Voice Parameters Research Articles

Endoscopic treatment of anterior laryngeal web using keel designed from ePTFE followed by voice therapy: a refined technique

BackgroundTreatment of laryngeal web is challenging due to possibility of recurrence and affected voice quality. Optimal treatment of laryngeal web should emphasize on improving both airway and vocal function. We refined the traditional endoscopic method using a new keel designed from expanded polytetrafluoroethylene (ePTFE) membrane. Our objective is to evaluate the voice outcomes following the endoscopic treatment and voice therapy.ResultsTen subjects presented with anterior laryngeal web. Auditory perceptual assessment, stroboscopic examination and acoustic studies were performed pre- and postoperatively. Endoscopic excision of laryngeal web was performed with cold instruments. An individually designed ePTFE keel was fixed by Nylon thread 2–0 at the anterior commissure and tied subcutaneously in the neck. The keel left for 3–5 weeks followed by voice therapy using abdomino-diaphragmatic breathing exercise and relaxation method. Vocal parameters measured were perceptual voice quality using Grade-Roughness-Breathiness-Asthenia-Strain voice scale (GRBAS), stroboscopic score, fundamental frequency (F0), jitter, shimmer, pitch perturbation question (PPQ), amplitude perturbation question (APQ) and harmonics-to-noise ratio (HNR). Significant decrease in GRBAS (P < 0.001) and significant increase in stroboscopic scores (P < 0.001) were noticed after operation and voice therapy. Also, acoustic voice parameters showed significant improvements. The mean jitter, shimmer, PPQ and APQ showed significant decrease (p = 0.0028, 0.0032, 0.0026, 0.0014, and 0.006 respectively). Overall, 90 % of our subjects have satisfactory voice outcome.ConclusionEndoscopic excision of anterior laryngeal with cold instrument followed by ePTFE keel fixation achieved good long-term voice results. The ePTFE is soft biocompatible material which does not make reaction. The keel should be left in place for sufficient period of time (3–5 weeks). This ensures perfect healing with less or no recurrence. Absence of foreign body reactions in the vocal folds is important for mucosal integrity and good voice outcome. So, the ePTFE could be good alternative for laryngeal keel. Hyperfunctional dysphonia with ventricular hypertrophy may develop in longstanding anterior laryngeal web which needs intensive voice therapy after operation. Our treatment targeted both the organic etiology of dysphonia and the underlying cause of the possible associated functional element of dysphonia.

Classification of Dysphonic Voices in Parkinson's Disease with Semi-Supervised Competitive Learning Algorithm.

This article proposes a novel semi-supervised competitive learning (SSCL) algorithm for vocal pattern classifications in Parkinson’s disease (PD). The acoustic parameters of voice records were grouped into the families of jitter, shimmer, harmonic-to-noise, frequency, and nonlinear measures, respectively. The linear correlations were computed within each acoustic parameter family. According to the correlation matrix results, the jitter, shimmer, and harmonic-to-noise parameters presented as highly correlated in terms of Pearson’s correlation coefficients. Then, the principal component analysis (PCA) technique was implemented to eliminate the redundant dimensions of the acoustic parameters for each family. The Mann–Whitney–Wilcoxon hypothesis test was used to evaluate the significant difference of the PCA-projected features between the healthy subjects and PD patients. Eight dominant PCA-projected features were selected based on the eigenvalue threshold criterion and the statistical significance level (p < 0.05) of the hypothesis test. The SSCL algorithm proposed in this paper included the procedures of the competitive prototype seed selection, K-means optimization, and the nearest neighbor classifications. The pattern classification experimental results showed that the proposed SSCL method can provide the excellent diagnostic performances in terms of accuracy (0.838), recall (0.825), specificity (0.85), precision (0.846), F-score (0.835), Matthews correlation coefficient (0.675), area under the receiver operating characteristic curve (0.939), and Kappa coefficient (0.675), which were consistently better than those results of conventional KNN or SVM classifiers.

