study of Parents and Children - ALSPAC). Seven indicators of pubertal timing were measured repeatedly from 7 to 17years (age at: peak height velocity, peak weight velocity, peak bone mineral content velocity, Tanner stage 3 pubic hair, Tanner stage 3 genitalia, axillary hair, and voice break), categorised into 'early', 'on-time,' and 'late' (mean ± 1 SD). Depressive symptoms (binary variable indicating higher versus lower levels) were assessed at 14 and 18years, and depression (ICD-10 diagnosis) was assessed at 18years. Multivariable logistic regression was used to examine associations between each indicator of pubertal timing and depressive symptoms/depression, adjusted for socioeconomic status (SES) and prepubertal body mass index (BMI). Compared to males with normative pubertal development, the odds of depression at age 18 were higher in those with early age at peak height velocity (OR: 2.06; 95% CI 1.27-3.34), early age at peak weight velocity (OR: 2.10; 95% CI 1.16-3.79), and early age at Tanner genitalia stage 3 (OR: 1.81; 95% CI 1.01-3.26). There was no evidence for associations between pubertal timing and depressive symptoms at age 14 or 18. We found evidence that males with an earlier pubertal timing had increased odds of depression at age 18. Early maturing boys could be targeted for interventions aimed at preventing depression.

Clinical Usefulness of Korean Items for the Differential Diagnosis of Adductor Spasmodic Dysphonia

Background and Objectives Adductor spasmodic dysphonia (ADSD) is a disease in which symptoms such as voice break, strained voice, and voice tremor occur during vocalization due to abnormal spasms of the adductor muscles of the vocal cords. In this study, we aimed to confirm the clinical effectiveness of recently developed Korean items for the differential diagnosis of ADSD and muscle tension dysphonia (MTD).Materials and Method Twenty patients who were diagnosed with ADSD and improved with treatment were set as the ADSD group, 7 patients diagnosed with MTD and received voice therapy as the MTD group, and 7 normal patients without voice disorders were set as the control group, and the medical records and voice test results were compared and analyzed. Recently developed Korean questions were read by the patient, and the degree of voice tremor, strained voice was evaluated. In addition, the recorded voice was analyzed with a spectrogram.Results A statistically significant difference between the two patient groups was confirmed in the auditory perceptual evaluation of voiced sentences and phrases, tense voiceless sentences and phrases of Korean items. Spectrogram analysis revealed that voice breaks were more frequent in the ADSD group during voiced sentences, and wide-spaced vertical striations were more prominent in the ADSD group during voiced sentences, phrases, and tense voiceless phrases.Conclusion It was confirmed that Korean items for the differential diagnosis of ADSD are useful in identifying speech task specificities in ADSD patients through spectrogram analysis as well as auditory perceptual evaluation.

Prevalence and Risk Factors of ENT Symptoms in Extra-Pulmonary Tuberculosis Patients

Background: Ear, nose, and throat (ENT) symptoms are less well-documented but are vital for diagnosis and treatment of extra-pulmonary tuberculosis (EPTB), which affects organs outside the lungs. Objective: The objective of the study was to evaluate the various ENT symptoms of TB in patients undergoing treatment at a tertiary care hospital's outpatient department (OPD). Methodology: In this cross-sectional research, which took place at Hazara University, KPK, between August 2020 and January 2021, 124 patients with ENT-related EPTB were included. Complete ENT histories, physical exams, and a range of diagnostic tests, such as biopsies, endoscopies, and chest X-rays, were performed on the participants. SPSS version 25 was utilized to analyze the data, and the chi-square test was used to look into any relationships between risk variables like smoking. Determining statistical significance required a p-value of less than 0.05. Results: Among the 124 patients with EPTB, the most prevalent ENT symptom was neck swelling, affecting 31 patients (25.00%). This was followed by laryngitis in 28 patients (22.58%) and pharyngitis in 25 patients (20.16%). Chronic sinusitis was observed in 22 patients (17.74%), while voice changes and otitis media were noted in 19 patients (15.32%) and 18 patients (14.52%), respectively. Hemoptysis was present in 15 patients (12.10%). The prevalence of these symptoms was notably higher in patients with symptoms lasting 6-12 months. Additionally, smoking was significantly associated with increased rates of laryngitis (p = 0.033) and hemoptysis (p = 0.039). Conclusion: The research demonstrates that common ENT symptoms in EPTB include neck edema, laryngitis, and pharyngitis, with symptom duration and smoking status having a major impact on their incidence.

