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Journal of Voice : Official Journal of... Jan 2023Bariatric surgery has been documented to improve comorbidities associated with obesity. Obesity can cause deposition of excess adipose tissue, narrowing of the vocal... (Review)
Review
OBJECTIVE
Bariatric surgery has been documented to improve comorbidities associated with obesity. Obesity can cause deposition of excess adipose tissue, narrowing of the vocal tract, and decreased lung capacity contributing to reduced vocal quality and increased vocal effort. Limited information is available regarding the impact of bariatric surgery on voice outcomes. This review seeks to examine the role of bariatric surgery on voice outcomes.
STUDY DESIGN
Systematic review.
METHODS
A systematic review was completed using PubMed and Embase for measures of vocal change before and after bariatric surgery. Studies were reviewed by three authors, and data related to acoustic, aerodynamic, auditory-perceptual, and patient-reported outcome measures were extracted.
RESULTS
Forty-nine abstracts were identified with seven meeting criteria for analysis. Voice outcomes pre and postbariatric surgery were measured across 122 individuals. Results revealed increased fundamental frequency (F) and increased maximum phonation time (MPT) during sustained vowel productions. Correlation coefficients for MPT for /a/ were -0.683 and -0.725 for F, respectively, indicating a strong negative correlation between body mass index and MPT and F. Trends toward improved auditory-perceptual ratings and improved patient-reported outcome measures were also noted. However, studies were limited by restricted patient demographics and limited use of standardized and/or comprehensive evaluation techniques.
CONCLUSION
Weight loss associated with bariatric surgery can result in improved voice outcomes; however, the mechanism by which it helps is unclear. To better understand this, otolaryngologists and speech-language pathologists may consider advocating for pre- and postsurgery voice evaluation in patients undergoing bariatric surgery.
PubMed: 36641252
DOI: 10.1016/j.jvoice.2022.12.019 -
Journal of Voice : Official Journal of... Jan 2017The study systematically reviews evidence-based frameworks for teaching and learning of classical singing training. (Review)
Review
OBJECTIVES/HYPOTHESIS
The study systematically reviews evidence-based frameworks for teaching and learning of classical singing training.
STUDY DESIGN
This is a systematic review.
METHODS
A systematic literature search of 15 electronic databases following the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines was conducted. Eligibility criteria included type of publication, participant characteristics, intervention, and report of outcomes. Quality rating scales were applied to support assessment of the included literature. Data analysis was conducted using meta-aggregation.
RESULTS
Nine papers met the inclusion criteria. No complete evidence-based teaching and learning framework was found. Thematic content analysis showed that studies either (1) identified teaching practices in one-to-one lessons, (2) identified student learning strategies in one-to-one lessons or personal practice sessions, and (3) implemented a tool to enhance one specific area of teaching and learning in lessons. The included studies showed that research in music education is not always specific to musical genre or instrumental group, with four of the nine studies including participant teachers and students of classical voice training only. The overall methodological quality ratings were low.
CONCLUSIONS
Research in classical singing training has not yet developed an evidence-based framework for classical singing training. This review has found that introductory information on teaching and learning practices has been provided, and tools have been suggested for use in the evaluation of the teaching-learning process. High-quality methodological research designs are needed.
Topics: Curriculum; Humans; Learning; Models, Educational; Singing; Students; Teaching
PubMed: 26804784
DOI: 10.1016/j.jvoice.2015.12.001 -
Journal of Voice : Official Journal of... Dec 2023Vocal fold fat injection is a technique for treating glottic insufficiency (GI) resulting from various conditions. The use of fat as a graft has several advantages over... (Review)
Review
UNLABELLED
Vocal fold fat injection is a technique for treating glottic insufficiency (GI) resulting from various conditions. The use of fat as a graft has several advantages over other grafts. Similar pliability, and vibratory characteristics as a normal vocal fold, not causing foreign body reactions, having the potential to contain stem cells, and often can be done in the office. Long-term results, however, are unpredictable. The objective of this study is to carry out a systematic review of published articles using the technique of fat injection in the vocal folds.
