Voice Clinic Research Articles

Vocal Effort in Clinical Settings of North and South American Countries: Characterization From Argentinian, Chilean, Colombian, and the United States Clinician’s Reports

BackgroundIn voice clinics, vocal effort is a prevalent complaint, with around 25% of clinicians citing it as the primary issue. AimThis study had two objectives. First, it sought to establish the prevalence of vocal effort, both as the primary and the only symptom, among patients receiving treatment from clinicians specializing in voice disorders in various countries across South and North America. Second, this study aimed to distinguish key factors, including country of clinical practice, clinicians’ experience, and the instruments employed to assess effort, associated with the identification of vocal effort. MethodsThis cross-sectional study surveyed speech-language pathologists (SLPs) from North and South America on vocal effort in patients. The survey covered SLP demographics, caseload composition, patient challenges, and measures of vocal effort that were used. Statistical analysis assessed relationships between SLP demographics, caseload, and vocal effort factors. Results and ConclusionThe results suggest significant geographical variations in SLPs’ experiences with vocal effort. Colombian clinicians report significantly fewer voice cases and a lower proportion of vocal effort in their caseload, while Argentinian clinicians were more likely to report vocal effort in their voice cases. Years of experience were identified as a significant predictor of a higher likelihood of a voice-dominant caseload and higher rates of vocal effort among patients. Interestingly, using the Vocal Fatigue Index during the assessments increased the likelihood of reporting vocal effort in the clinicians' caseload. These findings suggest a potential association between experience, outcome measure selection, and vocal effort caseload. These lead to suggestions that opportunities for additional voice disorder training beyond that which SLPs find in school are valuable.

A network analysis of voice hearing, emotional distress and subjective recovery before and after cognitive behavioural interventions.

There is a need to identify and to better understand key processes involved in voice hearing, which can inform the targeting and development of psychological interventions for distressing voices. The current study aimed to examine interrelations between the negative impact of voices, voice characteristics, emotional distress and recovery before and after cognitive behavioural interventions for voices (Coping Strategy Enhancement, guided self-help Cognitive Behavioural Therapy, Relating Therapy and Person-Based Cognitive Therapy). The sample consisted of 172 participants from the Sussex Voices Clinic who completed pre- and post-treatment assessments. The negative impact of voices, voice characteristics, emotional distress and recovery were used to estimate two networks, before and after cognitive behavioural interventions, using the graphical lasso method with the extended Bayesian information criterion. Centrality indices were also computed, and the two networks were compared on connectivity, structure and individual edge weights. Depression, anxiety and the negative impact of voices were identified as key central symptoms and acted as bridge symptoms in pre- and post-treatment networks. There were no significant differences in network structure (M = 0.155, p = .57), global strength (S = 0.188, p = .07) and centralities (C = -0.318, p = -.06) between the two networks. Our findings suggest that anxiety and depression are promising treatment targets, that can lead to reductions in voice-related distress, whereas the characteristics of voices and subjective recovery play little role in the network structure. Limitations include the lack of a control group and the lack of diversity within the sample.

Temperament and Voice Quality in Patients With Vocal Fold Nodules

BackgroundVocal fold nodules are most common in women and patients with vocal fold nodules represent the largest group in voice clinics. The prevalence of vocal fold nodules is particularly high in professions where the voice is used on a regular basis. The quality of the voice is influenced by a number of factors, including temperament, stress, and emotional state. These factors can influence the physiological conditions of phonation.The objective of this study was to assess the acoustic parameters of voice in patients with vocal nodules in comparison to healthy controls, and to determine whether voice quality is influenced by emotional state and coping with stress. MethodsA total of 32 patients admitted to the ENT Department of the University Medical School with voice disorders between March and June 2007 constituted the study group. All patients were found to have a vocal nodules on physical and stroboscopic examination. The control group consisted of 30 healthy individuals who did not report any voice disorders. All subjects underwent voice recordings in the voice laboratory. Following the completion of the voice evaluation form, anaerodynamic assessment (a, s, s/z-time), an index of vocal impairment, the Rosenbaum Schedule of Learned Resourcefulness (RLRS) and the Temperament and Characteristics Inventory (TEMPS-A), all subjects underwent further assessment. Acoustic analysis was conducted using the CSL program in MDVP and the Vocal Assessment component of Dr. Speech. ResultsThe decrease in MPT in the study group was statistically significant. There were statistically significant differences in the parameters MFo, Jitt, RAP, PPQ, SHdB, Shim, APQ, NHR, SPI from the MDVP, Jitter, Shim% from the voice assessment, and the perceptual rating (H, R, B) from Dr. Speech’s voice assessment analysis. The differences in the dimensions of anxious temperament and the examination of stress problem-solving strategies were significant between the study group and the control subjects. Differences in aerodynamic and acoustic parameters were found between disordered and healthy groups, as well as between individuals with different personalities. Overall, those with nodules were less likely to manage stress well than those without nodules. ConclusionThe study group and the control subjects showed significant differences in anxious temperament dimensions and stress problem-solving strategies. There were also differences in aerodynamic and acoustic parameters between the disordered and healthy groups, as well as between the groups with and without personality temperament differences. Overall, those with nodules were less likely to manage stress well than those without nodules. This finding indicates that stress management options are not effectively utilized in patients with vocal fold nodules. So, it might be a good idea to look into some kind of therapeutic approach and patient education for stress management.