Prospective Voice Assessment After Thyroidectomy Without Recurrent Laryngeal Nerve Injury

Background: Thyroidectomy, a surgical procedure for thyroid disorders, is associated with postoperative voice changes, even in cases without recurrent laryngeal nerve (RLN) injury. Our study evaluates the prevalence and predictors of voice disorders in thyroidectomy patients without RLN injury. Methods: Our single-center prospective study at the University Hospital Center Zagreb included 243 patients, with pre- and postoperative voice evaluations using acoustic analysis and videostroboscopy. Logistic regression, chi-square, MANOVA, and non-parametric tests assessed the impact of surgical, sociodemographic, and lifestyle factors. Results: The study analyzed 243 participants (141 lobectomy, 102 total thyroidectomy). Postoperative voice disorders occurred in 200 patients (100 lobectomy, 100 total thyroidectomy); 43 (17.7%) experienced no voice disorders. Significant associations were observed for surgery type (χ2 = 29.88, p &lt; 0.001), with total thyroidectomy having higher risk, surgery duration (χ2 = 16.40, p &lt; 0.001), thyroid volume (χ2 = 4.24, p = 0.045), and BMI (χ2 = 8.97, p = 0.011). Gender and age showed no significant correlation. Acoustic parameters differed significantly, with lobectomy patients showing better intensity, jitter, and shimmer values across postoperative measurements. Logistic regression identified surgery type (Exp(B) = 16.533, p = 0.001) and thyroid volume (Exp(B) = 2.335, p = 0.023) as predictors of voice disorders, achieving 82.7% classification accuracy. Multivariate analysis confirmed gender and surgery duration as significant contributors. Surgery duration exceeding 90 min and enlarged thyroid volume negatively influenced outcomes. Significant acoustic differences were also linked to BMI categories, with obese participants exhibiting poorer parameters, particularly shimmer and jitter. Conclusions: Surgery type, thyroid volume, BMI, and surgery duration are most likely significant predictors of postoperative voice disorders.

Efecto a largo plazo de la tuberculosis laríngea en la voz: Una revisión sistemática

Objective: This systematic review aims to describe the long-term effects of laryngeal tuberculosis on the adult voice.Materials and methods: The review followed the PRISMA statement guidelines and utilized the PIO model for database selection. The quality of evidence was assessed, and recommendations were graded using the GRADE system.Results: The review identified 36 articles meeting the inclusion criteria through keyword searches in the DECS and MESH databases. Laryngeal tuberculosis (LTB) was found to have significant long-term effects on the voice, as the larynx plays a crucial role in sound production and vocal quality. Even after the disease has been treated and cured, voice changes and alterations may persist. The vocal folds were the most affected and frequently mentioned structure leading to changes in voice quality and functionality. Dysphonia emerged as the primary effect of LTB, attributed to alterations in the flexibility and oscillatory function of the vocal folds for voice production.Conclusions: Laryngeal tuberculosis has a lasting impact on the adult voice, primarily affect-ing the vocal folds and resulting in dysphonia. These findings underscore the importance of ear-ly diagnosis and appropriate management to mitigate long-term voice-related consequences in individuals with LTB.

