Multi-Dimensional Voice Program Research Articles

Effects of Age-Dependent Hormonal Changes and Estrogen Supplementation on Voice in Girls with Anorexia Nervosa—Preliminary Report

IntroductionHuman development includes lots of physical and emotional changes. The human voice depends on age. Voice production is a complex physiological and acoustic phenomenon that depends on many factors such as structure, hormone level, degree of fatigue or nutrition and hydration of the body, systemic diseases and emotional state. All these factors can be present in anorexia nervosa (AN), such as excessive weight loss, generated hydro-electrolytic changes, nutritional deficiencies, hormonal disturbances in the function of the hypothalamic-pituitary-adrenal axis, the hypothalamic-pituitary-thyroid axis, the hypothalamic-pituitary-ovarian axis, and emotional distress. The prevalence of AN ranges between 0.3 and 3%, and it is the third most common chronic disease affecting adolescent girls. However, voice changes related to AN have not been fully investigated. ObjectiveThe purpose of this study was to evaluate the impact of AN on age-related changes in the voice of adolescent women – before and after puberty, particularly through acoustic analysis. An additional objective was to evaluate estrogen substitution in female patients with AN in order to investigate their effect on voice condition. Materials and methods126 girls diagnosed with AN (15.32± 2.12yrs, range 12-19, BMI=14.38 ± 1.67), were assessed for the condition of the voice such as perceptual voice evaluation on the GRBAS scale, maximal phonation time (MPT), laryngoscopy, with special attention to voice acoustic analysis - Multi-Dimensional Voice Program (MDVP). The control group (B) included 93 girls without eating disturbances (aged 12-19, mean age 15.52 ± 2.40, BMI= 21.50 ± 1.54). Perceptual voice assessment, aerodynamic test MPT, and acoustic parameters were analyzed in age groups (≤16 yrs. and >16 yrs). The human vocal tract is sensitive to sex hormones, so the analysis was carried out in the group up to the age of 16 and above 16 to check possible effects. ResultsGRBAS scale was higher in girls with AN compared to the control group for breathiness (B) (p=0.0002) and asthenia (A) (p<0.05). The median GRBAS scale for the older group of anorexic women was the highest (2.0). The mean MPT for group A was significantly lower (15.40±3.51s). Comparing age subgroups there was a prolongation of MPT in the healthy group (in group ≤16 yrs. and >16 yrs. respectively 21.13s vs 25.40s) and a shortening in the anorectic group (≤16 yrs. vs >16 yrs.: 17.06s vs 14.17s). There was no difference between groups A and C up to 16 years of age, but above 16 years of age appeared (14.17s vs 25.40s). Acoustic analysis revealed lower F0 values in group A and C in older subgroups (215,85Hz vs 236,01Hz - statistically significant), as well as between subgroups both groups (A: 251,38Hz vs 215,85Hz; C: 248,20Hz vs 236,01Hz). A narrowing of the vocal range in girls over 16 yrs in group A was observed. There were no statistically significant differences in F0 between subgroups ≤16 years in groups A and C (251.38Hz vs 248.20Hz). The ENT study found that more than half of the girls (54.55%) over the age of 16 who took hormone supplementation manifested laryngeal structure that was normal for their age, there was no effect of hormone supplementation on any of the MDVP parameters between the drug-taking and non-drug-taking groups. ConclusionsThe acoustic results of the voice in MDVP measurements in adolescent women with AN are not within the normal range and do not mimic the normal developmental changes of the voice. The most important acoustic characteristics of the voice are changes in the fundamental frequency F0 and the range of the voice tended to be more severe in anorectic women >16 years of age and to increase with age, indicating a possible cumulative effect of malnutrition-related disorders as well as hormonal dysfunctions. MDVP can be considered a simple, non-invasive method of assessing the voice organ in AN. MPT differentiated the study groups well: statistically significant differences were noted both between the groups, as well as between age groups. There was no significant effect of oral hormone supplementation on any parameters of the voice. In conclusion, body mass and fat volume in AN may be related to voice production/physiology, affecting voice quality, voice acoustic parameters, voice aerodynamics, and phonatory range in an age-dependent manner. Future studies are needed to assess the long‐term efficacy of estrogen treatment in AN.