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.

Randomized Controlled Trial of Awake Transnasal Laser-Assisted Surgery for Benign Laryngeal Lesions.

To compare functional and cost-effectiveness of awake transnasal laser assisted-surgery versus microlaryngeal surgery for benign laryngeal lesions. This was a prospective non-inferiority randomized controlled trial conducted from May 2021 to December 2022 at two tertiary referral hospitals in Hong Kong. Patients were block-randomized to receive either awake transnasal laser-assisted surgery or microlaryngeal surgery, with post-operative follow-up in a multidisciplinary voice clinic for 1-year. Primary outcome was Voice Handicap Index (VHI-30). Secondary outcomes included operation time, complications, length of stay, peri-operative discomfort, recurrence, and medical costs. Sixty-one patients were randomized to either awake transnasal laser-assisted surgery (n = 30) and microlaryngeal surgery (n = 31). Both groups had comparable demographics and laryngeal pathologies. Both groups showed significant improvement of VHI-30 score over time and had comparable post-operative VHI-30. Awake transnasal laser-assisted surgery group had a significantly shorter length of stay (0.5 vs. 1 day) and less throat discomfort (2 vs. 4) compared to microlaryngeal surgery group. Intraoperative complications were more common in microlaryngeal surgery group (14.3% vs. 0%). Otherwise, both groups had similar operative time and recurrence rate. Cost-analysis showed a significantly lower hospital cost for awake transnasal laser-assisted surgery (USD 3090) compared to microlaryngeal surgery group (USD 5120). Awake transnasal laser-assisted surgery was safe, functionally non-inferior, as measured by VHI-30, to microlaryngeal surgery in managing benign laryngeal lesions, while superior to microlaryngeal surgery in peri-operative discomfort and medical costs. 2 Laryngoscope, 134:3732-3740, 2024.

Hemorrhagic Pseudocyst (Polyst) and True Hemorrhagic Cyst of the Vocal Fold

ObjectiveThough haemorrhagic vocal fold polyps are a common entity, haemorrhagic vocal fold cysts have not been previously described. In our study we have evaluated patients who were diagnosed on stroboscopy as “haemorrhagic” cysts. MethodsThis 18-month retrospective study has received institutional ethics clearance. Using the database of our voice clinic, 14 patients diagnosed as haemorrhagic cyst by stroboscopy were reviewed. Age, sex, chief complaints, symptom duration, videostroboscopy findings, surgical details and the histopathology was noted. ResultsOut of a total 14 patients, 12 were males with a mean age of presentation as 41 years. Duration of hoarseness ranged from 2 - 24 months. Videostroboscopy revealed a markedly decreased amplitude of the mucosal waves over a well-delineated ovoid or spheroid haemorrhagic lesion, which seemed tethered down by overlying vocal fold epithelium. All patients had operative findings of a well encapsulated haemorrhagic lesion in the superficial lamina propria with anterior and posterior fibrotic bands. Histopathology of 13 patients was similar and revealed a haemorrhagic polypoidal lesion. A pseudo-capsule could be identified occasionally. These lesions seemed to be haemorrhagic pseudocysts, named “polyst” by us. In one male patient the histopathology revealed a true vocal fold cyst (type C Koren) with haemorrhage. ConclusionA haemorrhagic pseudocyst (polyst) of the vocal fold has stroboscopic and surgical findings resembling a true vocal fold cyst with haemorrhage, however histologically it resembles a haemorrhagic polyp. A true haemorrhagic cyst however is typically a type C Koren cyst with haemorrhage. Both these entities have not been previously described.

