Phonation Time Research Articles

The Effects of Sleep Inertia on the Acoustic and Perceptual Voice Changes in Adult University Students

Background: Sleep inertia, characterized by reduced alertness and cognitive functioning upon waking, has been well-researched in its effects on cognitive and motor abilities. However, its impact on voice quality remains less clear. Objectives: This study aimed to investigate the relationship between sleep inertia following nocturnal sleep and changes in acoustic and perceptual voice parameters in adults. Methods: Ninety healthy participants (45 females, 45 males, ages: 18 - 30 years) took part in a pre-post study using convenience sampling. Their voices were recorded before and after nocturnal sleep across multiple tasks, including vowel /a/ phonation, spontaneous speech, text reading, and maximum phonation time (MPT). Recordings were made in a quiet room using a Zoom H6 recorder at a 44.1 kHz rate. The acoustic analysis included measures of fundamental frequency (F0), standard deviation of F0 (SD F0), vocal intensity, harmonics-to-noise ratio (HNR), cepstral peak prominence smoothed (CPPS), jitter, shimmer, and formant frequencies. Auditory-perceptual evaluation was conducted using the GRBAS Scale. Statistical analysis was performed using SPSS-19. The Shapiro-Wilk test assessed normality, and a paired t-test compared variables, separately for males and females at a 0.05 significance level. Results: Acoustic analysis revealed that both females and males experienced a decrease in mean F0, mean intensity, HNR, and CPPS, and an increase in jitter, shimmer, and SD F0 across most voice samples after sleeping. These changes were particularly significant for females in all voice samples (P < 0.001). Perceptual analysis also showed a significant increase in grade, roughness, breathiness, asthenia, and strain for both genders after sleep (P < 0.001). Conclusions: This study demonstrated that sleep inertia negatively impacts vocal performance, resulting in a decline in voice quality for both genders after sleep compared to before. Notably, this decline in voice quality was more pronounced in women than in men.

Post-Extubated Dysphagia in Intensive Care Unit Patients Based on Flexible Endoscopic Evaluation of Swallowing Examination and Its Affecting Factors

Background and Objectives Post-extubation dysphagia (PED) is a condition characterized by swallowing difficulty following the removal of breathing tube. Untreated dysphagia leads to increased morbidity and mortality; however, no study has been conducted on the proportion of PED at RSUPN Dr. Cipto Mangunkusumo (RSCM), using flexible endoscopic evaluation of swallowing (FEES), or on the factors that contribute to its occurrence.Subjects and Method Anamnesis and medical record review were conducted on post-extubation patients in the RSCM intensive care unit (ICU) meeting inclusion criteria. Research subjects underwent maximum phonation time (MPT) examination thrice. FEES examination was carried out twice, with 24 hours of post-extubation on all subjects and 72 hours of postextubation on those with PED on initial FEES examination.Results The study involved 33 subjects who met the inclusion criteria. The proportion of mild to severe PED determined by FEES 24 hours after extubation was 66.7%, and those exhibiting laryngeal injury was 87.9%. The bivariate analysis revealed a significant correlation between the number of comorbidities, intubation duration, laryngeal injury severity, and MPT value with the incidence of PED in the RSCM ICU. Moreover, the multivariate analysis showed that the duration of intubation exceeding 24 hours had a statistically significant association with the incidence of PED (<i>p</i>=0.003; OR 15.30; 95% CI 2.46-95.19).Conclusion The proportion of mild to severe dysphagia in post-extubation patients in the RSCM ICU is quite high. Intubation duration exceeding 24 hours and having more than one comorbidity significantly contribute to the increased risk of dysphagia in post-extubated patients in the RSCM ICU.

