This study aimed to evaluate pain complaints, as well as voice and swallowing functions, in professional voice users, and to compare the effectiveness of three therapeutic approaches: vocal hygiene (VH), vocal function regulating exercises (VFRE), and transcutaneous electrical nerve stimulation (TENS). Twenty-seven professional voice users (18 females, 9 males; mean age 45.4 ± 12.2 years) were equally allocated into three groups (VH, VH+VFRE, VH+TENS). Pre- and post-therapy assessments included videolaryngostroboscopy, acoustic analysis (F0, jitter, shimmer, HNR), maximum phonation time (MPT), and self-reported scales: Voice Handicap Index (VHI-10), Singing Voice Handicap Index (SVHI), Voice-Related Quality of Life (VRQOL), Reflux Symptom Index (RSI), Dysphagia Handicap Index (DHI), Eating Assessment Tool (EAT-10), and Visual Analog Scale (VAS) for pain. Interventions were delivered over 8 weeks. Across all groups, RSI scores significantly decreased from 16.5 ± 10.1 to 10.3 ± 7.8 (p=0.028), reflecting meaningful improvement in reflux-related symptoms. However, in participants with baseline RSI >13 and concomitant laryngoscopic findings, scores remained above pathological threshold after therapy. Between-group analyses showed modality-specific effects: pain decreased most prominently in VH+TENS (p=0.033), jitter values post-therapy were lower in VH+VFRE compared with VH+TENS (p=0.022), and HNR was higher in VH+VFRE compared with VH (p=0.023). EAT-10 and DHI scores did not change significantly, likely due to low baseline swallowing burden and sample size-related floor effects. All three therapy pathways reduced reflux-related symptom burden, largely attributable to shared vocal hygiene education. VFRE provided favorable effects on acoustic stability, while TENS was most effective for pain reduction. Although swallowing outcomes did not change significantly, findings support a tailored approach: VH as a universal foundation, VFRE for acoustic inefficiency, and TENS for pain/tension. Larger and longer-term studies are needed to further clarify effects on swallowing.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder characterized by progressive degeneration of motor neurons. Early detection of bulbar symptoms is crucial for timely diagnosis and intervention; however, variability in symptom progression complicates clinical assessment. This retrospective observational study aimed to classify patients with ALS into three groups-spinal onset, spinal onset with bulbar involvement, and bulbar onset-and to identify speech evaluation metrics that effectively differentiate these groups. Data from 68 patients with ALS were retrospectively analyzed. Speech samples were collected and evaluated for alternating motion rate (AMR), maximum phonation time (MPT), nasality, maximum tongue pressure (MTP), speech rate, and speech intelligibility. Group comparisons and receiver operating characteristic (ROC) curve analyses were conducted to assess discriminatory ability. AMR significantly differed among the three groups, with the spinal-onset group demonstrating the highest rates and the bulbar-onset group showing the lowest rates. ROC analysis indicated that AMR exhibited excellent discriminatory power, particularly in distinguishing spinal- from bulbar-onset ALS. Significant differences were also observed in MTP, nasality, speech rate, and speech intelligibility, although some metrics were less effective in differentiating the intermediate group. No significant group differences were found in MPT. These findings suggest that the AMR is a sensitive and easily administered measure for detecting bulbar symptoms and distinguishing ALS subtypes. The intermediate characteristics observed in the spinal-onset with bulbar involvement group support this classification as a distinct clinical phenotype. Combining AMR with secondary measures such as MTP, nasality, speech rate, and speech intelligibility may enhance early detection of bulbar symptoms and improve clinical decision-making.

The Effectiveness of Eclectic Voice Therapy on Multidimensional Voice Parameters in Patients with Primary Muscle Tension Dysphonia.