Does Vocal Fold Pathology Play a Role in Determining the Timeline of Presentation to an Ear, Nose, and Throat Surgeon?

Abstract Background: The primary objective is to study the average time duration between the onset of vocal symptoms and presentation to an ear, nose, and throat (ENT) surgeon, in different vocal pathologies. Our second objective is to study gender distribution among various pathologies. Methods: Our voice clinic records were retrospectively reviewed for 1 year, from August 2022, for details regarding gender, and the average time taken for presentation (ATTFP) in months, to an ENT surgeon. Disorders were grouped into vocal fold nodules, polyps, cysts, paralysis/paresis, sulcus, spasmodic dysphonia (SD), and premalignant and malignant conditions. Results: A total of 17 patients of vocal fold nodules (15 females), 47 vocal fold polyp patients (45 males), 40 vocal fold cyst patients (24 females), 64 paralysis/paresis patients (44 males), 41 sulcus patients (31 males), 35 SD patients (22 females), and 65 premalignant and malignant condition patients (51 males) presented to us. The ATTFP for nodules was 8.1 months, 6.8 months for polyps, 10.2 months for cysts, 22.8 months for idiopathic and 6 months for other causes of paralysis/paresis, 32.4 months for sulcus, 26.1 months for SD, and 10.2 months for premalignant and malignant conditions. Conclusion: Sulcus patients took the longest time to present to an ENT surgeon, followed by SD patients, both groups averaging over 2 years. Vocal fold paralysis/paresis patients with a nonidiopathic diagnosis were the earliest to present. A high male preponderance in vocal fold polyps (96%) as opposed to a high female preponderance in vocal fold nodules (88%), both considered phonotraumatic lesions, warrants further research into possible varying etiopathogenesis.

Paediatric voice disorder: who to refer and how to assess? A summary of recent literature.

The purpose of this review is to update the reader with recent advances and current opinion on the assessment and management of paediatric voice disorders. Access to advanced multidisciplinary paediatric voice clinics has increased over the last decade. Often the assessment is combined between speech therapy/pathology and ENT surgery. Vocal fold nodules remain the most prevalent diagnosis at a paediatric voice clinic, but significant diseases will also present, for example laryngeal papilloma. Recently, more consideration of the psychosocial aspect of voice disorders and evaluation of auditory processing disorders have shown how these can have a negative impact. There also appears to be a lack of parental and teacher awareness of paediatric voice disorders and their significance. We would recommend multiparametric assessment and analysis of all children with a voice disorder. Most paediatric voice conditions will respond to skilled voice therapy. However, the exact techniques and dosage requires further evaluation and research. Paediatric voice conditions are common and should not be dismissed, as they may represent significant disease, for example papilloma, vagal palsy or have a significant psychosocial impact on the child.

Is There an Ideal Performance Time for the Latex Tube Exercise?

SOVTE has been widely used in voice clinic. Estimates of time to perform the technique with a flexible latex tube are still unknown. This study aimed to investigate the immediate effect of flexible latex tube immersed in water on amateur singers after 1, 3, 5 and 7 minutes, considering: (a) the singers' self-assessment regarding voice and vocal effort; (b) acoustic parameters; and (c) auditory-perceptual parameters of voice quality. Twenty nine amateur singers (14 women and 15 men) performed the exercise with latex tube (35 cm X 0.9 cm) in one 1-minute set and three 2-minute sets. Data collection was conducted before and immediately after each set using sustained emission of vowel [a]. Women and men were considered separately. Vocal self-assessment showed a statistically significant increase in negative sensations after 7 minutes of exercise for women. Auditory-perceptual analysis indicated voices were perceived more often as "equal" comparing pre exercise with first minute set and more often as "better" in the third and fifth minutes comparing with pre exercise only for women. The other parameters showed no significance. The exercise with flexible latex tube in amateur singers promoted improvement in vocal quality after 3 and 5 minutes for women. Also, the women presented significant negative sensations after 7 minutes. Immediate effect on the analyzed parameters was not observed in men.