Platelet Rich plasma injection of the vocal folds in benign vocal pathologies

PurposeThere are few options for treatment of dysphonia secondary to vocal pathology related to lamina propria scar, atrophy, sulcus, or inflammatory disorders. Platelet rich plasma (PRP) may provide anti-inflammatory and regenerative properties seen with other tissue engineering therapies without the risks associated with these treatments. We evaluated vocal fold (VF) injection of PRP for feasibility, phonatory effects, patient satisfaction and durability.MethodsPatients with dysphonia secondary to vocal fold scar, atrophy, sulcus and inflammatory lesions were included. PRP injections were administered in office, to bilateral vocal folds. Patients were followed up at 1 week, 1 month, 3 months and 6 months to assess outcomes (GRBAS scale, maximum phonation time, vocal fatigue index (VFI), voice handicap index (VHI-10) and stroboscopy).Results75 intracordal PRP injections were administered to 48 patients. All injections were completed, and no adverse reactions were experienced. Improvements in VHI-10 scores at 1,3,6 months were seen (mean VHI 21.73 at baseline, 15.62 at six months, p < 0.001). 72.3% rated improvement at 7 or above on Likert scale. 95.7% of patients would consider a future PRP injection. Secondary outcomes VFI, MPT, and GRBAS also demonstrated significant improvements over time. Patients receiving a single PRP injection (n = 26) still demonstrated significant VHI-10 improvements at 1,3 and 6 months.ConclusionsVF office PRP injections are feasible and safe and can provide phonatory benefit and reduce vocal effort in benign VF disorders. A single PRP injection is sufficient to provide sustained benefit in some cases.Level of evidenceLevel III: prospective cohort study.

Injection Laryngoplasty of Unilateral Vocal Fold Paralysis Evaluated With Pause and Speech Measurements

ObjectiveThe purpose of this study was to examine a number of pause and speech measurements in patients with unilateral vocal fold paralysis, before and after injection laryngoplasty. The non-invasive measurements were selected to investigate and explain the treatment effect on connected speech in these patients. Study designRetrospective study with repeated measurements design. MethodVoice recordings of 24 patients with unilateral vocal fold paralysis from before and after injection laryngoplasty in local anesthesia were analyzed retrospectively with the computer program Praat. Measurements examined were number of pauses, average pause duration, pause ratio (expressing the amount of pausing during a reading aloud task), number of breath groups, average duration of breath groups, articulation rate, speaking rate, maximum phonation time and voice handicap index. ResultsInjection laryngoplasty had a significant improving effect on the number of pauses, pause ratio, number of breath groups, average duration of breath groups, articulation rate, speaking rate, maximum phonation time and voice handicap index. Maximum phonation time before treatment correlated with several pause- and speech measurements. ConclusionThe results showed that treatment with injection laryngoplasty had a clear effect on several pause and speech measurements and that these measurements correlated with maximum phonation time, but not with voice handicap index.

Wearable Voice Dosimetry System

The objective quantification of voice acoustic parameters is used for the diagnosis, monitoring, and treatment of voice disorders. Such assessments are carried out with specialised equipment within the doctor’s office. The controlled conditions employed are usually not those of the real environment of the patient. The results, although very informative, are specific to those measurement conditions and to the time when they were performed. A wearable voice monitoring system, based on an accelerometer to ensure the message, can overcome these limitations. We present a miniaturised, low-power, and low-cost wearable system to estimate and record voice fundamental frequency (F0), intensity and phonation time for long intervals in the everyday environment of the patient. It was tested on two subjects for up to two weeks of recording time. It was possible to identify distinct periods in vocal activity, such as normal, professional, demanding or hyperfunctional. It provided information on the workload that the vocal cords needed to cope with over time and when and to what extent that workload was concentrated. The proposed voice dosimetry system enables the extraction and recording of voice parameters for long periods of time in the everyday environment of the patient, allowing the objectification of vocal risk situations and personalised treatment and monitoring.

A Prospective Comparative Analysis to Study the Impact on Voice Changes Following Endoscopic Thyroidectomy.