Predicting frailty in older adults using vocal biomarkers: a cross-sectional study

BackgroundFrailty is a common issue in the aging population. Given that frailty syndrome is little discussed in the literature on the aging voice, the current study aims to examine the relationship between frailty and vocal biomarkers in older people.MethodsParticipants aged ≥ 60 years visiting geriatric outpatient clinics were recruited. They underwent frailty assessment (Cardiovascular Health Study [CHS] index; Study of Osteoporotic Fractures [SOF] index; and Fatigue, Resistance, Ambulation, Illness, and Loss of weight [FRAIL] index) and were asked to pronounce a sustained vowel /a/ for approximately 1 s. Four voice parameters were assessed: average number of zero crossings (A1), variations in local peaks and valleys (A2), variations in first and second formant frequencies (A3), and spectral energy ratio (A4).ResultsAmong 277 older adults, increased A1 was associated with a lower likelihood of frailty as defined by SOF (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.74–0.96). Participants with larger A2 values were more likely to be frail, as defined by FRAIL and CHS (FRAIL: OR 1.41, 95% CI 1.12–1.79; CHS: OR 1.38, 95% CI 1.10–1.75). Sex differences were observed across the three frailty indices. In male participants, an increase in A3 by 10 points increased the odds of frailty by almost 7% (SOF: OR 1.07, 95% CI 1.02–1.12), 6% (FRAIL: OR 1.06, 95% CI 1.02–1.11), or 6% (CHS: OR 1.06, 95% CI 1.01–1.11). In female participants, an increase in A4 by 0.1 conferred a significant 2.8-fold (SOF: OR 2.81, 95% CI 1.71–4.62), 2.3-fold (FRAIL: OR 2.31, 95% CI 1.45–3.68), or 2.8-fold (CHS: OR 2.82, 95% CI 1.76–4.51, CHS) increased odds of frailty.ConclusionsVocal biomarkers, especially spectral-domain voice parameters, might have potential for estimating frailty, as a non-invasive, instantaneous, objective, and cost-effective estimation tool, and demonstrating sex differences for individualised treatment of frailty.

Correlation Between a Self-Voice Assessment and Objective-Voice Evaluation Outcomes in Speech Language Pathology Students

The aims of this study is to explore the correlation between the Voice Disorder Index (VDI) score and acoustic and phonatory respiratory voice parameters in speech language pathology (SLP) students with and without self-perceived voice disorders. The Voice Disorder Index (VDI) and the Lingwaves 3 "Voice Protocol" were administered to each participant in order to assess his/her self-perceived severity of his/her voice problem, as well as, acoustic and phonatory respiratory measurements. The correlation coefficients were used to evaluate and quantify the degree of a linear relationship between VDI scores and acoustic and phonatory respiratory voice measures in students with and without self-perceived voice disorders. Relatively strong, strong and strong positive correlations were revealed when comparing the VDI physical subscale with the Dysphonia Severity Index (r(11)=0.56, P=0.048), mean loudness when reading in English (r(11)=0.70, P=0.008) and mean loudness when reading in Greek (r(11) =0.69, P=0.009) respectively. SLP students may be more aware of the impact of their laryngeal discomfort and voice output characteristics on their daily activities that can predict certain acoustic parameters than the emotional and functional impact on their daily activities.

Detection of speech pathology based on parameters of analysis of dysphonia in speech and voice

Objective:To analysis speech pathology based on dysphonia in speech and voice（ADSV）. Methods:The acoustic signals of continuous vowels and continuous speech of one-hundred and thirteen individuals were collected, including 93 vocal cord polyps cases, 20 glottis laryngeal carcinoma cases and 47 volunteers without speech sound disorders. Cepstral peak prominence（CPP）, CPP standard deviation（CPP SD）, L/H spectral ratio（L/H ratio）, L/H ratio standard deviation（L/H ratio SD） and cepstral/spectral index of dysphonia（CSID） were analyzed by ADSV to explore the role of these parameters in the recognition of speech pathology. Results:In the acoustic signal of continuous vowels, CPP and L/H ratio in normal group were higher than those in pathological voice group（P<0.001）, while CPP SD and CSID were lower than those in pathological voice group（P<0.001）, CPP and CSID areas under ROC curve were 0.95 and 0.99, respectively, which were important acoustic parameters for diagnosing pathological voice. In continuous speech acoustic signals, CPP, CPP SD and L/H ratio in the normal group were all higher than those in the speech disorders group（P<0.001）, and the area under the curve of CPP SD was 0.90, which showed high accuracy in diagnosing pathological voice. The ADSV voice analysis parameters CPP, CPP SD, CSID, and L/H ratio also showed significant differences between the vocal cord polyp group and the glottic laryngeal cancer group. The results of the discriminant analysis model show that the use of ADSV voice parameters can distinguish vocal cord polyps and laryngeal cancers. Conclusion:The ADSV voice analysis parameters can not only distinguish the voice signals of the normal group and the pathological group, but also distinguish different types of pathological voices. It has high sensitivity and specificity in diagnosing pathological voices.

