Voice Changes In Patients Research Articles

Impact of Tonsillectomy and Associated Factors on Voice

AbstractTonsillectomy is commonly performed to treat repetitive tonsillitis. Tonsillectomy changes the shape and characteristics of the pharynx. It could also alter the resonating characteristics of the pharynx and affect the voice of the patient. We examined voice changes in patients undergoing tonsillectomy. A total of 33 adult patients who underwent tonsillectomy at our institution between July 2020 and December 2021 were included in the study. The participants consisted of 16 men and 17 women, with a mean ± standard deviation age of 33.7 ± 10.7 years. We measured the maximum phonation time, acoustic analysis values (jitter%, shimmer%, and noise-to-harmonic ratio [NHR]), speaking fundamental frequency and vocal range, first four formants (F1–F4) in the sustained vowel /a/, and Voice Handicap Index (VHI). We examined whether any changes occurring 3 months after the surgery compared with the findings before the surgery. The shimmer% and NHR decreased significantly after surgery compared with the observations prior to surgery. Among women, the speaking fundamental frequency tended to increase, and the F2 significantly increased after the surgery compared with that prior to surgery. Removal of the swollen tonsils reduced the resistance of the supraglottic space and resulted in a lower laryngeal adduction force required for phonation. The decreases in the shimmer% and NHR were attributed to a reduction in the turbulence in the supraglottic space. The change in the shape of the pharynx caused changes in the speaking fundamental frequency and formants. The changes were thought to be influenced by the size of the patient's pharyngeal cavity, volume of the tonsils, and scarring of the pharyngeal mucosa. Patients should be informed before surgery of the possibility of voice changes.

A deep learning approach to dysphagia-aspiration detecting algorithm through pre- and post-swallowing voice changes.

This study aimed to identify differences in voice characteristics and changes between patients with dysphagia-aspiration and healthy individuals using a deep learning model, with a focus on under-researched areas of pre- and post-swallowing voice changes in patients with dysphagia. We hypothesized that these variations may be due to weakened muscles and blocked airways in patients with dysphagia. A prospective cohort study was conducted on 198 participants aged >40 years at the Seoul National University Bundang Hospital from October 2021 to February 2023. Pre- and post-swallowing voice data of the participants were converted to a 64-kbps mp3 format, and all voice data were trimmed to a length of 2s. The data were divided for 10-fold cross-validation and stored in HDF5 format with anonymized IDs and labels for the normal and aspiration groups. During preprocessing, the data were converted to Mel spectrograms, and the EfficientAT model was modified using the final layer of MobileNetV3 to effectively detect voice changes and analyze pre- and post-swallowing voices. This enabled the model to probabilistically categorize new patient voices as normal or aspirated. In a study of the machine-learning model for aspiration detection, area under the receiver operating characteristic curve (AUC) values were analyzed across sexes under different configurations. The average AUC values for males ranged from 0.8117 to 0.8319, with the best performance achieved at a learning rate of 3.00e-5 and a batch size of 16. The average AUC values for females improved from 0.6975 to 0.7331, with the best performance observed at a learning rate of 5.00e-5 and a batch size of 32. As there were fewer female participants, a combined model was developed to maintain the sex balance. In the combined model, the average AUC values ranged from 0.7746 to 0.7997, and optimal performance was achieved at a learning rate of 3.00e-5 and a batch size of 16. This study evaluated a voice analysis-based program to detect pre- and post-swallowing changes in patients with dysphagia, potentially aiding in real-time monitoring. Such a system can provide healthcare professionals with daily insights into the conditions of patients, allowing for personalized interventions. ClinicalTrials.gov, identifier NCT05149976.

Voice Changes in Trans Men Administered Testosterone: Why Voice Intervention for Trans Men is not Required

Trans men are biological females who have a male identity and have a sense of discomfort with their own feminine physical characteristics. The administration of testosterone, a male hormone, for the treatment of gender incongruence induces physical masculinization, including changing the sound of the voice. We previously showed that continuous administration of testosterone lowered the basic frequency (F0) and masculinized the voice abruptly at three to six months from the treatment onset. We therefore examined and compared the voice changes in patients and their feelings of discomfort with their voice using the voice handicap index (VHI) before and after testosterone administration. We also compared these findings with the VHI scores of trans women before intervention. The VHI scores of trans men were lower after testosterone administration than before and not significantly different from those of a control group without voice disorder. Trans women were found to have a stronger feeling of discomfort with their voice before intervention than trans men, which may be why most individuals who receive voice treatment are trans women.