STUDY DESIGN
Systematic review.
REVIEW METHODS
A literature search was conducted utilizing the combination of the following keywords "vocal folds fat injection," "laryngoplasty," and "autologous fat injection vocal folds." The criteria inclusion of the study for the systematic review were based on PICOTS (population, intervention, comparison outcome, timing, and setting) and Preferred Reporting Items for Systematic Reviews and Meta-analyses statements. Outcomes reviewed included technique, study duration, perceptual and acoustic analysis, and quality of life preoperation and 1-year postoperation.
RESULTS
A systematic review on PubMed, Cochrane, and Embase databases included 13 studies analyzing the data of 472 patients, that had fat injection laryngoplasty for treatment of GI. The causes of GI varied substantially across studies. Considerable heterogeneity across studies was found, including technique for harvest, processing the fat, site of injection, and acoustic analysis. In the studies that measured maximum phonation time (MPT) there was a significant improvement in a follow-up of at least 1 year after the injection. The patient's perception of vocal quality, measured by the Voice Handicap Index, also showed significant improvement in several studies after fat injection laryngoplasty.
CONCLUSION
Fat injection laryngoplasty seems to be safe and effective for GI for at least 12 months. Multiple studies show favorable outcomes, but the lack of control groups, the heterogeneity in inclusion criteria, nonstandardized techniques, and objective voice evaluations limit this evaluation.
PubMed: 38142186
DOI: 10.1016/j.jvoice.2023.09.029 -
Journal of Voice : Official Journal of... Jan 2023The voice is an important marker of the transition process to the new gender identity of the transgender person. For 20% of patients seeking voice feminization, voice... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The voice is an important marker of the transition process to the new gender identity of the transgender person. For 20% of patients seeking voice feminization, voice therapy is not completely satisfactory, and surgery should be considered, with endoscopic glottoplasty being the current practice. While the increase in fundamental frequency (F0) after glottoplasty has been well described, no systematic review of the literature or meta-analysis regarding other acoustic parameters and quality of voice has been performed yet.
OBJECTIVE
To define the effect of endoscopic glottoplasty on acoustic measures and quality of voice by assessing F0, maximum phonation time (MPT), frequency range, and grade of dysphonia.
METHODS
A literature review was performed in Medline/PubMed, Cochrane, Science Direct, LILACS, and Google Scholar, following PRISMA guidelines, with no constraints on publication date. We included studies in English, Portuguese or Spanish that assessed transgender women who underwent endoscopic glottoplasty. All the included articles were measured in terms of their methodological quality.
RESULTS
The PRISMA approach yielded 14 studies, totaling 566 patients. There was significant heterogeneity between studies regarding follow-up time, surgical technique and perioperative care. Thirteen studies were submitted to meta-analysis. The results showed significant changes in pre- to postglottoplasty mean differences of F0 = 78.49 Hz (95%CI: 75.69-81.30), MPT = -1.11 seconds (95%CI -1.67 to -0.54), frequency range = -3.55 semitones (95%CI -5.74 to -1.36) and grade of dysphonia on the GRBAS scale = 0.44 (95%CI 0.27-0.61).
CONCLUSION
Glottoplasty is effective in significantly increasing fundamental frequency, but slightly decreases MPT, frequency range and vocal quality measured by the grade of dysphonia on the GRBAS scale.
Topics: Female; Humans; Male; Acoustics; Dysphonia; Gender Identity; Transsexualism; Voice; Larynx
PubMed: 33277130
DOI: 10.1016/j.jvoice.2020.11.005 -
Journal of Voice : Official Journal of... Jul 2023Caffeine is considered a dehydrating agent due to its diuretic effects and influences the body's fluid balance. The relationship between voice and hydration has been...