Perceptual-Auditory and Acoustic Analysis of Breathiness in Cis and Transgender Men and Women

ObjectiveTo verify breathiness in the cisgender and transgender men and women’s voices, compare values of acoustic and perceptual indicators of breathiness and fundamental frequency (f0) between groups, and compare them between the voices attributed as female and male. Study designCross sectional retrospective study. MethodsThe study as approved by the Research Ethics Committee (4,937,140). Sustained vowel /a/ and continuous speech recordings of 21 cisgender men (CISM), 31 transgender men (TM), 32 cisgender women (CISW) and 31 transgender women (TW) were analyzed. Three judges conducted a perceptive-auditory analysis regarding the degree breathiness, using visual analogue scale, and attributed gender (female or male). The ABI (Acoustic Breathiness Index) was extracted using the PRAAT software (6.1.16). The f0, Harmonic-Noise Ratio (HNR), Voice Turbulence Index (VTI) and Soft Phonation Index (SPI) were analyzed using the Multi-Dimensional Voice Program (KayPentax). ResultsThe ABI value for CISM was lower than for TM and CISW. CISW had the higher f0 than; TM had a higher f0 than CISM; and TW had a higher f0 than CISM. The groups did not differ for HNR and VTI. Regarding the SPI, CISM had higher values than CISW. Regarding the auditory perception, TM presented more intense breathiness than CISM in the vowel. Regarding gender attribution by voice, the voices CISM and CISW were 100% identified as male and female. On the other hand, in the vowel analysis, 45.2% of the TM voices were perceived as female and 59.4% of TW voices as male. ConclusionBreathiness occurs differently between groups and the voices perceived as male and female. Even when TM are submitted to the use of testosterone and undergo vocal changes, the transglottal airflow remains, which is a female characteristic of phonation.

Acoustic Voice Analysis in Children with Speech Sound Disorder and Intellectual Disability

Purpose: This study was conducted to analyze the acoustic differences associated with the presence of speech sound disorder (SSD) and/or cognitive ability. Methods: Medical records from 2016 to 2022 were retrospectively analyzed. The study included children aged 4 to 8 years who had undergone developmental assessments. Based on the assessment results, participants were divided into three groups: children with SSD without intellectual disability (ID), children with SSD and ID, and typically developing (TD) children. Voices were analyzed using the Multidimensional Voice Program (MDVP). Results: The average ages of children with SSD, those with SSD and ID, and those categorized as TD were 61.0±11.4, 62.3±10.7, and 64.2±9.4 months, respectively (&lt;i&gt;P&lt;/i&gt;=0.482). The proportion of children with SSD and ID who also had attention deficit hyperactivity disorder was significantly higher (53.3%) than in the other groups (&lt;i&gt;P&lt;/i&gt;=0.010). In the MDVP analysis, among values related to fundamental frequency, the number of segments computed was significantly lower in children with SSD and ID compared to the other groups (SSD, 25.0; SSD with ID, 17.0; TD, 19.0; &lt;i&gt;P&lt;/i&gt;=0.001). Similarly, the total number of pitch periods detected was significantly lower among those with both SSD and ID (SSD, 230.0; SSD with ID, 152.5; TD, 187.0; &lt;i&gt;P&lt;/i&gt;=0.001). No other parameters significantly differed across groups. Conclusion: Acoustic analysis can reflect voice changes in children with SSD and ID compared to both those with SSD and TD children. Therefore, voice analysis may serve as a supportive screening tool for patients with SSD.

Prediction of Voice Outcomes After Hemithyroidectomy Using Skin Electrode Intraoperative Neuromonitoring

Background and Objectives This study focused on predicting voice outcomes following hemithyroidectomy using skin electrode intraoperative neuromonitoring (IONM).Subjects and Method The study involved 82 patients who underwent hemithyroidectomy. During the surgery, the researchers recorded skin IONM values for the vagus nerve and recurrent laryngeal nerve. Voice quality evaluations were conducted before the surgery and at various intervals after the surgery (one week, one month, three months, six months, and one year) using the multidimensional voice program (MDVP), voice handicap index (VHI), and the grade, roughness, breathiness, asthenia, strain (GRBAS) scale. The study aimed to correlate perioperative skin IONM values with subjective and objective voice outcomes.Results The VHI scores increased up to three months post-surgery, with statistically significant changes observed at one week post-surgery. The GRBAS scale scores also increased significantly at one month post-surgery. Similar trends were observed in the MDVP data, including a decrease in the maximum pitch between one week and three months post-surgery. Additionally, the study found that lower delta-V values (difference between the preoperative and postoperative signal amplitude of vagus nerve stimulation) were associated with higher F0 values at one week and three months post-surgery, while jitter and noise-to-harmonic ratio were higher in the group with higher delta-V values at three months post-surgery.Conclusion Greater differences between the preoperative and postoperative signal amplitude of vagus nerve stimulation during surgery were linked to worse postoperative voice outcomes. Voice parameters worsened for up to 3 months after hemithyroidectomy but showed signs of recovery afterwards. These findings offer insights into predicting and managing voice outcomes after hemithyroidectomy.

