Voice Disorders Research Articles

The pathway to standardization in the diagnosis and treatment of voice disorders

The pathway to standardization in the diagnosis and treatment of voice disorders

Prevalence of Occupational Voice Disorder Among Teachers of Kathmandu District, Nepal.

The objective of this research was to identify the prevalence of voice disorders among teachers in the Kathmandu District of Nepal, with an emphasis on identifying possible risk factors that may be associated with these disorders. A cross-sectional study design was used, with both quantitative and qualitative data-gathering techniques using a mixed-methods approach. Data were collected from 95 non-teachers and 194 participating teachers from different schools in Kathmandu Valley. The analysis covered self-reported voice problem prevalence, job details, and demographic data. We examined the relationships between several variables and voice issues, including gender, class size, length of instruction, and tobacco usage. Findings: Compared with nonteachers (33.7%), teachers had a considerably greater prevalence of voice issues (69.1%). Greater class size and more than ten years of teaching experience were shown to be risk factors, while female instructors reported a greater prevalence of voice issues. Additionally, it was shown that instructors' voice issues are also linked to tobacco usage. The results of this study highlight how critical it is to provide voice therapy to educators employed in the Kathmandu District, particularly those in at-risk categories such as female instructors, more experienced educators, and educators with larger class sizes. The outcomes demonstrated important impacts on teacher well-being, job satisfaction, and academic achievement. More research and intervention strategies are needed to minimize the effects of voice problems and promote a positive teaching andlearning environment.

Oddychanie – ważny element profilaktyki uniwersalnej

The aim of the article is to reflect on the properties of respiratory, which should be the main element of the prevention of voice and speech disorders. Theoretical considerations include the issues of physiological respiratory. A contemporary, narrow concept of prevention is also signaled, which deserves attention due to its significant practical importance. With a view to being useful for teachers and speech therapists, the last part includes suggestions for respiratory exercises to be used when planning and conducting activities at the level of universal prevention. The study assumes a close connection between theoretical reflection and solutions to real preventive-diagnostic-therapeutic problems, because, as Franciszek Grucza wrote, “science and practice mutually determine each other, are mutually dependent on each other”.

Is it always Laryngopharyngeal Reflux? How Voice Disorders Can Manifest as LPR

Introduction. Laryngopharyngeal reflux (LPR) manifests with a constellation of common throat symptoms and inconclusive signs on laryngoscopic exam. It is a diagnosis, often made clinically, that can lead to prescriptions of proton pump inhibitors that are unnecessary and potentially harmful. Glottic insufficiency (GI) and the accompanying hyperfunctional laryngeal behaviors can also present with similar, common throat complaints that may or may not include a qualitative change to the voice. Methods. This is a reflection article. It is written to summarize, explain, and support with evidence the opinion of the author on the topic of how symptoms of voice disorders can easily be mistaken for symptoms of LPR. The offered reflection is based on his experience, research and the available literature. Reflection. This article intends to explore the similarities between GI and LPR, how to ultimately differentiate them and how to approach treatment with a broader differential diagnosis. Conclusion. LPR and GI can present with identical, vague throat, and voice symptoms. Empiric medication trials, behavioral interventions and objective laryngovideostroboscopy, impedance-based reflux, and esophageal motility testing may all be needed, sometimes in a trial and error fashion, to correctly diagnose and treat a patient’s symptoms.

A novel hybrid model integrating MFCC and acoustic parameters for voice disorder detection

Voice is an essential component of human communication, serving as a fundamental medium for expressing thoughts, emotions, and ideas. Disruptions in vocal fold vibratory patterns can lead to voice disorders, which can have a profound impact on interpersonal interactions. Early detection of voice disorders is crucial for improving voice health and quality of life. This research proposes a novel methodology called VDDMFS [voice disorder detection using MFCC (Mel-frequency cepstral coefficients), fundamental frequency and spectral centroid] which combines an artificial neural network (ANN) trained on acoustic attributes and a long short-term memory (LSTM) model trained on MFCC attributes. Subsequently, the probabilities generated by both the ANN and LSTM models are stacked and used as input for XGBoost, which detects whether a voice is disordered or not, resulting in more accurate voice disorder detection. This approach achieved promising results, with an accuracy of 95.67%, sensitivity of 95.36%, specificity of 96.49% and f1 score of 96.9%, outperforming existing techniques.

