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Journal of Voice : Official Journal of... Mar 2023To analyze voice outcomes and lesion regression in patients with vocal fold polyps treated in-office using lasers. (Review)
Review
OBJECTIVES
To analyze voice outcomes and lesion regression in patients with vocal fold polyps treated in-office using lasers.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
The search was performed in the Medline, Embase, and Cochrane databases using the preferred reporting items for systematic review and meta-analyses framework. There were no limitations to the year of publication and the search included studies looking at voice outcomes and lesion evolution of in-office laser treatment for vocal fold polyps measured through voice-handicap index, GRB, acoustic analysis or aerodynamics measures. Risk of bias was assessed using Cochrane's ROBINS-I tool for observational studies. Data analysis was performed SPSS software with a significance level of 5%.
RESULTS
We identified 167 articles, 10 of which met the inclusion criteria and were analyzed. The total number of participants was 242. Meta-analysis showed significant improvement in voice handicap index-10 scores (95% CI, [0.86; 1.45]) and decrease in GRB score (95% CI, [1.09; 4.13]) after in-office laser therapy. It also showed significant improvement in percent shimmer (95% CI, [0.26; 1.01]), and significant increase in maximum phonation time (95% CI, [-0.92; -0.18]).
CONCLUSIONS
Laser therapy an outpatient office setting is a reliable alternative to classical phono-microsurgery. Results show Office-based laser therapy of vocal fold polyps results in a significant improvement in subjective voice outcomes measures. This subjective improvement in voice quality is associated with partial or complete disease regression on laryngeal examination and an increase in maximum phonation time. Ovlaryngeal examination in patients with polyps treated with in-office laser.
PubMed: 37003865
DOI: 10.1016/j.jvoice.2023.03.003 -
Journal of Voice : Official Journal of... May 2022Voice complaints associated with menopause have been reported by a substantial number of studies. However, to assess the clinical relevance of menopause to voice is... (Meta-Analysis)
Meta-Analysis Review
Voice complaints associated with menopause have been reported by a substantial number of studies. However, to assess the clinical relevance of menopause to voice is still difficult as the extent to which menopausal symptoms are reflected on voice metrics remains unclear. A comprehensive review and meta-analysis were carried out to identify voice-related metrics that change with menopause and to quantify the magnitude of those changes. Academic Search Premier, Medline, SciELO, Scopus, PubMed, and Web of Science were searched without restriction of publication year until January 2020. Cross-sectional studies comparing voice-related metrics between pre- and post-menopausal women were included. Studies assessing effects of hormonal-replacement therapy were excluded. Datasets with more than one publication were also disregarded. Methodological quality of included studies was assessed applying the Newcastle-Ottawa Scale for cross-sectional studies. Given the heterogeneous nature of the primary studies, random-effects models were applied to pool the estimates. Eight articles were considered eligible for meta-analyses, assessing the effects of menopause on 6 voice metrics: mean fundamental frequency (f), extracted from (1) speech and (2) from sustained vowel /a/; frequency perturbation measures (3) jitter, (4) shimmer and (5) noise-to-harmonics ratio; and (6) maximum phonation time. Both speech fundamental frequency and f for sustained vowel /a/ were found to be 0.94 and 1.18 semitones lower in post- as compared to pre-menopausal women, respectively. Although significant, the magnitude of these decreases is below the just noticeable interval difference and well above the cutting point for distinguishing female from male voices. No significant differences were found for jitter, shimmer, noise-to-harmonics ratio, and maximum phonation time. The evaluation of acoustic metrics that reflect a single aspect of voice production at a time may conceal the effects of hormonal shifts during menopause. In addition, several variables interplay during voice production and acoustical measures may constitute weak predictors of vocal folds' status, where changes associated to sex steroid hormones are most likely to occur.