Prevalence of Objective Voice Measurement Use in Laryngology Practices in the United States.

The aim of this study was to assess the prevalence of use of objective voice measurements (OVM), instrumentation, and factors that may impact OVM outcomes, such as setting and implementation to clarify current practice. Doing so should clarify the impact of OVM research on patient care. A 12-question, one-time anonymous survey using the Research Electronic Data Capture tool was distributed during January 2023 to laryngologists in the United States identified through membership in The Voice Foundation (TVF) or previous participation in a TVF symposium. A total of 101 responses to 418 emails yielded a response rate of 24.2%. Seventeen point eight percentage (N=18) were in private practice, 63.4% (N=64) were in academic settings, and 18.8% (N=19) were classified as mixed private and academic. Common OVMs used were fundamental frequency 95.12% (N=78), maximum phonation time 90.24% (N=74), noise-to-harmonic ratio 71.95% (N=59), jitter 71.95% (N=59), and shimmer 70.73% (N=58). Common equipment and software used Pentax Multi-Dimensional Voice Program 42.68% (N=35), Pentax Computerized Speech Lab Model 4500B 37.80% (N=31), and Pentax Visi-Pitch, Model 3950C 23.17% (N=19), PRAAT 21.95% (N=18), OperaVOX 4.88% (N=4), VoceVista 3.66% (N=3). Fifty one point two percentage (N=42) stated that they used OVMs with the majority of their patients, most commonly for the assessment of treatment effectiveness (84.1%, N=69), documentation (78.0%, N=64), research (70.7%, N=58), and/or diagnosis (61.0%, N=50). Ninety point two percentage (N=74) stated that OVMs were used during initial evaluation of patients. This study estimates of the prevalence of OVM use among laryngologists in the United States. There appears to be sufficient consistency among laryngology centers to permit comparison of results between centers, although additional research is needed. Future OVM research should compare measurements and equipment commonly used by laryngologists to define further the generalizability of results.

Reinke’s Edema: New Insights into Voice Analysis, a Retrospective Study

Reinke's edema (RE) is a pathological condition involving increased volume of the vocal folds and resulting in significant impact on speech, fundamental frequency, and vocal range. Literature reports few studies which analyze vocal features according to the severity of RE. The aims of this study were to investigate the aerodynamics, acoustic characteristics, and sound spectrograms of a group of RE patients and to assess whether there was any correlation with their endoscopic grading. A total of 98 patients were included in the study, 49 patients with RE and 49 healthy volunteers (HV). Multidimensional Voice Program was used to perform objective voice assessment. Maximum phonation time (MPT) and Voice Handicap Index (VHI) questionnaire were collected. The spectrograms of the vowel /a/ and of the word /aiuole/, which contains the five Italian vowels, of each patient were analyzed according to the classification of Yanaghiara modified by Ricci Maccarini and De Colle. Laryngological assessment was used to record vocal folds morphology according to Yonekawa's classification. Univariate analysis was used to compare group outcomes. Bivariate analysis was used to compare endoscopic grading and voice analysis results. Univariate analysis of the HV and RE groups revealed statistically significant differences (P<0.05) for the following parameters: jitter%, shimmer%, harmonic-to-noise ratio (NHR), voice turbulence index (VTI), MPT, VHI except for soft phonation index. Spearman's rank correlation showed a positive correlation between vocal parameters such as jitter%, shimmer%, NHR, VTI, and RE gradings. A negative correlation was found between MPT and RE gradings. Bivariate analysis indicated a strong positive correlation between RE grading and the spectrogram classification performed both with the vowel / a / (Rho 0.86; P=0.0001) and with the word / aiuole / (Rho 0.81; P=0.0001). The present study demonstrates that patients with RE have different voice characteristics compared to HV. In particular, the voice analysis highlighted acoustic parameters that correlated to differing degrees of RE. In addition, spectrogram analysis should be considered for acoustic assessments before and after medical and surgical therapy and also in forensic medicine.

