Voice Handicap Index Questionnaire Research Articles

Prevalence and Risk Factors for Occupational Voice Disorders in Nepalese Teachers: A Cross-Sectional Study

Abstract Introduction Teachers are a high-risk group for the development of vocal dysfunction, as they use voice extensively in their profession. Objective To know the prevalence and risk factors associated with voice strain in teachers. Methods A cross-sectional study was conducted among schoolteachers in Chitwan, Nepal. The Voice Handicap Index questionnaire was used as a survey tool. Result A total of 315 teachers were enrolled in the study. The mean age of the participants was of 36.7 years. Teachers from public schools, primary grade classes, > 50 pupils in the classroom, > 24 hours of classes per week, dust in class, and recurrent tonsil problems were associated with various degrees of vocal handicap. Conclusion There is a high prevalence of voice disorder among teachers. A holistic approach, which includes teacher education regarding voice care during their work and management of their voice handicap by taking into consideration different risk factors, must be adopted.

Quebec French Translation, Cultural Adaptation, and Validation of the Singing Voice Handicap Index-10 Questionnaire for Singers with Dysphonia

OBJECTIVES/HYPOTHESISDysphonia is a common voice disorder that can significantly impact a person’s life; it requires a collaborative evaluation by both speech-language pathologists and otolaryngologists that takes the patient’s perspective into account. The aim of this study was to translate and culturally adapt the Singing Voice Handicap Index questionnaire (SVHI-10), a reliable patient-reported outcome evaluation tool for dysphonia, for the Quebec French population. The result is the Singing Voice Handicap Index-10-QC (SVHI-10-QC). STUDY DESIGNThis study was a prospective translation and validation process. METHODSThe translation process complied with international recommendations and followed a standard forward-backward translation procedure and cognitive debriefing with ten singers. The Quebec French version was administered to two study samples: 30 vocal professionals with no dysphonia and 53 vocal professionals with dysphonia as one of their primary complaints. The SVHI-10-QC was assessed for construct validity, internal consistency, discriminatory capacity, and test-retest reliability. RESULTSThe SVHI-10-QC is valid, reliable, and ready for use with singer-patients suffering from dysphonia. CONCLUSIONSThe SVHI-10-QC is a reliable and valid tool for assessing the impact of dysphonia on French Quebec singers’ quality of life.

Reinke’s Edema: New Insights into Voice Analysis, a Retrospective Study

Reinke's edema (RE) is a pathological condition involving increased volume of the vocal folds and resulting in significant impact on speech, fundamental frequency, and vocal range. Literature reports few studies which analyze vocal features according to the severity of RE. The aims of this study were to investigate the aerodynamics, acoustic characteristics, and sound spectrograms of a group of RE patients and to assess whether there was any correlation with their endoscopic grading. A total of 98 patients were included in the study, 49 patients with RE and 49 healthy volunteers (HV). Multidimensional Voice Program was used to perform objective voice assessment. Maximum phonation time (MPT) and Voice Handicap Index (VHI) questionnaire were collected. The spectrograms of the vowel /a/ and of the word /aiuole/, which contains the five Italian vowels, of each patient were analyzed according to the classification of Yanaghiara modified by Ricci Maccarini and De Colle. Laryngological assessment was used to record vocal folds morphology according to Yonekawa's classification. Univariate analysis was used to compare group outcomes. Bivariate analysis was used to compare endoscopic grading and voice analysis results. Univariate analysis of the HV and RE groups revealed statistically significant differences (P<0.05) for the following parameters: jitter%, shimmer%, harmonic-to-noise ratio (NHR), voice turbulence index (VTI), MPT, VHI except for soft phonation index. Spearman's rank correlation showed a positive correlation between vocal parameters such as jitter%, shimmer%, NHR, VTI, and RE gradings. A negative correlation was found between MPT and RE gradings. Bivariate analysis indicated a strong positive correlation between RE grading and the spectrogram classification performed both with the vowel / a / (Rho 0.86; P=0.0001) and with the word / aiuole / (Rho 0.81; P=0.0001). The present study demonstrates that patients with RE have different voice characteristics compared to HV. In particular, the voice analysis highlighted acoustic parameters that correlated to differing degrees of RE. In addition, spectrogram analysis should be considered for acoustic assessments before and after medical and surgical therapy and also in forensic medicine.