BACKGROUND
Caffeine is considered a dehydrating agent due to its diuretic effects and influences the body's fluid balance. The relationship between voice and hydration has been widely investigated and it is accepted that inadequate hydration has detrimental effects on phonation. Since dehydration negatively affects the vocal folds and caffeine is considered a dehydrating agent, it can be hypothesized that voice might be negatively affected by caffeine intake. This systematic review aims to summarize and appraise the available evidence regarding the effects of caffeine on voice.
METHODS
Randomized and non-randomized experimental studies of healthy participants were retrieved following an electronic searching of six databases in June 2020. No publication, language or date restrictions were applied. Data extraction of relevant data and risk of bias assessment was conducted independently by two reviewers.
RESULTS
Five non-randomized experimental studies were deemed eligible for inclusion. The format of the administered interventions in the included studies was either liquid (coffee) or solid (caffeine tablets). Reported outcome measures used to examine the effects of caffeine on phonation consisted of acoustic, aerodynamic and (auditory & self-) perceptual. No measures were adversely affected by caffeine consumption.
CONCLUSION
Clinicians commonly advise patients to refrain from caffeine, as caffeine intake increases diuresis with subsequent effects on fluid balance. Such imbalances can potentially induce dehydration which can be detrimental to phonation. This notion cannot be supported empirically, as the evidence is deemed unreliable and no firm conclusions can be elicited to guide clinical practice. The results of this review demonstrate the lack of research in the field and the necessity for future investigations in order to inform evidence-based practice through reliable and valid outcomes.
Topics: Humans; Caffeine; Voice Quality; Dehydration; Voice; Phonation; Randomized Controlled Trials as Topic
PubMed: 33752928
DOI: 10.1016/j.jvoice.2021.02.025 -
The Laryngoscope Jun 2024Adenotonsillectomy is one of the most common surgical procedures performed on children. Caregivers are often concerned about voice change after the procedure, and such... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Adenotonsillectomy is one of the most common surgical procedures performed on children. Caregivers are often concerned about voice change after the procedure, and such concerns remain unsettled. This meta-analysis analyzed voice change in children after adenotonsillectomy.
DATA SOURCES
The PubMed, Medline, EMBASE, and Cochrane databases.
REVIEW METHODS
The study protocol was registered on PROSPERO. Two authors independently searched for articles using keywords "adenoidectomy," "tonsillectomy, "voice," "nasalance,"and "speech." English articles specifying voice changes after adenotonsillectomy were pooled with standardized mean difference (SMD) using random-effects model. Evaluation methods were computerized acoustic voice analysis, aerodynamic analysis, nasometer, rhinomanometry, evaluations from a speech-language pathologist or otolaryngologist, and a caregiver assessment questionnaire.
RESULTS
Twenty-three studies with 2154 children were analyzed (mean age: 8.0 y; 58% boys; mean sample size: 94 children). Due to insufficient data for other outcome variables, this meta-analysis only summarized changes in the computerized acoustic voice analysis 1 month and 3 months after surgery. The computerized acoustic analysis revealed significant changes in jitter (SMD = -0.36; 95% confidence interval [CI]: -0.60 to -0.11), shimmer (SMD = -0.34; 95% CI: -0.57 to -0.11), and soft phonation index (SMD = -0.36; 95% CI: -0.57 to -0.15) at 1 month after surgery. Parameters including fundamental frequency, jitter, noise-to-harmonics ratio, and shimmer were not significantly changed at 3 months after surgery.
CONCLUSIONS
This meta-analysis observed small improvements in jitter, shimmer, and soft phonation index 1 month after surgery. No significant effects were observed in voice outcomes 3 months after surgery. Laryngoscope, 134:2538-2550, 2024.
Topics: Humans; Tonsillectomy; Adenoidectomy; Child; Voice Quality; Voice Disorders; Female; Male; Postoperative Complications
PubMed: 37909678
DOI: 10.1002/lary.31140 -
International Journal of Pediatric... Feb 2021To evaluate outcomes of injection laryngoplasty (IL) and laryngeal reinnervation for the treatment of pediatric Unilateral Vocal Fold Paralysis (UVFP), especially on... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate outcomes of injection laryngoplasty (IL) and laryngeal reinnervation for the treatment of pediatric Unilateral Vocal Fold Paralysis (UVFP), especially on swallowing and quality of voice.