Perceiving Body Height From Connected Speech: Higher Fundamental Frequency Is Associated With the Speaker's Height.

To a certain degree, human listeners can perceive a speaker's body size from their voice. The speaker's voice pitch or fundamental frequency (Fo) and the vocal formant frequencies are the voice parameters that have been most intensively studied in past body size perception research (particularly for body height). Artificially lowering the Fo of isolated vowels from male speakers improved listeners' accuracy of binary (i.e., tall vs not tall) body height perceptions. This has been explained by the theory that a denser harmonic spectrum provided by a low pitch improved the perceptual resolution of formants that aid formant-based size assessments. In the present study, we extended this research using connected speech (i.e., words and sentences) pronounced by speakers of both sexes. Unexpectedly, we found that raising Fo, not lowering it, increased the participants' perceptual performance in two binary discrimination tasks of body size. We explain our new finding in the temporal domain by the dynamic and time-varying acoustic properties of connected speech. Increased Fo might increase the sampling density of sound wave acoustic cycles and provide more detailed information, such as higher resolution, on the envelope shape.

Voice analysis in patients with postoperative laryngeal motility disorders after thyroid surgery

Objective — to analyse restoration of vocal function and features of the laryngoscopy picture in patients with paresis and paralysis of the larynx after thyroid surgery.&#x0D; Materials and methods. A prospective single-center investigation involved results of examinations of 132 patients with laryngeal motility disorders after thyroid surgery aged 18 to 70 years (the mean age 41.5 ± 1.4) years, from them 27 men (20.5 %) and 105 women (79.5 %). The diagnosis of laryngeal motility and voice quality disorders was performed by an otolaryngologist using indirect laryngoscopy, videolaryngoscopy and spectral analysis of the voice to determine the following indicators: maximum phonation time (MPT), fundamental frequency (FF), harmonic/noise ratio (HNR), Jitter, Shimmer and questionnaire of subjective self-assessment of voice quality (Voice Handicap Index, VHI — 30), a modified version by B.Jacobcon.&#x0D; Results. Restoration of vocal cords (VC) motility (laryngeal paresis) was observed in 123 (93.2 %) patients within 6 months after thyroid surgery, in 9 (6.8 %) patient’s laryngeal motility was not restored (laryngeal paralysis) with in a year after surgery. When assessing the voice in patients with laryngeal paresis after 6 months and laryngeal paralysis after 12 months, indices of voice acoustic analysis significantly improved in both groups compared to the early postoperative period, especially in patients with laryngeal paresis, but significantly differed in comparison to preoperative parameters.&#x0D; Conclusions. Method of voice spectral analysis has a significant diagnostic value; it allows to objectify the degree of voice disorders after thyroid surgery and their subsequent monitoring during treatment and rehabilitation. When restoring laryngeal motility, parameters of voice do not always restore completely, which indicates presence of relevant complaints and requires further examinations and administration of appropriate treatment.

Surgical management of laryngeal bilateral abductor palsy: comparative study between carbon dioxide and diode lasers

This study aims to compare the results of both CO2 laser and diode laser combined arytenoidectomy with posterior cordectomy in managing patients with bilateral vocal fold paralysis. A prospective study involved 80 bilateral vocal cord immobility patients in adduction. They are divided into two groups according to the laser used, whether CO2 (with a wavelength of 10.6 µm) or diode (with a wavelength of 980 nm). We used mMRC (Modified Medical Research Council) dyspnea scale to assess dyspnea in our patients, while the voice was evaluated by both maximum phonation time and the voice handicap index. Quantitative variables were described using means and standard deviations, while categorical variables were described using frequencies and were compared using the chi-square test, Fisher exact test, and Monte Carlo test. There was a statistically non-significant difference between the studied groups regarding mMRC dyspnea scale and Voice Handicap Index preoperatively and postoperatively. There is a statistically significant difference between the two groups regarding maximum phonation time postoperatively (significantly higher in the CO2 laser group) (p < 0.001). The CO2 laser and diode laser could be used safely for the management of bilateral vocal cord paralysis. The CO2 laser maintains better voice parameters and less postoperative pain, while the diode laser gives less operative time, lower cost, and simplicity of use.