Observations and Considerations for Implementing Remote Acoustic Voice Recording and Analysis in Clinical Practice.

Remote voice recording and acoustic analysis allow for comprehensive voice assessment and outcome tracking without the requirements of travel to the clinic, in-person visit, or expensive equipment. This paper delineates the process and considerations for implementing remote voice recording and acoustic analysis in a high-volume university voice clinic. Clinical Focus. Acoustic voice recordings were attempted on 108 unique patients over a 6-month period using a remote voice recording phone application. Development of the clinical process including determining normative data in which to compare acoustic results, clinician training, and clinical application is described. The treating Speech Language Pathologists (SLPs) were surveyed 2 months after implementation to assess ease of application, identify challenges and assess implementation of potential solutions. Of 108 unique patients, 83 patients were successful in completing the process of synchronous remote acoustic voice recording in conjunction with their SLP clinician. The process of downloading the application, setting up, and obtaining voice recordings was most commonly 10-20 minutes according to the 8 SLPs surveyed. Challenges and helpful techniques were identified. Remote acoustic voice recordings have allowed SLPs to continue to complete a comprehensive voice evaluation in a telepractice model. Given emerging knowledge about the viability of remote voice recordings, the success in obtaining acoustic data remotely, and the accessibility of a low-cost app for SLPs makes remote voice recordings a viable option to facilitate remote clinical care and research investigation.

Validation of an AI-assisted Treatment Outcome Measure for Gender-Affirming Voice Care: Comparing AI Accuracy to Listener’s Perception of Voice Femininity

OBJECTIVESThere is currently a lack of objective treatment outcome measures for transgender individuals undergoing gender-affirming voice care. Recently, Bensoussan et al. developed an AI model that is able to generate a voice femininity rating based on a short voice sample provided through a smartphone application. The purpose of this study was to examine the feasibility of using this model as a treatment outcome measure by comparing its performance to human listeners. Additionally, we examined the effect of two different training datasets on the model’s accuracy and performance when presented with external data. METHODS100 voice recordings from 50 cisgender males and 50 cisgender females were retrospectively collected from patients presenting at a university voice clinic for reasons other than dysphonia. The recordings were evaluated by expert and naïve human listeners, who rated each voice based on how sure they were the voice belonged to a female speaker (% voice femininity [R]). Human ratings were compared to ratings generated by (1) the AI model trained on a high-quality low-quantity dataset (voices from the Perceptual Voice Quality Database) (PVQD model), and (2) the AI model trained on a low-quality high-quantity dataset (voices from the Mozilla Common Voice database) (Mozilla model). Ambiguity scores were calculated as the absolute value of the difference between the rating and certainty (0 or 100%). RESULTSBoth expert and naïve listeners achieved 100% accuracy in identifying voice gender based on a binary classification (female >50% voice femininity [R]). In comparison, the Mozilla-trained model achieved 92% accuracy and the previously published PVQD model achieved 84% accuracy in determining voice gender (female > 50% AI voice femininity). While both AI models correlated with human ratings, the Mozilla-trained model showed a stronger correlation as well as lower overall rating ambiguity than the PVQD-trained model. The Mozilla model also appeared to handle pitch information in a similar way to human raters. CONCLUSIONSThe AI model predicted voice gender with high accuracy when compared to human listeners and has potential as a useful outcome measure for transgender individuals receiving gender-affirming voice training. The Mozilla-trained model performed better than the PVQD-trained model, indicating that for binary classification tasks, quantity of data may influence accuracy more than quality of the data used for training the voice AI models.

Examining therapy duration in adults with induced laryngeal obstruction (ILO)

