Voice Quality In Patients Research Articles

Nasal resonance changes after endoscopic endonasal transsphenoidal skull base surgery: Analysis of voice quality.

ObjectivesTo study the effect of endoscopic endonasal transsphenoidal surgery on voice quality in patients with pituitary lesions.MethodsAn observational study comparing voice quality before and after surgery was conducted between September 2015 and September 2017 at Srinagarind Hospital, Khon Kaen University, Thailand. Pituitary tumor patients who underwent endoscopic endonasal transsphenoidal surgery were recruited. The nasal corridors were created with a type I (preserving both middle turbinates with a rescue flap) or type II (cutting one middle turbinate with a raised nasoseptal flap) for the binostril with four‐hand technique. All patients were evaluated for nasal resonance, acoustic parameters, acoustic perception, and self‐assessment of their satisfaction with postoperative voice changes with a visual analog scale (VAS). The patients were evaluated 1 day before surgery and at 1 and 3 months after surgery.ResultsForty‐four patients, including 19 males and 25 females with a mean age of 50.0 ± 15.6 years, were enrolled. Mean scores for nasal resonance and all acoustic parameters were not significantly changed after surgery for either nasal corridor type (p > .05). Regarding acoustic perception, word and sentence and GIRBAS scores showed no significant difference before and after surgery (p > .09) in either type of nasal corridor. There was no incidence of hypernasality voice after surgery. Patients' self‐satisfaction ratings (i.e., VAS) with voice quality were high and showed no significant change 1 and 3 months postsurgery (p > .05).ConclusionsThese endoscopic endonasal transsphenoidal approaches are minimally invasive skull base surgery techniques that have minimal effects on postsurgery voice quality.Trial RegistrationThis trial was registered at ClinicalTrial.gov (NCT02828514).Level of Evidence4.

Acoustic and perceptual analysis of voice quality in patients with puberphonia before and after vocal therapy

Acoustic and perceptual analysis of voice quality in patients with puberphonia before and after vocal therapy

Acoustic and perceptual analysis of voice quality in patients with puberphonia before and after vocal therapy

Acoustic and perceptual analysis of voice quality in patients with puberphonia before and after vocal therapy

Effect of Ketogenic Diet Versus Regular Diet On Voice Quality Of Patients with Parkinson’s Disease

Purpose: Diets which have influence on wellness could alter in their structure. Apart from weight control, different diets are used in the treatment of many diseases. Ketogenic diet(KD) has been ventured to remedy of neurological diseases and obesity. Multiple sclerosis(MS) is a complex progressive disease of the central nervous system and it has an influence on quality of voice. Voice Handicap Index (VHI) is an assay that presents data to clinical and physiological appraisal about voice. We measured the effect of KD and RD on voice quality(VQ). Methods: Sixty-eight subjects with MS who narrated a voice disorder associated to their disease were indiscriminately distributed to the KD or regula diet(RD) groups. We studied the VHI alter of patients before and 3 months after diet. Results: Sixty-five MS subjects accomplished the study. Baseline VHI rates did not diverge seriously between groups. In the KD group, statistically improvement was seen in all VHI parameters 3 months after diet (p˂ 0.001). Conclusion: Presently there are many therapies that aim speech and voice disorders in patients with MS. As such KD may be an option therapy to renovate VQ of patients with MS. A bigger sample size is required to find the function and pathophysiology of KD on VQ of MS patients.

Impact of Ketogenic Diet Versus Regular Diet on Voice Quality of Patients with Multiple Sclerosis

Impact of Ketogenic Diet Versus Regular Diet on Voice Quality of Patients with Multiple Sclerosis

Does neuromonitoring affect voice quality in patients subjected to a complete thyroidectomy ?