Quality of Voice in Patients With Partial Deafness Before and After Cochlear Implantation

Quality of Voice in Patients With Partial Deafness Before and After Cochlear Implantation

A Preliminary Study on the Effect of Bhramari Pranayama on Voice of Prospective Singers

Bhramari Pranayama (BP) is a yogic breathing technique that involves producing a vibrating constant pitch sound emulating the buzzing of bumblebee. Since BP deals with breathing and humming in the sustained pitch, it is hypothesized that it can have implications for improving voice quality in individuals. However, there is a dearth of research available to support this assumption. Further, there are no published reports on the effect of BP on voice quality in prospective singers group. Current study was taken up to explore the effect induced by BP in the voice characteristics/quality of prospective singers. The participants included 30 healthy prospective singers in the age range of 18-35 years who were attending music schools within the state of Karnataka, India. BP regimen was demonstrated to all individuals. The voice recordings of the participants were obtained on day 0 and day 30 of BP practice. Acoustic analysis was performed to obtain AVQI and its constituent parameters and voice parameters from the MDVP program. Among the AVQI and its constituent parameters, Cepstral peak prominence-smoothed, Slope LTAS, and Tilt LTAS showed significant differences before and after BP. MDVP showed a significant difference in tremor measures before and after the practice of BP. Results of the present study indicated positive effects of BP on the voice characteristics of the prospective singers and it is reflected in objective acoustic outcome parameters of AVQI and MDVP. This supports the assumption that BP which involves yogic breathing will have beneficial effects on vocal physiology in turn leading to improved voice quality in these individuals. However, it is of future interest to validate these findings on larger samples and populations with different outcome measures. Also, future studies are warranted to verify the efficacy of BP in improving vocal quality and vocal efficiency of individuals with dysphonia.

Singing in different performance spaces: The effect of room acoustics on vibrato and pitch inaccuracy.

Previous literature suggests that musical performers may be influenced to some extent by the acoustic environment in which they sing or play. This study investigates the influence of room acoustics on singers' voice production, by analyzing consecutive sung performances of classically trained students in five different performance spaces. The analyzed voice parameters were vibrato rate, extent, and pitch inaccuracy. Nine classically trained student-singers performed the same aria unaccompanied on a variable starting pitch that was consistent between spaces. Variance in vibrato rate and pitch inaccuracy was primarily explained by individual differences between singers. Conversely, the variance attributable to the rooms for the parameter of vibrato extent was larger compared to the variance attributable to the performers. Vibrato extent tended to increase with room clarity (C80) and was inversely associated with early decay time (EDT). Additionally, pitch inaccuracy showed a significant negative association with room support (STv). Singers seem to adjust their vocal production when performing in different acoustic environments. Likewise, the degree to which a singer can hear themself on stage may influence pitch accuracy.

Effects of Face Masks on Physiological Parameters and Voice Production during Cycling Activity.

This study investigates the effects of face masks on physiological and voice parameters, focusing on cyclists that perform incremental sports activity. Three healthy male subjects were monitored in a climatic chamber wearing three types of masks with different acoustic properties, breathing resistance, and air filtration performance. Masks A and B were surgical masks made of hydrophobic fabric and three layers of non-woven fabric of 100% polypropylene, respectively. Mask S was a multilayer cloth mask designed for sports activity. Mask B and Mask S behave similarly and show lower sound attenuation and sound transmission loss and lower breathing resistance than Mask A, although Mask A exhibits slightly higher filtration efficiency. Similar cheek temperatures were observed for Masks A and B, while a significantly higher temperature was measured with Mask S at incremental physical activity. No differences were found between the masks and the no-mask condition for voice monitoring. Overall, Mask B and Mask S are suitable for sports activities without adverse effects on voice production while ensuring good breathing resistance and filtration efficiency. These outcomes support choosing appropriate masks for sports activities, showing the best trade-off between breathing resistance and filtration efficiency, sound attenuation, and sound transmission loss.

Out-of-Hospital Cardiac Arrest Detection by Machine Learning Based on the Phonetic Characteristics of the Caller's Voice.