Endoscopic approach has come up as a safe and feasible procedure for thyroidectomy with better cosmetic outcomes. However, concerns over its safety in terms of nerve injury and postoperative voice changes remain. This prospective study evaluated the role of vocal cord function assessment using laryngeal examination and voice analysis in patients who underwent endoscopic hemithyroidectomy either by the trans-oral endoscopic thyroidectomy vestibular approach (TOETVA) or the bilateral axillobreast approach (BABA). Thirty-nine consecutive patients were randomly allocated to either of the 2 groups of endoscopic hemithyroidectomy; 19 in TOETVA and 20 in the BABA groups. Vocal cord function was assessed subjectively using the GRBAS scale and objectively by acoustic analysis of parameters such as jitter, shimmer, mean frequency (F 0 ), noise-to-harmonic ratio (NHR), and maximum phonatory time (MPT) at baseline, postoperative day 10, and 3 months after surgery. There were no significant differences in mean GRBAS scores and values of mean frequency, jitter and shimmer between the 2 groups and on postoperative day 10 and at 3 months compared with baseline. The mean NHR and MPT showed no differences between the 2 procedures. However, there was a significant decrease in their values on day 10 postsurgery, compared with baseline. These values returned to their baseline at 3 months. The other operative parameters were comparable between the 2 groups, except for the shorter mean operative time in the TOETVA group. Perioperative quantitative voice parameters were comparable with no statistically significant difference between the 2 techniques of endoscopic thyroidectomy.

Hybrid SPEAK OUT! protocol improves aerodynamic measurements and PROMs in Parkinson's disease.

SPEAK OUT! has been shown to enhance various aspects of voice such as intensity, prosody, voice quality and perception of voice. However, their impacts on expiration and communication effectiveness have not yet been evaluated. This study aimed to evaluate the effectiveness of the Hybrid SPEAK OUT! method on aerodynamic measurements and patient-reported outcome measures (PROMs) in individuals with Parkinson's disease (PD). This study included 157 participants with PD who underwent an intensive 8-week multidisciplinary treatment program. The Hybrid SPEAK OUT! method consisted of three sessions per week, including two group sessions and one individual treatment session. Voice-related aerodynamic measures included maximum phonation time (MPT), vocal cord function using the S/Z ratio, and expiratory flow measures including peakexpiratoryflow (PEF) and peak cough flow (PCF). Two PROMs were included: the Hebrew version of the voice handicap index-10 and communication effectiveness questionnaire. The results of 111 participants were analysed. MPT duration increased, PEF and PCF increased, and better scores were found in PROMs. These findings would appear to support the effectiveness of the Hybrid SPEAK OUT! methods improving function, activity and participation in individuals with PD. However, further research is needed. What is already known on the subject Prior research has demonstrated the effectiveness of behavioral therapies, including the SPEAK OUT! program, in managing speech symptoms in individuals with Parkinson's disease (PD). These therapies have shown improvements in voice intensity, fundamental frequency, voice quality, and voice perception. However, the impact on aerodynamic measures, expiratory flow, and patient-reported outcome measures has not been extensively studied. What this paper adds to existing knowledge This study adds to the existing knowledge by demonstrating that a Hybrid SPEAK OUT! approach, can lead to improvements in aerodynamic measures, including maximum phonation time (MPT), expiratory and cough peak flow. In terms of motor learning, we found that two non-speech exhalation-related tasks that were not directly trained improved following the intensive speech training protocol. Furthermore, it shows positive changes in patient-reported outcome measures, with reduced voice-related disability and improved communication efficiency. What are the potential or actual clinical implications of this work? The findings of this study have important clinical implications for the management of speech symptoms in individuals with PD. The Hybrid SPEAK OUT! program, which combines group and individual sessions, can effectively improve voice, aerodynamic measurements and patient-reported outcome measures (PROMs), ultimately enhancing the overall quality of life for patients. These findings support the effectiveness of the Hybrid SPEAK OUT! methods for improving function, activity, and participation in individuals with PD.

Rehabilitation Program for Postlaryngectomy Patients Following Ileocolon Flap Transfer for Voice Reconstruction: An Essential Part of Success.