ObjectiveThis study examined the number of therapy sessions required to sufficiently improve (exercise) induced laryngeal obstruction (EILO/ILO) symptoms for discharge. Factors predicting therapy duration were examined as was the likelihood of patients returning for additional therapy sessions following initial discharge. MethodsRetrospective observational cohort design. Data for 350 patients were gathered from the University of Wisconsin-Madison Voice and Swallow Clinics Outcome Database. Patients (>18 years of age) diagnosed with EILO/ILO received therapy from a Speech-Language Pathologist (SLP) and were successfully discharged. EILO/ILO treatment details, symptoms, triggers, medical comorbidities, and patient demographics were collected from initial evaluations and subsequent course of therapy. ResultsPatients required an average of 3.59 (SD = 3.7) therapy sessions prior to discharge. A comorbid behavioral health diagnosis (p = .026), higher Vocal Handicap Index Score (p = .009) and reduced physical activity due to EILO/ILO symptoms (p = .032) were associated with increased therapy duration. Patients with ILO or EILO with secondary environmental triggers required significantly more sessions than those with exercise-induced symptoms (p < .01). Eight percent of patients returned for additional sessions following discharge. Patients returning for additional sessions all came from affluent neighborhoods as measured by the Area Deprivation Index (ADI). ConclusionsPatients with EILO/ILO required an average of 3.59 therapy sessions prior to discharge. As such, 4 sessions is a reasonable estimate for clinicians to provide patients. Six sessions may be a more conservative estimate for patients who present with a behavioral health diagnosis, a voice complaint, or reduced physical activity from EILO/ILO symptoms.

Dysphonia in Pediatric Professional Voice Users: Is It Just Nodules?

Objectives/HypothesisProfessional voice users of any age are often concerned about nodules, particularly in pediatric singers. However, an accurate diagnosis allows formulation of an optimal management plan and a successful continuation of these young patients’ careers. There is very little literature regarding pediatric professional singers; we aimed to share our experience of over a decade of referrals to our tertiary pediatric voice clinic. Study DesignThis was a retrospective review. MethodsA retrospective review was undertaken of all consecutive patients aged 0–18 years who self-identified as professional voice users and attended our tertiary pediatric voice clinic between December 2010 and December 2021. We analyzed demographics, professional singing status, diagnosis, management, and clinical voice scores. The patients were subdivided into those aged 0–9, 10–16, and 17–18 years. ResultsA total of 113 pediatric professional voice users attended the tertiary voice clinic in the study period. The commonest self-reported voice use was as a singer. Within the 0–9 years age group, there was a strong male predominance (22 males and three females) and mostly organic (52%) causes. For ages 10–16 years, there was a noted female predominance (15 males and 29 females). In the 17–18 years age group, there was a strong female predominance (10 males and 34 females), with predominantly functional diagnoses (48%). Of significance, only five of the 113 patients had nodules (4.4%). ConclusionsWe present a large data set of pediatric professional voice users and demonstrate the numerous underlying diagnoses for their dysphonia, particularly functional disorders. Our experience highlights the need for adequate vocal training for pediatric professional voice users and the need for a multidisciplinary diagnostic and management approach.

Case report: Successive ipsilateral and contralateral laryngeal nerve palsy as probable manifestation of neuroborreliosis

Neuroborreliosis is part of advanced stage of Lyme disease and often characterized by damage to the cranial and/or peripheral nerves. Involvement of one or both recurrent nerves is rare. Diagnosis is often difficult and based on a set of clinical manifestations, biological arguments, and cerebrospinal fluid (CSF) analysis. A 70-year-old man was referred to our Voice Clinic with a 3-month history of dysphonia caused by right vocal fold paralysis (VFP) without any cutaneous symptoms of tick bite or erythema migrans in the previous weeks and normal initial radiological examination (neck and thorax CT). Methylprednisolone had already been prescribed but without any clinical improvement. Late biological investigation 3 months after initial symptoms of VFP showed high IgG (93 U/mL; reference <10 U/mL) against Borrelia burgdorferi (BB), which was confirmed by two immunoblot markers (VIsE, p39 antigens). Therefore, a possible manifestation of Lyme disease with involvement of the right inferior laryngeal nerve was suspected, namely Lyme neuroborreliosis. However, given the spontaneous recovery of the patient after 7 months without any adapted antimicrobial regimen treatment, the diagnosis of neuroborreliosis was not confirmed by a lumbar puncture. Nineteen months later, the patient presented again for the same symptomatology but as left VFP. High IgG (68 U/mL) and IgM (>6, reference <0.90) levels against BB were confirmed by immunoblot. Subsequently, lumbar puncture was performed and revealed IgG against BB at 46.1 UA/mL (reference<5.5 UA/mL) in the CSF, with an extremely high IgG intrathecal synthesis antibody index (281.33, positive if > 1.5). Intrathecal antibody synthesis is the gold standard for Lyme neuroborreliosis demonstrating a specific immune response to BB in the central nervous system, but with the limitation of persistence for years after eradication. Our patient did not exhibit pleocytosis in the CSF. Therefore, two criteria of the European Federation of Neurological Societies (EFNS) guidelines are fulfilled for possible neuroborreliosis. Doxycycline treatment led to rapid recovery in less than 8 weeks and normal mobility of the left vocal fold. Because of this very uncommon clinical presentation with two successive episodes of VFP for no other obvious reason and serological evidence from the serum and CSF during the second episode, we consider it possible that the first episode of VFP could also have been a manifestation of neuroborreliosis. This case is the first report of possible relapse of laryngeal palsy successively on the right, and then the left side as a manifestation of Lyme neuroborreliosis.