Acoustic Characteristics and Voice Fatigue in Hearing Impared Adult Males according to the Degree of Hearing Loss

This study was conducted to use it as basic information to suggest the necessity and program for self-regulation that can properly maintain voice according to the degree of hearing loss. For this purpose, twenty-six men in their fifties were classified according to the degree of hearing loss, and multidimensional voice program (MDVP) (F&lt;sub&gt;0&lt;/sub&gt;, jitter, shimmer, noise to harmonics ratio [NHR]), cepstrum (cepstral peak prominence [CPP], low/high spectral ratio [L/H ratio], mean CPP F&lt;sub&gt;0&lt;/sub&gt;, cepstral/spectral index of dysphonia [CSID]) and vocal fatigue index (fatigue, physical, rest, total) were performed and analyzed. The more severe the degree of hearing loss, the higher the F&lt;sub&gt;0&lt;/sub&gt; and CSID, and the lower the L/H ratio, the overall quality of the voice deteriorated. Normal-mild hearing loss group indicated a positive correlation between mean CPP F&lt;sub&gt;0&lt;/sub&gt; and fatigue, rest and total, and negative correlation between CPP and rest. In severe-profound group, F&lt;sub&gt;0&lt;/sub&gt; and rest showed a negative correlation, and shimmer and rest showed a positive correlation. Through the analysis of vowel and connected speech, it was found that the more severe the degree of hearing loss, the higher the F&lt;sub&gt;0&lt;/sub&gt; in vowel phonation, the lower the L/H ratio and the higher the CSID, and the lower the overall sound quality. In addition, it was observed that that the more severe the hearing loss, the higher the fatigue level of the hearing-loss person who speaks due to severe voice misuse and abuse. Therefore, auditory rehabilitation patients with hearing loss optimal voice production, and voice rehabilitation programs that use proper voices should be supported.

Predicting glycemic control status and high blood glucose levels through voice characteristic analysis in patients with cystic fibrosis-related diabetes (CFRD)

Cystic fibrosis-related diabetes (CFRD) is associated with reduced life expectancy in adults with cystic fibrosis (CF). Voice analysis may be a convenient method for diagnosing and monitoring CFRD. This study aims to determine the relationship between voice characteristics and markers of glucose and glycemic control and to identify if voice analysis can predict high blood glucose levels and glycemic control in adults with CFRD. We conducted a prospective cross-sectional study in adults with CF from March to December 2021. We recorded 3-second voice samples of a sustained /a/ vowel and analyzed voice characteristic using the Computerized Speech Lab with the Multi-Dimensional Voice Program. In female participants with CFRD, the noise-to-harmonic ratio was significantly lower in those with HbA1c ≥ 7. Furthermore, fundamental frequency variation was significantly lower in both male and female participants with CFRD who had a glucose level of 200 mg/dL or higher at the time of collection. This finding was also associated with a high level of point-of-care glucose. The human voice has potential as a non-invasive tool for measuring glucose levels and glycemic control status in CFRD patients in the future.

Acoustics Features of Voice in Adolescent Females With Anorexia Nervosa

The process of human voice production is a complex physiological and acoustic phenomenon that depends on many structural, physical, and hormonal factors, systemic diseases as well as emotional states. All these factors can be present in eating disorders. However, studies on eating disorders and voice problems have usually been evaluated in terms of bulimia. Chronic starvation and emotional problems in the course of anorexia nervosa (AN) appear to be under-researched, despite various biochemical, metabolic, and hormonal changes. The purpose of this study was to evaluate voice quality, specifically acoustic analysis, in adolescent female with AN from the point of view of the possible influence on the function and structure of the larynx, low body mass accompanying AN, as well as energy deficiency, hormonal and emotional disturbances. A total of 84 girls diagnosed with AN (Gr.A) (15.32 years, SD=2.12; range 12-19, BMI=14.11±1.72)were assessed for the condition of the voice such as perceptual voice evaluation on the GRBAS scale, maximal phonation time (MPT), laryngoscopy, with special attention to voice acoustic analysis - Multi-Dimensional Voice Program (MDVP). The control group (Gr.C) included 62 girls without eating disturbances (aged 12-19, mean age 15.41±2.40, BMI=21.60±1.92). Perceptual voice assessment, aerodynamic test MPT, and acoustic parameters were analyzed according to girls' age. Total GRBAS scale was higher in girls with AN compared to the control group mainly for two parameters: breathiness (B) (P=0.00015) and asthenia (A) (P<0.05). TheMPT for Gr.A was significantly shorter compared to Gr.C (15.40±3.51seconds vs. 23.19±5.17seconds) (P<0.001), and a correlation of MPT values with the age of the adolescent female was observed: Spearman's coefficient for Gr.A=(-)0.5378, for Gr.C=0.5516 (P=0.0012). Acoustic analysis revealed the decrease in the basic frequency F0 in Gr.A compared to Gr.C (231.08Hz vs. 242.30Hz), and narrowing of the voice scale was observed, resulting mainly from a reduction in the upper limit. Significant differences were found for measures of frequency perturbations (Jita, Jitter, RPA, PPQ, sPPR), with Gr.A scoring significantly higher than Gr.C (P<0.05 for all). Significant changes in voice acoustic analysis parameters were found with age. Negative correlations were found for measures of F0 for Gr.A to a much greater extent compared to Gr.C. Positive correlations were found with measures of tremor assessment (SPI, FTRI, ATRI) for Gr.A.