Long-term voice evaluation after arytenoid adduction surgery in patients with unilateral vocal fold paralysis

PurposeLaryngeal framework surgery, including medialization laryngoplasty and arytenoid adduction (AA), is expected to have a lasting or permanent effect in patients with unilateral vocal fold paralysis (UVFP); however, there are few reports about the long-term outcomes of AA. This study aimed to evaluate the long-term postoperative effects of AA surgery and examine its stability and reliability.MethodsThis study collected the voice handicap index (VHI) questionnaire from patients with UVFP who underwent AA more than 2 years previously. The VHI values preoperatively and 3 months postoperatively (early postoperative evaluation) were retrospectively calculated, and VHI values more than 2 years after surgery (late postoperative evaluation) were collected by mailing a sheet to the patients and asking to fill and return it. Possible influenced subscales such as age, sex, causes of UVFP, affected side, and surgeons were also analyzed.ResultsA total of 77 patients with UVFP who underwent AA had significantly lower early and late postoperative evaluations than preoperative evaluations. In 38 patients with no missing values, there were no significant differences between early and late postoperative evaluations, measured at a median of approximately 5 years. There were also no significant differences between early and late postoperative evaluations in any of the subscale groups.ConclusionPatients with UVFP who underwent AA surgery achieved stable voice improvement in the long term after surgery.

Temporomandibular Dysfunction and Voice-Related Quality of Life Impairment.

Muscle tension in the head and neck may co-occur with temporomandibular dysfunction (TMD) possibly leading to voice change. Several studies have reported a correlation between TMD and dysphonia. However, literature on TMD and voice-related quality of life (QOL) is scant. This study aimed to investigate the relationship between TMD and self-perceived voice-related QOL impairment. Patients from TMD clinic were prospectively surveyed on voice-related quality of life using the Voice Handicap Index (VHI) questionnaire. Patients were queried using paper and pen upon initial evaluation in dentistry clinic for temporomandibular disorders by a single dentist or dental assistant in the otolaryngology department. A total of 53 patients completed the VHI. 80% of patients presenting to TMD clinic had VHI scores above zero, but most had minimal to mild impairment. Forty-two patients had scores between 1 and 86, (average 10.98); 11 patients had a score of zero (20.75%). Total average score: 8.70, range: 0-86, median: 4. Functional average score: 3.13, range: 0-29, median: 1. Physical average score: 3.58. range: 0-25, median: 2. Emotional average score: 1.98, range: 0-32, median: 0; these averages did not differ from historical controls. The majority of patients presenting to TMD clinic also presented with some level of voice-related QOL impairment, although minimal and consistent with historical VHI controls. Data indicates that TMD disease may be primarily defined as functionally and physically uncomfortable. Incorporation of interdisciplinary care, with laryngology, speech pathology, physical therapy, counseling, and pain management may be warranted. 4 Laryngoscope, 134:315-317, 2024.

Comparison and Relation Between Vocal Tract Discomfort and Voice Handicap Index in Teachers With and Without Muscle Tension Dysphonia

Objective One of the most voice-related complaints in teachers is vocal tract discomfort (VTD) which can increase the voice handicap index (VHI) to different degrees. In teachers Muscle Tension Dysphonia (MTD), increases voice complaints and decreases the voice-related quality of life. The aims of this study were to evaluate and compare the frequency and severity subscales of the VTD score and total score of VHI and determine the relation between them in primary school teachers with and without MTD. Materials &amp; Methods This study was cross-sectional and was performed on 80 primary female teachers with and without MTD. The participants in both groups were randomly selected after checking the inclusion criteria. Voice history, auditory-perceptual assessment of voice, palpation, and laryngeal video-stroboscopy were assessed on the teachers in two groups. Then, asked the participants to complete the Persian versions of the VTD and VHI scales. After determining the normal distribution of the data using the Kolmogorov-Smirnov test, the results of VTD, VHI, and their subscales were compared between two groups with an independent t-test. Also, the relationship between them was assessed with the Pearson correlation coefficient analysis. Results The mean score of the frequency subscale of VTD in teachers with MTD was more than in teachers without MTD (30.17±5.11, 8.22±2.26), respectively. The score of severity subscales of VTD in teachers with MTD was 39.12±4.94 and in teachers without MTD was 7.89±2.13. Also, the total score of the VHI questionnaire in teachers with MTD was significantly higher than teachers without MTD (P&lt;0.05). Moreover, there was a significant positive correlation between the frequency and severity subscales of VTD and the total score of VHI in the two groups (P&lt;0.05). Conclusion This study showed the frequency and severity scores of the VTD and the degree of VHI experienced by MTD are remarkably higher than teachers without MTD. The authors emphasize on the use of VTD and VHI scales in screening teachers who are at risk of voice problems, and the researchers pointed out the importance of paying attention to the reduction of discomfort feelings in the vocal tract and voice handicap in the voice therapy sessions of teachers with MTD.

