Vocal Nodules Research Articles

Outcome of Microlaryngeal Surgery for Vocal Fold Polyp on Quality of Voice

ABSTRACT Aim To study the outcome of microlaryngeal surgery for vocal fold polyp on quality of voice with voice handicap index-10 (VHI-10). Objective Microlaryngeal surgery for vocal fold polyp will improve the quality of voice. Materials and methods This is a nonrandomized prospective study with a quasi-experimental design. A total of 36 patients presenting with vocal cord polyp and who underwent a microlaryngeal surgery for the same from March 2016 to August 2016 were included in the study. All the patients were given a self-reporting questionnaire consisting of 10 questions — VHI-10 — and asked to score it. The same questionnaire was given 6 weeks postmicrolaryngeal surgery to these patients and both scores were compared. Results The mean age of the study population was 44.67 ± 0.34 with the maximum number of patients in the age group 31 to 50. Out of the 36 patients, 27 were males and 9 females. A total of 22 (61%) patients had right-sided polyp and 14 (39%) had left-sided polyp. The majority of the patients were voice professionals, with the maximum number being that of teachers. The mean preoperative and postoperative VHI-10 was 30.36 ± 6.42 and 1.11 ± 1.76 respectively. The reduction in preoperative and postoperative scores gave a p-value of <0.05 at a confidence interval of 95%. How to cite this article Nath HSS, Menon JR, Issac ME, Binukrishnan R, Sebastian A. Outcome of Microlaryngeal Surgery for Vocal Fold Polyp on Quality of Voice. Int J Phonosurg Laryngol 2017;7(1):13-15.

The combined treatment of dysphonia in the subjects engaged in the voice and speech professions

The objective of the present study was to evaluate the effectiveness of the application of homeovox for the combined treatment of small vocal cord nodules and acute laryngitis in the professional voice users. A total of 40 subjects presenting with dysphonia were examined after they were divided into two study groups and two groups of comparison depending on the nosological form of the pathological condition. The subjects comprising the study groups were given traditional therapy in the combination with the intake of homeovox whereas the patients included in the two groups of comparison received the traditional treatment alone. The outcome of the treatment was evaluated on days 1, 5, and 10 after the initiation of therapy based on the analysis of the changes in the videoendostroboscopic picture of the larynx and the acoustic characteristics obtained by the computer-assisted analysis of the voice. The analysis of the results of the combined treatment has demonstrated the statistically significant differences in some acoustic parameters of the voice between the subjects with small vocal cord nodules and acute laryngitis belonging to the study groups and the groups of comparison. It is concluded that the introduction of homeovox in the combined treatment of the patients presenting with the small nodules in the vocal cords and acute catarrhal laryngitis accelerates the recovery of the acoustic characteristics of the voice within various periods after the onset of the treatment in comparison with the patients treated with the use of traditional therapy alone.

Outcomes of teachers away from work forvoicedisorders, State Secretariat of Education, Federal District, 2009-2010.

Voice is an important working tool for teachers. These professionals are often forced to stay away from work due to voice disorders, resulting in high frequency of sick leaves, function restriction and professional readjustment. Toevaluate the epidemiological profile of teacher absenteeism due to voice disorders and the impact of dysphonia on reduction of work activities, function restriction and professional readjustment. A retrospective study of teachers away from work for more than 30 days was performed from January 2009 to December 2010 based on data collected from medical records at State Secretariat of Education, Federal District, Brazil. A total of 153 teachers away from work due to dysphonia were analyzed. The highest prevalence of voice disorders corresponded to women (96.7%). Vocal nodules were the most prevalent diagnosis, corresponding to 40% of the vocal lesions. The average time away from work was 120 days. About 55% of the teachers on sick leave were indicated function restriction and remained in that condition for 166 days, on average. In total, 25.5% of the teachers needed professional readjustment, and 73.8% were able to return to the classroom. Voice disorders are a frequent cause of sick leaves, resulting in high annual costs. Preventive measures and vocal orientation might significantly reduce the number of teachers with function restriction or requiring readjustment.

