Voice Handicap Index Scores Research Articles

IncobotulinimtoxinA (Xeomin) for the treatment of adductor laryngeal dystonia: A prospective, open-label clinical trial

ObjectivesDemonstrate an understanding of incobotulinumtoxinA efficacy in the treatment of adductor spasmodic dysphonia (SD). Understand that incobotulinumtoxinA can successfully be used as an alternative to onabotulinumtoxinA and for secondary non-responders. MethodsWe conducted a prospective open-label trial from 2016 until 2019 regarding the use of incobotulinimtoxinA for the treatment of adductor spasmodic dysphonia. Exclusion criteria included pregnant/nursing women, botulinum toxin for other indications, known allergy, neuromuscular or systemic diseases, use of aminoglycoside antibiotics, substance abuse, litigation regarding prior therapy, or other confounding conditions. Sixty-four injection sessions with completed with sixteen patients who were enrolled in the study and underwent EMG-guided incobotulinumtoxinA injections to the thyroarytenoid (TA) muscle using a hollow monopolar Teflon-coated needle via a trans-cricothyroid membrane approach. Dosages to each TA muscle were recorded and patients completed a Voice Handicap Index-10 (VHI-10), a validated worksheet regarding their perceived percent of normal function (PNF) following treatment, and a side effect profile. Outcomes were analyzed using the paired t-test. ResultsFor primary transitioners to incobotulinimtoxinA, VHI-10 scores and best percent normal function did not significantly change. For non-responders, VHI-10 decreased from 32.5 on Botox to 19.5 on incobotulinimtoxinA and best PNF increased from 37.6 to 90 %, which was statistically significant. Transient side effects included breathiness. ConclusionsOur study demonstrates that incobotulinimtoxinA may be used successfully for adductor SD either as first line treatment or in secondary non-responders to onabotulinumtoxinA.

Office-Based Structural Autologous Fat Injection Laryngoplasty for Unilateral Vocal Fold Paralysis.

Unilateral vocal fold paralysis (UVFP) is a common cause of incomplete glottic closure, leading to significant somatic and social disabilities. Office-based autologous fat injection laryngoplasty (AFIL) has been proposed as an effective treatment for glottic insufficiency but has not been well-studied for UVFP. We enrolled 23 patients who underwent office-based structural AFIL due to unilateral vocal paralysis at our institution between February 2021 and January 2022. In the procedure, autologous fat was harvested and injected into the vocal fold under the guidance of flexible digital endoscopy for structural fat grafting. The voice handicap index-10 (VHI-10) score and perceptual voice measurements were collected before the operation, 2 weeks postoperatively, and 3 months postoperatively. Twenty-two patients were followed-up for at least 3 months. The VHI-10 score improved significantly from 29.65 ± 8.52 preoperatively to 11.74 ± 7.42 at 2 weeks (p < 0.0001) and 5.36 ± 6.67 at 3 months (p < 0.0001). Significant improvements in grades of dysphonia (p < 0.0001), breathiness (p < 0.0001), and asthenia (p = 0.004) were also noted at 3 months postoperatively when perceptual measurements were investigated. Office-based structural AFIL is an effective treatment for improving voice-related disability for UVFP patients.

Outcomes of Laryngeal Cancer Surgery after Open Partial Horizontal Laryngectomies with Lateral Cervical Approach.

Background: Open partial horizontal laryngectomies (OPHL) are one of the surgical techniques used for the conservative management of laryngeal cancers. The aims of this study are to analyze the oncological and functional results of a group of patients affected by laryngeal squamous cell carcinoma (LSCC) treated with OPHL, performed using a minimally invasive technique. Methods: This is a prospective case–control study. We enrolled 17 consecutive patients with LSCC treated with OPHL through a lateral cervical approach (LCA). Patients were evaluated using their Penetration Aspiration Scale score (liquid, semiliquid and solid) and Voice Handicap Index (VHI) at three different endpoints: 15 days (T1), 3 months (T2), and 6 months (T2) after surgery. Results: The functional outcomes of the LCA are stackable with that of the classical anterior cervical approach in terms of respiration, swallowing, and speech. One-way ANOVA was performed to evaluate the variances of PAS and VHI scores at the three different observation points. No statistically significant differences were observed between OPHL- PAS scores for liquid (p = 0.1) at the three different observation points. A statistically significant improvement was observed in the OPHL- PAS score for semisolids and solids (p < 0.00001) between T1 and T3 (p = 0.0001) and for solids between T2 and T3 (p < 0.00001). The improvement of VHI-10 was statistically significative (p < 0.00001) at the three different observation points (T1–T2 and T2–T3). Conclusion: The LCA is a potential approach for laryngeal surgery in selected cases. The preoperative staging and planning are of the utmost importance to ensure oncological radicality. The main advantage of this approach is the preservation of the healthy tissues surrounding the larynx and the functional and oncological outcomes are stackable with the classic anterior cervical approach.