The Study of Vocal Function in Patients With Early Laryngeal Carcinoma After Transoral Laser Microsurgery

Objective Today transoral laser microsurgery is considered as one of the first options to control early laryngeal cancer, and voice disorder is one of the inevitable complications of this therapeutic component. This study aimed to compare the vocal function in patients with early-stage laryngeal cancer following laser surgery with healthy individuals with normal voice quality using acoustic analysis and the voice handicap index and to examine the correlation between the results of these two evaluations in each group. Materials &amp; Methods The current research is a descriptive-correlational and comparative study that was cross-sectioned using convenience sampling into two groups consisting of 60 men (Mean±SD of age 59.18±5.170 years) with early laryngeal cancer undergoing laser surgery as a patient group and 60 men (Mean±SD of age 56.68±5.491 years) with normal voice quality, and without any history of voice disorder as a control. The vocal function of participants was assessed using acoustic parameters (including jitter, shimmer, harmonic to noise ratio, fundamental frequency, smoothed cepstral peak prominence) and a 30-item Persian version of the voice handicap index questionnaire (including overall score and scores of physical, emotional and functional subscale). Then, data were analyzed using SPSS software, version 20, descriptive statistics, Kolmogorov-Smirnov, independent t-test, and Pearson correlation coefficient at the P&lt;0.05. Results The results show that the acoustic parameters and voice handicap index in the group undergoing laser surgery are significantly different from the control group (P&lt;0.001). Also, a significant direct correlation between jitter and shimmer with total score and physical subscale of VHI, a significant inverse correlation between the harmonic-to-noise ratio and total score, functional and physical subscales of VHI, as well as between smoothed cepstral peak prominence with total score and all subscales of VHI (P&lt;0.05). In addition, in the control group, there is no significant correlation between the acoustic parameters and the subscales of the voice handicap index (P&lt;0.05). Conclusion The findings of the acoustic analysis and the voice handicap index show impairment in vocal function and a decrease in voice-related quality of life (QoL) in patients with early laryngeal cancer after laser surgery. Furthermore, a significant correlation between the scores of the voice handicap index and acoustic analysis parameters, especially cepstral analysis indicates the necessity to pay attention to frequency-based analysis. Therefore the results of the present study emphasize the need for a comprehensive assessment of vocal function, providing voice therapy programs, and attention to psychological problems in patients with early laryngeal cancer after laser surgery.

Vocal Fatigue Index in Finnish-Speaking Population

Vocal fatigue is an important complaint that may indicate a voice disorder or a risk thereof. There is a need for a reliable tool to detect and quantify vocal fatigue and distinguish dysphonic and vocally healthy speakers. The Vocal Fatigue Index (VFI) questionnaire has been found valid and reliable among speakers of different languages. This study aims to validate it for speakers of Finnish. Experimental comparative study. The VFI questionnaire was translated from English to Finnish according to the WHO recommendations. Next, it was subjected to the validation procedure. In total, 160 Finnish speakers volunteered to participate in the study. Hundred-and-eight were voice patients (83 males, 25 females) and 52 were vocally healthy controls (37 females, 15 males). As a comparison, the Voice Handicap Index (VHI) questionnaire was completed and voice samples were recorded to enable Acoustic Voice Quality Index (AVQI03.01FIN) analysis. Results from the first and second completions of the VFI(F) questionnaire correlated strongly (Spearman's rho 0.901, P=0.01). Answers to the individual questions the VFI(F) also correlated strongly, showing high internal consistency. Factor 1 (Tiredness of voice and avoidance of voice use) of the VFI correlated strongly with the VHI, and the two other factors (Physical discomfort associated with voicing and Improvement of symptoms) correlated moderately with the VHI. Factor one of the VFI(F) correlated moderately with AVQI03.01FIN and its sub-parameters, CPPS, HNR, and shimmer. The VFI(F) showed good construct validity, differentiating voice patients and controls at cut-off 13.5, with sensitivity of 0.963 and specificity of 0.885. Discriminatory power was strong for all factors: F1 AROC=0.985, F2 AROC=0.864, and F3 AROC=0.821. The VFI(F) correlates with the VHI and with AVQI01.01FIN and it is a valid and reliable tool for detecting vocal fatigue in Finnish speakers.