Normative Values for the Spanish Version of the Voice Symptom Scale (VoiSS)

Objective. The aim of this study was to establish normative values for the Voice Symptom Scale (VoiSS) in the Spanish community population (without voice problems), using a sample from a large area of southeastern Spain. Method. The sample consisted of 115 adults from ages 16 to 87, 60 of whom were women and 55 were men. Participants included the family members of patients who attended the Otorhinolaryngology (ENT) and Speech Therapy Clinic at a referral hospital in the region of Murcia, Spain, and some of the clinic’s staff. All the participants reported never having suffered from any voice disorder before. Results. The normative values obtained in this study for the VoiSS were 14.61 (SD=8.18) for the total score, 7.57 (SD = 5.42) for the Impairment subscale, 1.04 (SD = 1.65) for the Emotional subscale, and 5.99 (SD = 3.61) for the Physical subscale. The percentile values were also obtained for the VoiSS scale and for its three subscales. Conclusions. This study presents normative values for the VoiSS scale that have not previously been obtained in Spain. These values can be used as a reference to detect possible voice disorders.

A Tribute to Dr. Cristina Jackson-Menaldi: A Pioneer in the Field of Voice Disorders

The field of voice disorders lost a true pioneer with the passing of Dr. Cristina Jackson-Menaldi (June 21, 1950 - November 20, 2020). A renowned voice pathologist and singing voice specialist, Dr. Jackson-Menaldi made significant contributions to our understanding and treatment of voice disorders. She was also a passionate advocate for voice education and disorder prevention.

Speed of Pitch Change in People with Parkinson’s Disease: A Pilot Study

Objective. To examine laryngeal maximum performance through a novel pitch diadochokinetic (DDK) task in people with Parkinson’s disease (PD) and healthy controls. Methods. This exploratory pilot study included a total of eight people with PD (seven male and one female) and eight healthy controls. Participants were instructed to rapidly transition or alternate between a chosen comfortable low and high pitch and were instructed to complete the task as a pitch glide. An Auditory Sawtooth Waveform Inspired Pitch Estimator-Prime model was used to first extract the pitch contour and then a customized MATLAB algorithm was used to compute and derive measures of pitch range and pitch slope. Results. Pitch range and slope were reduced in some participants with PD. Effects of age and disease duration were observed in people with PD: reductions in both pitch measures with increase in age and disease duration. Conclusions. A novel pitch DDK task may supplement the conventional laryngeal DDK task in the evaluation and treatment of motor speech and voice disorders. Individual variability analysis may provide specific diagnostic and therapeutic insights for people with PD.

Vocal Demand Response to the Educational Setting Based Communication Scenarios: A Single Subject Study

Objectives. This was a single-subject study, aimed to demonstrate different vocal demand situations that are typical for primary school and teacher's vocal demand response under two acoustical conditions, with and without voice amplification, during five working days. Methods. The long-term voice dosimetry with Vocal Holter Med (PR.O. Voice Srl) was carried out on a 49-year-old female teacher with voice disorders during daily teaching activities. A sound field amplification system (SFAS) PentaClass Runa was installed in the classroom. Voice dosimetry was provided under two different acoustical conditions: without SFAS (2 days) and with SFAS (3 days). Results. Phonation time percentage, sound pressure level (SPL), SPL SD, fundamental frequency (F0), F0 SD, cycle, and distance doses were investigated in seven communication scenarios (lessons, group/individual classes, sports lessons in the gym and schoolyard, breaks, lunch breaks, and other activities). The median scores of all voice parameters differed significantly between different vocal demand contexts. The significant statistical difference in the vocal demand response was in the communication situations with and without SFAS. In addition, the number of children, reverberation time, and ambient air relative humidity impacted voice SPL and the cycle dose. Conclusions. Lessons, sports lessons held in the gym or schoolyard, breaks, and lunch breaks were considered as high vocal demand communication situations requiring higher voice intensity and fundamental frequency, higher phonation time percentage, cycle, and distance doses. Group/individual work and other teacher activities during the day, unrelated to direct work with students, were categorized as low vocal demand communication scenarios.

