Voice Handicap Research Articles

A comparative study on the efficacy of different treatment methods for preventing vocal cord adhesion after laser treatment for glottic cancer

Objective:Comparing the primary tumor control, vocal function recovery, postoperative adhesion rate and degree of adhesion in early glottic cancer involving the anterior commissure treated with CO₂ laser staged and lateral surgery, one-stage surgery combined with laryngeal stent placement, and simple CO₂ laser excision. Methods:This study focuses on 83 patients with T1-2N0M0 stage glottic squamous cell carcinoma involving the anterior commissure who underwent CO₂ laser treatment. The study was divided into three groups: Group A with 15 cases, treated with staged resection surgery; Group B with 18 cases, treated with one-stage surgery combined with the placement of a silicone laryngeal stent; and Group C with 50 cases, treated with simple CO₂ laser excision. The Voice Handicap Index-10（VHI-10）, the GRBAS auditory-perceptual assessment, and the maximum phonation time（MPT） were used to evaluate the vocal function of the patients before and six months after surgery. The degree of vocal cord adhesion was assessed using the Cohen classification of vocal cord adhesion. Statistical analysis was performed to determine the differences in each indicator before and after surgery, and the primary tumor control rates among the three groups. Results:Local recurrence occurred in 1 case each in Groups A and B, and in 4 cases in Group C, with no distant metastasis observed. Postoperative vocal cord adhesion of varying degrees occurred in a total of 77 cases, with an adhesion rate of 73.3%（11/15） in Group A, 88.9%（16/18） in Group B, and 100%（50/50） in Group C. The postoperative vocal cord adhesion rate and degree in Group C were significantly higher than in Groups A and B. The postoperative VHI-10 scores in all three groups were significantly increased compared to preoperative scores（P<0.05）, and when compared between groups postoperatively, Group C was significantly worse than Groups A and B （P<0.05）. The postoperative maximum phonation time（MPT） in Group C was significantly reduced compared to preoperative and was markedly shorter than that of Groups A and B postoperatively（P<0.05）. The postoperative grades of G（Grade） and R（roughness） in Group C were significantly higher than preoperatively, indicating a noticeable deterioration in voice quality, and were also significantly worse than those postoperatively in Groups A and B, with all differences（P<0.05）. Conclusion:For early glottic cancer involving the anterior commissure, choosing staged surgery or one-stage surgery combined with the placement of a silicone anterior commissure laryngeal stent were better than simple laser tumor excision in terms of secondary vocal cord adhesion and voice function preservation.

Stereotactic Radiation Therapy in 3 Fractions for T1 Glottic Cancer

To report the results of a phase I-II study on SBRT for early glottic cancer. This a prospective study at a single Institution enrolling patients with T1 glottic cancer. The true vocal cords (TVC) were divided into thirds and the third(s) containing disease prescribed 36 Gy in 3 fractions. The portions of the TVCs next to the involved one were planned to receive 30 Gy in 3 fxs. SBRT was delivered by a LINAC-based approach using multiple arcs. Toxicity was scored by CTCAE and late events were considered those occurring 3 months after SBRT. Voice quality was investigated by the voice handicap index (VHI) at regular intervals. The planned sample size was 75 patients. Accrual was discontinued after 33 patients due to concerns for late toxicity. T stage was as follows: T1a: 23 pts (69.7%); T1b: 10 pts (30.3%). All patients received the planned treatment and the median follow-up time is 51.5 months (IQR: 47.9-61.0 months). At last follow up, all patients are alive and without evidence of disease but two patients who died for intercurrent causes. The local control rate is 100% at 4 yrs. Six patients (18.2%) developed soft tissue necrosis (N=4) or cartilage necrosis (N=2) after a median time of 14.9 months from SBRT. Five out of 6 necrotic events were observed in patients who kept smoking and/or had a recent COVID infection. All 4 soft tissue events healed with conservative therapy. After an initial deterioration the average VHI score significantly improved at 6 months over baseline. SBRT to 36 Gy in 3 fractions is highly effective in controlling T1 TVC carcinoma, but necrosis, though mostly transient, is a concern. Based on the present results, a reduction in total dose as well as a more accurate patient selection are warranted.