Investigating the Impact of Voice Impairment on Quality of Life in Stroke Patients: The Voice Handicap Index (VHI) Questionnaire Study.

The Voice Handicap Index (VHI) is a patient-centered evaluation tool specifically designed for assessing voice-related quality of life. Although the VHI has been extensively used in patients with voice disorders, its applicability in stroke patients has not been fully established. This prospective cross-sectional study aimed to investigate the feasibility of using the VHI questionnaire in identifying stroke patients with voice problems. The study included a cohort of acute to subacute first-ever stroke patients (n = 48), with or without voice problems, as well as other non-stroke patients (n = 31) who agreed to complete the VHI questionnaire. Stroke patients with self-reported voice problems demonstrated significantly higher VHI scores and poorer life quality scores compared to the control groups. These patients also had lower Mini-Mental State Examination (MMSE), Modified Barthel Index (MBI), and Euro-QoL-5D-5L (EQ-5D-5L) scores. Spearman correlation analysis revealed an inverse association between VHI scores and EQ-5D-5L (rho = -0.77, p < 0.001), Korean Mann Assessment of Swallowing Ability (rho = -0.51, p < 0.001), and other functional parameters, including the National Institutes of Health Stroke Scale, MMSE, and MBI scores. Multiple regression analysis indicated that the VHI score was the biggest contributing factor to EQ scores. This is the first study to demonstrate that stroke patients with voice problems may experience reduced quality of life, even after controlling for other confounding factors such as dysphagia or neurological deficits. Future studies are needed whether addressing these issues by implementing the VHI may facilitate the improvement of patients' quality of life.

Influencia del uso vocal en el índice de incapacidad vocal. Estudio de 180 casos

IntroductionSingers are one of the groups of voice professionals with higher prevalence of vocal pathology due to their profession and lifestyle. MethodProspective ex post study was carried out to study the self-perception of vocal disability of 180 subjects (91 singers and 89 non-singers) using the Jacobson et al. (1998) Voice Handicap Index (VHI). The relationship of the test score and various risk factors has also been studied. ResultsSingers scored higher (21.49) than non-singers (17) on the VHI questionnaire. Regarding on sex, women reached higher scores (28.15) than men (12.33). Regarding on risk factors we have observed that smokers show significant higher scores (23.42) than non-smokers (15.30). ConclusionsThe subjects with more vocal use, in this case the singers, present higher scores on the VHI. That also occurs with women and smokers. These results are statistically significant only in the case of the variables smokes and sex.

The Relationship Between Voice Handicap Index and Voice-Related Quality of Life in Patients with Early Laryngeal Cancer.

Voice production can be affected in early laryngeal cancer. The purpose of this study was to investigate the correlation between Voice Handicap Index (VHI) and Voice-Related Quality of Life (V-RQOL) among patients with early laryngeal cancer. Twenty-seven patients with early laryngeal cancer (T1, T2) and a mean age of 59.35 ± 7.77 years who were visited in Amir-Alam hospital, took part in this study. After a diagnosis of early laryngeal cancer by a laryngologist, the patients filled out the Persian versions of the VHI and V-RQOL questionnaires. The results showed the mean total score of VHI and V-RQOL were 65.94 ± 14.21 and 48.64 ± 9.75% in patients with early laryngeal cancer, respectively. These results indicated the total and subscales' scores of VHI increased while the scores of VRQOL decreased. The Pearson correlation between total scores of the VHI and V-RQOL was - 90. Also, there was a negative significant correlation between total and subscales' scores of VH and VRQOL (r Pearson= -0.46 to -0.90, p ≤ 0.05). Our findings demonstrated decreased quality of life related to voice in patients with laryngeal cancer who were in the early stages of tumor growth (T1, T2). Regarding the high negative significant correlation between results of VHI and V-RQOL in patients with early laryngeal cancer, both questionnaires can be used instead of each other for saving time in voice clinics.