Feature Selection based on Binary Particle Swarm Optimization and Neural Networks for Pathological Voice Detection

In this work, 52 Haralick texture features, extracted from two-dimensional wavelet coefficients of speech signals from recurrence plots (RPs) pathologies are used for pathological voice discrimination. Here, three pathologies are considered for analysis: vocal fold paralysis, edema and nodules. For feature selection, a binary particle swarm optimisation (PSO) algorithm using multilayer perceptron (MLP) neural network with cross validation is employed. The adopted fitness function is based on the maxima average accuracy rate. Statistical tests for individual measures were made and their results show statistical significance for several employed measures. The measures were combined and the more relevant ones based on the highest accuracy were selected by the PSO. The comparison with and without PSO by applying the statistical test of mean difference showed that the PSO use increased the accuracy rates. Furthermore, the PSO use reduced the amount of features for almost half of all initially used.

Giant laryngeal polyp: an unusual indication of tracheostomy.

Benign laryngeal lesions, especially laryngeal polyps are very common and they usually only cause hoarseness andrarely develop into dyspnea.This condition is generally attributed to smoking. Cardiorespiratory failure and sudden death due tolarge laryngeal polypwas reported in the literature. The preferred treatment of large polyps is surgical excision using suspension microlaryngoscopy. We present a case of a 60-year-old man presented to the emergency with stridor and severe dyspnea. He had a 4-month history of a neglected inspiratory dyspnea and dysphonia. Fiberoptic laryngoscopy revealed a large laryngeal mass causing airway obstruction. Administration of oxygen, inhalation and intravenous administrationof corticosteroid did not relieved hissymptoms. As intubation was judged impossible, an emergency tracheostomy was performed to salvage the patient. After tracheostomy, the dyspnea ceased. Computed tomography scan showed a homogeneous regular formation of 2.5×1.5 cm obstructing the glottis and the subglottislumen. Direct laryngoscopy under general anesthesia identified a valve-like large polyp attached to the anterior wall of the subglottic region. The polyp wastotally excised with no complication. Decannulation was carried out on the second postoperative day. The masswas histologically diagnosed as normal vocal cord polyp.

쉰목소리 완화를 위한 주파수 영역 음성 강조 필터 설계

The people who complain of pain due to voice causes such as vocal cord nodules is increasing year by year. If the voice is changed, it is possible to give to colleagues discomfort or inconvenience during conversation. In this paper, we propose a way to reduce discomfort by improving the husky voice during the conversation. A VBF (voice boosting filter) is firstly designed to improve the husky voices. This filter may further emphasize the formant frequency components than the frequency components around the formant frequency, because the value is relatively greater than the other frequency. And a fixed-point type DSP chipset, TMS320F2812 is applied to the system, the operating frequency is 150MHz. The system was implemented as a compact for use as a portable, its size is <TEX>$2.5cm{\times}10cm$</TEX>. Through the test using three husky voices with some type of statement, it was satisfactory in processing speed and sound quality improvement.

PHONOMICROSURGERY FOR BENIGN VOCAL FOLD LESIONS USING MEDIAL-MICROFLAP TECHNIQUE WITH COLD INSTRUMENTS IN A TEACHING HOSPITAL OF INDIA