Speech restoration is important for communication and social activities after pharyngolaryngectomy in head and neck cancer or corrosive injury. Several techniques of voice restoration have been developed to improve life quality. The aim of this paper was to focus on the microsurgical transfer of ileocolon flap and outcome of further voice rehabilitation. From 2010 to 2022, 69 patients had ileocolon flap at our hospital with postoperative speech training and regular follow-up for over 1 year. The patients received deglutition training first, followed by voice rehabilitation. Voice outcomes were evaluated at an interval of 3 months and finally at 12 months of voice training rehabilitation. Among other examinations, the speech function was evaluated using a 4-point Likert scale and senior surgeon (H-c.C.) scoring system. The results showed that speech function reached 13.1% of excellent voice, 65.1% of good voice, 13.1% of fair result, and 8.7% of poor result by Likert scales. Meanwhile, the senior surgeon (H-c.C.) score showed 17.4% of excellent, 63.8% of moderate, and 18.8% of poor results. About voice laboratory results, maximal phonation time was 11.0 seconds, and the average number counted in one breath was 15. Loudness and frequency showed 56.0 dB and 105.0 Hz, respectively. The study showed that after voice reconstruction with ileocolon flap followed by the voice rehabilitation program, the patients would have a better understanding of the altered anatomical structures and practice in a more efficient way. Adequate recommendation by the therapists to plastic surgeons for revision surgeries optimized voice function of the patients.

Seven Days of Voice Rest Post-phonosurgery Is Not Better than 3 days: A Prospective Randomized Short-term Outcome Study.

The aim of the study is to compare the short-term effect of 7 versus 3 days of voice rest (VR) on objective vocal (acoustic) parameters following phonosurgery. A prospective randomized study conducted at a tertiary referral medical center. Patients with vocal fold nodules, polyps, or cysts and scheduled for phonosurgery were recruited from the Voice Clinic. They were randomized into groups of 7- or 3-day postoperative VR periods and their voices were recorded preoperatively and at 4-week postoperatively. A mixed linear model statistical analysis (MLMSA) was used to compare pre- and postoperative jitter, shimmer, harmonic-to-noise ratio, and maximum phonation time between the two groups. Sixty-five patients were recruited, but only 34 fully complied with the study protocol, and their data were included in the final analysis (19 males, 20 females; mean age: 40.6 years; 17 patients in the 7-day VR group and 16 in the 3-day VR group). The groups were comparable in age, sex, and type of vocal lesion distribution. The preoperative MLMSA showed no significant group differences in the tested vocal parameters. Both groups exhibited significant (p < 0.05) and comparable improvement in all vocal parameters at postoperative week 4. A VR duration of 7 days showed no greater benefit on the examined vocal parameters than the 3-day protocol 4-week postoperatively. Our results suggest that a 3-day VR regimen can be followed by patients who undergo phonosurgery without compromising the vocal results. Larger-scale and longer-duration studies are needed to confirm our findings. 2 Laryngoscope, 134:4661-4666, 2024.

The Efficacy of Voice Therapy via Hybrid Group Telepractice Program with Asynchronous Components for Primary School Teachers: A Pilot Study

PurposeTo determine the efficacy of a hybrid group telepractice program in voice therapy for primary school teachers. MethodThe participants, consisting of 12 teachers with voice disorders (3 males and 9 females), participated in 11 sessions of the telepractice program, divided into 1 training session on vocal hygiene, 5 practice sessions by themselves, and 5 group practice sessions in 5 weeks. Data on the vocal handicap index (VHI) measure was obtained pre- and post-intervention. The voice analysis included fundamental frequency (local), jitter (local), shimmer (local), harmonic-to-noise ratio (local), and maximum phonation time assessed by Praat software. ResultThe VHI assessment revealed a statistically significant difference (p < 0.05) in the emotional domain. There was no statistically significant difference (p > 0.05) in physical, functional, and total scores. Both males and females had no statistically significant difference (p > 0.05) in mean fundamental frequency. However, there was a statistically significant difference (p < 0.05) in jitter (local), shimmer (local), harmonics-to-noise ratio (local), and the maximum phonation time. ConclusionThe group telepractice program in voice therapy for primary school teachers was effective. It could be utilized for voice therapy to prevent voice disorder problems in teachers.

Changes in and clinical utility of maximum phonation time and repetitive saliva swallowing test scores after esophagectomy.