Optimization of an integrated approach to voice correction for endocrinopathies (analytical review)

Dysphonia is a symptom of many endocrine pathologies. Hoarseness, voice fatigue, decrease of the voice pitch, reduce of the range are typical complaints for hypothyroidism, caused by an increased amount of polysaccharides and accumulation of fluid in the lamina propria of the vocal folds. An excess of growth hormone causes an overproduction of insulin-like growth factor-1, which leads to abnormalities in thecraniofacial region and proliferation of the upper respiratory tract tissues, including thickening of the laryngeal cartilages, vocal folds and decreasing of the voice pitch. Hyperglycemia, changes in the balance of fluid and electrolytes in diabetes mellitus can indirectly affect the voice: xerostomia complicates phonation due to impaired hydration of the laryngeal mucosa, diabetic neuropathy often disrupts the work of the laryngeal muscles involved in voice formation. Voice changes are observed not only in endocrine disorders, but also during puberty, the phases of the menstrual cycle and during menopause. Laryngeal structures are modified under the influence of hormones and external factors, which generally changes pitch and intensity of the voice, timbre and resonance, articulation and prosodic characteristics. The purpose of this review is to summarize and systematize data on physiological and pathological voice changes in patients of different age groups and sex. The possibilities of a multidisciplinary approach to rational voice correction are demonstrated.

Voice changes after surgically assisted rapid maxillary expansion

This study aimed to investigate voice changes in patients who had surgically assisted rapid maxillary expansion (SARME). Nineteen adult patients with maxillary transverse deficiency were asked to pronounce the sounds "[a], [ϵ], [ɯ], [i], [ɔ], [œ] [u], [y]" for 3seconds. Voice records were taken before the expansion appliance was placed (T0) and 5.8weeks after removal (T1, after 5.2months of retention). The same records were taken for the control group (n=19). The formant frequencies (F0, F1, F2, and F3), shimmer, jitter, and noise-to-harmonics ratio (NHR) parameters were considered with Praat (version 6.0.43). In the SARME group, significant differences were observed in the F1 of [a] (P=0.005), F2 of [ϵ] (P=0.008), and [œ] sounds (P=0.004). The postexpansion values were lower than those recorded before. In contrast, the F1 of [y] sound (P=0.02), F2 of [u] sound (P=0.01), the jitter parameter of [ɯ] and [i] sounds (P=0.04; P=0.002), and the NHR value of [ϵ] sound (P=0.04) were significantly than the baseline values. In the comparison with the control group, significant differences were found in the F0 (P=0.025) and F1 (P=0.046) of the [u] sound, the F1 of the [a] sound (P=0.03), and the F2 of the [ϵ] sound (P=0.037). Significant differences were also found in the shimmer of [i] (P=0.017) and [ɔ] (P=0.002), the jitter of [ϵ] (P=0.046) and [i] (P=0.017), and the NHR of [i] (P=0.012) and [ɔ] (P=0.009). SARME led to significant differences in some of the acoustics parameters.

Nasalance and perceived voice changes in patients undergoing septoplasty and turbinate hypertrophy reduction