Out-of-hospital cardiac arrest (OHCA) is a major public health issue. The prognosis is closely related to the time from collapse to return of spontaneous circulation. Resuscitation efforts are frequently initiated at the request of emergency call center professionals who are specifically trained to identify critical conditions over the phone. However, 25% of OHCAs are not recognized during the first call. Therefore, it would be interesting to develop automated computer systems to recognize OHCA on the phone. The aim of this study was to build and evaluate machine learning models for OHCA recognition based on the phonetic characteristics of the caller's voice. All patients for whom a call was done to the emergency call center of Rennes, France, between 01/01/2017 and 01/01/2019 were eligible. The predicted variable was OHCA presence. Predicting variables were collected by computer-automatized phonetic analysis of the call. They were based on the following voice parameters: fundamental frequency, formants, intensity, jitter, shimmer, harmonic to noise ratio, number of voice breaks, and number of periods. Three models were generated using binary logistic regression, random forest, and neural network. The area under the curve (AUC) was the primary outcome used to evaluate each model performance. 820 patients were included in the study. The best model to predict OHCA was random forest (AUC=74.9, 95% CI=67.4-82.4). Machine learning models based on the acoustic characteristics of the caller's voice can recognize OHCA. The integration of the acoustic parameters identified in this study will help to design decision-making support systems to improve OHCA detection over the phone.

Real-Time Light-Guided Vocal Fold Injection via the Cricothyroid Membrane in Unilateral Vocal Fold Paralysis: A Human Pilot Study.

Objectives. Vocal fold injection (VFI) via the cricothyroid (CT) membrane is used to treat various diseases affecting the vocal folds. The technical challenges of this technique are mainly related to the invisibility of the needle. Real-time light-guided VFI (RL-VFI) was recently developed for injection under simultaneous light guidance in the CT approach. Herein, we present the first clinical trial of RL-VFI, in which we investigated the feasibility and safety of this new technique in unilateral vocal fold paralysis (VFP).Methods. This prospective pilot study enrolled 40 patients, who were treated with RL-VFI for unilateral VFP between September 2020 and August 2021. Adverse events were monitored during the procedure and for 4 weeks postoperatively. The Voice Handicap Index-10, the GRBAS (grade, roughness, breathiness, asthenia, and strain) scale, aerodynamic studies, and acoustic analyses were evaluated to compare the voice improvement after 4 weeks with the baseline values.Results. The needle tip was intuitively identified by the red light. The mean procedure time was 95.6±40.6 seconds for the initial injection, while the additional injection required 79.2±70.5 seconds. The injection was performed under light guidance without additional manipulation after the needle reached the intended point. No acute or delayed adverse events were reported. Among the 40 patients, 36 completed voice analyses after 4 weeks. Subjective and objective voice parameters, including the Voice Handicap Index-10, GRBAS scale, maximum phonation time, mean expiratory airflow, fundamental frequency, jitter, shimmer, and noise-to-harmonics ratio improved significantly after RL-VFI (P<0.05), while the expiratory volume was maintained.Conclusion. RL-VFI is feasible and safe for treating patients with unilateral VFP. This technique is anticipated to improve the precision and safety of the CT approach in the treatment of unilateral VFP. This study provides a rationale for further structured clinical studies.

Effect of FFP2/3 Masks on Voice Range Profile Measurement and Voice Acoustics in Routine Voice Diagnostics

Introduction: Voice diagnostics including voice range profile (VRP) measurement and acoustic voice analysis is essential in laryngology and phoniatrics. Due to COVID-19 pandemic, wearing of 2 or 3 filtering face piece (FFP2/3) masks is recommended when high-risk aerosol-generating procedures like singing and speaking are being performed. Goal of this study was to compare VRP parameters when performed without and with FFP2/3 masks. Further, formant analysis for sustained vowels, singer’s formant, and analysis of reading standard text samples were performed without/with FFP2/3 masks. Methods: Twenty subjects (6 males and 14 females) were enrolled in this study with an average age of 36 ± 16 years (mean ± SD). Fourteen patients were rated as euphonic/not hoarse and 6 patients as mildly hoarse. All subjects underwent the VRP measurements, vowel, and text recordings without/with FFP2/3 mask using the software DiVAS by XION medical (Berlin, Germany). Voice range of singing voice, equivalent of voice extension measure (eVEM), fundamental frequency (F0), sound pressure level (SPL) of soft speaking and shouting were calculated and analyzed. Maximum phonation time (MPT) and jitter-% were included for Dysphonia Severity Index (DSI) measurement. Analyses of singer’s formant were performed. Spectral analyses of sustained vowels /a:/, /i:/, and /u:/ (first = F1 and second = F2 formants), intensity of long-term average spectrum, and alpha-ratio were calculated using the freeware praat. Results: For all subjects, the mean values of routine voice parameters without/with mask were analyzed: no significant differences were found in results of singing voice range, eVEM, SPL, and frequency of soft speaking/shouting, except significantly lower mean SPL of shouting with FFP2/3 mask, in particular that of the female subjects (p = 0.002). Results of MPT, jitter, and DSI without/with FFP2/3 mask showed no significant differences. Further mean values analyzed without/with mask were ratio singer’s formant/loud singing, with lower ratio with FFP2/3 mask (p = 0.001), and F1 and F2 of /a:/, /i:/, /u:/, with no significant differences of the results, with the exception of F2 of /i:/ with lower value with FFP2/3 mask (p = 0.005). With the exceptions mentioned, the t test revealed no significant differences for each of the routine parameters tested in the recordings without and with wearing a FFP2/3 mask. Conclusion: It can be concluded that VRP measurements including DSI performed with FFP2/3 masks provide reliable data in clinical routine with respect to voice condition/constitution. Spectral analyses of sustained vowel, text, and singer’s formant will be affected by wearing FFP2/3 masks.