Abstract Background Early glottic carcinoma primarily affects the vocal folds and most commonly presents with the symptom of dysphonia, which is an effect of the tumor interfering with normal vocal fold vibration. Radiotherapy for early glottic carcinoma is highly effective in controlling the tumor while preserving the larynx and voice. The aim of this study was to evaluate changes over time in voice outcomes among patients with early stage glottic cancers treated with definitive radiotherapy using stroboscopy as well as voice acoustic analysis. Methods The assessment was applied on 24 patients with T1 and T2 glottic carcinoma. It was conducted pre-radiotherapy, 3 months and 6 months post-radiotherapy as follow-ups. The assessment included laryngoscopic, videostroboscopic examination, and voice acoustic analysis. Results Marked improvement was found in videostroboscopic parameters, with parameters highly significant differences across the three phases for nearly all stroboscopic parameters, p -values (<0.001), with a significant difference noted specifically for the periodicity of mucosal waves in the right vocal fold p -value (0.005). Significant improvement was detected in voice acoustic analysis parameters, including the increase in harmonic to noise ratio and maximum phonation time, and reduction in jitter and shimmer by 6 months ( p < 0.001). Conclusions The overall outcomes of the current study pointed to improved glottic manifestations based on videostroboscopy parameters and voice acoustic analysis parameters by 6 months post-radiotherapy.

Objective: To systematically evaluate the effects of visual glottal closure training guided by swallowing electronic laryngoscopy and conventional voice training on the Voice Handicap Index (VHI) scores and Maximum Phonation Time (MPT) in patients with post-stroke dysphonia (PSD), providing evidence-based support for precise rehabilitation in such patients. Methods: A randomized controlled trial design was employed, selecting patients with post-stroke dysphonia who met the inclusion criteria as the study subjects. Patients were randomly divided into an experimental group (receiving visual glottal closure training) and a control group (receiving conventional voice training), with 32 cases in each group. Both groups underwent training for 8 weeks, twice a week, with each session lasting 30 minutes. The VHI scale was used to assess the subjective degree of voice impairment, and MPT was measured to evaluate vocal efficiency at four time points: baseline (T0), mid-treatment (T1, 4 weeks), end of treatment (T2, 8 weeks), and follow-up 3 months after treatment (T3). Statistical analysis was performed on the data. Results: A total of 64 patients were included, with 58 completing the study (29 in the experimental group and 29 in the control group), resulting in a dropout rate of 9.38%. There were no statistically significant differences in VHI scores and MPT between the two groups at baseline (T0) (P > 0.05). During the mid-treatment phase (T1), at the end of treatment (T2), and during the follow-up period (T3), the Voice Handicap Index (VHI) scores of patients in both groups significantly decreased compared to the baseline period (P < 0.05), and the Maximum Phonation Time (MPT) significantly increased compared to the baseline period (P < 0.05). Moreover, the VHI scores of the experimental group at each time point (T1: 42.35 points vs. 56.82 points, T2: 28.16 points vs. 45.73 points, T3: 25.48 points vs. 41.95 points) were significantly lower than those of the control group (P < 0.05), and the MPT (T1: 12.68s vs. 9.35s, T2: 16.82s vs. 11.57s, T3: 15.96s vs. 10.83s) was significantly longer than that of the control group (P < 0.05). Conclusion: Both visual glottal closure training guided by swallowing electronic laryngoscopy and conventional voice training can improve the subjective voice impairment and vocal efficiency of patients with post-stroke dysphonia. However, visual glottal closure training demonstrates superior efficacy and sustained therapeutic effects, making it a preferred rehabilitation option for patients with post-stroke dysphonia.