Topics: Benchmarking; Cross-Sectional Studies; Female; Humans; Male; Menopause; Phonation; Speech Acoustics; Voice Quality
PubMed: 32660847
DOI: 10.1016/j.jvoice.2020.06.012 -
Journal of Voice : Official Journal of... Mar 2021Laryngeal contact granuloma is a disease of benign hypertrophic granulation tissue at the medial side of vocal process. Numerous studies of conservative and surgical...
OBJECTIVE
Laryngeal contact granuloma is a disease of benign hypertrophic granulation tissue at the medial side of vocal process. Numerous studies of conservative and surgical management have reported effectiveness, yet optimal treatment has not been standardized. We compared primary and secondary outcomes of conservative and surgical treatment using endoscopic grading, Voice Handicap Index-10 (VHI-10), maximum phonation time (MPT), and recurrence rate.
METHODS
We performed literature searches of MEDLINE, PubMed, and EMBASE from November 1985 to October 2017, with randomized controlled trials and case control studies of at least three months follow-up as the inclusion criteria. Outcomes included laryngoscopic findings, MPT, and VHI-10. Data regarding study design, outcome analysis, follow-up time, and disease remission were systematically collected.
RESULTS
A total of 1069 patients were abstracted from 19 papers. With conservative treatment, 98% of patients' laryngeal granuloma resolved within three months, and 84% for the surgical group. There was a decrease in VHI-10 of 2.69 (95% credible interval (CI) -9.52 to 3.82) and 6.48 (95% CI -15.00 to 1.94) for conservative and surgical management, respectively. MPT improvement was 1.27 s (95% CI: 2.03-5.84) for conservative treatment and 5.02 s (95% CI: 0.78-8.07) for surgical. For all 19 studies, absolute recurrence risk for control, conservative, and surgical measures were respectively 4%, 16%, and 29%.
CONCLUSIONS
Most patients treated conservatively or surgically alone responded to treatment, but conservative management was favored. VHI-10 and MPT improvement in surgical patients were noted, but only the latter was statistically significant. In regard to recurrence, conservative management had better outcome than surgical. Taken together, the results suggest that minimally symptomatic granulomas have higher response rate and lower recurrence risk when treated conservatively, while larger, symptomatic granulomas may favor surgical excision followed by medical management to reduce risk of recurrence.
Topics: Conservative Treatment; Granuloma; Granuloma, Laryngeal; Humans; Recurrence; Voice
PubMed: 31628044
DOI: 10.1016/j.jvoice.2019.08.019 -
Journal of Voice : Official Journal of... Nov 2017The study aimed to review the prevalence of self-reported voice disorders in singers. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The study aimed to review the prevalence of self-reported voice disorders in singers.
STUDY DESIGN
The study is a systematic review and meta-analysis.
METHODS
A systematic review of five major scientific databases was conducted. An extensive search strategy was used considering the rules of each database. Original articles were included only if they had data related to self-perception of dysphonia in the past. Furthermore, heterogeneity and its relative significance were assessed.
RESULTS
There were 2371 articles identified; duplicates were deleted, screenings were conducted, and inclusion and exclusion criteria were applied. The final analysis was conducted on 11 studies. The most implemented instruments for the study were customized questionnaires. The findings about singing styles, voice use, and age were found to be different among subjects. The overall prevalence of self-reported dysphonia in singers was 46.09% (95% confidence interval: 38.16-54.12). The heterogeneity was considerable among the studied samples (I = 90.59%). Four groups were then established-students, teachers, classical, and nonclassical-and compared regarding overall prevalence (21.76% in students, and significantly higher and nondifferent in the other three groups, 55.15%, 40.53%, and 46.96%, respectively) and heterogeneity (low only for the students' studies).