Temporal and Permanent Changes Induced by Maxillary Sinus Lifting with Bone Grafts and Maxillary Functional Endoscopic Sinus Surgery in the Voice Characteristics-Systematic Review.

Sinus surgery procedures such as sinus lifting with bone grafting or maxillary functional endoscopy surgery (FESS) can present different complications. The aims of this systematic review are to compile the post-operatory complications of sinus elevation with bone grafting and FESS including voice changes, and to elucidate if those changes are either permanent or temporary. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used, and the literature was exhaustively searched without time restrictions for randomized and non-randomized clinical studies, cohort studies (prospective and retrospective), and clinical case reports with ≥4 cases focused on sinus lift procedures with bone grafts and functional endoscopic maxillary sinus surgery. A total of 435 manuscripts were identified. After reading the abstracts, 101 articles were selected to be read in full. Twenty articles that fulfilled the inclusion criteria were included for analysis. Within the limitations of this systematic review, complications are frequent after sinus lifting with bone grafts and after FEES. Voice parameters are scarcely evaluated after sinus lifting with bone grafts and no voice changes are reported. The voice changes that occur after FESS include a decreased fundamental frequency, increased nasality, and nasalance, all of which are transitory.

Relationship Between Oropharyngeal Geometry and Vocal Parameters in Subjects With Parkinson's Disease

To verify whether the dimensions of different segments of the oropharyngeal cavity have different proportions between Parkinson's disease patients and vocally healthy subjects and investigate whether the measurements of these subjects' oropharyngeal geometry associate with their acoustic measurements of voice. Quantitative, descriptive, cross-sectional, and retrospective study with secondary data, approved by the Human Research Ethics Committee under no. 4.325.029. We used vocal samples and data from the oropharyngeal geometry of 40 subjects - 20 with Parkinson's disease stages I to III and 20 who formed the control group, matched for sex and age. Each group had 10 males and 10 females, mean age of 61 years (±6.0). Formant (F1, F2, and F3) and cepstral measures of the sustained vowel /ε/ were extracted and arranged in the database to determine their values using Praat software. The data were descriptively analyzed, with statistics generated with R software. The proportion of oropharyngeal geometry measurements was arranged by mean values and coefficients of variation. Pearson's linear correlation test was applied to relate voice parameters to oropharyngeal geometry, considering P < 0.05, and linear regression test, to justify F2. The Parkinson's disease group showed a linear relationship between oral cavity length and F1 in males (P = 0.04) and between glottal area and F2 in females (P = 0.00); linear relationships were established according to age in both groups, and a regression model for F2 was estimated (R2 = 0.61). There was no difference between pathological and healthy voices; there was a difference in the proportional relationship of oropharyngeal geometry between the groups. The proportional relationship of oropharyngeal geometry differs between the Parkinson's disease group and the control group, as well as the relationship between oropharyngeal geometry and formant and cepstral values of voice according to the subjects' sex and age.

