Perceptual Voice Analysis Research Articles

Eclectic Voice Therapy Program in Hyperfunctional Voice Disorders: Evidence from Multidimensional Vocal Profiling

PurposeHyperfunctional Voice Disorder is a disorder of multifactorial origin. It can be speculated that an eclectic voice therapy program that uses combinatory approaches could bring about better efficiency of voice in these individuals. Nevertheless, very less attempts have been made to examine the efficacy of eclectic voice therapy using multidimensional voice outcome measures in the treatment of HFVD. Method10 individuals with HFVD in the age range of 20-55 years attended Comprehensive Voice Habilitation Program (CVHP), an eclectic voice therapy approach for 15 sessions spread across 3 weeks. A stroboscopy examination was performed at the baseline and post-therapy to track the changes in laryngeal functions. Further, perceptual voice analysis, Acoustic Voice Quality Index (AVQI), and Voice Handicap Index in Kannada (VHI-K) were obtained at the baseline, post-therapy, and two follow-ups to report the therapy outcomes. Related- samples Friedman’s Two-way Analysis of Variance by Ranks and Wilcoxn Signed Rank Test were used to note the pre-post and follow-up changes in voice outcomes. ResultsStroboscopy findings revealed significant improvement in movement patterns of the vocal folds and a reduction in ventricular hyperadduction. Perceptual ratings and AVQI scores decreased in post-therapy and follow-up evaluations indicating a decrease in dysphonia severity over time. In addition, a significant decrease in VHI-K scores indicated the alleviation of self-perceived disability/handicap. ConclusionThe current study provided preliminary evidence to support the efficacy of Eclectic voice therapy in HFVD by documenting significant changes in the voice-related outcome measures.

Comparing dysphonia severity index, objective, subjective, and perceptual analysis of voice in patients with multiple sclerosis and healthy controls

BackgroundImpairments in voice quality in Multiple Sclerosis (MS) have recently been investigated and different results were found. A voice-centered multidimensional assessment protocol with patient-reported outcome measures was conducted to evaluate all the aspects of the voice changes. ObjectivesThe study aimed to compare the objective, subjective, and perceptual measures of voice between the people with MS and the healthy control group. MethodsA total of 128 participants, including 64 people with MS age, and gender-matched healthy controls were enrolled in the study. Subjective, objective, and auditory-perceptual voice assessments of the participants were performed. The auditory-perceptual evaluation was performed with GRBAS. The Dysphonia Severity index was computed for both groups. All the participants completed the Turkish version of The Voice Handicap Index-10 (VHI-10) and the Voice-Related Quality of Life (VRQoL). ResultsAcoustic and aerodynamic parameters of voice were found significantly different for both males and females between the MS and control group. DSI was found significantly different for both males and females in the MS group compared to the control group (p<0.05). All components of the GRBAS scale were significantly higher in the MS group (p<0.001). Using a multivariate regression model, it was determined that age, gender, EDSS score, number of MS attacks, and disease duration did not affect the DSI. The overall VHI-10 score was higher in the MS group (median=1.0 range= 0–28) and lower in the control group (median=0 range= 0–4). The mean VRQoL was lower in the MS group (median=95 range= 62.5–100) than in controls (median=100 range= 85–100) (p<0.001). ConclusionOur results indicated that people with MS have significant differences in acoustic and aerodynamic parameters of voice compared to healthy individuals. A significant number of persons with MS are aware that their voice problem affects their quality of life. People with MS must be monitored for voice changes and a multidimensional voice assessment protocol should be implemented.