Multidimensional voice assessment after Lee Silverman Voice Therapy (LSVT®) in Parkinson's disease.

SUMMARYObjectiveTo investigate the effectiveness of Lee Silvermann Voice Treatment (LSVT®) in improving prosody in patients with Parkinson’s disease over medium-term follow-up.Methods15 patients with Parkinson’s disease were assessed before LSVT®, within one week, and 3 and 6 months after treatment. Subjective and objective evaluation included: Voice Handicap Index - 10 (VHI-10), perceptual assessment by GRBAS scale and item 18 of the Unified Parkinson’s Disease Rating Scale III (UPDRS III), maximum phonation time (MPT /s/) and acoustic analysis by means the Voice Range Profile (VRP) and the “Intonation Stimulability Protocol” of the Motor Speech Profile (MSP).ResultsA significant increase of the mean values of Imax and rF0 was observed until 6 months post-therapy (p < 0.001), whereas Running Speech Standard Deviation (rSTD) (p = 0.004), Amplitude Variability (rVAm) (p = 0.02) and Frequency Variability (rvF0) (p = 0-01) improved significantly after 3 months, but returned to pre-therapy levels after 6 months. The score of item 18 of the UPDRS III increased significantly early post-therapy (p = 0.03), but did not maintain the improvement at 3 and 6 months. Median values of Grade (G), Asthenia (A) and mean values VHI-10 score significantly decreased at each post-therapy control (p < 0.05).ConclusionsIn addition to the subjective and perceptual beneficial effect of LSVT®, we found a long-lasting increase of loudness and fundamental frequency. There was also improvement of acoustic parameters related to prosody, although it was temporary.

The Effect of Platelet-Rich Plasma Injection on Short Term Vocal Outcomes Following Phonosurgery-A Pilot Study.

Background and Objectives: The efficiency and optimal voice rest period following phonosurgery remains debatable. Platelet-rich plasma (PRP) is a safe and cheap alternative to many bioactive agents being studied on animal models, and is already in use in many medical areas. We investigate the short-term effects of PRP and voice rest on voice outcomes following phonosurgery as an alternative to voice rest alone. Materials and Methods: A prospective single-blinded pilot study was conducted. Sixteen patients with a diagnosis of vocal fold cyst and polyps were included, forming equal groups (PRP and voice rest vs. voice rest alone). Voice analysis was carried out on the preoperative day, day three, and week three following surgery. The measured parameters were fundamental frequency (F0), noise–signal ratio (NSR), harmonic poverty (HP), attack alteration (AL), pitch instability (PI), and amplitude instability (AI).VHI(Voice Handicap Index)-30 questionnaires were carried out before surgery and three weeks following surgery to assess the impact of subjective voice change on quality of life. PRP was obtained using commercial kits with separator gel. Results: An average 3.68-fold increase in platelets was obtained with PRP. No side effects were noted after injection. All voice parameters improved on day three and week three following surgery. Statistical significance was noted only in the fundamental frequency of male patients (p = 0.048) in favor of the PRP-voice rest group. In addition, the VHI- 30 questionnaire results between preoperative and postoperative assessments showed statistically significant differences in total VHI score (p = 0.02) as well as the physical (p = 0.05) and emotional (p = 0.02) scale in favor of the PRP-voice rest group. Conclusions: PRP presents short term safety in patients who undergo phonosurgery, although long-term outcomes are unknown. PRP and voice rest are superior to voice rest alone when considering subjective assessment of the voice. When analyzing acoustic parameters, PRP and voice rest are not superior to voice rest alone.