The purpose of this study was to investigate the changes in voice nasality after septoplasty and turbinate hypertrophy reduction and to evaluate the effect of these changes on patients' voice-related quality of life. Sixty patients with nasal obstruction symptoms caused by septal deviation and inferior turbinate hypertrophy who underwent septoplasty and inferior turbinate hypertrophy reduction and 25 healthy controls were included. Active anterior rhinomanometry and acoustic rhinometry were utilized for the evaluation of nasal patency and nasometry was used for quantitative assessment of nasalance. All participants completed validated questionnaires for assessing nasal obstruction symptom severity, psychological status and the impact of voice performance on their quality of life preoperatively and 6months after septoplasty. Patients presented preoperatively statistically significantly lower nasalance scores and higher VHI scores than controls (p < 0.05). Septoplasty and inferior turbinate hypertrophy reduction led to improvement of nasalance for the nasal text and the physical subscale of the VHI scores. Postoperatively, there were no statistically significant differences in nasalance and VHI scores between patients and controls. Significant correlations were found only for the baseline and the postoperative nasalance scores for the nasal text and the total nasal cavity volume (p < 0.05). Postoperatively, patients who presented significant improvement of nasal obstruction symptoms and resolution of stress levels were more likely to positively evaluate the impact of their voice quality on their daily life (OR: 2.32, 95% CI 1.08-5.15, p = 0.041 and OR: 3.06, 95% CI 1.15-7.04, p = 0.038, respectively). Septoplasty and inferior turbinate hypertrophy reduction may increase the nasal resonance, but in the long term, this change appears not to be significant enough. The severity of nasal obstruction symptoms and psychological status mainly affect the patients' perceptual assessment regarding the effect of voice performance on their quality of life.

Voice changes in patients with renal failure

Voice changes in patients with renal failure

Perceptual, Aerodynamic, and Acoustic Characteristics of Voice Changes in Patients with Laryngopharyngeal Reflux Disease.

Laryngopharyngeal reflux (LPR) is an inflammatory condition suspected to be associated with dysphonia. In this study, we investigated multidimensional perceptual, aerodynamic, and acoustic voice changes in patients with clinically diagnosed LPR compared to healthy participants. We prospectively included 80 outpatients with Reflux Finding Score (RFS) >7 and Reflux Symptom Index (RSI) >13 from September 2013 to April 2016 and we compared clinical and voice quality assessments of these patients with 80 healthy participants. Statistically significant differences were found between groups with regard to Voice Handicap Index, perceptual voice quality (grades of dysphonia, roughness, strain, breathiness, asthenia, and instability), phonatory quotient, percentage jitter, percentage shimmer, peak-to-peak amplitude variation, standard deviation of fundamental frequency, and noise to harmonic ratio. Granulation score of RFS was found to affect the highest number of acoustic parameters. We did not identify significant correlation between vocal fold edema and objective voice quality measurements. This study supports that patients with LPR have significant deterioration of both subjective and objective voice quality compared to healthy participants.

Voice Changes after Late Recurrent Laryngeal Nerve Identification Thyroidectomy

To assess voice changes in patients after thyroidectomy where the recurrent laryngeal nerve (RLN) was found late in the thyroid dissection and where the RLN was not injured (late RLN identification technique). This study was conducted on 64 patients who underwent thyroidectomy by late RLN identification technique. Voice was assessed preoperatively, 1 week, 3 months, and 6 months after surgery using the voice assessment protocol and Voice Problem Self-Assessment Scale. The study group was divided into two subgroups (hemithyroidectomy: N = 13 and total thyroidectomy: N = 51). Voice assessments of both subgroups were then compared with a control group (N = 20) of patients who recently underwent extracervical surgeries. All voice analysis differences between the control group and the individual study subgroup were nonsignificant. Dysphonia in the study group was significantly worse at 1 week and 3 months postoperatively but became nonsignificant at 6 months postoperatively. The deviations from the preoperative acoustic analysis were significant only in the first week postoperative comparison for fundamental frequency, noise-to-harmonic ratio, and maximal phonation time and thereafter became nonsignificant. Significant Voice Problem Self-Assessment Scale mean score increase (worsening) was also detected only at first week postoperatively. Minimal voice changes were reported early after late RLN identification thyroidectomy in absence of RLN injury and disappeared gradually in a few months. Those changes are comparable with that of other extracervical surgeries, making thyroidectomy with late RLN identification a relatively safe technique as regard voice.