Changes in Voice Quality after a Pure Tone Stimulation (PTS) Program

Introduction. Auditory feedback allows individuals to monitor their vocal characteristics and adjust to maintain optimal voice quality. One type of auditory stimulation for conversational voice training/therapy is pure tone stimulation. This technique presents binaural auditory stimuli consisting of pure tones separated by half-step intervals to modify the fundamental frequency of the speaking voice and expand the vocal range. Objectives. This study aimed to characterize detectable changes in voice production following the application of pure tone stimulation (PTS) among speakers with and without voice disorders. Methods. Data from thirty-nine participants (28 individuals with voice disorders and 11 individuals with normal voices) were analyzed for this study. All participants engaged in binaural PTS exercises. Participants recorded a sustained vowel /a/ before and after the PTS exercises. Multiple acoustic voice parameters were extracted from the sustained vowel samples (fundamental frequency, pitch strength, harmonics-to-noise ratio, and smoothed cepstral peak prominence). Additionally, a visual analogue scale (VAS) interpretation of narrowband (NB) spectrograms was conducted to assess voice quality. Results. Statistically significant increases in fundamental frequency were found after the PTS exercises, except for males in the normal voices group. Pitch strength increased after the PTS, regardless of gender. Participants also demonstrated an increase in the harmonics-to-noise ratio. VAS ratings of NB spectrograms indicated improvement in voice quality following the program. Conclusions. Voice changes after performing PTS suggest voice quality improvement, as measured by acoustic analysis of vowel production and qualitative assessment of NB spectrograms among participants with and without voice disorders.

Evaluation of the Diagnostic Efficacy of Fibreoptic Nasopharyngolaryngoscopy in a Tertiary Care Hospital

Introduction: Fiber optic nasopahryngolaryngoscopy is a visual examination of the larynx and surrounding organs. It is an excellent method for determining the reasons for laryngeal problems, voice change, throat discomfort, and swallowing difficulties, and therefore, this should be utilized consistently in all ENT clinics. This study aimed to evaluate the diagnostic effectiveness of flexible fibreoptic nasopharyngolaryngoscopy as a diagnosis tool for ENT diseases. Methods: This was a retrospective study conducted in the Department of Otolaryngology (ENT), Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from January 2024 to June 2024. We included 100 patients irrespective of gender who underwent Fibreoptic Nasopharyngolaryngoscopy at our institution. Result: The mean age of our patients was 37.39±18.92 years. Most of our study patients (58%) were male and 42% were female. The most common presenting symptom was a change in voice (86%), followed by a burning sensation in the throat (6%), hoarseness of voice (4%), FB sensation (2%), and thyroid swelling (2%). The vocal cord nodules were the most common condition, affecting 50% of patients followed by the left vocal cord polyps (10%), and laryngitis (12%). Most of the patients (48%) were advised for conservative treatment &amp; speech therapy. Conclusion: In our study, we found that fibreoptic nasopharyngolaryngoscopy is a beneficial diagnostic procedure for individuals experiencing symptoms related to the larynx. This process allows for a wide range of applications and may be carried out under local anesthesia in an outpatient department (OPD) setting.

Analysis of clinical characteristics of amyotrophic lateral sclerosis patients initially diagnosed with abnormal laryngeal function