Postoperative pneumonia in patients with esophageal cancer occurs due to swallowing dysfunction and aspiration. Recently, maximum phonation time (MPT) assessment and repetitive saliva swallowing test (RSST) have been focused on as swallowing function assessment methods that can identify patients as high risk for pneumonia. We aimed to evaluate the clinical utility of MPT assessment and RSST in patients undergoing oncological esophagectomy. In total, 47 consecutive patients who underwent esophagectomy for esophageal cancer between August 2020 and July 2023 were eligible. The perioperative changes in MPTs and RSST scores were examined. In addition, univariate and multivariate analyses were performed to identify the predictive factors of postoperative pneumonia. The median MPTs before surgery and on postoperative days (PODs) 3, 6, and 10 were 18.4, 7.2, 10.6, and 12.4s, respectively; postoperative MPTs were significantly lower than preoperative MPT. In addition, the MPT of POD 6 was significantly longer than that of POD 3 (P < 0.05). Meanwhile, there were no significant changes in perioperative RSST scores. Overall, 8 of 47 patients (17.0%) developed pneumonia postoperatively. A short MPT on POD 6 was one of the independent predictive factors for the incidence of postoperative pneumonia (odds ratio: 12.6, 95% confidence interval: 1.29-123, P = 0.03) in the multivariate analysis. The MPT significantly decreased after esophagectomy. However, the RSST score did not. The MPT on POD6 can be a predictor of postoperative pneumonia.

CO2 laser in benign vocal fold lesions: an observational study

BackgroundTo evaluate the clinical and functional outcome of patients having benign vocal fold lesions who were treated with carbon dioxide laser.MethodsFor this Study a total of 41 Patients who had hoarseness of voice and satisfied the inclusion criteria were included. A detailed medical history and a thorough ENT examination was performed. Voice evaluation was done using (G)rade, (R)oughness, (B)reathiness, (A)sthenia….weakness (S)train (GRBAS), voice handicap index (VHI), and maximum phonation time scores.ResultsAll 41 patients reported hoarseness of voice as their primary complaint, and most of them developed their symptoms gradually. The following causes seem to have contributed to the presence of hoarseness of voice: LPR in 8 patients, smoking in 25 patients, voice abuse in 14 patients, and irritation exposure in 6 patients. The most frequent lesion in 25 (60.97 percent) of the subjects was a vocal polyp. This study showed majority of patients 35 (85.4%) had posterior phonatory gap and six (14.6%) had anterior gap preoperatively. All patients had incomplete glottic closure preoperatively, whereas glottic closure was complete at first follow-up postoperatively. The mean preoperative GRBAS score in study subjects was 10.972 with an SD (standard deviation) of 2.1724 and a median of 10.000. The mean postoperative GRBAS score at six months was 0.268 with an SD of 0.4486, median 0.000, Z score − 5.618, and p value < 0.001 which is statistically significant.ConclusionPrecision, hemostasis, and minimal postoperative edema are benefits of using carbon dioxide laser. This research therefore supports the idea that benign vocal fold lesions might be successfully treated with the super-pulsed microspot carbon dioxide laser, which offers good voice outcomes.

Streamlining quantification of age‐related vocal atrophy

AbstractObjectivesAge‐related vocal atrophy (ARVA) has a significant impact on voice, communication, and quality of life. Vocal folds are bowed with incomplete glottic closure during phonation. Efficient quantification of vocal fold atrophy and collection of voice recordings in clinic remains challenging. The primary focus of this study is to describe a novel method for quantifying vocal atrophy and obtaining voice recordings in clinic among patients with ARVA.MethodsPatients with ARVA were included. Voice recordings were collected during the clinic visit, and acoustic analysis was subsequently performed. A novel mobile application was used to quantify the bowing index (BI).ResultsThe study included 10 patients with ARVA, with a mean age of 72.7 ± 6.8 years and body mass index (BMI) of 24.9 ± 2.4 kg/m2. Calculation of BI was feasible with a mean of 9.9 ± 1.8 units. On average, the audio recording took 2.6 ± 0.4 min, and subsequent analysis required 7.1 ± 1.8 min. Mean continuous speech f0 was 212.1 ± 10.1 and 134.2 ± 31.5 Hz for male and female patients, respectively. Smoothed cepstral peak prominence was 8.9 ± 1.5 dB (male) and 8.5 ± 0.3 dB (female), and maximum phonation time between male and female patients was 16.7 ± 9.8 and 13.8 ± 1.9 s, respectively.ConclusionWe present a feasible and streamlined method for quantification of vocal fold atrophy in the clinic among patients with ARVA. The accuracy and reliability of this new method are areas of ongoing investigation. Quantification of vocal atrophy may help with clinical decisions, including diagnosing vocal atrophy and tracking treatment progress. Moreover, this method may improve research data acquisition without burdening patients and clinicians with additional time‐consuming tasks.Level of evidence: 4.