Injection laryngoplasty with hyaluronic acid for glottal insufficiency in unilateral vocal fold paralysis: a systematic review of the literature.

Glottal insufficiency, mostly caused by unilateral vocal fold paralysis (UVFP) or vocal fold atrophy can be treated by injection laryngoplasty (IL). Materials such as hyaluronic acid (HA) gels are now widely available and used to improve voice quality. Various durability and effects of HA injection laryngoplasties have been reported. The aim of this study is to provide a systematic review of the literature for the use of HA in injection laryngoplasties. A systematic literature search was conducted in PubMed and Cochrane Libraries. Three reviewers assessed original research studies concerning vocal fold augmentation with HA for eligibility. English written full-text human studies from 2000 to 2020 with EBM level 1b-2 were included. In vitro studies, animal studies, case reports, case-control studies, correspondence and review articles, and articles with other injection materials were excluded. Demographical data, indication, type of HA, evaluation methods, follow-up, durability of implanted material and complications were assessed. A total number of 311 articles were found in PubMed and Cochrane Library, 13 studies were eligible for final analysis with 1063 patients, mean age of patients was 58.7years. Main indication for HA IL was unilateral vocal fold paralysis, evaluation methods were subjective-VHI (Voice Handicap Index) questionnaire and objective-acoustic and aerodynamic measurements, mean time of follow-up was 5.9months. Large-particle HA gels were more favorable for longer durability than small-particle HA, reported time of resorption of HA gels ranges between 6 and 12months, and complication rate was low. Hyaluronic acid injection laryngoplasty increases voice quality, improves results of voice therapy, and can be recommended as overlap treatment before permanent medialization surgery. Compared to other injected materials, HA seems to have more favorable effect on vibratory functions of the vocal folds and thus on the voice quality parameters.

Change in Voice Quality after Radiotherapy for Early Glottic Cancer.

Simple SummaryThe voice of a patient is expected to improve after successful radiotherapy for early glottic cancer. The aim of this study was to follow the changes in the voice for two years after a completed treatment. Subjective patient and physician assessments of the voice quality and objective acoustic analyses of the voice of each patient were used to follow up on the voice changes at regular intervals in 50 patients with T1 glottic cancer. A stroboscopy showed the progression of radiotherapy-induced fibrosis of the vocal folds, which influenced their vibration during phonation. A subjective assessment of the voice quality showed a gradual improvement, but an objective measurement showed a deterioration in a few voice parameters. Two years after the treatment, only 16% of patients had normal voices. The main cause of the impaired voice quality was post-radiotherapy scarring of the vocal folds.Our aim was to track the changes in voice quality for two years after radiotherapy (RT) for early glottic cancer. A videoendostroboscopy, subjective patient and phoniatrician voice assessments, a Voice Handicap Index questionnaire, and objective acoustic measurements (F0, jitter, shimmer, maximal phonation time) were performed on 50 patients with T1 glottic carcinomas at 3, 12, and 24 months post-RT. The results were compared between the subsequent assessments, and between the assessments at 3 months and 24 months post-RT. The stroboscopy showed a gradual progression of fibrosis of the vocal folds with a significant difference apparent when the assessments at 3 months and 24 months were compared (p < 0.001). Almost all of the subjective assessments of voice quality showed an improvement during the first 2 years, but significant differences were noted at 24 months. Jitter and shimmer deteriorated in the first year after RT with a significant deterioration noticed between the sixth and twelfth months (p = 0.048 and p = 0.002, respectively). Two years after RT, only 8/50 (16%) patients had normal voices. The main reasons for a decreased voice quality after RT for early glottic cancer were post-RT changes in the larynx. Despite a significant improvement in the voice after RT shown in a few of the evaluation methods, only a minority of the patients had a normal voice two years post-RT.