Impact of a Three-Week Workplace Vocal Health Promotion Program on a Teacher and Students' Voice Parameters

Objective. To determine the effect on voice parameters in pupils and their teacher of a three-week Workplace Vocal Health Promotion Program (WVHPP) in a school setting. Methods. Longitudinal study with a design phase and a pilot phase. Voice recordings of connected speech were used to collect information on voice functioning before and after the implementation of the program. The workplace vocal health promotion program was implemented with two purposes: (1) to reduce noisy conditions inside the classrooms that may cause loud voice production, which has been found associated with voice disorders among teachers and students and (2) to increase awareness about the relationship between noise and voice inside the classrooms. Results. The WVHPP was found to be statistically associated with a decrease in the fundamental frequency, standard deviation of the fundamental frequency, sound pressure levels, and SPL standard deviation among both pupils and their teacher. However, there was no statistically significant effect on cepstral peak prominence smoothed. Conclusion. The three-week WVHPP was found to have a significant impact on several acoustic parameters, such as the fundamental frequency and sound pressure levels. These findings highlight the potential of the WVHPP as an effective intervention for improving the vocal health of both teachers and students. However, the lack of a significant effect on cepstral peak prominence smoothed suggests that further research is needed to fully understand the impact of the WVHPP on voice quality.

The Minimal Important Difference of Acoustic Voice Quality Index in the Treatment of Voice Disorders.

The acoustic voice quality index (AVQI) is a reliable tool that objectively assesses dysphonia levels using six acoustic parameters. Despite its high criterion-related concurrent validity, diagnostic accuracy, and minimal detectable change derived from test-retest reliability, the minimal important difference (MID) of the AVQI has not been tested before. This study aimed to estimate the MIDs of AVQI for improvement audibly perceived by clinicians and self-reported improvement by patients. A retrospective study was conducted on 110 patients who received treatment for voice disorders. Patients completed AVQI and Voice Handicap Index-10 (VHI-10) questionnaires before and after the therapy. The MIDs of the AVQI were estimated using the anchor of either auditory-perceptual judgment of total dysphonia levels by clinicians or the VHI-10 questionnaire by patients. A distribution-based approach was also used to complement the results. First, using the auditory-perceptual anchor, a decrease of 0.95 in the AVQI was estimated as the MID for clinicians' perception, as a result of the receiver operating curve. Then, using the patient-reported anchor, an improvement of 1.36 in the AVQI was estimated as the MID for patients' voice-related disability. The distribution-based approach also ensured the anchor-based results of both the MIDs. The AVQI is a reliable and valid tool for evaluating voice quality, and a 0.95 decrease in the AVQI represents a meaningful improvement for clinicians' perception, whereas a 1.36 decrease in the AVQI influences patients' self-reported disability. This study contributes to understanding the minimal change necessary for clinicians to make informed decisions and ensure patient satisfaction. 3 Laryngoscope, 134:2805-2811, 2024.

Rehabilitation Treatment Specification System for Voice Therapy: Application to Everyday Clinical Care.