IntroductionObstructive sleep apnea (OSA) involves recurrent upper airway obstructions during sleep, leading to fragmentation and oxygen desaturation. Vocal complaints and orofacial myofunctional changes are common, but few studies assess both aspects in diagnosed patients.ObjectiveTo assess vocal parameters and orofacial myofunctional conditions in adults diagnosed with OSA, comparing them to a control group at low risk for OSA.MethodsCross-sectional study. A convenience sample (N = 63) was included: 33 with OSA confirmed by polysomnography and 30 controls at low risk for OSA (STOP-BANG < 3 and no reported snoring in Stanford Snoring Scale), aged between 18–60 years. Assessments included perceptual-auditory analysis of voice quality (GRBASI scale, Vocal Symptom Scale (VSS), maximum phonation time (MPT) for vowels and s/z ratio) and orofacial myofunctional evaluation (OMES-E protocol). Participants who had received previous treatment or medical conditions affecting OSA, voice or orofacial function were excluded.ResultsOSA group showed significantly higher scores on VSS and lower scores on OMES-E protocol. They also displayed shorter MPT, worse performance in s/z ratio, reduced pneumophonoarticulatory coordination, and higher frequency of vocal alterations. The OSA group revealed mean apnea-hypopnea index of 45.80, indicates predominance of severe cases, as well as increased desaturation index.ConclusionIndividuals with OSA exhibit impairments in both orofacial myofunctional and vocal parameters, with negative alterations observed in MPT speech rate, pneumophonoarticulatory coordination, and s/z ratio compared with subjects with no OSA complaints. These findings highlight the importance of evaluating vocal and orofacial aspects together in OSA.

Summary Introduction: Voice disorders require a complex evaluation including subjective and objective methods. Aim of the study: Overview. Comparison of the values of the parameters between groups of patients and controls, verification of the treatment results, and analysis of the correlation between selected parameters before treatment. Methods and design: 102 dysphonic patients and 68 non-dysphonic subjects were evaluated in the prospective study. The following parameters were analyzed: lowest and highest achieved phonation intensity (SPLmin, SPLmax), range of achieved intensities (SPLrange), lowest and highest achieved phonation frequency (fo_min, fo_max), average intensity and average fundamental frequency of the speaking voice (SPLspeech, fo_speech), maximum phonation time (MPT), jitter (JITT), Dysphonia Severity Index (DSI), GRBAS scale, subjective degree of vocal difficulty (0, 1, 2, 3), and score of the VHI-30 CZ questionnaire. Results: Compared to controls, patients had statistically significantly higher pre-treatment SPLmin, JITT, GRBA, subjective voice difficulty score, VHI-CZ 30, and lower SPLrange, fo_max, MPT, DSI. There was no statistically significant difference in subscale S in both men and women. In comparison to the pre-treatment state, at 3 months after treatment (n = 37), we found statistically significantly higher values of SPLrange, fo_max in females. The values of JITT, DSI, GRBA, subjective voice difficulty, and VHI-CZ 30 score were lower in both males and females. At 1 year after treatment (N = 23), we demonstrated statistically significantly higher values of SPLrange, SPLspeech in both males and females, and fo_max in females. The values of JITT, parametres G, R, B, A in the GRBAS scale, subjective degree of voice difficulty, VHI-CZ 30 in both males and females, and DSI in males were lower. We found weak to moderate correlation of selected parameters in the pretreatment group. Conclusion: A comprehensive voice examination is necessary for diagnosis, treatment, and further research. Our results show that although individual tests provide different information about voice disorders, they are to some extent related. Key words dysphonia – perceptual assessment – videolaryngostroboscopy – acoustic evaluation – aerodynamic – VHI-CZ 30 questionnaire

ABSTRACTIntroduction/AimsA pragmatic evaluation of bulbar function among adults with spinal muscular atrophy (awSMA) is needed, requiring the validation of a low‐cost, feasible outcome measure (OM). Maximum phonation time (MPT) and S/Z ratio (S/Z) are potential low‐cost OMs for bulbar function. This study aimed to evaluate the psychometric properties of MPT and S/Z among awSMA.MethodsThis single‐site prospective observational study followed awSMA over 12 months. Each participant completed MPT, S/Z, and a battery of routinely used OMs at baseline and 12 months. The psychometric properties of intra‐rater reliability (IRR), test–retest reliability (TRT), concurrent validity (CV), predictive validity (PV), and sensitivity to change were evaluated.ResultsFifteen awSMA completed the study, with a mean age of 35.5 (SD: 16.7) and 47% male participants. MPT correlated moderately with forced vital capacity (liters) and peak cough flow, and demonstrated high IRR (0.95, 0.94) and TRT over 12 months (0.80). MPT exhibited poor sensitivity to change over 12 months (0.08, 95% CI: −0.56 to 0.71). The S/Z did not exhibit significant CV, and demonstrated only modest TRT (0.55, 95% CI: 0.06–0.83), and low sensitivity to change (0.25, 95% CI: −0.32 to 0.83).DiscussionMPT is a low‐cost pragmatic tool to measure bulbar function and a surrogate for respiratory function OMs among awSMA. MPT may be helpful for patients with limited access to alternative bulbar or respiratory measures or for telehealth clinical care settings. MPT's low sensitivity to change limits its clinical utility over a 12‐month interval. Larger studies are necessary.