Impacto de la disfonía en la calidad de vida en la edad infantil

IntroductionVoice disorders can negatively affect the child's self-esteem and pose a problem for their socialization. The P-VHI (Pediatric Voice Handicap Index) is a quality of life questionnaire adapted for use in children that studies the impact of dysphonia on the functional, physical and emotional levels. MethodsRetrospective, observational and analytical study of a group of 87 patients aged between 5 and 14 years old with a diagnosis of dysphonia. The control group consisted of 31 patients same age range in whom was discarded the presence of otorhinolaryngological disease. We collected the data referred to age, sex, family environment and sport practice of both groups and analyzed their relationship with the presence of dysphonia. The impact of dysphonia on children's quality of life was studied using the Pediatric Voice Handicap Index (P-VHI) questionnaire. ResultsWe found a statistically significant relationship between the dysphonia and the male sex (65.5% in the group with dysphonia vs. 29% in the control group), having siblings (89.7% vs. 71%) and having a family history of voice disorders (33.3% vs. 3.2%). In the P-VHI questionnaire for all categories a significantly higher score was obtained in the group with dysphonia compared to the control group. ConclusiónDysphonia negatively affects children in the physical, emotional and social spheres. It is convenient an early detection, diagnosis and treatment, proportional to the impact generated.

Clinical study of injectable collagen scaffold with autologous fat cells for repair of severe vocal fold injury

Cell retention and survival after transplantation remains a major problem for long-term efficiency in therapy of severe vocal fold injury with autologous cells. In this study, injectable collagen scaffold was used to deliver autologous fat cells (AFCs) for repairing of severe vocal fold injury. We found injectable collagen scaffold could enhance the retention and survival of green fluorescent protein (GFP) labeled fat cells in the transplantation sites in rats. Based on these data, a randomized controlled clinical trial was conducted to evaluate the safety and efficiency of transplantation of collagen scaffold with AFCs for severe vocal fold injury. Ten patients with vocal fold paralysis were randomly assigned to control (AFCs only) and intervention (AFCs + collagen) groups. AFCs with or without collagen scaffold were injected into vocal folds of patients under general anesthesia, respectively. The safety and efficacy were regularly assessed during 24 months post-surgery. No obvious complications occurred in all patients during the follow-up. The collagen scaffold maintained the stability of implants after injection and reconstructed the vocal fold structure. The improvement of voice quality of patients was observed through voice quality evaluation with the voice handicap index (VHI) questionnaire, as well as acoustic analysis of maximum phonation time, jitter, and shimmer. The VHI score of patients in AFCs + collagen group improved significantly than those in AFCs group at 6, 12 and 24 months post-surgery. It demonstrates the injectable collagen scaffold is safe and efficient for delivering AFCs for vocal fold injury.

Effect of High Frequency Repetitive Transcranial Magnetic Stimulation Combined with Voice Training on Voice Function of Patients with Parkinson's Disease

<bold>Objective</bold> To observe the effect of high frequency repetitive transcranial magnetic stimulation (rTMS) combined with voice training on voice function of patients with Parkinson's disease (PD). <bold>Methods</bold> A total of 30 patients of Parkinson's disease with voice disorder were treated in the department of rehabilitation medicine and the department of geriatrics of Shanghai Fifth Rehabilitation Hospital from October 2019 to July 2021, which were randomly divided into the control group and the observation group according to Excel RAND function, with 15 cases in each group. The control group were treated with routine anti PD drugs and routine voice training, including abdominal breathing training, respiratory and vocal coordination training, breathing support ability training, voice real-time stress therapy, tonal training,vocal cord relaxation training, tone quality training,resonance relaxation training, etc.The training time was 40 minutes a time, once a day, continuous training for 30 days.The observation group received high-frequency rTMS stimulation on the basis of the control group. High frequency (5 Hz) rTMS was used to stimulate bilateral primary motor cortex (M1 area). The stimulation time was 10 minutes, 20 minutes a time,once a day, continuous training for 30 days. Before treatment, after treatment (after treatment for 30 days) and follow-up (30 days after the end of treatment), voice function detection and correction instrument, voice function detection and correction instrument were used to detect voice function under the framework of ICF, mainly including voice production index [(maximum phonation time, MPT), (maximum counting ability, cMCA), (fundamental frequency, F₀), (contact quotient, CQ), (contact quotient perturbation, CQP), (fundamental frequency tremor, F₀t),(frequency band energy concentration rate，Ec)] and voice quality index[Jitter, Shimmer, (normalized noise energy, NNE), F₂/u/,F₂/i/]. Voice handicap index (VHI) questionnaire were used to evaluate the subjective feelings of patients with voice disorders. <bold>Results</bold> Before treatment, there were no significant difference in MPT, cMCA, F₀t, Ec, F₀, CQ, CQP, Jitter, Shimmer, NNE, F₂/i/, F₂/u/, VHI between the two groups (<italic>P</italic>&gt;0.05). Compared with before treatment, MPT,cMCA, F₀t, Ec and F₂/i/ of the two groups after treatment were significantly increased, F₀, NNE and VHI score of the two groups after treatment were significantly decreased (<italic>P</italic>&lt;0.05); MPT, cMCA, F₀t, Ec, F₂/i/ score of the observation group follow-up were significantly increased (<italic>P</italic>&lt;0.05),and the scores of F₀, NNE and VHI score of the observation group follow-up were significantly decreased (<italic>P</italic>&lt;0.05). Compared with after treatment, MPT and cMCA of the observation group follow-up were significantly decreased (<italic>P</italic>&lt;0.05). Compared with the control group at the same time, MPT, cMCA, F₀t, Ec, F₂/i/ of the observation group after treatment and follow-up were significantly increased, and the scores of CQP, NNE and VHI score were significantly decreased (<italic>P</italic>&lt;0.05). <bold>Conclusion</bold> High frequency rTMS combined voice training can improve the respiratory support ability, the coordination ability of breathing and vocalization, the regularity of vocal cord closure, the forward movement ability of tongue in PD patients; reduce vocal cord tremor, attenuation of harmonic energy during vocal cord vibration,breath sound and self subjective feeling of voice disorder, and its long-term effect is also good, which is worthy of clinical promotion.