Surgical and Non-Surgical Treatment Outcome Assessed by Voice Handicap Index of Patients with Vocal Fold Nodule

Background: Vocal nodules are a frequently occurring type of laryngeal disorder. Vocal fold nodules are usually bilateral swellings of variable size (&lt; 3mm) found at the mid-part of the membranous vocal cords. Vocal abuse, misuse and overuse are frequently claimed to be the causes of vocal nodules and mostly affect professional voice users. It has important public health implications and impact on patient quality of life (QoL). Voice handicap index (VHI) is an important tool for quality of life assessment and outcome of intervention in voice disordered patients.&#x0D; Objective: To compare the outcome of Voice handicap index (VHI) score after surgical and non-surgical intervention of vocal cord nodule.&#x0D; Methods: In this prospective study 30 patients with vocal nodules refractory to the first session of voice therapy were diagnosed by fiber optic laryngoscopy. After simple random allocation management was done either by voice therapy or surgery. VHI (Voice Handicap Index) was applied as outcome measures for assessing the efficiency of intervention between surgical and non-surgical groups.&#x0D; Results: The mean value of Voice handicap index total (VHIt) was 54.40 (± 8.56) before voice therapy which significantly changed to 25.80 (± 6.23) after voice therapy in non-surgical group(n2).&#x0D; Bangladesh J Otorhinolaryngol 2022; 28(1): 29-36

Voice Handicap Index in Iranian Rehabilitation Professors with and Without Vocal Complaints

Background: University professors are a group of professional voice users who report more voice problems than the general population, which may affect their quality of life. The World Health Organization defines health as a multidimensional concept: "A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." The Voice Handicap Index (VHI) can assess university professors' vocal health even before having a voice problem. Objectives: We aimed to study the Voice Handicap Index (VHI) in Iranian rehabilitation professors with and without vocal complaints. Methods: This cross-sectional online study enrolled 235 professors (100 men and 135 women) from Iranian rehabilitation colleges selected through stratified random sampling. The inclusion criterion was being a university professor. The assessment tools included VHI and a four-part questionnaire about vocal complaints. The Kolmogorov-Smirnov test checked the normality of quantitative data. The Mann-Whitney and chi-square tests compared the two groups. The data were analyzed by SPSS21 at a significance level of 0.05. Results: The rate of voice problems was significantly more in professors with vocal complaints (29.12%) than in those without complaints (9%), according to VHI30 (P &lt; 0.001). The mean VHI differences between the two groups, with and without vocal complaints, were significant in the scores of the total scale (P &lt; 0.000) and its subtests physical (P &lt; 0.000), emotional (P &lt; 0.000), and functional (P &lt; 0.002). Some information was also obtained about vocal complaints in professors, including the frequency of nine vocal complaints. The frequency of the complaints was 64.1% for vocal fatigue, 61.2% for hoarseness, 24.3% for pain, 16.5% for breathy voice, 15.5% for strain, 13.6% for monotone voice, 11.7% for pitch breaks, 5.8% for aphonia, 4.9% tremor in professors with vocal complaints, 78.64% for the effect of vocal complaints on communication, and 72.8% (acute) and 27.2% (chronic) for the duration of vocal complaints. Conclusions: Iranian university professors of rehabilitation science with vocal complaints had higher VHI scores than those without vocal complaints, which shows they may be apt to voice problems. Vocal fatigue was the most common voice complaint, and voice tremor was the least. Also, most reported complaints were acute that affected professors' communication. In future research, it seems necessary to design comprehensive prevention and treatment programs focusing on the vocal health of professors in rehabilitation colleges.

Validity, internal consistency, and test-retest reliability of the Montenegrin 10-item Voice Handicap Index.

The purpose of the this cross-sectional study was to assess clinical validity, internal consistency, and test-retest reliability of the adapted Montenegrin translation of the Voice Handicap Index 10 (VHI-10). It included 50 patients with voice disorders, divided into three subgroups according disease aetiology: structural, neurological, and functional and a control group of 50 vocally healthy participants. Mean patient VHI-10 score of 21.1±7.6 was significantly higher than the 2.3±2.5 score of controls (p<0.001). Each of the three patient subgroups also scored significantly higher than control (p<0.001). Spearman’s rank correlation coefficient of 0.90 (p<0.001) indicated a very strong correlation between the Montenegrin VHI-10 score and self-reported perception of the severity of voice disorder. Excellent internal consistency was found in the patient group, with a Cronbach’s alpha of 0.94. Test-retest reliability was also excellent, with intra class correlation coefficient of 0.98. The translated Montenegrin version of VHI-10 is a valid, reliable, and clinically useful tool for self-assessment of the severity of voice disorders in individuals with voice problems in daily practice and in research projects.