Rehabilitation intervention descriptions often do not explicitly identify active ingredients or how those ingredients lead to changes in patient functioning. The Rehabilitation Treatment Specification System (RTSS) provides guidance to identify the critical aspects of any rehabilitation therapy and supported the development of standardly named ingredients and targets in voice therapy (Rehabilitation Treatment Specification System for Voice Therapy [RTSS-Voice]). This study sought to test the content validity of the RTSS-Voice and determine if the RTSS-Voice can be used to identify commonalities and differences in treatment (criterion validity) across clinicians in everyday clinical practice. Five speech-language pathologists from different institutions videotaped one therapy session for 59 patients diagnosed with a voice or upper airway disorder. Specifications were created for each video, and iterative rounds of revisions were completed with the treating clinician and two RTSS experts until consensus was reached on each specification. All 59 sessions were specified without the addition of any targets or ingredients. There were two frequent targets: (a) increased volition and (b) decreased strained voice quality. There were three frequent ingredients: (a) information regarding the patient's capability and motivation to perform a therapeutic behavior, (b) knowledge of results feedback, and (c) opportunities to practice voicing with improved resonance and mean airflow. Across sessions treating vocal hyperfunction, there was large variability across clinicians regarding the types and number of treatment components introduced, types of feedback provided, and vocal practice within spontaneous speech and negative practice. The RTSS and the RTSS-Voice demonstrated strong content validity, as they comprehensively characterized 59 therapy sessions. They also demonstrated strong criterion validity, as commonalities and differences were identified in everyday voice therapy for vocal hyperfunction across multiple clinicians. Future work to translate RTSS principles and RTSS-Voice terms into clinical documentation can help to understand how clinician and patient variability impacts outcomes and bridge the research-practice gap. https://doi.org/10.23641/asha.24796875.

Professional voice disorders and possibilities of treatment

Professional voice disorders and possibilities of treatment

Clinical Utility and Validation of the Acoustic Voice Quality and Acoustic Breathiness Indexes for Voice Disorder Assessment in English Speakers.

While several acoustic voice metrics are available for clinical voice assessment, there remains a significant need for reliable and ecologically valid tools. The Acoustic Voice Quality Index version 03.01 (AVQI-3) and Acoustic Breathiness Index (ABI) hold potential due to their comprehensive assessment approach, incorporating diverse voice aspects. However, these tools still need to be validated in English-speaking populations. This study assessed the discriminatory accuracy and validity of AVQI-3 and ABI in 197 participants, including 148 with voice disorders. Voice samples were collected, followed by AVQI-3 and ABI calculations. Additionally, auditory-perceptual assessments were conducted by a panel of speech-language pathologists. AVQI-3 and ABI effectively identified disordered voice quality, evidenced by high accuracy (AUCs: 0.84, 0.89), sensitivity, and specificity (thresholds: AVQI-3 = 1.17, ABI = 2.35). Strong positive correlations were observed with subjective voice quality assessments (rs = 0.72, rs = 0.77, p < 0.001). The study highlights AVQI-3 and ABI as promising instruments for clinically assessing voice disorders in U.S. English speakers, underscoring their utility in clinical practice and voice research.

Current Practices in Voice Data Collection and Limitations to Voice AI Research: A National Survey.

Accuracy and validity of voice AI algorithms rely on substantial quality voice data. Although commensurable amounts of voice data are captured daily in voice centers across North America, there is no standardized protocol for acoustic data management, which limits the usability of these datasets for voice artificial intelligence (AI) research. The aim was to capture current practices of voice data collection, storage, analysis, and perceived limitations to collaborative voice research. A 30-question online survey was developed with expert guidance from the voicecollab.ai members, an international collaborative of voice AI researchers. The survey was disseminated via REDCap to an estimated 200 practitioners at North American voice centers. Survey questions assessed respondents' current practices in terms of acoustic data collection, storage, and retrieval as well as limitations to collaborative voice research. Seventy-two respondents completed the survey of which 81.7% were laryngologists and 18.3% were speech language pathologists (SLPs). Eighteen percent of respondents reported seeing 40%-60% and 55% reported seeing >60 patients with voice disorders weekly (conservative estimate of over 4000 patients/week). Only 28% of respondents reported utilizing standardized protocols for collection and storage of acoustic data. Although, 87% of respondents conduct voice research, only 38% of respondents report doing so on a multi-institutional level. Perceived limitations to conducting collaborative voice research include lack of standardized methodology for collection (30%) and lack of human resources to prepare and label voice data adequately (55%). To conduct large-scale multi-institutional voice research with AI, there is a pertinent need for standardization of acoustic data management, as well as an infrastructure for secure and efficient data sharing. 5 Laryngoscope, 134:1333-1339, 2024.

Upper Airway-Related Symptoms According to Mental Illness and Sleep Disorders among Workers Employed by a Large Non-Profit Organization in the Mountain West Region of the United States.