Vocal Outcomes Following Laser-Assisted Sulcus Release for Superficial and Deep Vocal Fold Sulcus

The objective is to study vocal outcomes following laser-assisted sulcus release (LASR), having documented the length and depth of the sulcus intraoperatively. LASR performed for superficial and deep sulci were included. Retrospective, observational. The preoperative and 3-month postoperative and post voice-therapy Voice Handicap Index 10 (VHI), Grade-Roughness-Breathiness-Asthenia-Strain of the voice (GRBAS), Maximum Phonation Time (MPT), Fundamental Frequency (FO), and stroboscopy findings were noted retrospectively from our voice clinic records of LASR patients. Intraoperative sulci length and depth details were noted from records. Patients with coexisting lesions, surgically tackled, were excluded. In a total of 14 patients, 21 superficial sulci and eight deep sulci were operated by LASR. The average preoperative VHI improved from 25.3 to 9.9, GRBAS from 10.6 to 3.5, and MPT from 7.6 to 12.3seconds. The preoperative average FO was 235.9Hz in 12 patients (no pick-up in two) with a postoperative 248.4Hz. Using the Mann-Whitney U test, we found a statistically significant improvement in MPT, VHI, and GRBAS of the patients. There was no significant improvement in the FO of the patients. There was no postoperative voice deterioration in any patient. A preoperative phonatory gap was found in all patients, which postoperatively was absent in 10, markedly decreased in three, present in one with stroboscopy revealing an improvement in mucosal wave amplitude in 13 patients. In four patients with deep bilateral sulci where the LASR had been ligament deep, VHI improved from 26 to 13.3, GRBAS from 12 to 6.5, and MPT from 4.3 to 9.5seconds. Using the Mann-Whitney U test, all three parameters were significantly improved. A statistically significant vocal improvement in VHI, GRBAS, and MPT was observed at 3months, in superficial and deep sulci, operated by LASR. LASR is a simple, quick, and easily replicable surgery. Larger multi-centric studies with long-term follow-up are recommended.

Interpretable Computer Vision to Detect and Classify Structural Laryngeal Lesions in Digital Flexible Laryngoscopic Images.

To localize structural laryngeal lesions within digital flexible laryngoscopic images and to classify them as benign or suspicious for malignancy using state-of-the-art computer vision detection models. Cross-sectional diagnostic study SETTING: Tertiary care voice clinic METHODS: Digital stroboscopic videos, demographic and clinical data were collected from patients evaluated for a structural laryngeal lesion. Laryngoscopic images were extracted from videos and manually labeled with bounding boxes encompassing the lesion. Four detection models were employed to simultaneously localize and classify structural laryngeal lesions in laryngoscopic images. Classification accuracy, intersection over union (IoU) and mean average precision (mAP) were evaluated as measures of classification, localization, and overall performance, respectively. In total, 8,172 images from 147 patients were included in the laryngeal image dataset. Classification accuracy was 88.5 for individual laryngeal images and increased to 92.0 when all images belonging to the same sequence (video) were considered. Mean average precision across all four detection models was 50.1 using an IoU threshold of 0.5 to determine successful localization. Results of this study showed that deep neural network-based detection models trained using a labeled dataset of digital laryngeal images have the potential to classify structural laryngeal lesions as benign or suspicious for malignancy and to localize them within an image. This approach provides valuable insight into which part of the image was used by the model to determine a diagnosis, allowing clinicians to independently evaluate models' predictions.