A meta-analysis on the improvement of vocal function in unilateral vocal cord paralysis by reinnervation of the recurrent laryngeal nerve

Objective:To conduct a systematic description and meta-analysis of the treatment of unilateral vocal cord paralysis（UVCP） with recurrent laryngeal nerve reinnervation through literature search, and to analyze the therapeutic effect of recurrent laryngeal nerve reinnervation on improving vocal function in UVCP. Methods:Electronic databases Pubmed, Web of Science, EMBASE, Cochrane Library, CNKI, and Wanfang databases were searched using relevant keywords and screened in strict accordance with the inclusion and exclusion criteria, and quality evaluations were conducted. Reported treatment outcomes were measured by relevant data extracted from literature, such as auditory perception assessment（GRBAS）, voice handicap index（VHI）, maximal phonation time（MPT）, jitter, shimmer, and noise harmonic ratio（NHR）, etc. Meta-analysis was performed by Revman5.3 and heterogeneity was analyzed using fixed effects or random effects models. Results:Eight articles were included in this study, all of which showed that the postoperative maximum phonation time of patients was significantly prolonged compared to preoperative, while the postoperative GRBAS score, Jitter, Shimmer, and NHR decreased compared to preoperative with statistical significance. Conclusion:The innervation of the internal laryngeal muscle was obtained through the reinnervation of the recurrent laryngeal nerve, which effectively improved the patient's vocal function and had a good long-term therapeutic effect. Although there was no difference in the efficacy of surgical methods for reconstructing the recurrent laryngeal nerve, the anastomosis between ansa cervicalis nerve and the recurrent laryngeal nerve is more ideal. Further randomized controlled studies with longer follow-up periods and larger samples will increase the credibility of their effectiveness.

Feasibility of Intensive Voice Therapy for Pediatric Vocal Fold Nodules Delivered via Telepractice: Pilot Study

PurposeThe aim of this study is to assess the feasibility of an intensive voice therapy delivered via telepractice for pediatric vocal fold nodules (VFNs). MethodTen children with VFNs (mean age = 6 years, range = 5-8 years) were recruited in this study. Assessments including stroboscopic ratings, acoustic parameters, aerodynamic and auditory perceptual measures, and parent-reported Pediatric Voice Handicap Index were administered pretreatment and within 1 week post treatment. Eight resonant voice therapy sessions were provided three times a week via a secure online platform, which were completed within 3 weeks. The assessments were conducted in a clinical face-to-face modality in China, whereas the therapy sessions were all conducted online, with the participants and their caregivers in China and the speech-language pathologist in Taiwan. ResultsAll participants completed the therapy sessions as scheduled, and there were no dropouts. Statistical analyses showed that significant improvements in acoustic and aerodynamic parameters, as well as stroboscopic and auditory-perceptual ratings. ConclusionThis study provides positive preliminary results indicating intensive voice therapy delivered via telepractice may be feasible and effective for the pediatric VFN population. Service providers and families may consider this delivery modality for ease of access when voice therapy is recommended.

Efficacy analysis of ansa cervicalis anterior root-recurrent laryngeal nerve anastomosis in the treatment of unilateral vocal cord paralysis

Objective:Investigates the application and clinical efficacy of ansa cervicalis anterior root-recurrent laryngeal nerve（RLN） anastomosis in the treatment of unilateral vocal fold paralysis（UVFP）. Methods:A prospective study was conducted with 92 UVFP patients admitted to our department from January 2018 to January 2022 who received ansa cervicalis anterior root-RLN anastomosis. The course of nerve injury ranged from 6 to 24 months. Videostroboscopy, voice subjective auditory perceptual assessment（GRBAS）, Voice Handicap Index（VHI-10）, voice objective acoustic analysis and laryngeal electromyography（EMG） were used to evaluate the efficacy of the operation. Results:Videostroboscopy showed that although the movement of vocal cords did not return to normal 12 months after operation, their volume and muscle tension were significantly improved and their positions were adducted to the median or near-median. Also the glottic closure, vocal cord position, vocal cord edge, symmetry and regularity of vocal cord vibration were significantly improved than pre-operation（P<0.01）. The five indexes of GRBAS（Grade, Roughness, Breathiness, Asthenia, Strain） and VHI-10, as well as voice acoustic parameters（Jitter, Shimmer, NHR） post-operation were significantly reduced, while the maximum phonation time（MPT） was significantly longer（P<0.01）. The results of laryngeal EMG indicated that the maximum voluntary motor unit recruitment（VMUR） post-operation was significantly recovered（P<0.01）, which confirmed that the affected laryngeal muscle obtained effective nerve reinnervation. Conclusion:Ansa cervicalis anterior root-RLN anastomosis can effectively improve the voice function of patients which is safe and satisfactory. It is an ideal method for the treatment of unilateral RLN injury.