CONCLUSION
Although with low homogeneity, singers present a high prevalence of self-perceived dysphonia over their careers. Singing students were the group with a lower prevalence. On the other hand, traditional and popular music singers, as well as singing teachers, revealed significantly higher prevalence of self-perceived dysphonia. Overall, singers are likely to report voice disorders, no matter their singing style or skills. This highlights the need of a preventive approach to address voice disorders in traditional and untrained singers.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Auditory Perception; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Occupational Diseases; Occupational Health; Occupations; Prevalence; Risk Factors; Self Concept; Self Report; Singing; Voice Disorders; Young Adult
PubMed: 28342677
DOI: 10.1016/j.jvoice.2017.02.010 -
The Journal of Laryngology and Otology Nov 2023To evaluate the outcomes of reinnervation techniques for the treatment of adult unilateral vocal fold paralysis and bilateral vocal fold paralysis.
OBJECTIVE
To evaluate the outcomes of reinnervation techniques for the treatment of adult unilateral vocal fold paralysis and bilateral vocal fold paralysis.
METHODS
A literature review was conducted in the Embase and Medline databases in English, with no limitations on the publication date. The outcome parameters of interest included visual, subjective perceptual, acoustic, aerodynamic analysis and electromyography. A meta-analysis with a random-effects model and inverse variance was calculated.
RESULTS
The systematic Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach resulted in 27 studies, totalling 803 patients (747 unilateral cases and 56 bilateral cases). Thyroid cancer and/or surgery had caused unilateral vocal fold paralysis in 74.8 per cent of cases and bilateral vocal fold paralysis in 69.6 per cent of cases. Statistically significant improvements in patients were observed for voice, deglutition and decannulation (bilateral vocal fold paralysis). Meta-analysis of 10 reinnervation techniques was calculated for the maximum phonation time of 184 patients.
CONCLUSION
Reinnervation was shown to improve voice, swallowing and decannulation, but studies lacked control groups, limiting generalisability. Larger studies with controls are needed.
PubMed: 37982255
DOI: 10.1017/S0022215123001950 -
Journal of Voice : Official Journal of... Feb 2022To analyze the effect of phonation in a glass tube immersed in water compared to other interventions on general degree of vocal deviation, fundamental frequency, sound... (Review)
Review
The Effect of Phonation into a Glass Tube Immersed in Water Compared to Other Interventions on General Degree of Vocal Deviation, Fundamental Frequency, Sound Pressure Level, and Vocal Self-assessment in Vocally Healthy Individuals: A Systematic Review and Meta-analysis.
OBJECTIVE
To analyze the effect of phonation in a glass tube immersed in water compared to other interventions on general degree of vocal deviation, fundamental frequency, sound pressure level, and vocal self-assessment in vocally healthy individuals.
METHODS
This is a systematic review and meta-analysis developed from the research question: "In vocally healthy individuals, what is the effect of phonation into a glass tube immersed in water versus other vocal interventions, other activities, or no intervention on general degree of vocal deviation, fundamental frequency, sound pressure level, and vocal self-assessment?" An electronic search was performed using Medline, LILACS, Cochrane Library, Embase, Web of Science, and SCOPUS databases, and a manual search was performed in the gray literature (Brazilian Digital Library of Theses and Dissertations and OpenGrey), the Journal of Voice, and the citations of the studies. Studies with (P) population of adults with healthy voices, (I) intervention with phonation into a glass tube immersed in water, (C) comparison with other vocal interventions, other activities, or no intervention, (O) outcomes of the general degree of vocal deviation, fundamental frequency, sound pressure level, and vocal self-assessment, and an (S) study with the experimental or quasi-experimental design were included. Risk of bias assessment and meta-analysis of the outcomes were performed.
RESULTS
A total of 457 studies were found in the search; four were selected for the systematic review and meta-analysis. In the risk of bias assessment, there was an uncertain risk of selection and performance bias in 100% of the studies and uncertain risk of detection bias of 75%. All studies had an experimental design, and most of them were conducted on women. In the fundamental frequency analysis, there was no difference between the effect sizes of the interventions (z = 0.471, P = 0.638). In the vocal self-assessment, the estimated odds ratio was 1.31, showing a greater chance of improvement in the intervention group than with the comparison group (z = 3.45, P < 0.001). There were not enough studies to analyze the general degree of vocal deviation and sound pressure level outcomes.