Effect of Vocal Function Exercises on the Voice Handicap Index, Vocal Fatigue Index, and Number of Vocal Fatigue Symptoms in Bank Workers: Single-Blinded Randomized Controlled Trial.

Vocal fatigue (VF) is a significant portion of occupational voice disorders. Researchers have proposed numerous therapeutic approaches to alleviate VF. However, the efficacy of vocal function exercises (VFEs) as a safe, effective, and simple method is unclear. The current study aims to investigate the effect of VFEs on occupational-related VF in Iranian bank workers. A single-blinded randomized controlled trial with four-level blocking After screening 444 workers, 43 persons with vocal fatigue (VF) were allocated between intervention and control groups. The gender of participants was considered a confounding parameter. Intervention group participants (IGP) (20 males and two females) practiced vocal function exercises (VFEs) (online training) for two weeks, while control group participants (CGP) (20 males and a female) continued their routine lifestyle. The Number of Vocal Fatigue Symptoms (NoVFS), Maximum Phonation Time (MPT), Voice Handicap Index (VHI), and Vocal Fatigue Index (VFI) at pre-intervention and post-intervention levels were gathered and compared. According to the intergroup, pre-/post-intervention differences, and intragroup analysis, the IGP experienced a significant reduction in the NoVFS (P = 0.006, P = 0.009), the mean score VHI (P:0.006, P: 0.001, P: 0.001), the total mean score of VFI (P < 0.001, P < 0.001, P < 0.001), and the first (P = 0.005, P = 0.002, P < 0.001) and second (P = 0.006, P < 0.001) factors' mean score of VFI. Additionally, there was an improvement in the MPT (P < 0.001, P < 0.001, P < 0.001) and the third factor (P = 0.01, P = 0.004, P = 0.021) mean score of VFI. Vocal function exercises can alleviate symptoms, voice handicaps, tiredness, avoidance, and physical discomfort of vocal fatigue in bank workers. Additionally, it can improve glottal (pulmonary) sufficiency and rest recovery of vocal fatigue in this group of workers.

Do Acoustic Characteristics of Dysarthria in People With Parkinson's Disease Differ Across Languages?

Cross-language studies suggest more similarities than differences in how dysarthria affects the speech of people with Parkinson's disease (PwPD) who speak different languages. In this study, we aimed to identify the relative contribution of acoustic variables to distinguish PwPD from controls who spoke varieties of two Romance languages, French and Portuguese. This bi-national, cross-sectional, and case-controlled study included 129 PwPD and 124 healthy controls who spoke French or Portuguese. All participants underwent the same clinical examinations, voice/speech recordings, and self-assessment questionnaires. PwPD were evaluated off and on optimal medication. Inferential analyses included Disease (controls vs. PwPD) and Language (French vs. Portuguese) as factors, and random decision forest algorithms identified relevant acoustic variables able to distinguish participants: (a) by language (French vs. Portuguese) and (b) by clinical status (PwPD on and off medication vs. controls). French-speaking and Portuguese-speaking individuals were distinguished from each other with over 90% accuracy by five acoustic variables (the mean fundamental frequency and the shimmer of the sustained vowel /a/ production, the oral diadochokinesis performance index, the relative sound level pressure and the relative sound pressure level standard deviation of the text reading). A distinct set of parameters discriminated between controls and PwPD: for men, maximum phonation time and the oral diadochokinesis speech proportion were the most significant variables; for women, variables calculated from the oral diadochokinesis were the most discriminative. Acoustic variables related to phonation and voice quality distinguished between speakers of the two languages. Variables related to pneumophonic coordination and articulation rate were the more effective in distinguishing PwPD from controls. Thus, our research findings support that respiration and diadochokinesis tasks appear to be the most appropriate to pinpoint signs of dysarthria, which are largely homogeneous and language-universal. In contrast, identifying language-specific variables with the speech tasks and acoustic variables studied was less conclusive.