The effect of two speech and language approaches on speech problems in people with Parkinson's disease: the PD COMM RCT.

Speech impairments are common with Parkinson's disease (reported prevalence 68%), increasing conversational demands, reliance on family and social withdrawal. The PD COMM trial compared the clinical and cost-effectiveness of two speech and language therapy approaches: Lee Silverman Voice Treatment LOUD and National Health Service speech and language therapy for the treatment of speech or voice problems in people with Parkinson's disease to no speech and language therapy (control) and against each other. PD COMM is a phase III, multicentre, three-arm, unblinded, randomised controlled trial. Participants were randomised in a 1 : 1 : 1 ratio to control, National Health Service speech and language therapy or Lee Silverman Voice Treatment LOUD via a central computer-generated programme, using a minimisation procedure with a random element, to ensure allocation concealment. Mixed-methods process and health economic evaluations were conducted. United Kingdom outpatient and home settings. People with idiopathic Parkinson's disease, with self-reported or carer-reported speech or voice problems. We excluded people with dementia, laryngeal pathology and those within 24 months of previous speech and language therapy. The Lee Silverman Voice Treatment LOUD intervention included maximum effort drills and high-effort speech production tasks delivered over four 50-minute therapist-led personalised sessions per week, for 4 weeks with prescribed daily home practice. National Health Service speech and language therapy content and dosage reflected local non-Lee Silverman Voice Treatment speech and language therapy practices, usually 1 hour, once weekly, for 6 weeks. Trained, experienced speech and language therapists or assistants provided interventions. The control was no speech and language therapy until the trial was completed. Primary outcome: Voice Handicap Index total score at 3 months. Secondary outcomes: Voice Handicap Index subscales, Parkinson's Disease Questionnaire-39; Questionnaire on Acquired Speech Disorders; EuroQol-5D-5L; ICEpop Capabilities Measure for Older Adults; Parkinson's Disease Questionnaire - Carers; resource utilisation; and adverse events. Assessments were completed pre-randomisation and at 3, 6 and 12 months post randomisation. Three hundred and eighty-eight participants were randomised to Lee Silverman Voice Treatment LOUD (n = 130), National Health Service speech and language therapy (n = 129) and control (n = 129). The impact of voice problems at 3 months after randomisation was lower for Lee Silverman Voice Treatment LOUD participants than control [-8.0 (99% confidence interval: -13.3, -2.6); p = 0.001]. There was no evidence of improvement for those with access to National Health Service speech and language therapy when compared to control [1.7 (99% confidence interval: -3.8, 7.1); p = 0.4]. Participants randomised to Lee Silverman Voice Treatment LOUD reported a lower impact of their voice problems than participants randomised to National Health Service speech and language therapy [99% confidence interval: -9.6 (-14.9, -4.4); p < 0.0001]. There were no reports of serious adverse events. Staff were confident with the trial interventions; a range of patient and therapist enablers of implementing Lee Silverman Voice Treatment LOUD were identified. The economic evaluation results suggested Lee Silverman Voice Treatment LOUD was more expensive and more effective than control or National Health Service speech and language therapy but was not cost-effective with incremental cost-effectiveness ratios of £197,772 per quality-adjusted life-year gained and £77,017 per quality-adjusted life-year gained, respectively. The number of participants recruited to the trial did not meet the pre-specified power. People that had access to Lee Silverman Voice Treatment LOUD described a significantly greater reduction in the impact of their Parkinson's disease-related speech problems 3 months after randomisation compared to people that had no speech and language therapy. There was no evidence of a difference between National Health Service speech and language therapy and those that received no speech and language therapy. Lee Silverman Voice Treatment LOUD resulted in a significantly lower impact of voice problems compared to National Health Service speech and language therapy 3 months after randomisation which was still present after 12 months; however, Lee Silverman Voice Treatment LOUD was not found to be cost-effective. Implementing Lee Silverman Voice Treatment LOUD in the National Health Service and identifying alternatives to Lee Silverman Voice Treatment LOUD for those who cannot tolerate it. Investigation of less costly alternative options for Lee Silverman Voice Treatment delivery require investigation, with economic evaluation using a preference-based outcome measure that captures improvement in communication. This study is registered as ISRCTN12421382. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 10/135/02) and is published in full in Health Technology Assessment; Vol. 28, No. 58. See the NIHR Funding and Awards website for further award information.