Voice dysfunction is the most common complication of thyroid surgery. The use of intraoperative neuromonitoring (IONM) is to protect the recurrent laryngeal nerves, the damage of which causes voice dysfunction. The aim of the study was to evaluate voice quality in patients who underwent complete thyroidectomy operated on with the application of IONM as well as a group of patients operated on with only macroscopic nerve visualization. In the analysis, clinical voice assessment was performed with particular focus on voice efficiency using the Voice Handicap Index (VHI), Vocal Tract Discomfort (VTD) and GRBAS scale. The study group consisted of 205 patients operated on with IONM. The control group consisted of 162 patients subjected to surgery only with macroscopic visualization of recurrent laryngeal nerves, without IONM. During the follow-up period from 2 to 10 years after surgery, checkups were performed. Each patient who came for a checkup was subjected to perceptual voice evaluation with the use of the GRBAS scale, indirect laryngoscopy procedure and voice selfevaluation with two questionnaires (VHI and VTD). The frequency of vocal fold palsy did not differ significantly statistically in the study group and the control group. Both in the study group and in the control group, patients with vocal fold paralysis had statistically significantly higher results in the VHI and VTD questionnaires as well as in the GRBAS study. Patients with recurrent laryngeal nerve injury show significant differences in the scope of voice handicap, both in the voice quality assessment with the use of the GRBAS scale, and self-evaluation questionnaires: VHI and VTD. All voice disorders evaluated with self-assessment are medium voice disability.

Effect of mobile-based voice therapy on the voice quality of patients with dysphonia

Effect of mobile-based voice therapy on the voice quality of patients with dysphonia

Voice Quality and Laryngeal Findings in Patients With Suspected Lung Cancer

ObjectiveTo describe laryngeal findings and voice quality in patients with suspected lung cancer, relative to voice quality and possible laryngeal pathology.Study DesignProspective cohort study.SettingTertiary care center.MethodsPatients with known or suspected lung cancer were approached before planned thoracic surgery, and they completed acoustic analysis, the Voice‐Related Quality of Life (V‐RQOL) questionnaire, and stroboscopy. The prevalence of dysphonia, V‐RQOL and Cepstral Spectral Index of Dysphonia (CSID) scores, and laryngeal findings were examined and compared between patients ultimately found to have lung cancer and those without cancer.ResultsSixty‐one patients (45 cancer, 16 noncancer) were analyzed. Patients with cancer were older than those without (mean ± SD, 72.3 ± 9.94 vs 62.6 ± 9.30 years; P =. 001). Otherwise, the distribution of stroboscopy findings, acoustic measures, and self‐reported voice handicap were similar between the cancer and noncancer cohorts. Prior to surgery, no patients had vocal cord paralysis or obvious neoplasm, though 4 (6.56%) had leukoplakia and 28 (45.9%) had vocal fold movement asymmetry on stroboscopy. Overall, 21 patients (35.0%) had average CSID scores >19, and 13 (21.7%) had CSID scores >24; however, only 4 self‐described their voice as not working as it should, and only 2 had a V‐RQOL score <85.ConclusionPatients with suspected lung cancer have moderate dysphonia on acoustic measures, though self‐reported impact on quality of life is low. While leukoplakia was seen in 4 patients, obvious neoplasm and occult paralysis were not seen in this cohort. Together, these findings suggest that patients with suspected lung cancer should be assessed for subjective voice dysfunction, but routine laryngeal screening may otherwise be unnecessary.

Laryngeal and Voice Disorders in Patients with Pulmonary Tuberculosis.

Introduction:Laryngeal tuberculosis (LTB) is the most frequent granulomatous disease of the larynx. The aim of the present work was to study the laryngostroboscopic features and voice quality of patients with laryngeal TB secondary to pulmonary TB.Materials and Methods:Participants were 35 patients diagnosed as having pulmonary TB and dysphonia. All patients had a complete history, clinical and laboratory workup. Patients were assessed using a protocol of voice assessment which included Auditory-perceptual analysis of voice, voice analysis using the Multidimensional Voice Profile (MDVP), and laryngostroboscopy. Results:The participants were 24 males and 11 females and their mean age was 43.7 years. The voice acoustic analysis revealed a significant difference from normal in jitter percent, shimmer percent, and harmonic to noise (H/N) ratio. Laryngeal gross lesions were found in 11 patients while the other 24 patients had normal laryngoscopic findings with nonspecific stroboscopic changes as reduced mucosal waves and mild glottic gap. Diffuse lesion of the whole vocal folds was found in 5 patients and anterior predilection in 4 patients. The type of lesions were granulomatous lesions in 7 patients and non-specific inflammatory mild exophytic lesions in 4 patients. Conclusions:Voice disorders in pulmonary TB include disturbance in the mechanism of voice production with or without detectable laryngeal lesion. Videostroboscopy has the advantage of showing the extension of laryngeal involvement, vocal folds vibrations, and mucosal waves.