Objective: To study the laryngeal functional characteristics of patients with amyotrophic lateral sclerosis (ALS)disease diagnosed at the voice clinic. Methods: A retrospective analysis(case series study) was conducted on the laryngeal functional characteristics of 7 patients [2 males, 5 females, age ranged from 43 to 76(60.85±13.18)]with motor neuron disease who visited the voice clinic and were ultimately diagnosed by neurologists. The data included laryngostroboscopy, fiberoptic endoscopic examination of swallowing(FEES), acoustic analysis and laryngeal electromyography(LEMG). Descriptive methods were used for analysis. Results: ①There were 2 males and 5 females, with an average age of (60.85±13.18) years. They had previously visited the otolaryngology department more than twice, visit frequency with an average of 3.57 and an average diagnosis time of 12.28 months. The main complaints of the patient at the time of treatment were voice change, dysphagia or vocal fatigue. ②LEMG: Among 7 cases, 4 cases demonstrated neurogenic damage, all of which were bilateral, and 3 cases showed normal findings on examination. Spontaneous potentials (SP) were present in three cases for more than 6 months, with the longest duration being 24 months. Three cases exhibited the coexistence of spontaneous potential and reinnervated motor unit potentials (MUPs), and two cases showed bundle tremor potential.③Laryngostroboscopy revealed bilateral vocal fold asymmetry and glottic insufficiency in 7 cases, and decreased vocal cord movement in 4 cases, and vocal cord atrophy in 5 cases. FEES showed that 7 patients presented with mild to severe swallowing dysfunction, 3 cases had soft palate insufficiency and mild to severe food residues in the epiglottic valley and pyriform fossa. 1 case showed leakage and 1 case showed aspiration. Conclusions: Patients presenting with initial symptoms of abnormal laryngeal function should be vigilant for the possibility of motor neuron disease, especially when laryngostroboscopy reveals abnormal vocal fold movement and swallowing dysfunction. LEMG examination reveals bilateral neurogenic damage, prolonged spontaneous potential, coexistence of spontaneous potential and reinnervated MUPs, and the appearance of bundle tremor potential, which is beneficial for early detection of motor neuron disease.

Effects of face protector devices on acoustic parameters of voice.

The SARS-CoV-2 pandemic required the use of personal protective equipment (PPE) in medical and social contexts to reduce exposure and prevent pathogen transmission. This study aims to analyse possible changes in voice and speech parameters with and without PPE. Speech samples using different types of PPE were obtained. Recordings were then analysed using PRAAT software (version 6.1.42). Statistical analysis was conducted using ANOVA in Jamovi software. A post-hoc test was performed to compare PPE-related results. Statistically significant differences were found in Cepstral Peak of Prominence-Smoothed, Harmonic to Noise Ratio (HNR), slope of Long-Term Average Spectrum (LTAS), tilt of trendline through LTAS, shimmer parameters, HNR mean and standard deviation of vowels, vowels and consonants formants. HNR values increased whereas shimmer parameters and formant values reduced using PPE [PPE combined>filtering face piece (FFP)> surgical masks>no PPE]. Our data show improvement in many parameters of voice and speech quality and modification of speech articulation when using masks, particularly in case of combined PPE. The most relevant changes were found with a combination of face shield and FFP2 masks. This may be due to unconscious improvements in speech articulation and increased demand on vocal folds to achieve better speech intelligibility.

A study on voice changes after thyroid surgery

Thyroid surgery can lead to significant voice changes, which is one of the most serious complications. This study examines post-thyroidectomy vocal changes using a multi-dimensional assessment approach, including perceptual evaluation, subjective voice evaluation (voice handicap index), acoustic analysis, aerodynamic assessments, and vocal fold vibration analysis (stroboscopy, high-speed videoendoscopy, and kymography). The perceptual evaluation showed that patients experienced reduced vocal clarity, stability, and increased vocal fatigue following surgery. Acoustic analysis revealed changes in the fundamental frequency, increased jitter and shimmer values, and a reduced harmonics-to-noise ratio, which indicated a decrease in vocal stability and clarity. Aerodynamic assessments showed a decrease in maximum phonation time and expiratory pressure, suggesting weakened vocal fold closure and insufficient respiratory support. Vocal fold vibration analysis revealed asymmetry and irregular vibration patterns, which further confirmed the observed degradation in vocal quality. These findings highlight the importance of employing a comprehensive, multi-faceted evaluation to accurately assess post-thyroidectomy vocal changes. This approach is essential for guiding targeted rehabilitation efforts aimed at improving vocal recovery and minimizing long-term voice problems following thyroid surgery.