Efficacy of Posterior Pharyngeal Wall Injection for Velopharyngeal Dysfunction in Adults.

Posterior pharyngeal wall (PPW) injection is often employed to treat velopharyngeal deficiency (VPD). We sought to analyze the impact of PPW injection on severity of dysphagia and dysphonia. Retrospective chart review was conducted of patients undergoing PPW injection from 2018 to 2023 at a tertiary laryngology center. Effects on Voice Handicap Index-10 (VHI-10), Eating Assessment Tool-10 (EAT-10), soft palate closure on modified barium swallow, and auditory-perceptual measures of hypernasality and audible nasal air emission were analyzed. 67 PPW injections were performed in 29 patients (11 female). Mean age was 59.4 ± 17.0 years. Etiologies were head and neck cancer (n = 23) and neurologic conditions (n = 6). 30 PPW injections were performed concurrent with intervention on the upper esophageal sphincter (25 dilations, 3 myotomies, 2 botulinum toxin injections), and 8 with a glottic procedure (6 vocal fold injections, 2 thyroplasties). Change scores were 3.87 (-6.85 to -0.89, p = .012) for VHI-10 and -3.00 (-4.75 to -1.25, p = 0.001) for EAT-10. These were statistically different from 0 for the whole cohort but not in the subset of patients undergoing concurrent voice and/or swallow surgery. Soft palate closure scores tended to be better (but not statistically significant) on MBS after PPW injection. Hypernasality and audible nasal air emission both improved after injection. PPW injection appears to have a therapeutic effect on dysphagia/dysphonia in patients with VPD; however, many patients have multifactorial impairment. Additional study is needed to determine benefit of PPW when performed in conjunction with other procedures in this complex patient population. Level 4 (Case series) Laryngoscope, 2024.

Voice analysis in women with polycystic ovary syndrome

BackgroundPolycystic ovarian syndrome (PCOS) is a common endocrine disorder affecting one in five women of reproductive age. Polycystic appearance of the ovaries in ultrasonography is associated with oligomenorrhea, and clinical and or biochemical hyperandrogenism. PCOS has been associated with voice alterations for many years. However, there is insufficient research on voice analysis in PCOS patients.ObjectivesThis research aimed to examine the voice characteristics among women with PCOS.Patients and methodsOur study included 25 women confirmed with PCOS and 25 control. A complete voice assessment was performed for all participants using primary demographic data, vocal symptoms, auditory perceptual evaluation of the voice, Arabic version of the Voice Handicap Index, acoustic analysis, and video laryngoscopic examination of the larynx.ResultsOur study revealed statistically significant differences between PCOS and control groups in phonasthenic symptoms, auditory perceptual assessment of the voice, acoustic parameters, and laryngoscopic examination.ConclusionPCOS women with hirsutism are complaining of vocal symptoms, changes in vocal characters, and deterioration of the acoustic parameters of the voice. High serum levels of androgen can cause the deepening of the voice, which is essential for the early detection of vocal symptoms in PCOS patients to prevent virilization of their voice.Trial registrationNCT06085170. Registered 20 August 2023—retrospectively registered, https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://classic.clinicaltrials.gov/ct2/show/NCT06085170&ved=2ahUKEwjEyLqUq6KGAxWxRPEDHb57DIQQFnoECBQQAQ&usg=AOvVaw1xTurnA6mJEZ9PK0vQS8VL.

Work and Environment Related Characteristics Associated with Voice Disorders among Primary School Teachers

The objective of this study is to assess work and environment related factors associated with voice disorders among primary school teachers in the Colombo district in Sri Lanka. Methods: An institution based cross sectional study was conducted among 790 primary school teachers, in the Colombo District in Sri Lanka. They were selected by a stratified random sampling method. The validated Voice Handicap Index (VHI-30) questionnaire and a self-administered questionnaire were used for data collection. Sound levels within 10 selected classrooms were measured objectively using CR:303 sound level meter (Cirrus). Data analysis was by bivariate method with chi squared and logistic regression. Results: Among the work related characteristics assessed teaching 5 or more subjects (OR=1.40, CI = 1.039, 2.90), staying after school hours (OR=1.69, CI = 1.19, 2.38) were significantly associated with voice disorders. Among the factors associated with work environment, teachers having a speech pattern in yelling and shouting category (OR=2.25, CI=1.68, 2.99), speaking in noisy environments (OR=1.09, CI= 1.15, 3.15), being exposed to smoky dusty environments (OR = 1.61, CI= 1.19, 2.16), having average or high dust levels in classrooms (OR=2.03, OR=1.50, 2.76), having a moderate to high noise level in classrooms (OR= 1.93, CI=1.45, 2.58) and having ‘just adequate, inadequate and average’ space in a classroom (OR=1.74, CI=1.29, 2.34) were significantly associated with voice disorders. The sound levels objectively measured in classrooms revealed that all classrooms had higher than acceptable noise levels during a teaching session. Conclusions and recommendations: The association of voice disorders with work related characteristics were similar to the findings in other studies. However, the high noise levels detected in the classrooms on objective measurement were high. It is recommended that these findings be addressed through a multidisciplinary approach and National standards for acceptable noise levels within classrooms be established.