Accumulation of Experience and Newly Developed Devices Can Improve the Safety and Voice Outcome of Total Thyroidectomy for Graves’ Disease

Total thyroidectomy (TT) in patients with Graves’ disease is challenging even for an experienced thyroid surgeon. This study aimed to investigate the accumulation of experience and applying newly developed devices on major complications and voice outcomes after surgery of a single surgeon over 30 years. This study retrospectively reviewed 90 patients with Graves’ disease who received TT. Forty-six patients received surgery during 1990–1999 (Group A), and 44 patients received surgery during 2010–2019 (Group B). Major complications rates were compared between Group A/B, and objective voice parameters were compared between the usage of energy-based devices (EBDs) within Group B. Compared to Group B, Group A patients had higher rates of recurrent laryngeal nerve palsy (13.0%/1.1%, p = 0.001), postoperative hypocalcemia (47.8%/18.2%, p = 0.002), and postoperative hematoma (10.9%/2.3%, p = 0.108). Additionally, Group A had one permanent vocal cord palsy, four permanent hypocalcemia, and one thyroid storm, whereas none of Group B had these complications. Group B patients with EBDs had a significantly better pitch range (p = 0.015) and jitter (p = 0.035) than those without EBDs. To reduce the major complications rate, inexperienced thyroid surgeons should remain vigilant when performing TT for Graves’ disease. Updates on surgical concepts and the effective use of operative adjuncts are necessary to improve patient safety and voice outcome.

Objective and subjective evaluation of Velopharyngeal Dysfunction (VPD) following surgical repair of the cleft palate using the furlow palatoplasty - A new tool

Velopharyngeal dysfunction (VPD) diagnosis and speech surgery outcomes are currently based solely on subjective evaluation criteria consisting of perceptual speech assessment and functional imaging. This study describes an objective and comparable method in VPD assessment and investigates the concurrence between the objective and subjective evaluations. The present study included 20 paediatric patients presenting with VPD after primary repair (intravelar veloplasty) of cleft palate. Our protocol was based on computerized analysis of voice parameters by means of an objective tool, spectrography integrated with Multi-Dimensional Voice Program (MDVP). The protocol also included perceptual evaluation by speech therapist and phoniatrician (consensus listening), and parents. This is a single surgeon, single centre experience and all patients underwent a secondary Furlow's palatoplasty. Assessments were performed pre- and postoperatively and upon completion of speech therapy. Results were compared using the two-tailed t student test for paired data. Statistical significance was set for p-values <0.05. Data analysis confirmed an improvement in velopharyngeal closure after surgery and speech therapy consistently with the results of perceptual evaluations. The results of the study confirmed the availability and reliability of an objective method for VPD evaluation based on the analysis of voice parameters with investigations that are simple and easily available in a hospital setting.

Voice in Parkinson's Disease: A Machine Learning Study.

IntroductionParkinson's disease (PD) is characterized by specific voice disorders collectively termed hypokinetic dysarthria. We here investigated voice changes by using machine learning algorithms, in a large cohort of patients with PD in different stages of the disease, OFF and ON therapy.MethodsWe investigated 115 patients affected by PD (mean age: 68.2 ± 9.2 years) and 108 age-matched healthy subjects (mean age: 60.2 ± 11.0 years). The PD cohort included 57 early-stage patients (Hoehn &Yahr ≤ 2) who never took L-Dopa for their disease at the time of the study, and 58 mid-advanced-stage patients (Hoehn &Yahr >2) who were chronically-treated with L-Dopa. We clinically evaluated voices using specific subitems of the Unified Parkinson's Disease Rating Scale and the Voice Handicap Index. Voice samples recorded through a high-definition audio recorder underwent machine learning analysis based on the support vector machine classifier. We also calculated the receiver operating characteristic curves to examine the diagnostic accuracy of the analysis and assessed possible clinical-instrumental correlations.ResultsVoice is abnormal in early-stage PD and as the disease progresses, voice increasingly degradres as demonstrated by high accuracy in the discrimination between healthy subjects and PD patients in the early-stage and mid-advanced-stage. Also, L-dopa therapy improves but not restore voice in PD as shown by high accuracy in the comparison between patients OFF and ON therapy. Finally, for the first time we achieved significant clinical-instrumental correlations by using a new score (LR value) calculated by machine learning.ConclusionVoice is abnormal in early-stage PD, progressively degrades in mid-advanced-stage and can be improved but not restored by L-Dopa. Lastly, machine learning allows tracking disease severity and quantifying the symptomatic effect of L-Dopa on voice parameters with previously unreported high accuracy, thus representing a potential new biomarker of PD.