Background: Phonomicrosurgery is a challenging and evolving field. One of the key techniques used for this is micro-flap technique used along with cold micro instruments. Objective: To convey the role of Microflap technique in phonosurgery and the role of basic microlaryngeal instrumnets in such surgery when sophisticated phonomicrosurgical instruments are not available. Methods: This is a retrospective study of 33 patients of benign vocal fold lesions who have undergone phonomicrosurgery using microflap technique from the year January 2011 to January 2016. Majority of these cases were vocal nodules (16cases) followed by Cyst in the vocal cord (10 cases) and 5 cases of polyps. Results: Cases were analyzed using GRBAS scoring and stroboscopic findings. A significant improvement was noted in the voice outcome of these patients except two cases where endoscopic paraglottic fat injection was done along with hyaluronic acid with steroid infiltration into the Reinke’s space, after which there was improvement in voice. Conclusion: Microflap technique for vocal fold lesion is a unique surgical procedure that allows preservation of vocal cord morphology and at the same time prevents post surgical scarring with excellent voice outcome. ThisThis surgery can be performed with good quality regular microsurgical instruments.

Endoscopic Resection of a Vocal Cord Polyp in a Patient with Difficult Laryngeal Exposure

Endoscopic Resection of a Vocal Cord Polyp in a Patient with Difficult Laryngeal Exposure

Correlation of electroglottograph with vocal cord pathology

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Vocal cord disorders are very commonly encountered in ENT Outpatient. Electroglottogram is a non-invasive method for the examination of the vocal fold vibrations. It exerts no influence at all on articulation and production of sound and is cost effective. The aim of the present study was to validate the clinical correlation of electroglottogram in patients presenting with hoarseness of voice&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 30 patients with history of hoarseness of voice and 30 normals were selected from ENT outpatient and inpatient department over a period of 2 years. All subjects underwent detailed ENT history taking, clinical examination, rigid laryngoscopy and electroglottography and results were documented&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Electroglottography waveforms of various voice disorders like vocal cord nodule, polyp, papilloma and haemangioma showed specific changes like double peak or notch in closing phase of waveform in case of mass lesion over the vocal cords and fuzzy waveform with prolonged closing time in case of vocal cord palsy. Significant difference was noted in certain electroglottographic parameters for phonated vowels /a/, /i/ and /u/ for certain vocal cord disorders&lt;span lang="EN-IN"&gt;. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Electroglottograph helps in diagnosing the pathology related to vocal cords, whether it is mass lesion over the vocal cords or vocal cord palsy but to differentiate in between mass lesions, clinical examination has to be done to confirm the diagnosis&lt;span lang="EN-IN"&gt;.&lt;/span&gt;&lt;/p&gt;

Expression and clinical significance of YAP in laryngeal squamous cell carcinoma patients

The aim of the present study was to investigate the expression levels of Yes-associated protein (YAP) in different grades of laryngeal squamous cell carcinoma (LSCC) tissues and vocal cord polyps tissues, and to investigate any correlations with clinical factors. The expression of YAP in 128 cases of LSCC and 10 cases of vocal cord polyps tissues was tested using immunohistochemistry. YAP was primarily present in the nucleus of LSCC and controls, whereas phosphorylated YAP expression was present in the cytoplasm. The results indicated that YAP expression was upregulated in LSCC samples compared with vocal cord polyps tissues. YAP expression was positively correlated with the malignant degree of LSCC (P<0.01) and a high level of YAP expression in LSCC tissues was correlated with pathological type, lymphatic metastasis and clinical stage. The present study provided evidence for the expression and localization of YAP in LSCC and vocal cord polyps tissues. Thus, YAP may be involved in the occurrence and development of LSCC as an oncogene.

Vocal Tract Adjustments of Dysphonic and Non-Dysphonic Women Pre- and Post-Flexible Resonance Tube in Water Exercise: A Quantitative MRI Study