Comparison of voice quality in patients with oral cancer at both pre and post treatment stage

Background: Patients with oral cancer have very common complaints of change in voice. This research is designed to study the effect of oral cancer and its treatment on the various domains of voice like functional, physical, and emotional along with parameters of voice like pitch, loudness and quality. Method: This study included total 48 participants (34 males and 14 females) with oral cancer. The voice quality of the participants was analysed both before and after treatment using Dr. speech and the voice handicap index (VHI). First, the voice analysis done when the patient was diagnosed as a case of oral cancer by the head-neck oncosurgeon after completion of all required investigations. Patients were recalled for voice analysis after completion of treatment. Results: There was a significant difference observed in all three domains of the VHI at both before and after treatment. The difference in the functional domain was more prominent. The VHI was not linked to tumor or nodal staging. However, post treatment the voice parameters are greatly affected as compared to pre-treatment stage. Conclusions: The administration of the VHI should be made mandatory prior to treatment of oral cancer and the findings of the test should be discussed with the patient prior to start of any treatment modality and accordingly the realistic expectations can be set. Therefore, voice analysis using Dr speech will also help in timely assessment and rehabilitation of voice before and after treatment.

Vocal dysfunction following thyroid surgery: a multidimensional subjective and objective study

Background and objectiveFollowing thyroid surgery, vocal changes are a common complication and well-known morbidity that may be linked to neuronal and non-neuronal voice breakdown. Nevertheless, their effects on different voice characteristics are not fully understood, and their bases are still poorly characterized. In order to determine the diagnostic indicators that address the nature of such post-thyroidectomy voice alternations, this study was designed to provide a multidimensional assessment of vocal function after thyroid surgery.MethodsThis research was a 1-year prospective cohort study conducted on 100 adult patients aged 40.19 (± 12.82) years who were recruited from the outpatient clinic of Phoniatric Unit, Assiut University Hospital, and scheduled to undergo thyroid surgery during the period from November 2020 to November 2021. All subjects underwent vocal assessment preoperatively and 15 days, 1 month, and 2 months postoperatively by filled in subjective evaluation of voice complaints via voice handicap index (VHI-30), auditory perceptual assessment (APA) of the voice, and videolaryngoscopy in addition to acoustic analysis using computerized speech lab (CSL). Statistical analysis was performed to compare multi-parameter voice assessment tools across different assessment time points.ResultsThe voice changes were significantly decreased from 51.0% after 15 days postoperatively to 33.0% after 2 months of follow-up. Among these cases, 35.0% cases developed vocal fold paralysis and complained of a breathy voice (27% developed unilateral vocal fold paralysis, and 8% developed bilateral focal fold lesions), and the remaining 16.0% cases had no paralytic manifestations. Also, only one case developed gross lesion “bilateral vocal fold nodules.” The subjective evaluation of voice outcome after thyroidectomy showed significant improvement in VHI subscales and total score from 15 days postoperatively to 2 months of follow-up (P < 0.001). All of the acoustic parameters except HNR showed a significant difference across the different assessment settings (P < 0.001).ConclusionThyroidectomy can result in significant vocal alterations, even in cases where the laryngeal nerve is unharmed. These changes should be taken into consideration in patient having thyroid surgery, especially a total thyroidectomy because of malignant lesions. More efforts are needed in order to determine the extent and pathophysiological reasons for the vocal alterations following thyroid surgery in order to reduce the morbidity associated with one of the most popular surgical procedures performed globally.

Factors Associated With Improvement Following In-office Steroid Injections for Vocal Fold Scar.