Preliminary Results on the Safety and Efficacy of Silk-Hyaluronic Acid for Treatment of Glottic Insufficiency

Silk-Hyaluronic Acid (Silk-HA) is a novel vocal fold augmentation material that has been used in humans since July 2020. There is a paucity of published data on Silk-HA and its longevity remains a question. This study aimed to evaluate a single surgeon's initial experience performing Silk-HA injection laryngoplasty for the treatment of glottic insufficiency. Retrospective chart review of Silk-HA injections between July 2020 and December 2021. Subject demographics, diagnoses, volume of material injected, VHI-10 data, and complications were collected. A blinded perceptual voice analysis of voice samples was performed by two voice-specialized speech-language pathologists (SLP) for a subset of unilateral vocal fold paralysis patients before and 3-months following silk-HA injection. Univariate assessment of the change in VHI-10 and perceptual voice analyses at 3-month follow up was determined. 58 patients (43.1% female) underwent Silk-HA injection with a mean age of 64 (range 21-88). 38 subjects had unilateral paralysis (65.6%), and the remaining had scar, atrophy, paresis or a combination thereof. 49 injections were unilateral (84.5%). Mean volume of silk injected was 0.26 mL. Complications were rare, most notable though for 2 admissions for dyspnea and laryngoscopic evidence of hemi-laryngeal edema (3.4%). Mean change in CAPE-V overall severity rating was -32.9 (P<0.0001), and VHI-10 was -14.6 ± 10 (P=0.0013). 14 patients underwent a repeat silk-HA injection for ongoing glottic insufficiency (loss of augmentation vs under-augmentation). Preliminary results for Silk-HA show potential for ongoing improvement of glottic insufficiency at 3 months from date of augmentation. Clinician and patient perception of voice outcomes showed overall improvement at three months, though longevity remains to be determined. While overall well tolerated and without serious complications in 96% of the cohort, patients should be counseled on the potential for airway edema and symptomatic dyspnea requiring steroid management and observation.

Acoustical and Perceptual Analysis of Voice in Individuals with Parkinson's Disease.

Parkinson's disease is a neurodegenerative disorder that affects motor efficiency which is also required for voice production. Voice is part of the identity of a person, any abnormality in voice quality hampers the quality of communication, and quality of life. This study aimed to analyse the voice of individuals with Parkinson's disease objectively through acoustic analysis, and subjectively through perceptual analysis. Quasi-experimental study conducted in a tertiary health care centre. The study comprised two groups: 12 individuals with Parkinson's disease (11 males and 1 female, mean age: 72.41years), and 12 healthy controls (10 males and 2 females, mean age: 53.83years). The voice samples of all the participants were recorded and analyzed using the MDVP software of CSL 4500. The voice samples were analyzed for eleven acoustical parameters, and the perceptual analysis was carried out using the GRBAS scale by two experienced Speech Language Pathologists. Mann-Whitney U test was performed to compare the two groups of participants, and Cronbach's alpha test was performed to find the inter-judge reliability between the perceptual ratings of two listeners. Acoustical comparison showed significant variations in seven parameters (jitter, shimmer, PPQ, APQ, Fatr Hz, Fftr, ATRI), and the perceptual analysis between two listeners showed a fair amount of reliability.

A Comparative Study on the Outcomes of Early and Delayed Type-1 Thyroplasty Following Unilateral Vocal Cord Palsy

Unilateral Vocal cord palsy typically presents with dysphonia, shortness of breath and swallowing difficulty. It can be iatrogenic, idiopathic or may occur secondary to damage to recurrent laryngeal nerve following trauma, impinging mass lesions, neurological disorders or neuro-musculoskeletal diseases, or infectious in aetiology. To study and compare the effects of Type I Thyroplasty depending on the time of presentation, that is, early and delayed presentation. Ambispective Study Design. Our study included 32 patients who presented to our Institution with history of dysphonia, diagnosed with unilateral vocal cord palsy. Depending on the duration of symptoms on presentation, patients were categorised into 2 groups, which is early subgroup who presented within 1 year of symptom onset, 21 patients and delayed subgroup who presented after 1 year of symptom onset, 11 patients. Complete preoperative evaluation including perceptual analysis of voice quality, acoustic measures of voice quality, Aerodynamic measures of voice quality, quality of life measure, tele laryngoscopy was done. All patients underwent Type I Thyroplasty and were followed up at 2 weeks, 1 months, 3 months and 6 months, with follow up criteria including perceptual analysis of voice, MPT and VHI-10. Out of 32 patients, Male to female ratio was 26 : 6, with mean age of presentation being 47 years. The laterality of the palsy was R: L → 4: 28. When compared to the Delayed subgroup, early Subgroup had significant improvement in outcomes with respect to GRBAS Scale, VHI-10 and MPT. Keywords: Unilateral vocal cord palsy, Early &amp; Delayed