Acoustic parameters for the evaluation of voice quality in patients with voice disorders.

To investigate the value of the standard deviation of the fundamental frequency (F0 SD), jitter, and shimmer for the evaluation of voice quality and the description of vocal characteristics in patients with voice disorders. This prospective cohort study included 4 groups: vocal cord polyps (VCP) group (n=55), early-stage (stage I-II) laryngeal carcinoma (ELC) group (n=35), mutational falsetto (MF) group (n=17), and a normal control group (n=29). The participants were asked to emit a sustained vowel /a/ and raise the pitch gradually. Acoustic parameters, including F0, F0 SD, jitter, and shimmer, were recorded and analyzed. The F0 SD was highest in the MF group. The F0 SD in the MF group and the ELC group was significantly higher than that in the VCP group and the control group (P<0.05), and the F0 SD in the VCP group was significantly higher than that in the control group (P<0.05). However, there was no significant difference in F0 SD between the MF group and the ELC group (P>0.05). The jitter and shimmer in the ELC group were significantly higher compared to the other groups (P<0.05), and the jitter and shimmer in the VCP group were significantly higher than those in the MF group and the control group (P<0.05). There were no significant differences in jitter or shimmer between the MF group and the control group (P>0.05). F0 SD, jitter, and shimmer are important parameters for the evaluation of pitch variation during sustained phonations, and can discriminate between MF and voice disorders.

Influence of Tracheal stenosis on Vocal Fold Vibration: A case report

Objectives: Patients with laryngotracheal stenosis (LTS) suffer from various problems such as dyspnea, stridor, intolerance of a speaking valve or inability of tracheostomy decannulation. The impact of LTS on the voice has been poorly understood and studied, particularly in adults. There has been no detailed qualitative or quantitative data about voice quality in patients with LTS. This case report presents tracheal stenosis with stridor and dysphonia with abnormal patterns of vocal fold vibration.Case Report: We report a female patient with post-tracheostomy tracheal stenosis presented with moderate stridor and dysphonia due to an atypical pattern of vibration, which has been reversed after balloon tracheal dilatation using rigid bronchoscopy. The case showed marked improvement after dilatation in respiratory distress, dyspnea and the voice quality as evidenced subjectively by Auditory Perceptual Assessment (APA) and objectively by acoustic analysis.Conclusion: Tracheal stenosis affects the mechanism of vocal fold vibration, which is reversed after tracheal dilatation with subsequent improvement of vocal fold vibration.

Proposal for a Core Outcome Set of Measurement Instruments to Assess Quality of Voice in Adductor Spasmodic Dysphonia Based on a Literature Review

Uniform evaluation of treatment effect on the quality of voice in adductor spasmodic dysphonia (AdSD) is challenging due to the broad variety of available outcome measurement instruments (OMIs). The European Laryngological Society categorized five types of measurement domains for voice quality evaluations: patient-reported outcome measures, perceptual analyses, acoustic analyses, visual analyses, and aerodynamic measurements. The aim of this study was to propose a core outcome set (COS) for these domains, enabling systematic assessments of treatment effects on the quality of voice in patients with AdSD. The PubMed, Embase, and Cochrane databases were searched for eligible studies published before July 2019. The results were systematically analyzed following the protocol of the COnsensus-based Standards for the selection of health Measurement INstruments/Core Outcome Measures in Effectiveness Trials initiative. The proposed COS is based on the prevalence of OMIs, quality of the included studies, criteria for good measurement properties, and correlations to other OMI domains. A total of 76 articles were included, with nearly all studies and OMIs found to be of moderate or low quality. The 19 studies that reported on the correlation of OMIs demonstrated conflicting results. Appraising the best available evidence, our proposed COS consisted of patient-reported outcome measures (voice handicap index), perceptual measurements (grade, roughness, breathiness, strain, and voice breaks) and acoustic measurements (voice breaks, voice onset time, aperiodicity, and multiparameter algorithms). A review of OMIs evaluating treatment effects in AdSD was conducted. Based on this review, a uniform COS was proposed. However, evidence for the selected instruments was limited. Further exploration into the validity and reliability of OMIs for AdSD is recommended.