This study aims to evaluate the clinical outcomes of patients receiving in-office vocal fold steroid injections (VFSI), highlighting relatively new measures around vocal pitch. Patients with a diagnosis of vocal fold scar who received in-office VFSI from 2013 to 2024 were evaluated. Pre- and post-steroid Voice Handicap Index (VHI-10) scores, stroboscopic vibratory parameters, acoustic measures of cepstral peak prominence (CPP), and fundamental frequency coefficient of variation (F0CoV) during sustained phonation were analyzed using Wilcoxon signed-rank tests and McNemar's tests. Twenty-two patients had follow-up data 1-3 months after steroid injection. The median decrease in VHI-10 after one injection was 4 points (p = 0.02). We found no difference in CPP and F0CoV measures at follow-up. Forty-five percent of patients improved in mucosal wave and amplitude of at least one vocal fold. Earlier presentation from vocal injury was associated with improvement in mucosal wave and amplitude of the left vocal fold (p = 0.03). We found no difference in sex, tobacco smoking history, singing status, secondary diagnosis, and baseline VHI-10 score between patients who improved in vibratory parameters and those who did not. This single-center study is one of the largest exploring patient outcomes following in-office VFSI. Though patients reported modest improvement in voice use after VFSI, this may not be as impactful as previously believed. Improvement in videostroboscopy is expected in about half of the patients, with recency from vocal injury a likely predictor of success. These partially negative results provide insight into counseling patients regarding benefits from in-office VFSI. 4 Laryngoscope, 2024.

Prevalence of self-reported voice and swallowing complaints in an outpatient geriatric population.

Older adults suffer from increased rates of dysphagia and dysphonia, both of which have a profound effect on quality of life and are often underdiagnosed. We sought to better understand the prevalence of these complaints and the potential utility of a patient-reported screening program in a geriatrics clinic. Using an IRB-approved cross-sectional survey and retrospective cohort design, we recruited participants from a population of new patients seeking care at an academic geriatrics clinic. We used three validated questionnaires to assess self-reported dysphagia, dysphonia, and pill dysphagia: the Eating-Assessment Tool-10 (EAT-10), the Voice Handicap Index-10 (VHI-10), and the PILL-5. Patients who screened positive on any questionnaire were offered referral to a laryngologist for additional evaluation. Patients who screened positive on the PILL-5 were also offered referral to our geriatric pharmacist. Among our 300 patients surveyed, the mean age was 76 (SD 8.46). A total of 82 (27.3%) patients screened positive (73 on EAT-10, 10 on PILL-5, 13 on VHI-10) and were offered referral, of which 36 accepted. These positive screening patients took more prescription medications (p = .024) and had a higher GDS score (p < .001) when compared to the patients who screened negative. Many new patients seeking generalized care at our center screened positively for dysphagia and/or dysphonia on validated questionnaires. Geriatric patients may benefit from integrating screening for these disorders to identify the need of further evaluation. It is unknown if these survey tools are appropriate in a non-otolaryngology clinic. III.

Polish versions of Voice Handicap Index: VHI-POL and VHI-10

Polish versions of Voice Handicap Index: VHI-POL and VHI-10

Augmentation laryngoplasty: Results and decision plan

AbstractObjectivesAugmentation laryngoplasty represents a therapeutic choice for patients who suffer from glottic insufficiency of different etiologies. There have been multiple injectables that have been proven effective. The present study examines the short‐term effects of vocal fold augmentation on phonation, swallowing, and breathing in individuals with glottic insufficiency. In addition, a decision plan is also proposed.MethodsData from medical records and operative notes were used to conduct a retrospective cohort study on patients with glottic insufficiency who underwent vocal fold augmentation from 2016 to 2023. Hyaluronic acid, calcium hydroxyapatite, and polydimethylsiloxane were the injectable materials that were used. An analysis was conducted on phonation, breathing, swallowing, and laryngoscopy findings both before and after vocal folds' augmentation.ResultsSeventy‐nine patients were included, which represents 97 injections. The median (IQR) preoperative Voice Handicap Index‐10 (VHI‐10) score improved from 21 (15–28) to 16 (9–25) postoperatively (p &lt; 0.001). The GRBAS scale also significantly decreased (p &lt; 0.001). The median (IQR) preoperative Dyspnea Index score improved from 6 (0–17) to 2 (0–10) postoperatively (p &lt; 0.05). Laryngoscopic findings showed significant improvement in the bulk of the vocal folds. There was no significant change in swallowing.ConclusionsIn case of dysphonia secondary to glottic insufficiency, augmentation laryngoplasty using various injectable materials has proven to be an effective option across a range of different etiologies, as it results in significant improvements in voice quality. The choice of the injectable material depends upon the severity and the etiology of glottic insufficiency.