Voice Telerehabilitation in Iatrogenic Unilateral Vocal Fold Paralysis: From Necessity to Opportunity in the COVID-19 Time

To evaluate results of telerehabilitation (TR) during the coronavirus disease 2019 pandemic for the treatment of dysphonia caused by permanent post-thyroidectomy unilateral vocal fold paralysis (UVFP). Forty subjects with post-thyroidectomy UVFP (onset <1 month) underwent TR. Videostrobolaryngoscopy, acoustic and perceptual voice analysis and patient self-assessment were carried out in person before, at the end of TR and 6 months later. Twenty-five subjects spontaneously recovered full vocal fold motility at some time during follow-up, whereas 15 had a permanent UVFP at the end of the follow-up period. These subjects constituted our study group. At the early posttherapy control 10/15 subjects (66.6%) showed a complete glottal closure, while in 5/15 (33.3%) a glottal gap remained (P=0.03). These results did not change 6 months after TR. At the late posttherapy control the maximum phonation time improved significantly (P=0.02). Both post-therapy Voice Handicap Index scores were significantly lower than the pre-therapy ones (P=0.04). Grade, Breathiness, and Asthenia parameters of the Grade-Roughness-Breathiness-Asthenia-Strain scale improved 6 months after TR (P < 0.05). The number of voice signals suitable for acoustic analysis increased significantly after therapy. Finally, 87% of patients were satisfied with TR. With careful patient selection, TR may be considered as a promising method for voice therapy in postthyroidectomy UVFP.

Management of Contralateral Reactive Vocal Fold Lesions, a Retrospective Study

To evaluate the anatomical and voice results of conservative management of patients diagnosed with contralateral reactive lesions (CRL) in our voice unit. A retrospective chart review was conducted of all new adult patients with benign vocal fold lesions with or without CRL, treated in the voice unit at Universidad Católica Clinical Hospital between 2015 and 2019. Patients were divided into two groups, without CRL (group A) and with CRL (group B). Analysis of preoperative and 1 month after surgery videostroboscopy, GRBASI, Voice Handicap Index-10 (VHI-10), Voice Related Quality of Life (VRQOL) surveys and management of CRL was conducted. A total of 62 patients were included, 45 (72.6%) had CRL. When compared, bivariate and multivariate analysis revealed that age was significantly associated as a mild protective factor of presenting a CRL (P < 0.05). No significative differences were found between preoperative group A and B perceptual voice analysis or voice surveys. In terms of CRL management, 30 (66.6%) were injected, conservative management with observation was performed in 12 patients (26.7%) and, three (6.7%) were surgically resected. After 1 month follow-up, 32 (71.1%) had complete CRL resolution, eight (17.8%) had CRL persistence and, five (11.1%) had CRL recurrence. Postoperative vocal outcomes, GRBASI, VHI-10 and VRQOL showed significative improvement as compared with preoperative data for each group. No differences were seen between group A and B in terms of postoperative vocal outcomes. CRL are prevalent, and their management is controversial. On our study 72.6% of BFVL presented with CRL and 93.3% of them were conservatively managed. Improvement in perceptual voice analysis and quality of life surveys were similar in both groups.