Predictors of attendance at the Emergency Department in a population of patients with COPD

Voice changes are not a direct symptom of chronic obstructive pulmonary disease (COPD), but many COPD patients experience voice changes.The aim of this work was to establish the voice changes in patients with chronic obstructive pulmonary disease.Fifty COPD patients were conducted in this study. Patients were enrolled after obtaining informed consents. All patients were subjected to clinical diagnostic aids which include history taking (age, sex, smoking index and drug history), general and chest examinations, spirometry, arterial blood gases, chest X-ray, endoscopic examination of the larynx, auditory perceptual assessment and acoustic analysis of voice.The age of the patients ranged from 32 to 76 years, all patients were current or former smokers and the pack year index ranged from 20 to 66 with a mean ± SD value of 41.16 ± 13.80. Dysphonia was perceived in 25 (50%) patients. There was significant positive correlation between the smoking index with Jitter%, Shimmer% and the grade of dysphonia. There was significant positive correlation between Jitter%, Shimmer% and the grade of dysphonia with the large doses of ICSs usage and with pMDIs usage. Moreover, there was significant inverse correlation between Jitter%, Shimmer% and the grade of dysphonia with DPIs usage and with FVC, FEV1 and MMEF% of predicted values.Dysphonia (hoarseness) in COPD patients is multifactorial. Successful analysis should depend on cooperation between pulmonologists, voice specialists, and laryngologists.

Voice changes in patients with chronic obstructive pulmonary disease

IntroductionVoice changes are not a direct symptom of chronic obstructive pulmonary disease (COPD), but many COPD patients experience voice changes. Aim of the workThe aim of this work was to establish the voice changes in patients with chronic obstructive pulmonary disease. Patients and methodsFifty COPD patients were conducted in this study. Patients were enrolled after obtaining informed consents. All patients were subjected to clinical diagnostic aids which include history taking (age, sex, smoking index and drug history), general and chest examinations, spirometry, arterial blood gases, chest X-ray, endoscopic examination of the larynx, auditory perceptual assessment and acoustic analysis of voice. ResultsThe age of the patients ranged from 32 to 76years, all patients were current or former smokers and the pack year index ranged from 20 to 66 with a mean±SD value of 41.16±13.80. Dysphonia was perceived in 25 (50%) patients. There was significant positive correlation between the smoking index with Jitter%, Shimmer% and the grade of dysphonia. There was significant positive correlation between Jitter%, Shimmer% and the grade of dysphonia with the large doses of ICSs usage and with pMDIs usage. Moreover, there was significant inverse correlation between Jitter%, Shimmer% and the grade of dysphonia with DPIs usage and with FVC, FEV1 and MMEF% of predicted values. In conclusionDysphonia (hoarseness) in COPD patients is multifactorial. Successful analysis should depend on cooperation between pulmonologists, voice specialists, and laryngologists.

J09 When do voice changes affect quality of life in Huntington's disease?

BackgroundChanges in the articulation of speech and in voice function (dysarthria) are known to be affected particularly in the latter stages of Huntington's disease, and are seldom investigated in the...

A Short-Term Investigation of Dysphonia in Asthmatic Patients Using Inhaled Budesonide

Dysphonia is one of the most common side effects of patients who use corticosteroid inhalers. The aim of this study was to investigate, prospectively, the occurrence of dysphonia in patients who used corticosteroid inhalers. Outpatients aged 18 years or older initially treated with inhaled corticosteroids were recruited. All patients were prescribed budesonide/formoterol. Questionnaires, perceptual studies, and acoustic analysis were performed five times during the study: at study entry and after 1, 4, 8, and 12 weeks. Videostroboscopy was performed at study entry and at 12 weeks. The data collected were analyzed by repeated-measures analysis of variance tests and Wilcoxon's signed rank test (P<0.01). Sixty-two patients were enrolled and 29 patients (M:F=19:10) completed the study. Seven patients reported that they had problems with their voice; however, there were no statistically significant changes in the perceptual studies or the acoustic analysis. The videostroboscopy showed that "injection" and "increase of mucus" significantly increased by week 12. Vocal fold bowing was not noted in any of the patients. The results of this study showed no significant voice changes in patients using corticosteroid inhalers over a period of 3 months. However, minor mucosal changes were found on videostroboscopy.

VOCAL CORD PARALYSIS AND VOICE CHANGES IN PATIENTS WITH SURGICAL HYPOPARATHYROIDISM.

VOCAL CORD PARALYSIS AND VOICE CHANGES IN PATIENTS WITH SURGICAL HYPOPARATHYROIDISM.