To compare vocal tract (VT) adjustments of dysphonic and non-dysphonic women before and after flexible resonance tube in water exercise (FRTWE) at rest and during phonation using magnetic resonance imaging. Prospective study. Twenty women, aged 20-40 years, 10 dysphonic with vocal nodules (VNG) and 10 controls (CG), underwent four sets of sagittal VT MRI: two pre-FRTWE, at rest and during phonation, and two post-FRTWE, during phonation and at rest. The subjects performed 3 minutes of exercise. Nine parameters at rest and 21 during phonation were performed. Pre-FRTWE, eight significant differences were found, three at rest and five during phonation: at rest - laryngeal vestibule area, distance from epiglottis to pharyngeal posterior wall (PPW) and interarytenoid complex length were smaller in the VNG; during phonation - laryngeal vestibule area, angle between PPW and vocal fold (VF), epiglottis to PPW, and anterior commissure of the larynx to laryngeal posterior wall were smaller in the VNG; tongue area was larger in the VNG. Post-FRTWE, only three significant differences were found, two during phonation and one at rest: during phonation - angle between PPW and VF and the membranous portion of the VF length were smaller in the VNG; at rest - distance from epiglottis to PPW was smaller in the VNG. Results suggest that the habitual VT adjustments of dysphonic and non-dysphonic women are different at rest and during phonation. The FRTWE promoted positive VT changes in the VNG, reducing the intergroup differences.

Pediatric Vocal Fold Nodule Etiology: What Are Its Usual Causes in Children?

In this study, the relation between phonotrauma and presence of siblings and social activities was investigated, and the incidence of voice disorders in the mothers of children with vocal fold nodules was studied with objective (clinical voice analysis) and subjective (laryngostroboscopy, Voice Handicap Index) methods. Twenty-nine children with vocal fold nodules (age range 5-14 years), 45 age-matched children without any voice disorders as a control group, and their mothers were included in the study. All patients had laryngostroboscopy and clinical voice analysis, and their mothers filled out the Pediatric Voice Handicap Index. We noted the most common place or situation where children used their voice in excessively high volume according to their mothers, including home, school, sportive activities, and singing or reciting poem activities, to recognize the major cause of phonotrauma. In addition, presence of siblings was recorded. It was found that 15 patients (51.7%) had younger siblings, seven patients (24.1%) had older siblings, five patients (17.2%) had both younger and older siblings, and two patients (6.8%) did not have any siblings. It was seen that excessive usage of high-volume voice at home had a correlation with presence of only younger siblings, and both younger and older siblings tended to cause phonotrauma at home (86.7%). Additionally, eight boys (44.4%) reported presence of sportive activities, whereas none of the girls had such an activity (P = 0.012). Presence of siblings seems to be an important factor for vocal nodule formation. Maternal relationship does not seem to be a major factor for vocal misuse.

Personality traits inventory in patients with vocal nodules.

The objective of the study was to analyze temperament and character in females with vocal nodules (VN) compared to a vocally healthy control population. 61 females were examined over a 17-month period for dysphonia with VN (mean age 46years, duration of vocal complaints from 2months to 6years). 71 control females were recruited in their environment (mean age 34years). The validated French Version of the Temperament and Character Inventory (TCI) was used. Patients with VN had significantly (p<0,05) greater scores for Persistence and Novelty Seeking, particularly for the subscales exploratory excitability and extravagance. They had lower scores for Harm Avoidance, in particular fear of uncertainty, shyness and fatigability. Scores on Reward Dependence were not significantly different except for the subscale dependence, which were significantly lower in patients. No significant difference was found with regard to scores on Self-directedness, except for scores on the subscale self-acceptance, which were significantly lower in patients. Scores on Cooperativeness were not significantly different, except for the subscale helpfulness, which were significantly higher in patients. Patients had significant greater scores for Self-transcendence overall and specifically on the subscales self-forgetfulness and spiritual acceptance. Our findings suggested that women with VN are likely to have a passionate temperament, which might constitute an indirect predisposition to elevated vocal loading and greater risk for phonotrauma. The risk for developing or maintaining VN could be decreased by attending to those personality-specific maladaptive behaviors. A possible personalized approach to voice therapy could be organized on the basis of the TCI findings.