Perceptual, Aerodynamic and Acoustic Evaluation of Vocal Characteristics in Subjects With Obesity

Obesity has tripled since 1975 and affects health across many domains. Increasing body mass index increases the risk to the obese subject of many non-communicable diseases. The study evaluated the perceptive, aerodynamic, and acoustic parameters that characterize the voice of the obese population. Eighty adult subjects (40 participants in each obese and control group) aged 18-50 years were enrolled. The perceptual voice analysis was performed using the Consensus Auditory Perceptual Evaluation of Voice. The aerodynamic and acoustic voice analyses were performed using the MIR Spiro lab instrument and Doctor's Speech software. A digital stopwatch was also used to measure maximum phonation time. Statistical analysis revealed a significant difference (P-value <0.05 and t value >2) between two groups on acoustic parameters, specifically Normalized noise energy and fundamental frequency tremor (F0 tremor). Normalized noise energy and fundamental frequency tremor were greater in the obese group. Moreover, maximum phonation time and expiratory reserve volume were significantly reduced in the obese group. Results of the present study showed poor voice quality and reduced expiratory reserve volume in obese individuals. This could be credited to the adverse effects of accrued adipose on the functioning of the laryngeal and respiratory systems. Increasing body mass index escalates the risk to the obese subjects of many non-communicable diseases.

Phonatory Characteristics of Male Patients with Classic Essential Tremor.

Voice tremor (VT) is one of the characteristics of essential tremor (ET). This study was designed to describe the group and phonatory characteristics of classic ET patients with VT. This retrospective case-control study compared classic ET patients with age and sex-matched controls. The ET population was subgrouped based on auditory perceptual voice analysis. Electroglottography and acoustic voice samples obtained from both groups were analyzed for contact quotient (CQ) and multidimensional voice program parameters, i.e., fundamental frequency (F0), perturbation, noise, and tremor parameters. The CQ, F0, perturbation, noise, and tremor characteristics significantly increased from the moderate VT group to the severe VT group. The CQ, F0, and noise characteristics reflected the vocal folds' functionality. The perturbation and tremor parameters variation were reasoned considering the tremor-related changes occurring in the laryngeal, vocal tract, and expiratory muscles in patients with ET. Thus, phonatory analysis may help in monitoring the progression of ET.

An eclectic Voice Therapy Program for the Treatment of Hyperfunctional Voice Disorders (HFVD)

An eclectic voice therapy program includes sequenced and structured set of exercises combining direct and indirect intervention methods. Tailor-made exercise prescription with specific cultural adaptations are needed to provide a holistic change to voice quality.1 This study detailed the construction of an exercise prescription for participants with hyperfunctional voice disorder [HFVD] in the Indian context. The exercise program was developed based on literature related to vocal therapy approaches and delivery methods. Adaptations were introduced to a selected set of exercises. Five voice experts verified the exercises and their prescription for content and feasibility of use in the Indian context. Modification suggested by the experts were included for framing the final version of the exercise program. This structured therapy program was planned for 6 weeks (30 minutes duration/session offered individually twice per week, with a gap of two days between sessions in a week) with the goals to improve voice quality, flexibility, and endurance while speaking. Five participants with HFVD partook in the study for pilot testing. Stroboscopy, perceptual voice analysis, Dysphonia Severity Index (DSI) and Vocal Fatigue Index in Tamil (VFI-T) were used to report the therapy outcomes. Participants' report on the learning process and generalization of the program were documented. Wilcoxon-signed rank test was used to test the pre-post outcome measures. An eclectic voice therapy program, i.e., Comprehensive Voice Habilitation Program [CVHP] was constructed and it included vocal hygiene instructions, warm-up & cool-down, easy onset, resonant voice, and carry over exercises. Participants completed the program in 14-18 sessions (over 7 to 9 weeks of therapy). All participants showed significant changes in vocal fold movement patterns, reduction in ventricular hyperadduction, overall grade of voice quality, DSI and VFI-T. Participants reported that pictorial illustrations, feedback, and monitoring sheets were useful in learning the exercises. CVHP showed significant change in the voice-related outcome measures and was a viable program for treating HFVD.