The effect of tonsillectomy on voice quality

Introduction/Objective. Tonsillitis is a very common condition found in the pediatric population but also in adult patients. One of the consequences of such conditions is poor voice quality. Hoarseness, poor voice impostation, interruption, and hypernazalization are just some of the differences in patient voice quality. The objective of this paper was to examine the effects of tonsillectomy on the voice quality. Methods. The sample included 37 patients, 17 female and 20 male, ranging in age 3?39 years. The method involved recording patients one month before and one month after tonsillectomy with a digital sound recorder, with recordings analyzed in the Praat program. The variables monitored in the basic voice were as follows: voice pitch, standard deviation of voice, degree of voice interruption, jitter, shimmer, and signal-to-noise ratio. In the statistical analysis, in addition to standard descriptive analyzes, t-test and ACNOVA were also used. Results. The results showed that there are effects of tonsillectomy on standard deviation of baseline voice (p = 0.002), shimmer (p = 0.002), baseline voice interruption rate (p = 0.023), signal to noise ratio (p = 0.003). There were no differences in the effects of tonsillectomy with respect to the sex of the subjects. Conclusion. Based on the conducted research, there were some methodological conclusions that could be considered as a recommendation for future research: increase the number of persons in the sample, introduce a variable of chronological age, type of surgical intervention, and gradation of size of the tonsil and adenoid tissue.

Evaluation of Voice Quality in Patients With Vocal Fold Polyps: The Size of a Polyp Matters or Does it?

ObjectiveThis study aimed to investigate the correlation between morphological features of vocal fold polyps (VFPs) and subjective/objective voice parameters. MethodsPerceptual evaluations, aerodynamic and acoustic tests were performed on 47 patients with VFPs. Still images were captured from video and the morphological features associated with the size of VFP were quantified. To reveal the correlation between size-related morphological features (length of polyp base, the ratio of polyp base to vocal fold length, glottal gap area) and objective/subjective parameters of voice, Pearson's and Spearman's tests were carried out. ResultsThis cohort was composed of 30 (63.8 %) male and 17 (36.2%) female patients with the mean age of 45.2 years and 41.3 years, respectively. No correlation was found between the morphological features of VFPs and any of perceptual, aerodynamic and acoustic voice parameters. ConclusionsOur findings indicated that controversies still exist regarding the role of vocal fold polyp morphology in clinical decision making.

Electroglottographic and acoustic analysis of voice in children with vocal nodules

PurposeVocal fold nodules are usually caused by voice overuse or vocal hyperfunction, and their symptoms include persistent hoarseness – a disturbance in the vocal fold vibrations which results in a turbulent passage of air in the glottis, manifested as a raspy, rough voice. The aim of the study was to present data concerning voice quality in patients with vocal nodules and to compare electroglottographic analysis (EGG) with acoustic analysis. MethodsThe study examined 57 children with vocal fold nodules (Group 1). Each patient underwent a phoniatric evaluation of the vocal tract, a videolaryngoscopic examination, and a voice quality assessment, employing electroglottographic and acoustic analyses. The control group consisted of 37 healthy children (Group 2). The following parameters were analyzed: Closed Quotient (EGG signal), Peak Slope, Normalized Amplitude Quotient and Cepstral Peak Prominence (acoustic signal - waveform). ResultsChanges in the EGG signal could be detected in 95% of the patients with vocal nodules, indicating the occurrence of vocal nodules and glottal insufficiency. The acoustic analysis confirmed breathy phonation in 63% of the patients. The Closed Quotient parameter proved to be more effective than Peak Slope. Closed Quotient, Peak Slope and Normalized Amplitude Quotient allowed for the differentiation of the EGG signal and the acoustic signal in groups 1 and 2 in a statistically significant way. ConclusionsThe results of electroglottographic and acoustic analysis show incorrect voice parameters in patients with vocal nodules with reference to the control group. At the same time, the EGG analysis proved to be more effective than the analysis of the acoustic signal.