Evaluation of voice handicap and emotional status among dysphonic and non-dysphonic individuals: A cross-sectional survey

Background: Dysphonia impairs verbal communication of the sufferer, which can lead to social isolation, depression, and reduced quality of life. Evaluation of voice handicap and emotional impact of dysphonia are not routinely consider in our laryngology and voice clinics, despite the fact that about 50% to 60% of patients with dysphonia have social and psychological problems. Aims: The aim of this study is to investigate the voice handicap and emotional status among dysphonic and non-dysphonic individuals in our environment. Materials and Methods: It was a cross-sectional study that included dysphonic patients and non-dysphonic individuals matched for age and gender. A detailed clinical history was obtained, and the Voice Handicap Index (VHI) questionnaire was used to assess the voice handicap and emotional status of the participants. The mean VHI score of dysphonic and non-dysphonic participants was compared. Results: Ninety dysphonic patients and equal number of non-dysphonic controls completed the study. The mean VHI score dysphonic patients was higher (46.8 ± 17.7) than that of the controls (5.2 ± 3.9), and there was a statistical significant difference between the two groups (P = 0.000). Most of the dysphonic patients 69(77.8%) had poor emotional status, while most of the controls had good emotional status 83(92.3%). Conclusion: This study found high Voice Handicap Index and poor emotional status among dysphonic patients compared to controls. Therefore, patients with dysphonia should be reviewed by a psychologist in order to address the emotional aspect of their problem.

Extreme Vocal Effects Distortion, Growl, Grunt, Rattle, and Creaking as Measured by Electroglottography and Acoustics in 32 Healthy Professional Singers

SummaryVocal effects - also called extreme or extended vocal techniques - with the intention to sound hoarse or rough are widely used as part of many genres and styles of singing, yet scarcely documented in research. Physiological studies detail the involvement of supraglottic structures for the production of vocal effects, yet the acoustic impact of such involvement has not been documented systematically across phonation types. PurposeTo report acoustic measurements and electroglottography-specific measurements for the five rough-sounding vocal effects Distortion, Growl, Grunt, Rattle, and Creaking across phonation types to demonstrate differences between notes with and without vocal effects added. MethodsThirty-two professional singers and singing teachers produced sustained vowels in each of the four vocal modes with alternations of adding and removing the vocal effects. The singers were recorded with a microphone at a constant distance as well as with EGG. ResultsThe vocal effects Distortion, Growl, Grunt, Rattle, and Creaking impact the acoustic spectra in separate and systematic ways across genders and phonation types. Each vocal effect impacted the spectrum in specific and particular frequency regions between 0 and 3.5 KHz as well as in higher partials after 12 kHz with statistical significance. EGG-waveforms were un-impacted by most of the vocal effects produced using supraglottic sound sources, whereas Grunt and Creaking conditions did impact EGG-waveform signals, though not consistently between participants. EGG measures confirmed sustained and unchanged Qx and Fx for most conditions, with statically significant changes in noise measurements Harmonic-to-Noise Ratio, Normalised Noise Energy, Relative Average Perturbation, and Cepstral Peak Prominence, despite Sound Pressure Level differing significantly only for a few specific conditions. Singers scored an average of 5,95 on Voice Handicap Index questionnaires and were all reportedly healthy. ConclusionsVocal effects added to phonation produce specific increases and specific decreases in particular frequency regions in a systematic way and can be produced in a healthy and sustainable manner, as measured by Voice Handicap Index. Vocal effects can be added to different phonation types with differing acoustic output and singers were able to sustain and control involvement of the supraglottic sound source(s) independently of phonation type.