Comparative perceptual evaluation and acoustic voice analysis of a transgender client male to female before and after laser-assisted voice adjustment surgery

In this study, we examined changes in the voice quality of a transgender client who had previously undergone male-to-female (MtF) transition. We conducted a longitudinal phonetic analysis after obtaining recordings from our client before and after undergoing laser-assisted voice adjustment (LAVA) surgery. The following acoustic parameters were compared: fundamental frequency (F0) measures, local jitter, shimmer, harmonic to noise ratio, phonation time, and long-term average spectrum. We assumed that the voice would not change significantly as a result of previous hormonal and vocal therapy, and that its timbre would be closer to female values after LAVA surgery. Since the client was on hormone therapy before the surgery, the average values of F0 corresponded to the values of a normal female voice (190.1 Hz), and, after surgery, the voice became significantly higher in phonation (235.6 Hz). Before surgery, the voice was high for a male voice during reading (mean F0 = 150.19 Hz for non-fricative text (NT) and mean F0 = 158.06 Hz for fricative text (FT)). After surgery, the voice exhibited higher F0 values (F0 = 184.72 Hz for NT and F0 = 191.87 Hz for FT). Before surgery, the voice was average high for a male voice during spontaneous speech (F0 = 119.90 Hz), while after surgery the F0 was 161.33 Hz during spontaneous speech, which is somewhat lower than the average pitch values of the female voice, but its timbral quality is more feminine. Since spontaneous speech is very important for comparison vocal timbre, we can conclude that the 42 Hz difference observed is notable. Although the minimal and maximal values of F0 based on phonation were significantly higher after surgery (p &lt; 0.001), the range was limited. The total results of the F0 measures are higher than expected, while the shortened phonation time points to the need for voice therapy. Considering all our results, we can conclude that it is important to discuss a client’s profession before considering LAVA surgery.

Voice diagnostics in phonosurgical interventions

Stimmdiagnostische Untersuchungen vor und nach phonochirurgischen Eingriffen dienen zum einen der detaillierten Planung der chirurgischen Vorgehensweise und zum anderen der Nachvollziehbarkeit des postoperativen Ergebnisses. Die Stimmdiagnostik verfolgt dabei eine vielschichtige Vorgehensweise und umfasst Aspekte aus perzeptiver Stimmklangbeurteilung, Laryngostroboskopie, Stimmakustik, Aerodynamik und der Selbsteinschätzung durch die Patient*innen. Die Auswahl stimmdiagnostischer Methoden sollte sich dabei immer am aktuellen Wissensstand orientieren und das einrichtungsinterne Vorgehen prägen.

Effect of vocal rehabilitation after chemoradiation for non-laryngeal head and neck cancers.

SUMMARYObjectiveThis study evaluated the effect of voice intervention in patients who received chemoradiation to the neck for non-laryngeal head and neck malignancies.MethodsTwenty individuals with non-laryngeal malignancies of the head and neck who received chemoradiation were divided by block randomisation into an intervention group that received voice rehabilitation and a control group without rehabilitation. All patients underwent acoustic analysis, perceptual and subjective analysis of voice before the commencement of chemoradiotherapy and at 1, 3 and 6 months after chemoradiotherapy.ResultsIn both groups, all parameters were significantly altered at one month follow-up except for fundamental frequency (females in control group and males in intervention group). In the intervention group, all parameters returned to pretreatment levels (no statistical differences) at 6 months. In the control group, all except for a few subjective parameters (grade, breathiness and asthenia) remained significantly altered at 6 months compared to the levels before radiotherapy.ConclusionsIn non-laryngeal head and neck malignancies, voice rehabilitation offered at 1 month after treatment ameliorates chemoradiation-induced dysphonia within 6 months.