Trauma, Attachment, Emotions, and Voice Care: Exploratory Research

Abstract: Previous research has indicated that early-life experiences can impact an adult in a variety of ways, from health, to behavior, to voice, to the likelihood of seeking support when needed. The authors, across two preliminary studies, investigate relationships between psychological factors (e.g. childhood trauma, attachment, emotions), Voice Handicap Index (VHI) and Voice-related Quality of Life (VRQOL) measures, and whether participants ever saw a voice specialist. Across samples, we hypothesized that psychological measures would demonstrate relationships with VHI, VRQOL and seeking care. Our predictions were partially supported. These studies open a window to the importance of exploring specific psychological factors in relation to voice and as potential barriers to voice care.

Acoustic Analysis of Mandarin-Speaking Transgender Women

ObjectiveThis study aims to investigate the speech characteristics and assess the potential risk of voice fatigue and voice disorders in Chinese transgender women. MethodsA case-control study was conducted involving transgender women recruited in Shanghai, China, from 2022 to 2024. The participants included 15 transgender women (TW), 20 cisgender men (CISM), and 20 cisgender women (CISW). Acoustic parameters, including formants (F1, F2, F3, F4), cepstral peak prominence (CPP), jitter, shimmer, harmonic-to-noise ratio (HNR), noise-to-harmonics (NHR), fundamental frequency (fo), and intensity, were analyzed across vowels, passages, and free speech. Additionally, the Voice Handicap Index-10 (VHI-10) and the Voice Fatigue Index (VFI) were administered to evaluate voice-related concerns. Results(1) The F1 of TW was significantly higher than that of CISW for the vowels /i/ and /u/, and significantly higher than that of CISM for the vowels /a/, /i/, and /u/; The F2 was significantly lower in TW compared to CISW for the vowels /i/ and /u/, and significantly higher than CISM for the vowels /a/ and /u/. F3 was significantly lower in TW than in CISW for the vowels /a/ and /i/. The F4 formant was significantly lower in TW than in CISW for the vowels /a/ and /i/, but significantly higher than in CISM for the vowel /u/. (2) The fo of TW was significantly lower than that of CISW for the vowels /a/, /i/, /u/, during passage reading, and in free speech, but was significantly higher than CISM during passage reading and free speech. Additionally, TW exhibited significantly higher intensity compared to CISW for the vowel /a/ and during passage reading. (3) Jitter in TW was significantly higher than in CISW for the vowels /i/ and /u/, and significantly lower than in CISM during passage reading and free speech. Shimmer was significantly higher in TW compared to both CISW and CISM across the vowels /a/, /i/, during passage reading, and in free speech. The harmonic-to-noise ratio (HNR) in TW was significantly lower than in both CISW and CISM across all vowels, during passage reading, and in free speech. The NHR was significantly higher in TW than in CISW across the vowels /a/, /i/, /u/, during passage reading, and in free speech, and significantly higher than in CISM for the vowels /a/, /i/, during passage reading, and in free speech. The CPP in TW was significantly lower than in CISW during passage reading and free speech, and significantly lower than in CISM across all vowels, during passage reading, and in free speech. (4) The VHI-10 scores were significantly higher in TW compared to both CISM and CISW. ConclusionsTransgender women exhibit certain acoustic parameters, such as fo and some of the formants, that fall between those of CISW and CISM without undergoing phonosurgery or voice training. The findings suggest a potential risk for voice fatigue and the development of voice disorders as transgender women try to modify their vocal characteristics to align with their gender identity.

Smoking has detrimental effects on voice related Quality of Life of University Teachers.

To compare voice related quality of life of smoker and non-smoker university teachers. This Cross-Sectional descriptive study was conducted at Riphah International University over a period of six months January to June, 2022. A sample of N=352 University teachers of both genders, aged 25 to 65 years, who were faculty members and working at least 8 hours per day in teaching positions with at least one-year experience were included in the study. Demographic sheet, Voice Related Quality of Life (VRQOL) and Voice Handicap Index (VHI) were used for data collection and analysis conducted on SPSS Version 21. Mean scores of VRQOL and VHI for smokers and non-smokers were compared using Mann Whitney U Test. & Spearman's correlation was utilized to determine any association between the tool scores. P<0.01 was considered significant. Results reveal that the mean score of Voice related quality of life scale was significantly (p=0.000) higher in smokers compared to non-smokers indicating worse voice quality in smokers. Similarly, voice handicap index scores were much higher in smokers (p=0.000) indicating more handicap in the smokers. The study concludes that smoking has a detrimental effect on voice and voice related quality of life of university teachers and voice related quality of life as determined by VRQOL scale is significantly better in non-smokers.