The relationships between selected upper airway-related symptoms (speech disturbances, voice disorders, cough, and breathing abnormalities) and mental illness and sleep disorders have been previously demonstrated. However, these relationships have not been compared in a single study with consideration of potential confounding variables. The current research incorporates a descriptive study design of medical claims data for employees (~21,362 per year 2017-2021) with corporate insurance to evaluate the strength of these relationships, adjusting for demographic variables and other important confounders. The upper airway-related symptoms are each significantly and positively associated with several mental illnesses and sleep disorders, after adjusting for demographic and other potential confounders. The rate of any mental illness is 138% (95% CI 93-195%) higher for speech disturbances, 55% (95% CI 28-88%) higher for voice disorders, 28% (95% CI 22-34%) higher for cough, and 58% (95% CI 50-66%) higher for breathing abnormalities, after adjustment for the confounding variables. Confounding had significant effects on the rate ratios involving cough and breathing abnormalities. The rate of any sleep disorder is 78% (95% CI 34-136%) higher for speech disturbances, 52% (95% CI 21-89%) higher for voice disorders, 34% (95% CI 27-41%) higher for cough, and 172% (95% CI 161-184%) higher for breathing abnormalities, after adjustment for the confounding variables. Confounding had significant effects on each of the upper airway-related symptoms. Rates of mental illness and sleep disorders are positively associated with the number of claims filed for each of the upper airway-related symptoms. The comorbid nature of these conditions should guide clinicians in providing more effective treatment plans that ultimately yield the best outcome for patients.

Multidimentional assessment of voice quality in patients with laryngopharyngeal reflux disease.

&lt;b&gt;&lt;br&gt;Introduction:&lt;/b&gt; Gastroesophageal Reflux Disease (GERD) is a common disorder in world population. As a result of the regurgitation of acid content from the stomach to laryngopharynx and larynx, secondary damage of laryngeal mucosa occur, which is highly sensitive to hydrochloric acid, and morphological changes are observed. Symptomatology of laryngopharyngeal reflux is varied which makes differential diagnosis difficult.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Aim:&lt;/b&gt; The aim of the study was the assessment of voice quality, morphological changes in larynx as well as etiology of Laryngopharyngeal Reflux Disease.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Material and method:&lt;/b&gt; The severity of dysphonia was classified using perceptual and acoustic methods as well as RSI. Morphological control was performed using HSDI technique and RFS. Etiological factors were examined basing on barofunction of upper esophageal sphincter and 24-hour pH-metry of air exhaled expressed in Ryan score.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Results:&lt;/b&gt; In the majority of patients with Laryngopharyngeal Reflux, dysphonia was recognized, intensified especially in women (G3R2B0A0S3), which was confirmed in Yanagihara classification (type III) and parameters of acoustic analysis. Voice disorders were the most frequently the result of edema and congestion of interarytenoid area, aytenoids and vocal folds. Those symptoms were caused by the decrease of upper esophageal sphincter tension and acidity of exhaled air which was confirmed in 24-hour pHmetry.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Conclusions:&lt;/b&gt; It is important to educate physicians and patients about the possibilty of negative impact of reflux disease on the occurrence of voice quality disorders. Current diagnostic methods for dysphonia guarantee accurate recognition and therapeutic success improving the prognoses of patients with Laryngopharyngeal Reflux.&lt;/br&gt.

Modified oropharyngeal muscle training and scientific vocalization are effective in treating mild-to-moderate obstructive sleep apnea hypoventilation syndrome in adults