Auditory-Perceptual Evaluation of Deep Brain Stimulation on Voice and Speech in Patients With Dystonia

To determine the effects of globus pallidus interna (GPi) deep brain stimulation (DBS) on speech and voice quality of patients with primary, medically refractory dystonia. Voices of 14 patients aged ≥18 years (males = 7 and females = 7) with primary dystonia (DYT1 gene mutation dystonia = 4, cervical dystonia = 6, and generalized dystonia = 4) with bilateral GPi DBS were assessed. Five blinded raters (two fellowship-trained laryngologists and three speech/language pathologists) evaluated audio recordings of each patient pre- and post-DBS. Perceptual voice quality was rated using the Grade, Roughness, Breathiness, Asthenia, and Strain scale and changes in speech intelligibility were assessed with the Clinical Global Impression scale of Severity instrument. Inter-rater and intrarater reliability rates for perceptual voice ratings were assessed using the kappa coefficient. Voice quality parameters showed mean improvements in Grade (P < 0.0001), Roughness (P = 0.0043), and Strain (P < 0.0001) 12 months post-DBS. Asthenia increased from baseline to 6 months (P = 0.0022) and declined significantly from 6 to 12 months (P = 0.0170). Breathiness did not change significantly over time. Speech intelligibility also improved from 6 to 12 months (P = 0.0202) and from pre-DBS to 12 months post-DBS (P = 0.0022). Grade and Strain ratings had nearly perfect and substantial inter-rater agreement (0.84 and 0.71, respectively). Voice and speech intelligibility improved after bilateral GPi DBS for dystonia. GPi DBS may emerge as a potential treatment option for patients with medically refractory laryngeal dystonia.

Impact of speech therapy on the improvement of voice quality in patients with unilateral vocal fold paralysis

Aim of study: Evaluation of the speech therapy on voice quality in patients with unilateral vocal fold palsy. Material and methods: The study group included 11 patients, 8 women and 3 men, in age between 16 to 72 years, with unilateral vocal fold palsy, diagnosed in ENT Department of Warsaw Medical University between 2017-2018. Each person completed questionnaires: the voice disability self-assessment scale (VHI), the voice-based quality of life (VRQoL) scale, the vocal tract discomfort scale (VTD). All questionnaires were completed twice, before and after the voice therapy. In addition, the acoustic analysis of the voice, the assessment of the maximum phonation time and the breathing tract were performed twice in each patient. Each of the patients had a voice rehabilitation consisting of a series of 10 meetings. Results: Statistical analysis of the results of maximum phonation time, the self-assessment of voice disability, the quality of life depending on the voice, discomfort of the vocal tract voice acoustic analysis showed statistically significant differences in the results before and after rehabilitation (p &lt;0.005). In addition, the improvement of the respiratory tract was observed in the majority of patients. Conclusions: Speech therapy significantly affects the voice quality of patients with unilateral laryngeal nerve palsy.

Follow-up analysis of voice quality in patients with late-onset Pompe disease

BackgroundLate-onset Pompe disease (LOPD) is a metabolic myopathy disorder characterized by progressive muscle damage and among others dysfunction of the voice apparatus, which affects speech and – above all – voice quality. Symptoms include dysphonia, instability, glottic insufficiency, and tense voice. The aim of this study was to evaluate and compare voice quality disorder in a group of 15 LOPD patients who were first examined in 2014 and then re-examined in 2017.MethodsIn both 2014 and 2017, the same 15 LOPD patients, ranging in age from 15 to 57, from 10 different families, underwent the following examinations: perceptual assessment of voice quality on the RBH scale, electroglottographic recordings, and acoustic recordings. All the patients were on enzyme replacement therapy (ERT).ResultsThree years after the 2014 study, the LOPD patients demonstrated a deterioration in voice quality. A statistically significant increase in glottic insufficiency (p = 0.0399) and a shift towards tense voice (p = 0.0417) were observed. Two patients – out of three who had received presymptomatic treatment – demonstrated stable voice quality compared with 2014.ConclusionsThe results suggest increased muscle weakness and progression of LOPD. The parameters Closed Quotient (calculated on the basis of an electroglottographic signal) and Peak Slope (calculated on the basis of an acoustic signal) proved to be the most sensitive.