Correlations among the Mandarin Voice Handicap Index, its shortened version, and the Voice-Related Quality of Life Measure for laryngectomees.

The Voice Handicap Index (VHI) and the Voice-Related Quality of Life Measure (V-RQOL) are seldom administered to alaryngeal patients who use pneumatic artificial larynx (PAL) and esophageal speech (ES). As such, the specificity of VHI and 10-item VHI (VHI-10) for assessing voice-related changes in such patients is unclear. Accordingly, this study investigated the correlation between scores on the VHI, its shortened version (VHI-10), and the V-RQOL for Mandarin-speaking laryngectomees using PAL and ES, with the aim of establishing which of these instruments is suited to such patients. The participants comprised 126 PAL and 26 ES patients from Taiwan who completed the Mandarin VHI and V-RQOL. Fifty-two of these alaryngeal participants then completed both those instruments a second time, between 8 and 64 days later. One item appearing in both the Mandarin long-form VHI and the VHI-10 was excluded because more than half the participants left it unanswered. The correlation of scores on the remaining 29 items on the former with the nine on the latter was high ( r = 0.968), while that between the former and V-RQOL scores was moderate ( r = -0.569), as was the correlation between short-form VHI and Mandarin V-RQOL scores ( r = -0.582). Structural equation modeling was then used as the basis for simplifying the Mandarin long-form VHI into a new 10-item VHI specifically for alaryngeal Mandarin speakers (MA-VHI-10), to eliminate the scoring effect of the original VHI's and VHI-10's work-related item. MA-VHI-10 scores were highly correlated with those on the Mandarin long-form VHI ( r = 0.983). The Mandarin versions of long-form VHI, short-form VHI, and MA-VHI-10 are interchangeable for a Mandarin-speaking alaryngeal population. However, neither of the former two instruments should be substituted for the V-RQOL.

Vocal outcomes after COVID-19 infection: acoustic voice analyses, durational measurements, self-reported findings, and auditory-perceptual evaluations.

PurposeThe ongoing literature suggests that COVID-19 may have a potential impact on voice characteristics during the infection period. In the current study, we explored how the disease deteriorates different vocal parameters in patients who recovered from COVID-19.MethodsA total of 80 participants, 40 patients with a prior history of COVID-19 (20 male, 20 female) with a mean age of 39.9 ± 8.8 (range, 21–53) and 40 gender and age-matched healthy individuals (mean age, 37.3 ± 8.8; range, 21–54) were included to this study. The data of acoustic voice analyses, durational measurements, patient-reported outcomes, and auditory-perceptual evaluations were compared between the study group and the control group. Correlation analyses were conducted to examine the association between the clinical characteristics of the recovering patients and measured outcomes.ResultsMaximum phonation time (MPT) and the scores of both Voice Handicap Index-10 (VHI-10) and Voice-Related Quality of Life (V-RQOL) questionnaires significantly differed between the groups, which was more evident in female participants. The overall severity score of dysphonia was found to be higher in the study group than the control group (p = 0.023), but gender-based comparisons reached significance only in males (p = 0.032). VHI-10 and V-RQOL revealed significant correlations with the symptom scores of the disease.ConclusionsPatients with a prior history of COVID-19 had significantly lower MPT, increased VHI-10 scores, decreased voice-related quality of life based on the V-RQOL questionnaire, and higher overall severity scores in the auditory-perceptual evaluation. Self-reported voice complaints disclosed close relationships with the symptom scores of COVID-19 disease.

Dysphonia in Smokers of Combustible Cigarettes and E-cigarettes Measured Using the Filipino Voice Handicap Index