Leukaemic Secretion of Calcitriol: A Novel Mechanism of Hypercalcaemia in AML

Introduction:Whilst relatively common in lymphoid malignancies, hypercalcaemia is an extremely rare complication of acute myeloid leukaemia (AML). Previous case reports have described ectopic parathyroid hormone secretion, leukaemic bony invasion and the release of boneresorptivemediators as causes of hypercalcaemia in AML (GewirtzAM et al. Br JHaematology1983;31(12):1590,ZidarBL, et al.NEJM.1976;295:692). We describe a case of severe hypercalcaemia with acute kidney injury (AKI) accompanying a new diagnosis of AML, subsequently demonstrated to be secondary to leukaemic blast production of active vitamin D (calcitriol) with gross over-expression of vitamin D related genes. This represents a novel pathogenic mechanism causing hypercalcaemia in a myeloid malignancy.Case Report:AA, a 68 year old male presenting with fatigue and found to have circulating blasts was subsequently diagnosed with acutemyelomonocyticleukaemia(78% blasts on bone marrow biopsy). Additionally, he had marked hypercalcaemia (calcium 3.3mmol/L, normal range 2.1-2.6mmol/L) and AKI (creatinine 263umol/L, normal range 60-110umol/L). Given the rarity of AML-associated hypercalcaemia, extensive investigations were undertaken to elucidate the cause. In search of a second concurrent malignancy, AA underwent computed tomography and positron emission tomography scanning, with subsequent biopsy of FDG avid vocal cord nodules; but only benign pathology could be demonstrated. Parathyroid hormone (PTH) levels were appropriately suppressed (0.9pmol/L, normal range 1.6-6.9pmol/L) and levels of PTH-related peptide and serum ACE were normal (<2pmol/L, and 37units/L, normal range 20-70units/L, respectively). Inactive vitamin D, (calcidiol or 25(OH)D3) levels were also normal (88nmol/L, normal range 50-250nmol/L). However, the active vitamin D (calcitriol or 1,25(OH)2D3) level was grossly elevated beyond the upper limit of assay (>500pmol/L, upper limit of normal: 190pmol/L).Both the hypercalcaemia and kidney injury proved refractory to multiple therapeutic strategies including aggressive hydration with an average of over 2.5L of crystalloid per day, as well as intravenouspamidronate. However, as depicted in Figure 1, there was a precipitous response following the initiation of chemotherapy (idarubicinandcytarabine, 7+3 regimen). Within several days, AA's serum calcium levels returned to normal levels, and his kidney function followed a similar pattern of improvement shortly thereafter. The rapid resolution of serum calcium levels also mirrored peripheral blast clearance, and repeat testing of calcitriol levels showed progressive improvement towards a normal concentration. AA achieved complete remission following induction chemotherapy and remains leukaemia free after consolidation chemotherapy and current maintenanceazacitidine. His hypercalcaemia has not recurred and his renal function remains normal.Having excluded other causes of hypercalcaemia and given the dramatic response to chemotherapy, we hypothesised that AA’s AML blasts were secreting calcitriol. Accordingly, quantitative PCR was performed on AA’s stored leukaemic cells for genes essential to vitamin D metabolism: the vitamin-D receptor (VDR), CYP24A1, and CYP27B1 (1-α-hydroxylase). RNA was extracted from AML cells using the QIAGEN RNeasykit. cDNAwas synthesised from 400ng of RNA using the Roche First Strand cDNASynthesis Kit. Gene expression was assessed by quantitative real-time PCR, relative to the housekeeping gene GAPDH. AA’s leukaemia cells demonstrated markedly elevated expression of these vitamin-D related genes compared to healthy control CD34+ cells and four other independent primary AML cells (Figure 2, labelled AML 1-4), which were selected for absence of patient hypercalcaemia from our institution’s tissue bank (Figure 2).Conclusion:Hypercalcaemia secondary to secretion of calcitriol can be a manifestation of lymphoid malignancies, however our case is the first documented occurrence of this phenomenon in a myeloid cancer. The PCR studies demonstrated striking overexpression of vitamin D related genes in leukaemia cells, resulting in the patient's hypercalcaemia and AKI. This finding represents a novel mechanism for a rare complication in AML. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Progress in diagnosis and treatment of vocal fold nodules