"Lombard Effect" and Voice Changes in Adductor Laryngeal Dystonia: A Pilot Study.

The aim was to describe the acoustic, auditory-perceptive, and subjective voice changes under the Lombard effect (LE) in adductor laryngeal dystonia (AdLD) patients. Subjective perception of vocal effort (OMNI Vocal Effort Scale OMNI-VES), Maximum Phonation Time (MPT), and the perceptual severity of dysphonia (GRBAS scale) were assessed in condition of stillness and under LE in 10 AdLD patients and in 10 patients with typical voice. Speakers were asked to produce the sustained vowel /a/ and to read a phonetically balanced text aloud. Using the PRAAT software, the following acoustic parameters were analyzed: Mean Pitch (Hz), Minimum and Maximum Intensity (dB), the Fraction of Locally Unvoiced Frames, the Number of Voice Breaks, the Degree of Voice Breaks (%), the Cepstral Peak Prominence-Smoothed (CPPS) (dB). Under LE, the AdLD group showed a decrease of both G and S parameters of GRBAS and subjective effort, mean MPT increased significantly; in the controls there were no significant changes. In both groups under LE, pitch and intensity of the sustained vowel /a/ significantly increased consistently with LE. In the AdLD group the mean gain of OMNI-VES score and the mean gain of each parameter of the speech analysis were significantly greater than the controls' ones. Auditory feedback deprivation obtained under LE improves subjective, perceptual-auditory, and acoustics parameters of AdLD patients. These findings encourage further research to provide new knowledge into the role of the auditory system in the pathogenesis of AdLD and to develop new therapeutic strategies. 4 Laryngoscope, 134:3754-3760, 2024.

A comparison of the phonation quotient between patients with voice disorders caused by benign vocal fold lesions and normal adults 20-80 years of age

Background: A voice evaluation is an important first step in analyzing voice symptoms and determining appropriate treatment plans. The phonation quotient is a valid aerodynamic parameter in voice evaluations which is an indirect source of information for evaluating the valve function of the vocal folds of patients with voice disorders, especially patients with voice disorders caused by tumors of the vocal folds which is the most common cause in the patients with voice disorders. Objective: The present study aims to determine and compare the phonation quotient between patients with voice disorders caused by benign vocal fold lesions and normal adults between 20-80 years of age. Materials and methods: The participants comprised 40 adults with voice disorders caused by benign vocal fold lesions and 40 with normal voices. All participants’ voices were evaluated in the Speech Clinic at Ramathibodi Hospital, Bangkok. The phonation quotient (PQ) was calculated by the ratio of vital capacity (VC) to the maximum phonation time (MPT). VC and MPT were measured using a phonatory aerodynamic system (PAS). Results: The results of the present study indicated that the mean value of the PQ of adults with normal voices was 122.60 cc/sec (SD=16.36). The mean value of the PQ of adults with voice disorders caused by benign vocal fold lesions was 292.08 cc/ sec (SD=97.14). The mean value of the PQ in the group with voice disorders caused by benign vocal fold lesions was significantly more significant than the mean value of the PQ in the group with normal voice. Conclusion: The significant difference between the phonation quotient of adults with voice disorders caused by benign vocal fold lesions and adults with normal voice was that the PQ might be an indicator for indirect evaluation of the airflow leakage related to the efficiency of vocal fold movement during phonation. The PQ can be the optional voice measurement for monitoring and analyzing the outcomes of voice therapy.