Effectiveness of a Single Office-Based Blue Laser Therapy Session for Vocal Fold Dysplasia and Its Correlation with the Grade of Dysplasia: A Case Series.

Voice, Swallowing, Fatigue, Anxiety, and Depression in Post-COVID-19 Patients.

To assess the impact of synkinesis on voice restoration in idiopathic vocal fold paralysis (IVFP) patients with different disease courses, a cohort of 130 IVFP patients (comprising 71 males and 59 females; 78 cases with left-sided paralysis and 52 cases with right-sided paralysis) was categorized into two groups according to their disease courses (group 1: < 3months, group 2: 3-6months). Each group was subsequently subdivided based on the presence or absence of synkinesis according to the laryngeal electromyography (LEMG) results, as evaluated by two physicians who are board-certified in electrodiagnostic medicine. The specific information of the IVFP patients were blinded to both the two evaluators, and the LEMG results evaluated by them were also blinded to each other. Then the analysis revealed that the individuals in the group 2 (45 cases) demonstrated significantly greater maximum phonation time (MPT) and maximum sound pressure level (SPLmax) compared to those in the group 1 (85 cases) (MPT, 8.34 ± 7.35s vs 5.55 ± 4.29s, t = - 2.008, P = 0.049; SPLmax, 94.53 ± 14.72dB vs 87.88 ± 9.82dB, t = - 2.101, P = 0.040). Furthermore, the group 2 exhibited a higher prevalence of synkinesis than that in the group 1 (35.56% vs 14.12%, P = 0.005). Notably, within the group 2, the patients with synkinesis had significantly lower MPT values (4.10 ± 1.79s vs 8.20 ± 5.84s, t = - 2.569, P = 0.019), as well as higher amplitudes of paralytic recurrent laryngeal nerve (RLN) compared to those without synkinesis (7.71 ± 8.35mV vs 1.70 ± 1.31mV, t = - 2.493, P = 0.023). Conversely, in the group 1, no significant differences were observed in the comparison of MPT values or amplitudes of RLN between the individuals with synkinesis and those without synkinesis (MPT, 6.01 ± 5.83s vs 5.46 ± 4.01s, t = - 0.334, P = 0.740; the amplitudes of RLN, 2.62 ± 2.35mV vs 2.74 ± 3.14mV, t = 0.104, P = 0.917), which were analyzed by Bonferroni (a multiple-comparison correction method, m = 2, ɑ = 0.025), and the P value less than 0.025 represents a significant difference in such condition. These findings suggest that synkinesis adversely affects voice restoration in the IVFP patients with a disease course of 3-6months, indicating that the IVFP patients should accept diagnosis and treatment within 3months after onset to improve their voice qualities, avoiding the adverse effects caused by synkinesis.

To assess the short-term voice quality in unilateral vocal fold paralysis (UVFP) patients after office-based hyaluronic acid injection laryngoplasty (OBIL) using the European Laryngeal Society (ELS) multidimensional voice quality assessment. Patients with UVFP that underwent OBIL were prospectively recruited from November 2022 to November 2024, at a tertiary university medical center (laryngology unit). Voice handicap index (VHI), GRBAS perceptual evaluation, maximum phonation time (MPT), and acoustic parameters were evaluated seven days and one month post-OBIL. Videolaryngostroboscopy was evaluated to assess the glottic closure (complete or incomplete) using the ELS recommendations. Thirty-two patients with UVFP were included. The amount of injectable ranged from 0.2 mL to 0.8 mL. Improvement in glottal closure was observed in 22/32 (75%) patients at Day-7 and 21/32 (68.8%) at one month post-OBIL. VHI significantly decreased after injection (p = 0.02). Other vocal outcomes (f0, percent jitter, percent shimmer, harmonic to noise ratio) revealed non-significant improvements (p > 0.05). MPT did not change (p = 0.37). Perceptual outcomes decreased non-significantly following OBIL, with 'breathiness' improving the most (p > 0.05). OBIL improves voice quality in patients with UVFP. All voice quality outcomes show early improvement at Day-7 and continue to improve at Month-1 after injection. VHI emerged as the most sensitive tool for detecting voice changes.