ABSTRACT Objectives: To determine the prevalence of dysphonia, defined as any perceived voice pathology, in conventional cigarette smokers and e-cigarette users and to quantify and compare the Filipino Voice Handicap Index (VHI) scores of the two groups based on the mean scores for each of the three domains of this tool, as well as the mean total score for each group. Methods: Design: Cross-sectional study Setting: Tertiary National University Hospital Participants: 52 adults between the ages 18-65 with no previously known laryngeal illness or condition were divided into 26 conventional smokers and 26 e-cigarette users and completed the self-administered Filipino Voice Handicap Index. Results: The prevalence of impairment in the sample using a total VHI score cut-off of 18 was 17.31% (9 out of 52, CI 8.23-30.32%) and the prevalence of dysphonic symptoms in the sample was 86.54% (45 out of 52, CI 74.21-94.41%). There were no significant differences between smokers and e-cigarette users for impairment using this cut-off (z: -1.36, p: .07) and dysphonic symptoms (z: 0.4063, p: .68). The prevalence of moderate impairment was 3.85% (1 out of 26, CI: 0.10-19.64%) among those using e-cigarettes; and 1.92% (1 out of 52, CI: 0.04-10.26%) among the entire sample population. Conclusion: There appears to be no statistically significant difference between the Filipino VHI scores of conventional smokers and e-cigarette users. Further inquiry into the subject would benefit from a larger sample size, comparison with a control group, inclusion of other factors relevant to the development of dysphonia, and correlation with objective means for voice analysis.

Vocal Outcome After Cordectomy by Transoral CO2 Laser Microsurgery in Patients With Laryngeal Intraepithelial Neoplasia and Non-neoplastic Lesions

This study investigates vocal outcome after cordectomy by transoral CO2 laser microsurgery (TLM-cordectomy) in patients with laryngeal intra-epithelial neoplasia (LIN) or non-neoplastic lesions (NNL), for improved individual patient advice and potential adjustment of national treatment strategy by which patients suspected to have glottic LIN or T1a cancer are offered TLM-cordectomy, without prior biopsy. Prospective, longitudinal, quasi-experimental time series. Consecutively included patients (n=155) with LIN (n=84) or NNL (n=71) who underwent voice assessments before and after TLM-cordectomy. The multi-dimensional voice assessment protocol comprised voice and speech range profiles, aerodynamics, acoustic analysis, self-evaluated voice handicap, and perceptual auditory voice ratings. Median follow-up time was 195 (range 50-1121) days for patients with LIN and 193 (range 69-1294) days for patients with NNL. Statistically significant changes, LIN: in voice handicap index (VHI) and breathiness after TLM-cordectomy. Statistically significant changes, NNL: voice range profile (voice range area, intensity range, and frequency range) and VHI after TLM-cordectomy. All group-wise changes were to less disordered voices. Previous smokers had the largest decreases in VHI and breathiness. Patients with baseline VHI scores >65 had smaller increases in VHI, however 13-19% of the patients had increases in VHI above the clinically relevant threshold after TLM-cordectomy. Overall, TLM-cordectomy in patients with LIN and NNL improved vocal outcome and our study thus supports the current Danish treatment strategy and improves the basis for proper patient advice. Multi-dimensional voice assessment is suggested preoperatively and six-nine months postoperatively, with focus on individual vocal differences and voice demands.

Long-term results and safety of fibroblast growth factor injection for unilateral vocal fold paralysis.

ObjectivesTreatments for unilateral vocal fold paralysis (UVFP) include conservative voice rehabilitation, vocal fold injection, and laryngeal framework surgery. We proposed basic fibroblast growth factor (bFGF) injection as a potential novel treatment for UVFP and have reported the short‐term results. In this study, we present the long‐term results and safety of vocal fold bFGF injection as a treatment for UVFP.MethodsThis retrospective study included 42 patients (25 males and 17 females) with UVFP who were administered a local injection of bFGF. The injection regimen involved injecting FGF (0.5 μg/ml in 0.5 ml per side) into the bilateral vocal folds using a 23‐gauge injection needle. Phonological outcomes were evaluated 6 months and 12 months after the injection.ResultsOverall, 26 patients received a single injection of bFGF, six patients received an additional injection, and 10 patients received the additional framework surgery. Maximum phonation time, mean flow rate, pitch range, jitter and shimmer percentages, the total GRBAS (grade, roughness, breathiness, asthenia, strain) score, and voice handicap index scores improved significantly in the long term. In patients who received the additional injection or framework surgery, the effects of bFGF injection were temporary, but did not interfere with the performance of the framework surgery.ConclusionIn total, 42 patients who underwent vocal fold bFGF injections were reviewed. The bFGF injections were effective and safe in the long‐term results for UVFP in the selected cases. Some patients with severe symptoms benefited from the additional framework surgery but not the additional bFGF injection.