Stroboscopy and acoustic analysis of voice following endotracheal intubation in otological surgeries

BackgroundStroboscopy is an endoscopy that is performed with intermittent light at a frequency that approximates the frequency of a moving object so that it appears in slow motion or motionless. It is used to analyze the structure and motion of the vocal fold.Aim and objectiveTo compare the stroboscopic findings of various vocal parameters such as symmetry, amplitude, periodicity, mucosal wave of vocal folds, and glottis closure before and after elective endotracheal intubation and to compare acoustic analysis of voice using fundamental frequency, intensity, maximum phonation time, and dysphonia severity index in patients before and after elective intubation, who were undergoing otological surgeries. It also assesses the correlation between changes in these vocal and acoustic parameters and the size of the endotracheal tube, duration of intubation, and number of attempts made during intubation. This study creates awareness and provides insights to avoid intubation-related vocal fold injury.MethodsThis was a prospective cohort study involving 31 patients done in a Tertiary Care Centre. All patients who underwent otological surgeries by elective endotracheal intubation were included. All of them underwent stroboscopic and acoustic evaluation preoperatively, 24 h, and 7 days postoperatively.ResultsStatistically significant changes in mucosal wave pattern score were observed in the 1st postoperative day that reverted to normal by the end of 7th postoperative day and in GRBAS which was significant at the end of both 1st and 7th POD. Other parameters like fundamental frequency, intensity, DSI, MPT, amplitude, symmetry, periodicity, and glottis closure remain unaltered. There was a moderate positive correlation between the duration of intubation (minutes) and mucosal wave 1st POD (P-value: 0.003).ConclusionThe majority of the patients (61%) had normal laryngeal structures. A total of 39% had evidence of injury, the most common being right vocal fold hemorrhage improved by the end of 7th postoperative day and became normal.

Voice handicap and voice-related quality of life in COVID-19 patients

ObjectivesIdentifying voice handicap and voice-related quality of life in patients presenting pulmonary impairment associated with COVID-19 infection, comparing pulmonary parameters between these patients and individuals in the control group, as well as correlating pulmonary parameters to self-assessment questionnaires (IDV-10 and QVV). MethodsThirty-five (35) patients presenting pulmonary impairment with COVID-19 infection were herein selected and compared to 35 individuals who were not affected by COVID-19 infection. Two self-assessment questionnaires were applied (vocal handicap index and voice quality of life protocol). Maximum phonation time Forced Expiratory Pressure (PEF) and Forced Inspiratory Pressure (PIF) were measured and videolaryngoscopy was performed. ResultsThere was statistically significant difference in scores recorded in voice self-assessment questionnaires (IDV-10 and QVV), Expiratory Pressure (PEF) and Forced Inspiratory Pressure (PIF) between patients with pulmonary impairment associated with COVID-19 infection and those in the control group. Correlation between PEF/PIF and scores recorded in voice self-assessment questionnaires was also observed. ConclusionPulmonary impairment associated with COVID-19 infection has worsened voice handicap and voice-related quality of life in the assessed patients, as well as reduced their forced expiratory and inspiratory pressure in comparison to the control group. Level of evidence4.

Association of perioperative oral swallowing function with post-esophagectomy outcomes and nutritional statuses in patients with esophageal cancer.

Dysphagia after esophagectomy is a serious complication; however, no method has been established to accurately assess swallowing function. We evaluated the association of swallowing function tests with patients' post-esophagectomy complications and nutritional statuses. We retrospectively reviewed the data of 95 patients with esophageal cancer who underwent esophagectomy between 2016 and 2021. We performed perioperative swallowing function tests, including the repetitive saliva swallowing test (RSST), maximum phonation time (MPT), and laryngeal elevation (LE). Patients with recurrent laryngeal nerve palsy (RLNP) and respiratory complications (RC) had significantly lower postoperative RSST scores than patients without them; the scores in patients with or without anastomotic leakage (AL) were similar. Postoperative MPT in patients with RLNP was shorter than that in patients without RLNP; however, it was similar to that in patients with or without AL and RC. LE was not associated with any complications. Patients with an RSST score ≤2 at 2weeks post-esophagectomy had significant weight loss at 1, 6, and 12months postoperatively compared with patients with an RSST score ≥3. The proportion of patients with severe weight loss (≥20% weight loss) within 1year of esophagectomy was significantly greater in patients with RSST scores ≤2 than in those with RSST scores ≥3. Multivariate analysis showed that an RSST score ≤2 was the only predictor of severe post-esophagectomy weight loss. RSST scoring is a simple tool for evaluating post-esophagectomy swallowing function. A lower RSST score is associated with postoperative RLNP, RC, and poor nutritional status.