CONCLUSION
Phonation into a glass tube immersed in water has a greater positive effect on vocal self-assessment than other interventions in vocally healthy individuals.
PubMed: 35193789
DOI: 10.1016/j.jvoice.2022.01.021 -
European Archives of... Jan 2018Esophageal speech (ES), tracheoesophageal speech (TES) and/or electrolarynx speech (ELS) are three speech rehabilitation methods which are commonly provided after total... (Review)
Review
BACKGROUND
Esophageal speech (ES), tracheoesophageal speech (TES) and/or electrolarynx speech (ELS) are three speech rehabilitation methods which are commonly provided after total laryngectomy (TL).
METHODS
A systematic review of the literature was conducted to evaluate comparative acoustic, perceptual, and patient-reported outcomes for ES, TES, ELS and healthy speakers.
RESULTS
Twenty-six articles could be included. In most studies, methodological quality was low. It is likely that an inclusion bias exists, many studies only included exceptional speakers. Significant better outcomes are reported for TES compared to ES for the acoustic parameters, fundamental frequency, maximum phonation time and intensity. Perceptually, TES is rated with a significant better voice quality and intelligibility than ES and ELS. None of the speech rehabilitation groups reported clearly better outcomes in patient-reported outcomes.
CONCLUSIONS
Studies on speech outcomes after TL are flawed in design and represent weak levels of evidence. There is an urge for standardized measurement tools for evaluations of substitute voice speakers. TES is the favorable speech rehabilitation method according to acoustic and perceptual outcomes. All speaker groups after TL report a degree of voice handicap. Knowledge of caretakers and differences in health care and insurance systems play a role in the speech rehabilitation options that can be offered.
Topics: Humans; Laryngectomy; Patient Reported Outcome Measures; Speech Intelligibility; Speech, Alaryngeal; Treatment Outcome; Voice Quality
PubMed: 29086803
DOI: 10.1007/s00405-017-4790-6 -
European Archives of... Sep 2022Transoral laser microsurgery (TOLMS) with carbon dioxide is a safe approach for laryngeal carcinoma. In literature there are three main methods for evaluating speech... (Review)
Review
PURPOSE
Transoral laser microsurgery (TOLMS) with carbon dioxide is a safe approach for laryngeal carcinoma. In literature there are three main methods for evaluating speech outcomes: acoustic and aerodynamics analysis, perceptual evaluation and patient-reported outcomes (PROs). The aim of this study was to systematically review the literature about the voice quality outcomes of TOLMS according to type of cordectomy.
METHODS
A systematic literature review was performed and all the results until December 2021 were extrapolated. We evaluated the acoustic and aerodynamics parameters (fundamental frequency, harmonics to noise ratio, jitter, shimmer and maximum phonation time), perceptual data (GRBAS scale) and patient-related outcomes (VHI scale).
RESULTS
24 studies met the inclusion criteria for a total number of 1207 patients enrolled. The number for each type of cordectomy are: 287 type I (23.78%), 311 type II (25.78%), 328 type III (27.14%), 129 type 4 (10.69%) and 152 type V (12.60%). Patients are grouped according to the type of cordectomy in: limited cordectomy (type I and II) and extended cordectomy (types III-IV-V). The difference between two groups is statistically significative in terms of acoustic analysis, perceptual data and patient-related outcomes (p < 0.05).
CONCLUSIONS
Patients who underwent type I or II cordectomy have significantly better quality of voice in terms of VHI, perceptual voice quality evaluations and acoustic parameters compared to type III, IV and V cordectomies. The effect of TOLMS on the voice should depend from the extent of the resection and in particular from the scar of the vocal muscle.
Topics: Carbon Dioxide; Glottis; Humans; Laryngeal Neoplasms; Laser Therapy; Lasers, Gas; Microsurgery; Retrospective Studies; Treatment Outcome; Voice Quality
PubMed: 35505113
DOI: 10.1007/s00405-022-07418-3 -
Journal of Voice : Official Journal of... May 2019The present study aimed to perform a systematic literature review to assess the effects of phonation therapy on voice quality and function in singers. The systematic...