Parents’ Perceptions of and Attitudes Toward Voice Therapy

PurposeThis study aimed to investigate Chinese parents’ perceptions of pediatric voice disorders to determine their level of health literacy and knowledge gaps to understand the determinants of initiating voice therapy for children with dysphonia. MethodA cross-sectional survey was conducted in three voice clinics in Chengdu, China, from October 1, 2021, to October 1, 2022. Impairment of children’s quality of life as perceived by parents was assessed using the pediatric Voice-Related Quality-of-Life (pVRQOL) scale. ResultsOverall, 206 parents whose children were recommended voice therapy were recruited (Mean ± SD age, 35.0 ± 4.62 years; male/female = 1:3). When otolaryngologists recommended that their children with dysphonia initiate voice therapy, most participants had positive responses (n = 176, 85.4%). The mean pVRQOL score was 40.8 in the accept group and 37.6 in the reject group (difference, 1.7; 95% CI, −4.98 1.69). Participants who had a more influential work status, had an only-child, had children with shorter-term voice symptoms, and visited specialized hospitals were more likely to have negative practices related to children’s voice therapy (P < 0.05). ConclusionsThis study represents an important first step in understanding Chinese parents' perceptions of and motivations for initiating voice therapy for their children with dysphonia. Initiation of treatment as recommended in pediatric populations depends on multiple factors, such as the duration of voice symptoms, family structure, and hospital type. It is imperative to promote public health care education on voice therapy among parents, as health care literacy is the primary driving factors in decision-making.

A Retrospective Study of Disease Burden as a Consequence of Delayed Patient Follow-up in the COVID-19 Pandemic in a Tertiary Care Voice Clinic

A Retrospective Study of Disease Burden as a Consequence of Delayed Patient Follow-up in the COVID-19 Pandemic in a Tertiary Care Voice Clinic

Pediatric Dysphonia: When to Refer.

The reported prevalence of voice disorders in the pediatric population varies widely between studies, ranging from 3.9% to 23%. Despite this, not all children with dysphonia are referred to a voice specialist for further evaluation. The objective of this study is to examine the relationship between dysphonia history, voice assessment, and laryngeal findings to help guide referrals of dysphonic children. A retrospective review was conducted of pediatric patients at a tertiary voice clinic between January 2014 and December 2017. Data including dates of presentation, demographics, co-morbidities, presenting symptoms, laryngeal exam findings, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores, and Pediatric Voice Handicap Index (pVHI) scores were collected and analyzed. Of 475 patients initially identified, 459 met inclusion criteria and were reviewed. In all, 272 (59.3%) were male and 187 (40.7%) were female. Mean age at first presentation was 8.6 years old (range: 2-18). Males were more likely to present at a younger age than females. CAPE-V data were available for 439 patients, and pVHI data were available for 109 patients. The mean CAPE-V Overall Severity score was 38.2. The mean total pVHI score was 25.4. Males had higher CAPE-V Overall Severity (40.0 vs. 35.4), Roughness (32.2 vs. 27.6), and Strain scores (37.2 vs. 32.4) than females. Patient pVHI scores did not differ by gender. In all, 283 patients self-reported a length of symptoms prior to evaluation. Children with a longer duration of symptoms prior to evaluation had higher CAPE-V Overall Severity scores. Diagnoses of vocal fold movement impairment and benign vocal fold lesions that were not nodules were associated with higher average CAPE-V Overall Severity scores. Overall, 310 patients (67.5%) were recommended intervention for their dysphonia. These patients had higher CAPE-V Overall Severity scores than those who were solely recommended observation (42.8 vs. 28.0). Males were more likely than females to present with dysphonia and presented with more severe perceptual dysphonia scores on average. The length of symptoms and certain diagnoses correlated with higher CAPE-V Scores. Referrals to a pediatric voice clinic should be considered in patients with a dysphonia history lasting greater than 3 months and in patients with more severe symptoms.

What students can teach each other: Promoting optimal voice use for teaching through a speech-language pathology student-led voice clinic

Initial teacher education (ITE) students experience voice problems while studying and subsequently in their careers with the potential to impact their teaching careers. Education about voice and vocal techniques required for teaching is not routine in teacher education. Speech-language pathology (SLP) programs require clients for voice-related training. This descriptive study considered student experiences and perceptions of benefit related to an SLP student-led voice clinic for ITE students. A cross-sectional survey revealed that 28.9% of ITE students presented with a voice problem on the Screen6, and 24.4% perceived themselves as vocally handicapped (VHI-10). Findings support the importance of routine screening of voice in ITE students, and that a student-led clinic may address preparation/training needs of both ITE and SLP students.