Looking for an Objective Parameter to Identify Early Vocal Dysfunctions in Healthy Perceived Singers

The finding of minimal laryngeal dysfunctions in professional voice users is essential to prevent the onset of organic vocal pathologies. The purpose of this study is to identify an objective parameter that supports the phoniatric evaluation in detecting minimal laryngeal dysfunctions in singers. 54 professional and non-professional singers have been evaluated with laryngostroboscopy, Multi-Dimensional Voice Program (MDVP), Dysphonia Severity Index (DSI), maximum phonation time (TMF), minimum intensity of sound emission (I-min), maximum frequency (F-max), voice handicap index (VHI), singing voice handicap index (SVHI), manual phonogram and audiometric examination. The SVHI of all the “healthy” singers was on average 23.7 ± 22.5, while that of the “dysfunctional” 20.9 ± 18. No statistically significant difference was found between the SVHI scores of the total of healthy singers compared to the scores of the dysfunctional ones on the VSL (p = 0.6). The between-group comparison of the means of individual parameter values of DSI, TMF, F-max, Jitter, Shimmer, NHR, and SPI was not statistically significant (respectively p = 0.315, 0.2, 0.18, 0.09, 0.2, 0.08, 0.3). The only parameter analyzed that was statistically significant was the I-min (p < 0.05). SVHI is a valid instrument for the evaluation after a therapy but in our experience, it is not useful in distinguishing healthy from dysfunctional patients. The minimum intensity of sound emission measured with the sound level meter (I-low2) resulted a reliable parameter to identify minimal laryngeal dysfunctions and a useful tool in supporting the phoniatric diagnostic-therapeutic process in singers.

Analysis of the Effect of Intralesional Steroid Injection on the Voice During Laryngeal Microsurgery

Background and Objectives Vocal fold (VF) scar is known to be the most common cause of dysphonia after laryngeal microsurgery (LMS). Steroids reduce postoperative scar formation by inhibiting inflammation and collagen deposition. However, the clinical evidence of whether steroids are helpful in reducing VF scar formation after LMS is still lacking. The purpose of this study is to determine whether intralesional VF steroid injection after LMS helps to reduce postoperative scar formation and voice quality.Materials and Method This study was conducted on 80 patients who underwent LMS for VF polyp, Reinke’s edema, and leukoplakia. Among them, 40 patients who underwent VF steroid injection after LMS were set as the injection group, and patients who had similar sex, age, and lesion size and who underwent LMS alone were set as the control group. In each group, stroboscopy, multi-dimensional voice program, Aerophone II, and voice handicap index (VHI) were performed before and 1 month after surgery, and the results were statistically analyzed.Results There were no statistically significant differences in the distribution of sex, age, symptom duration, occupation and smoking status between each group. Both groups consisted of VF polyp (n=21), Reinke’s edema (n=11), and leukoplakia (n=9). On stroboscopy, the lesion disappeared after surgery, and the amplitude and mucosal wave were symmetrical on both sides of the VFs in all patients. Acoustic parameters and VHI significantly improved after surgery in all patients. However, there was no significant difference between the injection and control group in most of the results.Conclusion There was no significant difference in the results of stroboscopy, acoustic, aerodynamic, and subjective evaluation before and after surgery in the injection group and the control group.