Intraoperative neuromonitoring (IONM) has been increasingly used in thyroid surgery, yet its clinical value remains controversial. This randomized controlled trial aimed to evaluate the efficacy and safety of IONM in thyroid cancer surgery. The standardized four-step monitoring protocol was used in the IONM group. Primary endpoints included RLN injury rates and postoperative voice function recovery. Secondary endpoints included surgical parameters (operation time, blood loss), complication rates, and oncological outcomes. Voice function was assessed using VHI-10 scoring and maximum phonation time (MPT). Patients were followed up for a median of 6months. The IONM group demonstrated significantly lower rates of temporary vocal cord paralysis (2.0% vs 10.0%, P = 0.038) and higher nerve identification rates (100% vs 96.0%) compared to the control group. Voice function recovery was notably faster in the IONM group, with smaller changes in VHI-10 scores (Δ = 4.2 ± 1.5 vs 7.6 ± 2.1, P < 0.001) and shorter MPT recovery time (14.2 ± 3.5 vs 25.6 ± 5.2days, P < 0.001). Although operation time was longer in the IONM group (125.6 ± 18.3 vs 108.4 ± 15.7min, P < 0.001), no significant differences were found in blood loss (45.3 ± 12.6ml vs 48.7 ± 13.2ml, P = 0.183), complication rates, or oncological outcomes between the groups. IONM technology greatly lowers the risk of temporary recurrent laryngeal nerve injury and speeds up voice function recovery in thyroid cancer surgery. Although operation times are slightly extended, the technique is safe and preserves oncological integrity.

This study investigated the vocal characteristics of children receiving GH treatment. This analytical, observational cohort study include 57 paediatric patients (33 males and 24 females). Females and males were divided into two groups: prepubertal and pubertal. Voice recordings were obtained from all patients at pretreatment, 3 months posttreatment and 6 months posttreatment. Acoustic analyses were conducted using the Dr. Speech software, and the fundamental frequency (F0), jitter, shimmer, harmonic-to-noise ratio (HNR), and maximum phonation time (MPT) were evaluated. In prepubertal and pubertal males, a significant decrease in F0 values was observed between the pre- and posttreatment periods and between the 3- and 6-month assessments. In prepubertal females, there was a statistically significant difference between the pre- and posttreatment periods, but there was no significant difference was found between the 3- and 6-month assessments. In pubertal females, no significant difference in f0 values was found between the groups. No significant differences in the jitter or shimmer values were observed between groups. The HNR values were not statistically significant. While there was a general improvement in MPT, this prolongation was significant among females. GH treatment causes changes in vocal characteristics by changing acoustic parameters, even within a short time. These changes are important for the social development of children. Our study is the largest number of patients reporting acoustic analysis results in children receiving GH treatment in the literature. For this reason, it is important due to the reliability of the results and their contribution to science.

Phonosurgery for vocal fold polyps: A comprehensive analysis of multidimensional voice outcomes in 201 cases and the impact of polyp size.

Results of transoral injection laryngoplasty in the apneic window.

Nationwide Survey on the Characteristics and Treatment of Age-Related Vocal Fold Atrophy in Japan.