La voz en los cantantes líricos. Protocolo para su valoración clínica y acústica

El objetivo de esta investigación es elaborar un protocolo clínico y acústico con diversas técnicas para evaluar la voz de los cantantes líricos. Se seleccionaron 18 cantantes líricos, que se consideraban sanos, clasificados como soprano, mezzosoprano, contralto, tenor, barítono y bajo. A todos se les realizó la anamnesis, el S-VHI y una serie de estudios aerodinámicos (TMF, índice s/e y cociente de fonación) y acústicos (F0, intensidad, HNR, Jitter, Shimmer, espectrograma, fonetograma y LTAS), así como una exploración clínica e instrumental estroboscópica. El 33% eran fumadores, siendo este hábito más frecuente en hombres. El S-VHI detectó 20 puntos sobre 144 posibles, puntuación relativamente alta de su grado de incapacidad. Casi la mitad obtuvieron valores fuera del rango de normalidad en el TMF, índice s/e y cociente de fonación. Las características acústicas de su voz y los rangos vocales y dinámicos estaban, en la mayoría de los casos, dentro de la normalidad. En el 55% se observó algún tipo de patología laríngea. Los cantantes deberían evitar el uso del tabaco, así como hacer revisiones frecuentes para detectar patologías laríngeas que pasan desapercibidas. Los valores aerodinámicos y acústicos muestran alteraciones con respecto a los valores normales de referencia. La presencia de vibrato y formante del cantante puede verse en el espectrograma y el LAST, así como el rango dinámico y vocal con el fonetograma. El uso del protocolo clínico y acústico proporciona importante información que completa la obtenida por el terapeuta vocal o el profesor de técnica vocal en el análisis perceptual de la voz profesional.

Platelet-Rich Plasma for Vocal Fold Scar: A Preliminary Report of Concept

Vocal fold atrophy and scar can lead to loss of normal superficial lamina propria, negatively affecting the vibratory function of the vocal fold. These changes can lead to dysphonia, vocal fatigue, decreased volume, and altered pitch. Treatment options for these conditions are limited. Platelet-rich plasma (PRP) consists of platelets, growth factors, and cytokines derived from the patient's own blood and is believed to activate tissue regeneration. The purpose of this study was to review the technical aspects of collecting PRP and injecting it into the vocal fold injection - based on our initial experience with this procedure. A patient with vocal fold scar was identified and enrolled in an ongoing prospective clinical trial study of a series of 4 monthly subepithelial vocal fold PRP injections, which was temporarily halted due to the COVID-19 pandemic. Patient underwent a single injection of autologous PRP into the left vocal fold. There were no adverse events during the study period. Subjective improvement in voice was noted at 1 month after injection with subsequent return to baseline over the next 4 months. Videostroboscopy performed on postinjection day 1 and day 7 and demonstrated no concerning exam changes. Compared to the preinjection baseline, the patient-reported voice-handicap index-10 (VHI-10) and voice catastrophization index were similar at 4 months following injection (20 to 20 and 4 to 3, respectively). Independent perceptual analysis of voice showed improvement at 4 months postinjection, compared to baseline consensus auditory-perceptual evaluation of voice 60 to 44. This preliminary report was part of a prospective trial investigating the use of PRP to treat vocal fold atrophy and scar. This work highlights the technical considerations for injecting PRP into the vocal fold. Planned prospective enrollment in this study will help to validate the safety and efficacy of PRP injections.