Increasing the speech intelligibility by the use of voice therapy in patients with profound hearing loss

Objective: The purpose of this study is to evaluate changes in the acoustic properties of voice in patients with profound sensorineural hearing loss to determine the effectiveness of voice therapy. Material-Method: Our study consisted of 15 individuals from the 20-25 years of age with bilateral symmetrical hearing loss (Group A), and 15 individuals in the 26-65 age group with post lingual cochlear implants (Group B). The control group (Group C) included 15 adults with the normal hearing range from the age group of 20-30. Prospective analysis methods was utilized for this research. In order to quantitatively measure the psychosocial consequences of voice-related disorders the Voice Handicap Index (VHI) was given, and, to determine the acoustic measures of the voice quality, the /ah/ sound was digitally recorded with the Multidimensional Voice Program (Kay Elemetrics) in all groups. Conclusion: Average Fundamental frequency (F0), jitter percentage (jitter), shimmer, noise-harmonic ratio (NHR), voice turbulence index (VTI), soft phonation index (SPI), PPQ and APQ parameters were analyzed through acoustic sound analysis program. When the data in Group A are compared with Group B, the acoustic parameters show a statistically significant higher value. Discussion: Speech intelligibility increased in individuals with profound hearing loss who received sound therapy and who used cochlear implants. According to the results of the VHI, individuals with cochlear implants benefit from voice therapy.

Test-retest reliability and discriminatory power of multidimensional voice analysis program.

The objectives of this study were to evaluate and compare the test-retest reliability of acoustic parameters (jitter [%], shimmer [%], noise-to-harmonic ratio [NHR], and voice turbulence index [VTI]) by using multidimensional voice program, and to detect the discriminatory power of the acoustic measures with respect to dysphonic voices and normal voices. Fifty-four (25 male and 29 female) participants with voice disorders and fifty-one (27 male and 24 female) participants with normal voices were enrolled in this study. They were assessed by anamnesis, visual examination, auditory perceptual assessment (GRBAS), and acoustic measurements. The intraclass correlation coefficient was used to determine the test-retest reliability. The effect size (d value) and p value obtained from the t-test were used to determine the discriminatory power. In the normal group, good reliability was observed for jitter, shimmer, and NHR, and moderate reliability was observed for VTI. With regard to the dysphonic group, jitter, shimmer, and VTI were moderately reliable, and the NHR had good reliability. Meanwhile, the discriminatory powers of jitter and shimmer were evaluated as 'medium', and those of NHR and VTI as 'small'. The reliability and discriminatory powers of our acoustic measures were high compared with most other studies. Their level of reliability and discriminatory power can be maximised by using stringent rules. However, attaining an excellent level of reliability and discriminatory seems infeasible power owing to the variable characteristic of voice. Therefore, acoustic measures should be adopted as a complementary tool.

Voice Quality Analysis of Reinke's Edema According to Recent New Classification

Reinke's edema is a benign laryngeal disease characterized by inflammation and swelling of the superficial layer of the lamina propria of the vocal fold, known as Reinke's space. The aim of this study was to evaluate the quality of voice by quantitative acoustic measurements in patients affected by RE according to new classification proposed by de Vincentiis. Prospective case-control. We enrolled 76 consecutive patients with RE: eight type 1, 36 type 2, four type 3. and 28 type 4. A population of 30 healthy subjects was enrolled too. A voice recording for each subject was performed and the analysis were performed using the Multi-Dimensional Voice Program. The parameters considered were: fundamental frequency (F0), Jitter% (Jitt%), Shimmer% (Shim%), and Noise Harmonics to Ratio (NHR). Statistical analyses were performed using GraphPad Prism 8 software. A level of significance of P < 0.05 was used. The mean values and standard deviation for each parameter for the male group of patients affected by RE are: F0 101.06 (± 9.56) Hz, Jitt% 2.254 (±0.93), Shim% 9,037 (±2.21) and NHR 0.235 (±0.099). About the female group, the mean values are: F0 147,58 (±13.68) Hz, Jitt% 3,733 (±1.12), Shim% 11.172 (±3.54) and NHR 0.278 (±0.12). The difference between the types of RE and reference sample people in male and female groups are statistically significative (P < 0.05) for each parameter. In the female group all outcomes are statistically different except the F0 and NHR between healthy people and type III RE patients. RE is one of the most common diseases of true vocal folds and the classification proposed by de Vincentiis is a synthesis of endoscopic findings. In this paper we underline the change in vocal quality before surgery according a new type of RE classification.