Toward Sham Interventions for Behavioral Voice Treatment Outcome Research in Female Students Without Dysphonia

Objectives/HypothesisTo develop sham voice treatment techniques to be used in voice treatment outcomes research, and to investigate their effectiveness as sham. This entails that the techniques induce no changes in voice or voice physiology, yet still lead to a perception of efficacy. Study DesignProspective randomized blinded controlled study MethodsThree distinct sham intervention protocols (SIPs) were conceptualized as placebic comparators for three common voice treatment approaches with focus on vocalization (SIP1), respiration (SIP2), and manipulation (SIP3). Forty-eight female students participated in the study. Each participant attended ten 30-minute sessions over five weeks, including a baseline evaluation, three sessions of one SIP, an inter-SIP voice assessment, three sessions of a second SIP, and a final post-SIPs assessment. Auditory-perceptual and instrumental voice evaluations were used as voice treatment outcomes measures. The participants' perception of voice-related quality of life was evaluated using the French Voice Handicap Index (VHIFR). Frequentist as well as Bayesian statistical methods were applied for group comparisons. The effects of combining two SIPs, the potential influence of SIP order, and experimenter/clinician effects were also investigated. ResultsThe respiration-based SIP2 showed changes only in sound intensity level on sustained vowel across the three sham intervention sessions. In contrast, the vocalization-based SIP1 impacted sound intensity level on sustained vowel, sound intensity level on read text, and maximum phonation time. The manipulation-based SIP3 affected smoothed cepstral peak prominence on read text, Acoustic Voice Quality Index, and Dysphonia Severity Index. SIP2 thus demonstrated the highest alignment with the study's objectives, followed by SIP1 and SIP3. GRBASI ratings revealed no statistical differences for any SIP. VHIFr decreased significantly after all three SIPs. Combining the SIPs generally replicated the effects observed when each SIP was used individually. There was no order effect or experimenter/clinician effect on the results. ConclusionsThis study demonstrated significant changes in participants' perceived voice quality (measured with VHIFr) across various sham intervention protocols, despite minimal impact on objective voice function measures. Further investigation is necessary to establish one or more protocols as genuinely sham interventions.

Evaluation of Pediatric Posterior Glottic Diastasis Using Dynamic Voice Computed Tomography.

Posterior glottic diastasis (PGD) is an underappreciated etiology of dysphonia in patients with prior airway reconstruction or prolonged intubation. In endoscopic posterior cricoid reduction (ePCR), cricoid is removed to minimize the posterior glottic gap. Dynamic voice computed tomography (DVCT) permits visualization of the posterior glottis, estimating the amount of cricoid to be removed. Posterior glottic gaps in patients undergoing ePCR were compared to non-dysphonic patients to describe pediatric PGD and establish surgical parameters for ePCR. DVCTs performed in non-dysphonic patients and dysphonic patients undergoing ePCR from 2014 to 2023 were reviewed. EPCR operative reports were queried. Pre- and postoperative Pediatric Voice Handicap Index (pVHI) and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores and aerodynamic measures were reviewed. Seventeen pediatric patients who underwent ePCR and 19 non-dysphonic patients were included. Posterior glottic gaps were significantly larger in the dysphonic group (median 2.4 mm [IQR: 2.0, 2.8] vs. 1.3 mm [IQR: 1.1, 1.7], p < 0.001). Mean width of the cricoid removed was 1.6 mm (SD 0.4 mm). Mean (SD) pre- and postoperative pVHI scores were 55.5 (19.9) and 34.6 (16.0; p < 0.001). Mean (SD) pre- and postoperative CAPE-V scores were 52.7 (15.4) and 36.5 (20.4; p < 0.001), respectively. Children in this cohort tolerated an average 1.3 mm posterior glottic gap without dysphonia. Dysphonic patients with PGD had a median 2.4 mm gap and underwent cricoid reduction by 1.6 mm. All ePCR patients demonstrated improvement in dysphonia. Results seek to optimize the management of pediatric PGD and present a safe and effective amount of cricoid to remove during ePCR. 4 Laryngoscope, 2024.