Efficacy of Larynx Preservation Surgery and Multimodal Adjuvant Therapy for Hypopharyngeal Cancer: A Case Series Study.

Background: Larynx preservation surgery (LPS) combined with multimodal adjuvant therapy (MAT) is re-emerging as treatment option for hypopharyngeal cancer (HPC). This study aims to explore the survival and functional outcome of this combined approach. Methods: This is a retrospective cohort study. Selected patients with primary HPC treated by LPS and MAT at two large Beijing medical centers between 2005 and 2019 were included. In addition to LPS, patients received one or more of the following treatments: preoperative induction chemotherapy, postoperative intensity-modulated radiotherapy, chemotherapy, or targeted therapy. Results: In total, 64 patients were included (62 were men, and median age was 57.5years). The disease in most patients was in stage III (28.1%) or IV (56.3%), or in stage T2 (34.4%) or T3 (45.3%), based on the TNM scale. Across all patients, the rate of overall survival (OS) was 60.7% at 3yr and 47.3% at 5yr. OS was significantly higher for patients with stage I or II disease than for those with stage III or IV disease (HR 8.64, 95% CI 3.69-20.2, log-rank P = .010). Decannulation was successful in 55 patients (85.9%), and swallowing function was satisfactory (stage 0-III, on Functional Outcome Swallowing Scale) for 50 (78.1%). Median Voice Handicap Index-10 score on voice performance was 19 (range 4-40), and median Functional Assessment of Cancer Therapy-General Questionnaire score for QoL was 75 (range 16-105). Conclusions: LPS and MAT can provide satisfactory oncologic control and good functional outcomes for selected patients with HPC, especially those with stage I or II disease.

Voice Symptoms and Quality of Life in Individuals With Marfan Syndrome: A Cross-Sectional Study

Marfan Syndrome (MFS) is a connective tissue disorder that affects skeletal, ocular, pulmonary, cardiovascular, and central nervous systems. Symptoms may lead to diminished quality of life (QoL) in individuals with MFS compared with healthy individuals. Currently, there is little evidence regarding the impact of MFS on voicing and QoL. This study examined perceptions of voicing difficulties and QoL among persons with MFS. A total of 356 participants with a self-reported diagnosis of MFS completed the Quality-of-Life Index (QLI) and voice handicap index-10 (VHI-10) and provided medication regime. Some degree of voice handicap was reported by a majority of participants. Analyses assessing correlations between responses to the VHI-10, QLI scores, and reported medications were conducted. Specific medications and responses on the VHI-10 were significantly associated with QLI scores. Multiple regression analyses revealed that a summed VHI-10 score was the strongest predictor of QLI satisfaction, QLI importance, and overall QLI. The findings of the current study suggest that individuals with MFS may experience self-perceived phonatory dysfunction which impact QoL. Specific classes of drugs may also be associated with reported voice handicap and QoL satisfaction in MFS. These findings have implications for physicians and clinicians who work with individuals with MFS.

Voice Telerehabilitation in Iatrogenic Unilateral Vocal Fold Paralysis: From Necessity to Opportunity in the COVID-19 Time

To evaluate results of telerehabilitation (TR) during the coronavirus disease 2019 pandemic for the treatment of dysphonia caused by permanent post-thyroidectomy unilateral vocal fold paralysis (UVFP). Forty subjects with post-thyroidectomy UVFP (onset <1 month) underwent TR. Videostrobolaryngoscopy, acoustic and perceptual voice analysis and patient self-assessment were carried out in person before, at the end of TR and 6 months later. Twenty-five subjects spontaneously recovered full vocal fold motility at some time during follow-up, whereas 15 had a permanent UVFP at the end of the follow-up period. These subjects constituted our study group. At the early posttherapy control 10/15 subjects (66.6%) showed a complete glottal closure, while in 5/15 (33.3%) a glottal gap remained (P=0.03). These results did not change 6 months after TR. At the late posttherapy control the maximum phonation time improved significantly (P=0.02). Both post-therapy Voice Handicap Index scores were significantly lower than the pre-therapy ones (P=0.04). Grade, Breathiness, and Asthenia parameters of the Grade-Roughness-Breathiness-Asthenia-Strain scale improved 6 months after TR (P < 0.05). The number of voice signals suitable for acoustic analysis increased significantly after therapy. Finally, 87% of patients were satisfied with TR. With careful patient selection, TR may be considered as a promising method for voice therapy in postthyroidectomy UVFP.