A Comparison of Healthy and Disordered Voices Using Multi-Dimensional Voice Program, Praat, and TF32

Instrumental voice assessment plays a critical role in identifying vocal issues and for documenting treatment outcomes. The reported voice data, however, are sensitive to the algorithm used by each acoustic analysis software program (AASP) to analyze the corresponding waveform. In the present study, five acoustic measures were compared across healthy speakers and speakers with dysphonia for three AASPs commonly used in research, education, and clinical practice: Multidimensional Voice Program (MDVP) by Computerized Speech Lab, Praat, and TF32. Sustained vowel phonations for the quantal vowels /ɑ/, /i/, and /u/ were analyzed for 80 speakers with organic dysphonia and 60 age- and sex-matched healthy controls. Descriptive, inferential, and correlation data are reported for mean fundamental frequency (mean F0), standard deviation of fundamental frequency (SD F0), short-term perturbation measures of jitter and shimmer, and harmonic-to-noise ratio (HNR). The present study replicated previous findings of interprogram differences for healthy speakers, with MDVP consistently yielding higher values than Praat and TF32 for SD F0, jitter, and shimmer and lower values for HNR. Similar, but magnified patterns of results were observed for speakers with dysphonia. The variation observed across programs calls into question the validity in comparing voice outcomes reported by one AASP to those previously obtained by another, particularly for acoustic signals with aperiodic components that are commonly present in disordered voices. It is advised that waveforms be visually inspected prior to conducting acoustic analysis, and that voice outcomes not be combined or compared across AASPs.

Objective and subjective evaluation of Velopharyngeal Dysfunction (VPD) following surgical repair of the cleft palate using the furlow palatoplasty - A new tool

Velopharyngeal dysfunction (VPD) diagnosis and speech surgery outcomes are currently based solely on subjective evaluation criteria consisting of perceptual speech assessment and functional imaging. This study describes an objective and comparable method in VPD assessment and investigates the concurrence between the objective and subjective evaluations. The present study included 20 paediatric patients presenting with VPD after primary repair (intravelar veloplasty) of cleft palate. Our protocol was based on computerized analysis of voice parameters by means of an objective tool, spectrography integrated with Multi-Dimensional Voice Program (MDVP). The protocol also included perceptual evaluation by speech therapist and phoniatrician (consensus listening), and parents. This is a single surgeon, single centre experience and all patients underwent a secondary Furlow's palatoplasty. Assessments were performed pre- and postoperatively and upon completion of speech therapy. Results were compared using the two-tailed t student test for paired data. Statistical significance was set for p-values <0.05. Data analysis confirmed an improvement in velopharyngeal closure after surgery and speech therapy consistently with the results of perceptual evaluations. The results of the study confirmed the availability and reliability of an objective method for VPD evaluation based on the analysis of voice parameters with investigations that are simple and easily available in a hospital setting.

Efficacy of the Accent Method of Voice Therapy in Professional Voice Users with Minimal Associated Pathological Lesions of the Vocal Folds.

Minimal associated pathological lesions (MAPLs) of the vocal folds are a group of benign disorders commonly related to phonotraumatic conditions and behaviors. Voice therapy (VT) can play a major role in readjusting these maladaptive behaviors and improve overall voice quality, thereby replace surgical intervention in some cases or act as a complementary treatment to enhance the ultimate therapeutic outcomes. This study aims to explore the short-term effect of the Accent method of VT on vocal subjective measures and acoustics in professional users with MAPLs, evaluate the responsiveness of each vocal fold lesion to the VT, and propose a simple model for providing VT to a sector of the population in great need of non-invasive management. This analytical cross-sectional included fifty professional voice users with different MAPLs were exposed to multidimensional voice assessments before and after receiving VT training in a tertiary care hospital. These assessments include GRBAS score, Multidimensional Voice Program (MDVP) and validated Arabic version Voice Handicap Index (VHI-30). This study showed variable positive effects of VT on the different types of MAPLs. Cysts had the highest level of responsiveness to VT in comparison to other lesions, followed by nodules, polyps, contact granuloma, and Reinke's edema. VT is a substantial solution for managing voice disorders. It should be considered in the management plan of the various types of MAPLs, even in Reinke's edema, which showed the minimum improvement.

Electromyographic Assessment of the External Laryngeal Muscles of Opera Singers During Phonation and Non-Phonation Tasks

IntroductionThe surface EMG technique (sEMG) gives valuable assessment of vocal tract as well as diagnosis or outcome assessment in dysphonia. There are very few papers on the use of sEMG in vocal professionalists. AimThe aim of this study was to evaluate the electromyographic characteristics of selected external laryngeal and neck muscles in professional opera singers. MaterialThe study material consisted of 50 subjects. Twenty-six opera professional singers and 24 healthy non-singers. MethodEach person underwent otolaryngologic and phoniatric examination, laryngeal videostroboscopy, hearing testing, multiparametric acoustic voice analysis (multidimensional voice program) and sEMG of submentalis, cricothyroid and sternocleidomastoid muscles. ResultsStatistical analysis of the values of the amplitudes of the submentalis and the cricothyroid muscles showed significant differences between the vocalists and the control group. Moreover, during vowel phonation and glissando, significantly greater differences in the asymmetry of sternocleidomastoid muscles amplitudes were observed in singers compared to the control group. In most subjects, the studied muscles did not show asymmetry during saliva swallowing. ConclusionsLaryngeal muscle function should be assessed during different phonation and non-phonation tasks. Singers have different SEMG characteristics than non-singers. Knowledge of the patient's history and endoscopic studies is needed to interpret EMG recordings.