Methods of sparing surgical treatment of chronic edematous-polypous laryngitis, edema Reinke

Introduction. Laryngeal pathology occupies a leading place in the general structure of diseases of the upper respiratory tract, chronic edematous-polypous laryngitis, Reinke-Gayek edema accounts for 5.5% of all benign diseases of the vocal folds. The main method of treating Reinke-Gayek's disease is surgical treatment, which consists in removing excess mucosa, or “stripping” - tearing a strip of mucosa with forceps from the vocal fold. One of the main principles of laryngeal surgery is the maximum preservation of the structures of the vocal fold, obtaining a flexible vibration of the muscular-membranous part and the mucous membrane of the vocal fold.Purpose. The purpose of our work is to improve the effectiveness of treatment of chronic edematous-polypous laryngitis using a CO2 laser.Tasks. To develop a differentiated approach to the surgical treatment of chronic edematous-polypous laryngitis using a carbon dioxide laser.Materials and Methods. We treated 46 patients with Reinke-Gayek disease, including 35 women and 11 men. The age of the patients ranged from 40 to 67 years. Preoperative examination included endoscopic examination, laryngostroboscopy. The type was determined according to the classification of H. Yonekawa, for the choice of further surgical tactics. In type II, an incision of the mucosa, aspiration of gelatinous matter from the Reinke space, and laying of the mucosa were performed. With type III, it is made by forming M-shaped flap to close the defect.Results. All patients in the preoperative period were surveyed with the VOICE HANDICAP INDEX(VHI-30) questionnaire, laryn-gostroboscopy, and maximum phonation time. In the postoperative period, the examination was performed twice, 1 month after the operation and 3 months after the operation. There is a significant increase in indicators, an increase in the maximum phonation time, a decrease in VHI-30 points.Conclusion. The use of this technique allowed to significantly accelerate the recovery of the voice, reduce the time spent in the hospital, minimally damaging the structure of the mucous membrane of the vocal folds.

Voice Outcome After Cold Knife Surgery According to the Characteristics of Vocal Fold Polyp

Voice change is one of the major symptoms in patients with vocal fold polyp. As a result, phonomicrosurgery is commonly required in these patients. Since voice outcomes after polyp treatment can be variable according to polyp characteristics, we aimed to investigate the predicting factors of postoperative voice improvements in terms of polyp characteristics in patients with vocal fold polyp who underwent cold knife surgery. A total of 77 patients who were diagnosed with vocal fold polyp and underwent phonomicrosurgery with cold knife instruments. The polyp characteristics of color, size, shape, and location were evaluated at baseline. Acoustic and aerodynamic analyses, voice handicap index questionnaire and grade, roughness, breathiness, asthenia, strain scale were evaluated at baseline and 6 weeks after surgery. All values of postoperative voice parameters improved after cold knife surgery. (P < 0.05) In patient with an organized vocal fold polyp, less improvement in postoperative values of maximum phonation time were observed. (P < 0.05) Likewise, less improvement of voice handicap index questionnaire score and grade, roughness, breathiness, asthenia, strain scale after surgery was shown in organized vocal fold polyp. (P < 0.05) CONCLUSIONS: Among the various polyp characteristics, the organized polyp was significantly related to relatively less improvement of objective and subjective voice parameters after surgery. These polyp characteristics would help to predict postoperative voice improvement and plan for personalized treatment in patients with vocal fold polyp.