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.

Stereotactic Ablative Radiotherapy for Early-Stage Glottic Larynx Carcinoma: Results From the Phase II LT-SABR Study

<h3>Purpose/Objective(s)</h3> Traditional radiotherapy for early-stage larynx cancer irradiates the whole larynx over 5.5-6 weeks. Phase I data suggest that stereotactic ablative radiotherapy (SAbR) is a viable strategy in this population to reduce the irradiated volume and compress the treatment time. This phase II study evaluated the efficacy of gLoTtic larynx SAbR (LT-SABR), utilizing a 5 or 16 fraction regimen depending on treatment volume and smoking status. <h3>Materials/Methods</h3> Eligibility required stage 0-II biopsy-proven carcinoma of the true glottic larynx, including squamous cell variants. The arytenoid cartilage could not be involved beyond the vocal process, and patients smoking more than one pack-per-day were excluded. The planning target volume (PTV) consisted of the gross tumor volume, including respiratory motion assessed on a 4D-CT, with a 3 mm AP/LR margin and 5 mm SI margin. Patients without active smoking and PTV volume < 10 cc receive 42.5 Gy in 5 fractions, two fractions per week; all other patients received 58.08 Gy in 16 daily fractions. The routine beam arrangement included 2 coplanar VMAT arcs and 2 non-coplanar arcs. Patients were treated with swallow-gating using surface imaging. The study required 25 patients to show that the local control probability is non-inferior to 75% at 2 years. <h3>Results</h3> A total of 25 patients were accrued to this study, with 21 and 4 treated with 5 and 16 factions, respectively. The stage distribution was CIS (n=1), T1a (n=16), T1b (n=5), and T2 (n=3). The median age was 72 years, with a prior smoking history in 16 and active smoking in one. Dosimetry metrics (mean values) are summarized in the Table. At a median follow-up of 21.1 months (IQR 14-31.8) in surviving patients, there have been two in-field recurrences (one in each dose cohort). One was salvaged with partial laryngectomy and the other died from local and regional disease. The cumulative risks of local failure were 4.2% and 9.3% at 1 and 2 years, respectively. There have been no acute or late grade 3+ toxicities. The baseline, 6 and 12 month total Voice Handicap Index (VHI) scores were: 53.0 (n=25), 9.8 (n=18), and 18.4 (n=15). The improvements in VHI between 6/12 months and baseline were both statistically significant (p<0.001). <h3>Conclusion</h3> Highly conformal stereotactic radiotherapy is safe and efficacious for early-stage glottic larynx cancer, with encouraging patient-reported outcomes. Additional follow-up and ultimately comparative studies are necessary to validate this paradigm.

Efficacy of cidofovir versus bevacizumab in recurrent respiratory papillomatosis: A randomized, double-blind, placebo-controlled pilot study

ObjectivesAfter surgical resection of papilloma, adjuvant therapy may be recommended for the control of recurrent respiratory papillomatosis (RRP). As the efficacy of adjuvant therapy remains unproven, the aim of this study was to compare the efficacy of cidofovir versus bevacizumab used as adjuvant therapies for the control of RRP. MethodsThis randomized, double-blind, placebo-controlled pilot study was performed in a national respiratory disease referral centre. Patients with RRP were recruited prospectively and were divided into juvenile or adult RRP. Participants were randomly assigned to receive adjuvant therapy with cidofovir, bevacizumab or placebo. The study drug or placebo was administered after direct microlaryngoscopy with papilloma resection using cold instruments. The Derkay severity score and the Voice Handicap Index (VHI) were assessed at 3–6-week intervals, for a total of 3 visits. Follow-up included VHI and Derkay score assessments at 2-month intervals over the course of one year. Annual rates before and after surgical treatment were compared. ResultsFive children and 11 adults were enrolled in the study. After one year, the group treated with cidofovir had a significant decrease in Derkay score (p=.027). No difference between treatment arms was observed in the annual surgery rate. There was a significant decrease in the VHI score in all treatment groups (p<.001), and no significant difference was observed between groups (p=.32). ConclusionWhile we observed a significant decrease in RRP severity with intralesional cidofovir, we were unable to provide proof of efficacy of intralesional bevacizumab.Clinicaltrials.gov Identifier: NCT02555800.