Vocal folds nodules among Egyptian children and adolescents: Behavior aspects

Objective: This study aimed to verify the relationships between voice, and behavior in children and adolescents with and without dysphonia based on parents’ reports and perceptual voice analysis by Phoniatricans.Study Design: This is a case control study.Patients and Methods: The study involved 51 of dysphonic school-age children and adolescents and 62 vocally normal controls aged from 6-18 years. Participants were assessed with auditory perceptual voice analysis, clinical laryngoscopic examination (CLE). Parents of all participants completed the Child Behavior Checklist for ages 6–18 years (CBCL)..Results: Children and adolescents with dysphonia scored higher on Internalizing, Externalizing, Anxiety/depression, Withdrawal/depression, Somatic complaints, Social problems, Attention problems, Rule-breaking, and Aggressive behavior. Children and adolescents with vocal problem scored lower on Activities, Social, School, and thought problems. Correlation analysis between dysphonia severity and CBCL scores demonstrated significant positive correlation in the following scales (Internalizing scale r=0.549; P=0.001, externalizing scale (r=0.370; P= 0.001 and total Behavior scales (r= 0.581; P=0.00), school scale score (r= 0.288; P=0.002), and total Competence indicators (r= 0.230; P= 0.014), withdrawal/depression, social problems, rule-breaking, and aggressive behavior .Conclusion: Vocal fold nodules may be a risk for behavior problems due to the higher scores on behavior problems scales in children and adolescents, especially internalization and externalization aspects and significant positive correlation found between dysphonia severity and CBCL scores. Early interventions of these problems are needed to prevent the persistence of such problems, and reduce its negative impact.

Self-Perception of Vocal Loading Effects and Short-Term Voice Care Outcomes in Egyptian Soccer Fans Volunteers

Background: Soccer fans create violent vocalizations for hours and not adjust their voices as professional voice users. Acute phonotrauma is the result of sound produced when one's voice is shouted or strained. To our knowledge, no further studies are available in the research area performed on a related group of samples in Egypt.Objective: Self-assessment of acute changes in voices of soccer fans who volunteered to the current study after a soccer match as a vocal loading challenge and assessed in three different times (pre-match, post-match) and 1 week post-match after receiving vocal hygiene measures and investigate the impact of voice hygienic measures in overloading vocal tasks.Patients and Methods: During the 2019 Africa Cup of Nations a longitudinal follow-up was conducted among volunteer soccer fans. Clinical laryngoscopic examination (CLE) was performed to all participants to exclude vocal fold lesions before the match. Auditory perceptual voice analysis (APA), and Voice Handicap Index (VHI) questionnaire were adminstered in three time points apart: before the match, within 9 to 15 h post-match, and 1 week after the match. All participants were subjected to voice hygiene instructions post-match and reevaluated after 1 week.Results: VHI scores increased statistically significantly after the match, compared with pre-match scores (P < 0.05). There was a significant positive correlation between post-match VHI scores and post-match dysphonia grade (P < 0.05). Positive statistical significance was found when comparing grade of dysphonia post-match and follow-up.Conclusion: Phono-traumatic behaviors are the likely source of vocal impairment. It is thought that VHI and perceptual voice analysis should be done together for diagnosis and follow-up of voice changes in vocal loading tasks. Short-term vocal hygiene program was beneficial in improving vocal quality.

Speech disorders in Parkinson’s disease - characteristics, assessment and treatment

Introduction. Parkinson?s disease belongs to the group of extrapyramidal neurodegenerative diseases and occurs as a consequence of the loss of dopaminergic neurons in the substantia nigra of the mesencephalon. Persons with Parkinson?s disease may experience a wide range of motor and non-motor symptoms. Material and Methods. A literature search was conducted using electronic databases on the Internet and electronic databases of Serbian libraries. Results. Speech disorders in Parkinson?s disease are classified in the group of hypokinetic dysarthria. Empirical data show that the basic characteristics of dysarthria in people with Parkinson?s disease are changes in voice quality, difficulties in articulating consonants, abnormalities in vowel production, monotonous speech, changes in speech rate, rough and breathy voice, increased voice nasality, reduced intensity of voice, involuntary pauses during speech, and palilalia. Methods used in the assessment of speech disorders include perceptual voice analysis, such as the overall dysphonia Grade, Roughness, Breathiness, Asthenia, Strain and Consensus Auditory Perceptual Evaluation of Voice scales, acoustic voice analysis (e.g., Multi-Dimensional Voice Program), and voice quality self-assessment methods (e.g., Voice Handicap Index and the Dysarthria Impact Profile). In the treatment of dysarthria, various behavioral methods of speech therapy are used, among which the Lee Silverman method is particularly important. Conclusion. Speech disorders in Parkinson?s disease manifest as altered patterns of respiration, phonation, resonance, articulation and prosody. The best results in the treatment are achieved by combination of medical, surgical, and behavioral therapy, through the cooperation of experts of different profiles as well as with family members of the patient.