Background Obstructive Sleep Apnea-hypopnea Syndrome (OSAHS) has become a major public health challenge globally. Most patients have a concomitant voice disorder. The existing treatment methods have problems.Aims/Objectives: This study investigates the therapeutic effect of adding scientific vocalization to oropharyngeal muscle training on OSAHS patients. Material and methods A total of 30 patients were selected from September 2020 to October 2022. They underwent overnight polysomnography (PSG) and were identified as having mild to moderate obstructive sleep apnea hypoventilation syndrome. They were then chosen for a three-month period of modified oropharyngeal muscle training combined with scientific vocalization. Results Out of the 30 selected patients, 26 patients completed the training. Results showed a significant changes in multiple sleep-related indicators. he clinical outcomes were as follows: 7 cases were cured, 13 cases were effective, and 6 cases were ineffective. The overall effective rate was 76.92%. Conclusions and significance The combination of oropharyngeal muscle training and scientific vocalization for the treatment of mild to moderate OSAHS in adults significantly improves several measures used in the treatment of the condition. The method is easy to learn, effective, safe to use, and affordable. It provides more options for the treatment of OSAHS.

A General Survey of Pharynlaryngeal Diseases and Voice Disorders Among Basic Education Teachers in Tianjin

ObjectiveIn this study, we created a city-wide database of pharyn-laryngeal diseasess and voice disorders among basic education teachers to analyze the incidence, distribution, and risk factors of Pharyn-laryngeal diseases and voice disorders. MethodsA total of 47,823 teachers in primary and secondary schools and kindergartens of Tianjin were enrolled in this study and underwent questionnaires and throat examinations. In addition, the data were subjected to descriptive statistics, chi-square analysis, and univariate and multivariate logistic regression analyses. ResultsPharyn-laryngeal diseases and voice disorders had an overall prevalence of 69.42% among basic education teachers in Tianjin, wherein the prevalence of chronic pharyngitis, chronic hyperplastic laryngitis, and chronic simple laryngitis were the highest at 39.45%, 19.80%, and 15.59%, respectively. The results of multivariate logistic regression analysis suggest that pharyn-laryngeal diseases and voice disorders were statistically correlated with gender (P<0.001), years of teaching (P<0.001), school district (P<0.001), class size (P<0.001), subjective assessment of teachers on vocal loudness (P<0.001), neck and shoulder discomfort (P<0.001), smoking (P<0.001), psychological stress (P=0.002), and frequent habitual throat clearing (P<0.001). Furthermore, the risk factors for pharyn-laryngeal diseases and voice disorders were age (P=0.002), school district (P<0.001), class size (P=0.008), neck and shoulder discomfort (P=0.038), smoking (P<0.001), water intake habits during class (P=0.023), and frequent habitual throat clearing (P=0.001) for male teachers and for female teachers it was age (P<0.001), school district (P<0.001), daily teaching hours (P=0.005), class size (P<0.001), subjective assessment of teachers on vocal loudness (P<0.001), neck and shoulder discomfort (P<0.001), smoking (P=0.033), psychological stress (P=0.003), and frequent habitual throat clearing (P<0.001). ConclusionDue to the high prevalence of pharyn-laryngeal diseases and voice disorders among basic education teachers, throat and voice health education-related activities should be conducted for teachers, to intervene in the occurrence of pharyn-laryngeal diseases and voice disorders at an early stage.

Screening of Voice Pathologies: Identifying the Predictive Value of Voice Acoustic Parameters for Common Voice Pathologies

Voice acoustic analysis is important for objectively assessing voice production and diagnosing voice disorders. This study aimed to investigate the sensitivity of various voice acoustic parameters in differentiating common voice pathology types. Data from the publicly available Perceptual Voice Qualities Database were analyzed; the database includes recordings of participants with and without voice disorders. A wide range of acoustic parameters was estimated from the recordings, such as alpha ratio, harmonics-to-noise ratio (HNR), cepstral peak prominence smoothed (CPPS), pitch period entropy (PPE), fundamental frequency, jitter, shimmer, and sound pressure levels. The predictive capabilities of the parameters were evaluated using receiver operating characteristic curves. Linear regression analysis determined the associations between parameters and voice disorders. Principal component analysis was conducted to identify important parameters for distinguishing voice disorders. This study has identified significant differences in acoustic parameters between those with and without voice disorders. Notably, the combination of five parameters-namely, PPE, shimmer, jitter, CPPS, and HNR-was identified as a strong predictor in voice disorder screening. These findings contribute substantially to the field of voice disorders, offering valuable insights for screening and diagnosis.