Vocal fold nodules is the common cause of the hoarseness,which seriously affected people's living standard.At present,the treatment of the vocal fold nodules should be based on conservative treatment,surgical treatment as a supplement.Conservative treatment mainly includes:rest the voice,drug treatment,intervention and voice therapy.Surgical treatment is mainly the laryngomicrosurgery in suspension laryngoscope. The purpose of this study is to summarize the diagnosis and the treatment of vocal fold nodules,improving the reference of clinical workers.

High-speed Imaging of Vocal Fold Vibration Onset Delay: Normal Versus Abnormal

Vocal fold vibration onset delay (VFVOD) is heard frequently in spasmodic dysphonia and in muscle tension dysphonia. VFVOD changes due to other vocal pathologies have not been investigated. VFVOD during sustained vowel production was estimated with high-speed video in 10 normal and 40 pathologic subjects (scars, vocal fold paralysis, vocal fold nodules, and polyps). Analysis of high-speed video was done using digital kymography. VFVOD can be divided into two portions. Pre-phonation delay (PPD) is the duration when the vocal folds are nearly approximated to the time of first observed oscillation. Steady state delay (SSD) is the time when vocal folds are observed to come into oscillation until steady state of oscillation is observed. Normal subjects have almost zero PPD with vocal fold oscillation observed before full vocal fold adduction. Pathologic cases showed prolonged PPD because of (1) false cord adduction, (2) prolonged true vocal fold adduction, and (3) delay to onset of vocal fold vibration. Normal subjects have SSD of three to five cycles before steady state. Pathologic states result in increased SSD. Causes for increased SSD include (1) slow ramping up to steady state, (2) partial vibration of vocal folds, and (3) diplophonia with alternating beats before achieving steady state. There are significant differences between normal and pathology groups in both PPD and SSD. VFVOD is elevated in pathologic states. This can be due to increase in PPD or SSD. VFVOD is an under-recognized phenomenon that may contribute to complaints of vocal fatigue and dysphonia.

Real-time Simultaneous DKG and 2D DKG Using High-speed Digital Camera

For the evaluation of voice disorders, direct observation of vocal cord vibration is important. Among the various methods, laryngeal videostroboscopy (LVS) is widely used, but it was not a true image because it collects images from different cycles. In contrast, high-speed videoendoscopy and videokymography have much higher frame rates and can assess functional and mobility disorders. The purpose of the study is to describe real-time, simultaneous digital kymography (DKG), two-dimensional scanning (2D) DKG, and multi-frame (MF) LVS system using a high-speed digital camera, and identify the efficacy of this system in evaluating vibratory patterns of pathologic voice. The pattern of vocal fold vibration was evaluated in a vocally healthy subject and in subjects with vocal polyp, vocal nodules, vocal cord scar, and vocal cord paralysis. We used both quantitative (left-right phase symmetry, amplitude symmetry index) and qualitative (anterior-posterior phase symmetry) parameters for assessment of vocal fold vibration. Our system could record videos within seconds and required relatively little memory. The speed of replay in the DKG, 2D DKG, MF LVS, and high-speed videoendoscopy was controllable. The number of frame per cycle with MF LVS was almost the same as the fundamental frequency. Our system can provide images of various modalities simultaneously in real time and analyze morphological and functional vibratory patterns. It can be possible to provide a greater level of information for the diagnosis and treatment of vibratory disorders.