The present study aimed to perform a systematic literature review to assess the effects of phonation therapy on voice quality and function in singers. The systematic search was performed in February and updated in October 2017. No restriction of year, language, or publication status was applied. The primary electronic databases searched were LILACS, SciELO, PubMed, and Cochrane. Kappa coefficient was used to assess the agreement between examiners in judging article eligibility. The eligible articles were analyzed based on their risk of bias using the tools proposed by the Joanna Briggs Institute. Mendeley Desktop 1.13.3 software package (Mendeley Ltd, London, UK) was used to standardize the references of identified articles. The general sample consisted of 1965 articles screened out of the electronic databases. Two examiners analyzed the sample in the search for eligible articles. The agreement between examiners reached excellent outcomes (kappa coefficient = 0.88). After the selection, phase 6 articles remained eligible. Together, the eligible studies accounted 141 subjects (65 men and 76 women) aged between 18 and 72 years old. Electroglottography was considered as the most common method (83.33%) of assessment of the effects of phonation therapy in singers. The most prevalent exercises within the therapies were phonation into straws and phonation into glass tubes. The phonation into glass tubes immersed in water, straws, and LaxVox tubes promoted positive effects on the voice quality in singers, such as more comfortable phonation, better voice projection, and economy in voice emission.
Topics: Adolescent; Adult; Aged; Electrodiagnosis; Female; Humans; Male; Middle Aged; Phonation; Singing; Treatment Outcome; Vocal Cords; Voice Quality; Voice Training; Young Adult
PubMed: 29731378
DOI: 10.1016/j.jvoice.2017.12.005 -
Journal of Voice : Official Journal of... Feb 2023Injectable laryngoplasty with hydroxyapatite and hyaluronic acid is frequently used for the treatment of glottic incompetence. The effectiveness of these substances is... (Review)
Review
BACKGROUND
Injectable laryngoplasty with hydroxyapatite and hyaluronic acid is frequently used for the treatment of glottic incompetence. The effectiveness of these substances is controversial due to the heterogeneity of studies.
OBJECTIVES
To evaluate the effectiveness of the treatment for glottic incompetence using hydroxyapatite and hyaluronic acid.
STUDY DESIGN
Systematic review and meta-analysis.
DATA SOURCES
MEDLINE, PUBMED, LILACS, SCOPUS, EMBASE, Cochrane, clinicaltrials.gov, published and unpublished trials, Web of Science.
ELIGIBILITY CRITERIA
Studies that evaluated vocal fold function before and after 4-6 weeks and 6 months of hydroxyapatite and hyaluronic acid injection in adults with glottic incompetence.
EXCLUSION CRITERIA
studies with outcome, follow-up time or type of intervention outside the predetermined pattern or systematic review and meta-analysis.
SYNTHESIS OF METHODS
Primary outcome - Maximum Phonation Time. Secondary outcomes - Voice Handicap Index (VHI)-30, Parameters G and B of GRBAS Scale. Outcomes were analyzed for mean differences with the corresponding 95% CI.
RESULTS
Six hundred forty-four studies identified, 12 included (5 CaHA; 6 HA; 1 HA and CaHA). After 4-6 weeks the mean difference were: MPT (+5.86), IDV (-39.32), G (-1.14), and B (-1.46). After 6 months: MPT (+5.97), IDV (-30.13), G (-1.33), and B (-1.33).
LIMITATIONS
Studies comparing injectable drugs are small, as well as the number of patients in each one, making the isolated comparison of substances difficult.
CONCLUSIONS AND IMPLICATIONS
There is an evidence that the injectable substances HA and CaHA are effective in the treatment of glottic incompetence, however, it is important that more studies are carried out comparing the two substances.
PubMed: 36804345
DOI: 10.1016/j.jvoice.2023.01.020