Unilateral vocal cord paralysis (UVCP) is a debilitating disorder that affects patients' vocalization and swallowing. Medialization thyroplasty (MT) and injection laryngoplasty (IL) are the most widely used surgical procedures for treating UVCP. This is the first direct meta-analysis on the effectiveness of IL in treating UVCP in comparison with MT. On the 15th of December, 2024, a systematic search was conducted in biomedical databases. Search results were gathered and screened for relevant primary studies. Data were extracted, and inverse variance meta-analysis was conducted whenever applicable using the RevMan software. The results were pooled as mean difference (MD) or standardized MD, each reported with its corresponding 95% confidence interval. Statistical significance was determined when the P-value was under 0.05. Thirteen studies that enrolled 896 patients were included (428 underwent IL while 444 underwent MT). A trend towards short- and long-term improvements was noticed in voice jitter with IL (short-term: MD=-0.59, 95% CI: [-1.03, -0.14], P = 0.01; long-term: MD=-0.70, 95% CI: [-1.00, -0.41], P < 0.001) and in voice shimmer with MT (short-term: MD=-2.06, P = 0.003; long-term: MD=-2.51, P = 0.003), likely of the variation in each procedure's mechanics. Both IL and MT resulted in comparable improvements in the harmonic-to-noise ratio (P = 0.3), the maximum phonation time (P = 0.8), and the voice handicap index (P = 0.6) within six months post-operatively. We conclude comparable improvements in UVCP with both IL and MT. Further long-term studies that investigate this comparison on a large scale are required to provide case-specific conclusions.

Background and Objectives: This study aimed to evaluate postoperative changes in voice quality and glottic function following early injection laryngoplasty with hyaluronic acid performed using a modified general anesthesia approach without airway instrumentation in patients with unilateral vocal fold paralysis. Materials and Methods: Thirty-two patients (19 females, 13 males; mean age 51.8 years, range 21–70) who underwent injection laryngoplasty within the first three months after the onset of paralysis were included in this retrospective study. All procedures were performed under general anesthesia without endotracheal intubation, using endoscopic visualization. Objective acoustic and aerodynamic analyses and videostroboscopic examinations were performed preoperatively and postoperatively. Data were analyzed using the Wilcoxon signed-rank test, with p < 0.05 considered statistically significant. Results: Significant postoperative improvement was observed in acoustic and aerodynamic parameters. Shimmer, jitter, and noise-to-harmonic ratio (NHR) values significantly decreased (p < 0.001, p < 0.001, and p = 0.001, respectively), while maximum phonation time (MFT) increased markedly (p < 0.001) and the S/Z ratio decreased (p = 0.006). The mean fundamental frequency (F0) decreased slightly but not significantly (p = 0.085). Videostroboscopic findings demonstrated improved glottic closure and vocal fold vibration. No major complications occurred. Conclusions: Early injection laryngoplasty with hyaluronic acid performed under general anesthesia and endoscopic guidance provides significant improvement in objective voice parameters and glottic efficiency in unilateral vocal fold paralysis. Early intervention appears to enhance phonatory stability and may prevent maladaptive laryngeal changes.

Abstract Background: Thyroidectomy is one of the most common operations performed, with recurrent laryngeal nerve injury (RLNI), both complete and incomplete, being one of the most serious potential complications. In this study, we used acoustic analysis of jitter, shimmer, noise-to-harmonic ratio (NHR), and maximum phonation time (MPT) as an objective method of diagnosing RLNI. Materials and Methods: We evaluated the mean values of jitter, shimmer, NHR, and MPT in patients undergoing thyroidectomy. These values, in addition to laryngoscopy, were measured preoperatively, at 1 week post operatively, and at 3 months postoperatively. Results: The values of jitter, shimmer, NHR, and MPT were all raised in the first postoperative follow up; however, jitter, shimmer, and NHR were significantly raised ( P &lt; 0.001) in patients whose recurrent laryngeal nerve (RLN) was not identified intraoperatively in comparison to those where it was identified. All of these parameters returned to near-normal levels at 3 months postoperatively. Conclusion: Identification of the RLN intraoperatively during thyroidectomy significantly decreased the incidence of its injury both completely and incompletely. The use of acoustic analysis is an objective way of measuring incomplete injury of the RLN postoperatively.