Factors Involved in Vocal Fatigue: A Pilot Study

Objective: The purpose of this retrospective study was to determine the vocal characteristics of a treatment-seeking population with the primary complaint of vocal fatigue (VF). Methods: Forty-three men (mean age 42 years, range 19-69) and 145 women (mean age 34 years, range 18-68) were included. None of the subjects had received voice therapy or previous laryngeal surgery. A questionnaire, laryngeal and perceptual evaluations, aerodynamic and acoustic parameters, and the Dysphonia Severity Index (DSI) were used to determine vocal characteristics. Results: In 74% of the subjects, flexible laryngeal videostroboscopic evaluation revealed a vocal pathology, with vocal nodules and muscle tension dysphonia as the most frequently diagnosed pathologies. Vocal abuse/misuse was present in 65% of the subjects. A median DSI value of -0.4 and -0.8 was found in female and male patients, respectively. Aerodynamic and acoustic parameters and DSI scores were significantly different from normative data. Conclusion: VF is a vocal sign with a significant need for medical consultation, especially in future professional voice users. Understanding the occurrence and the influencing variables of VF may help to close the gap between early stages of a vocal problem and the starting point of a well-established disorder.

Correlations Between Serum Apolipoprotein A-I and Formation of Vocal Cord Polyp

This study aims to investigate the correlations between serum apolipoprotein A-I (ApoA-I) and the formation of vocal cord polyps (VCPs). This study used the nonmatched case-control study method. The serum total cholesterol (TC), triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, ApoA-I, apolipoprotein B (ApoB), and ApoA-I/ApoB levels of 89 VCP patients and 87 normal volunteers were compared. Additionally, such VCP-related factors as excessive vocal use, vocal abuse, smoking, drinking, and the size of VCPs were analyzed. The two groups did not significantly differ with regard to triglyceride, low-density lipoprotein cholesterol, ApoB, and ApoA-I/ApoB levels (P > 0.05), whereas they did significantly differ with regard to TC, HDL-C, and ApoA-I levels (P < 0.05) according to independent t tests. Logistic regression analysis showed that excessive vocal use and vocal abuse were risk factors for VCPs (P < 0.05), with odds ratio values of 5.675 and 12.781, respectively. The ApoA-I level was negatively associated with VCPs (P < 0.05), with an odds ratio of 0.511; however, TC and HDL-C were not associated with the formation of VCPs (P > 0.05). The size of VCPs in females was negatively correlated with the serum ApoA-I level (r = -0.349, P = 0.032), whereas that in males was not (P > 0.05). As the serum ApoA-I level was negatively correlated with the formation of VCPs, ApoA-I may reduce the risk of VCPs. These findings may facilitate the prevention and treatment of VCPs.

Hierarchical Classification and System Combination for Automatically Identifying Physiological and Neuromuscular Laryngeal Pathologies

Speech signal processing techniques have provided several contributions to pathologic voice identification, in which healthy and unhealthy voice samples are evaluated. A less common approach is to identify laryngeal pathologies, for which the use of a noninvasive method for pathologic voice identification is an important step forward for preliminary diagnosis. In this study, a hierarchical classifier and a combination of systems are used to improve the accuracy of a three-class identification system (healthy, physiological larynx pathologies, and neuromuscular larynx pathologies). Three main subject classes were considered: subjects with physiological larynx pathologies (vocal fold nodules and edemas: 59 samples), subjects with neuromuscular larynx pathologies (unilateral vocal fold paralysis: 59 samples), and healthy subjects (36 samples). The variables used in this study were a speech task (sustained vowel /a/ or continuous reading speech), features with or without perceptual information, and features with or without direct information about formants evaluated using single classifiers. A hierarchical classification system was designed based on this information. The resulting system combines an analysis of continuous speech by way of the commonly used sustained vowel /a/ to obtain spectral and perceptual speech features. It achieved an accuracy of 84.4%, which represents an improvement of approximately 9% compared with the stand-alone approach. For pathologic voice identification, the accuracy obtained was 98.7%, and the identification accuracy for the two pathology classes was 81.3%. Hierarchical classification and system combination create significant benefits and introduce a modular approach to the classification of larynx pathologies.