Voice Component Relationships with High Reflux Symptom Index Scores in Muscle Tension Dysphonia.

To analyze the Reflux Symptom Index (RSI) and the Voice-Related Quality of Life (V-RQOL) scores based on the perceptual and analytical parameters in primary MTD patients with no reflux. Cross-sectional study. One hundred and eighteen participants, that is, sixty patients with normal voices and fifty-eight patients with primary MTD were recruited in this study. The diagnosis of primary MTD was made by perceptual voice analysis, neck palpation, video-laryngoscopic examination, and exclusion of other etiologies. Acoustic analysis and the GRBAS (Grade, Roughness, Breathiness, Asthenia, and Strain) scale were evaluated for all participants. The V-RQOL and RSI questionnaires were then given to all participants. This study included 118 participants of 29 males (48.3%) and 31 females (51.7%) in the normal group. MTD group also included 27 males (46.6%) and 31 (53.4%) female patients. Mean (SD) RSI and V-RQOL scores were 12.35 (3.84) and 11.09 (2.20) for the normal group, and 22.87 (6.97) and 22.89 (7.94) for the MTD group (P = .000). In the MTD group, V-RQOL had a positive correlation with jitter for /i/ and /u/, Noise to Harmonic Ratio (NHR) for /i/, /a/, and /u/, and Grade, Roughness, and Strain of GRBAS scale (P < .05). In addition, RSI had a positive correlation with Strain in the MTD group (P < .05). MTD patients in the absence of laryngopharyngeal reflux findings may have high RSI scores. Hence, patients with high RSI scores and disproportionate acoustic and perceptual analysis would require a thorough evaluation of MTD. 4 Laryngoscope, 131:E1573-E1579, 2021.

Comprehensive Evaluation of Voice-Specific Outcomes in Patients With Essential Tremor Before and After Deep Brain Stimulation

Deep brain stimulation (DBS) is a treatment for medically refractory essential tremor (ET), but there is a paucity of literature examining the effects of DBS on voice in patients with ET pre-DBS and post-DBS. This study aimed to report a comprehensive evaluation of voice in patients with ET pre-DBS and 6-months post-DBS. Case series. Five patients receiving DBS for ET underwent voice evaluations pre-DBS and 6-months post-DBS. One patient had concurrent ET of the vocal tract (ETVT). The evaluation included patient-reported, perceptual, acoustic, and phonatory aerodynamic analyses of voice. Voice Handicap Index-10, Grade, Roughness, Breathiness, Asthenia, Strain Scale, perturbation measures, cepstral spectral index of dysphonia, cepstral peak prominence, and mean phonatory airflow measures were also among the data collected. Patients with ET presented with minimal changes in perceptual, acoustic, and phonatory aerodynamic parameters. Perceived vocal roughness significantly increased 6-months post-DBS (P = 0.047). The patient with ETVT presented with clinically significant improvement in almost all collected voice parameters 6-months post-DBS. This is the first study to provide data encompassing auditory perceptual voice analysis, voice-specific patient-reported quality of life measures, acoustic, and phonatory aerodynamic outcomes in patients pre-DBS and 6-months post-DBS for ET. The results of our preliminary study have implications for the use of a comprehensive voice assessment to identify and measure change in voice outcomes in patients with ET and ETVT pre- and postsurgery.