METHODS
A literature review was performed in Medline/PubMed and Cochrane Library, following PRISMA guidelines, with no constraints on publication date. We included studies in English, Portuguese or Spanish about surgical treatment for UVFP on the pediatric population (0-21 years) that documented outcomes for one of the following techniques: IL or laryngeal reinnervation. Study characteristics, patient demographics, technical aspects of each procedure, complications, and outcomes for voice and swallowing were extracted. A meta-analysis with inverse variance, random-effects model was performed.
RESULTS
The PRISMA approach yielded 22 studies, totaling 267 patients. Seven reinnervation articles were included in meta-analysis for maximum phonation time (MPT) and quality of voice measured by Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) scale. Cardiac surgery had caused UVFP in 62.8% (142/226) of the cases. The main indication for IL was aspiration and for reinnervation was dysphonia. For IL, there was an improvement of 84.5% (confidence interval [CI] 82.6-88.4%) in swallowing and 81.4% (CI 74.6-88.1%) in voice. For reinnervation, there was an improvement of 91.6% (CI 88.2-94.9%) in swallowing and 96.8% (CI 95.5-98.0%) in voice. We found an increase of 6.19 s (CI 1.00 to 11.38) in MPT and a mean difference in GRBAS sum of -3.53 points (CI -6.15 to -0.91) after reinnervation.
CONCLUSION
Retrospective cohort studies suggest that injection laryngoplasty and reinnervation are both effective in improving swallowing and voice in children with UVFP. There was clinical evidence of improvement in the MPT and GRBAS scale meta-analysis in patients undergoing reinnervation.
Topics: Child; Dysphonia; Humans; Laryngoplasty; Retrospective Studies; Treatment Outcome; Vocal Cord Paralysis; Vocal Cords
PubMed: 33333340
DOI: 10.1016/j.ijporl.2020.110553 -
International Journal of... Feb 2017The purpose of this study is to systematically review the literature on resonant voice therapy and to evaluate the level of evidence on the effectiveness of using... (Review)
Review
PURPOSE
The purpose of this study is to systematically review the literature on resonant voice therapy and to evaluate the level of evidence on the effectiveness of using resonant voice therapy in treating dysphonia.
METHOD
Refereed journal papers from 1974 to 2014 were retrieved and reviewed by two independent reviewers using the keywords "Humming, Resonance, Resonant Voice, Semi-occluded or closed tube phonation" using available database systems. Quality of evidence was evaluated by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).
RESULT
Thirteen papers met the search criteria. Nine papers were selected by the two reviewers. Two of the papers were randomised-controlled studies and the other seven were observational studies. At least four types of resonant voice therapies were described. They included the Lessac-Madsen Resonant Voice Therapy, Y-Buzz, Resonance Therapy and Humming. The overall level of quality of evidence was graded as "moderate".
CONCLUSION
There were limited studies that investigated the effectiveness of resonant voice therapy. Most studies were small-scale uncontrolled observational studies with the inclusion of only small samples or specific populations. There is clearly a need for more large-scale randomised controlled studies with a wider range of populations to provide further evidence on the effectiveness of resonant voice training for different populations.