Assessment of health-related quality of life (HRQoL) in patients with spasmodic dysphonia

Background: There is paucity of literature regarding health related quality of life in Spasmodic Dysphonia (SD) especially from India. This study assessed HRQoL in it’s global and disease specific aspect by previously validated instruments in patients with SD.Methods: The study was performed in AIIMS, New Delhi. Subjects with SD as well as age and gender matched healthy controls were enrolled from Movement Disorder and botulinum toxin clinic, Department of Neurology, AIIMS, New Delhi. Uneducated patient, those could not read questionnaires &amp; cases who had received botulinum toxin within 6 months were excluded from the study. Each patient filled SF-36, BDI, VoiSS-30 and VPQ questionnaire.Results: 14 pts of Spasmodic Dysphonia (SD) were enrolled. Compared with controls SD patients suffered from statistically significant impaired global health related quality of life (SF36) in areas of role physical (p = 0.007), general health (p = 0.004), social functioning (p = 0.024), role emotion (p = 0.008) and mental health (p=0.039). Patients with SD scored much worse in BDI scale than their control group (12.57±8.0 vs. 4.71±5.0, p=0.005). 65% pt of SD had depression out of whom 14% had moderate depression. SD patient group showed statistically significant impaired scores in disease-specific QOL (VoISS) in 2 out of 3 subscales, impairment (p= &lt;0.001) and emotional (p=&lt;.001) but not in physical (p=0.44). Voice quality of patients with SD was severely affected compared to controls (mean 37± 8.0 vs. 12.9± 1.5).Conclusions: This study clearly demonstrated that patients with SD suffered from significant impairment in HRQoL as compared to controls. Higher proportion of patients with SD suffered from mild to moderate depression compared to their control.

Detection of voice changes due to aspiration via acoustic voice analysis

ObjectiveAspiration can occur during swallowing. The present study investigated the feasibility of identifying aspiration risk (AR) via acoustic voice parameters. Materials and methodsIn total, 165 patients scheduled for a videofluoroscopic swallowing study (VFSS) were included. The patients were divided into two groups (AR and non-AR) based on their VFSS results. The AR group, which had ingested materials on or below the vocal folds, included 59 patients (42 males and 17 females). The non-AR group, which showed normal swallowing, included 106 patients (49 males and 57 females). The major cause of swallowing disorders was a stroke. A sustained vowel/a/for at least 3s was recorded before and after swallowing. Eight acoustic voice parameters were measured using PRAAT, including fundamental frequency, standard deviation of F0, jitter, relative average perturbation (RAP), shimmer, amplitude perturbation quotient (APQ), harmonic-to-noise ratio (HNR), and noise-to-harmonic ratio (NHR). Changes in each acoustic voice parameter before and after the VFSS were compared between the two groups with a repeated-measures mixed analysis of variance. ResultsOnly RAP showed a statistically significant interaction between group (non-AR and AR) and time (pre- and post-swallowing; p=0.030). RAP decreased after swallowing in the AR group; however, it increased in the non-AR group. Jitter and NHR increased in the non-AR group but decreased in the AR group after swallowing, but the difference was not statistically significant. ConclusionsOur results suggest that the accumulation of pasty food in the vocal folds may modify vocal fold vibration and change voice quality in patients with penetration/aspiration. Several acoustic voice parameters, especially jitter, RAP, and NHR, were affected by AR. Thus, acoustic voice analysis may be helpful in making a diagnosis of AR as a supplementary tool for standard swallowing study including VFSS or fiberoptic examination.