Clinical and Cellular Evidence of Glycyrrhiza glabra and Platycodon grandiflorus for Vocal Fold Nodules Complementary Treatment.

Vocal fold nodules (VFNs) are the most frequent cause of hoarseness. The management comprised medical, surgical and physical therapy but the effectiveness is not always satisfactory. In this study, we try to figure out an alternative treatment from our clinical experience summary. We retrospectively reviewed VFNs patients who received traditional Chinese medicine (TCM) treatments from July 2018 to August 2020 and traced their Chinese Voice Handicap Index-10 (VHI-C10) and multidimensional voice program (MDVP) analysis results. For further evaluation, we conducted an inflammatory response of porcine vocal fold epithelial (PVFE) cells with 50 ng/mL TNF-alpha. The inflamed PVFE cells were separately cultured in the aqueous extract of Glycyrrhiza glabra (G. glabra) and Platycodon grandifloras (P. grandifloras). In these VFNs patients (n = 22), the average VHI-C10 score decreased from 17.6 to 6.6 (p < 0.001). MDVP analysis revealed improvements in jitter, shimmer, noise-harmonic ratio, and GRBAS scoring system. Of the TCM prescription patterns, G. glabra and P. grandiflorus were used most frequently. In the MTT assay of PVFE cells, no adverse effects of our extracts were observed at doses of 1-200 µg/mL. Western blot analysis revealed downregulation of p65 and mitogen activated protein kinase pathway proteins. The results from both the clinical and in vitro aspects of this study revealed that the herbs G. glabra and P. grandiflorus may offer beneficial outcomes as alternative treatments for VFNs after precise diagnosis.

Prognostic Indicators of Non-Transection Nerve Injury and Vocal Fold Motion Impairment After Thyroid Surgery - Correlation Between Intraoperative Neuromonitoring Findings and Perioperative Voice Parameters.

ObjectivesIn patients with recurrent laryngeal nerve (RLN) injury after thyroid surgery, unrecovered vocal fold motion (VFM) and subjective voice impairment cause extreme distress. For surgeons, treating these poor outcomes is extremely challenging. To enable early treatment of VFM impairment, this study evaluated prognostic indicators of non-transection RLN injury and VFM impairment after thyroid surgery and evaluated correlations between intraoperative neuromonitoring (IONM) findings and perioperative voice parameters.Methods82 adult patients had postoperative VFM impairment after thyroidectomy were enrolled. Demographic characteristics, RLN electromyography (EMG), and RLN injury mechanism were compared. Multi-dimensional voice program, voice range profile and Index of voice and swallowing handicap of thyroidectomy (IVST) were administered during I-preoperative; II-immediate, III-short-term and IV-long-term postoperative periods. The patients were divided into R/U Group according to the VFM was recovered/unrecovered 3 months after surgery. The patients in U Group were divided into U1/U2 Group according to total IVST score change was <4 and ≥4 during period-IV.ResultsCompared to R Group (42 patients), U Group (38 patients) had significantly more patients with EMG >90% decrease in the injured RLN (p<0.001) and thermal injury as the RLN injury mechanism (p=0.002). Voice parameter impairments were more severe in U Group compared to R Group. Compared to U1 group (19 patients), U2 Group (19 patients) had a significantly larger proportion of patients with EMG decrease >90% in the injured RLN (p=0.022) and thermal injury as the RLN injury mechanism (p=0.017). A large pitch range decrease in period-II was a prognostic indicator of a moderate/severe long-term postoperative subjective voice impairment.ConclusionThis study is the first to evaluate correlations between IONM findings and voice outcomes in patients with VFM impairment after thyroid surgery. Thyroid surgeons should make every effort to avoid severe type RLN injury (e.g., thermal injury or injury causing EMG decrease >90%), which raises the risk of unrecovered VFM and moderate/severe long-term postoperative subjective voice impairment. Using objective voice parameters (e.g., pitch range) as prognostic indicators not only enables surgeons to earlier identify patients with low voice satisfaction after surgery, and also enable implementation of interventions sufficiently early to maintain quality of life.