Topics: Dysphonia; Humans; Voice Training
PubMed: 27705008
DOI: 10.1080/17549507.2016.1226953 -
Cells Nov 2020Unilateral vocal fold paralysis (UVFP) is a common disorder that may cause glottal closure insufficiency and then hoarseness of voice and aspiration during swallowing.... (Meta-Analysis)
Meta-Analysis
Unilateral vocal fold paralysis (UVFP) is a common disorder that may cause glottal closure insufficiency and then hoarseness of voice and aspiration during swallowing. We conducted a systematic review and meta-analysis to evaluate whether hyaluronic acid (HA) injection laryngoplasty (IL) is an effective treatment for patients with UVFP. Comprehensive systematic searches were undertaken using PubMed, EBSCO Medline, and Cochrane Library databases. We appraised the quality of studies according to preset inclusion and exclusion criteria. The lengths of follow-up were divided into "short-term" (3 months or shorter), "medium-term" (6 months), and "long-term" (12 months or longer). We performed random-effect meta-analysis to estimate the changes in voice-related quality of life, perceptual evaluation by grading systems, voice lab analysis of maximal phonation time, and normalized glottal gap area, before and after HA IL. Fourteen studies were eligible for the final analysis. The results showed that patients' glottal closure insufficiency could be improved; maximal phonation time could be prolonged; perceptual evaluations of the voice and quality of life were better after HA IL, but the duration of treatment effect varied among different studies. In conclusion, HA IL is an effective treatment for UVFP, which may achieve a long-term effect and therefore reduce the likelihood of requiring permanent medialization thyroplasty.
Topics: Humans; Hyaluronic Acid; Injections; Laryngoplasty; Surveys and Questionnaires; Vocal Cord Paralysis; Vocal Cords
PubMed: 33167303
DOI: 10.3390/cells9112417 -
Scandinavian Journal of Pain Apr 2010Introduction Trismus, or limited mouth opening, is a well-known complication of head and neck cancer and its treatment. It may be caused by tumour infiltration into the...
Introduction Trismus, or limited mouth opening, is a well-known complication of head and neck cancer and its treatment. It may be caused by tumour infiltration into the masticatory muscles or by treatment like surgery and radiotherapy. A limited mouth opening may have a negative effect on nutrition, phonation, dental hygiene and treatment, and quality of life. The severity of this complication depends on the location of the tumour, the type of reconstruction, the total radiation dose, fractionation, and treatment techniques. If there is no intervention, these changes may be progressive and persist for life. There are no specific treatments for trismus. Current strategies emphasize prevention and, in instances of existing trismus, collaboration between health care professionals to establish pain control, prevent the progression of trismus, and restore function. The prevalence of trismus in head and neck cancer patients ranges from 5% to 38%. Despite numerous studies, reliable data on the aetiology of trismus and appropriate treatment for it are scarce. Case report We describe a patient with squamous cell carcinoma of the oropharynx who developed trismus after surgery and radiotherapy. A multidisciplinary treatment strategy including analgesics, regional blocks, hyperbaric oxygenation therapy, external dynamic bite opener and physiotherapy, increased the mouth opening from 5 mm to 22 mm, however, the patient still suffered from xerostomia and had problems with intake of solid food. Material and methods A systematic literature search (starting January 1., 1980, and ending June 1., 2009) was performed to identify evidence-based interventions for the treatment of trismus in head and neck cancer patients. A total of 244 articles were identified from the databases. Of these, eight were excluded because of the absence of an English abstract and 214 were excluded because they were of marginal relevance to the inclusion criteria. The remaining 22 articles were evaluated independently by two experts using the Scottish Inter-collegiate Guidelines Network criteria for quality and evidence. Results There were few studies of good methodological quality on this topic. Two systematic reviews and two RCTs were identified. The other reports involved cohorts, case series, and expert opinions. Discussion Evidence in the form of clinical studies on therapeutic interventions is scarce. Numerous pharmacological treatment modalities have been described, but few are supported by the results of comparative trials involving control groups. Few studies have documented therapeutic effects for longer than a year. Better evidence was found for non-pharmacological methods, especially for physical therapy with passive and active stretching exercises, an important first-line strategy. The interincisal distance criterion for trismus varies between authors from 15 to 40 mm, which renders comparison between studies difficult. The absence of a standardized assessment protocol may also have contributed to variation between studies. An interincisal distance of 35 mm has been proposed as a definition of trismus. Explicit and precise treatment algorithms could not be established based on the available literature. However, a coordinated multidisciplinary approach in order to estimate and understand patient dysfunction is recommended; a systematic treatment plan should result in good symptom control and patient care. Prevention of trismus is more desirable than treatment for trismus.
PubMed: 29913945
DOI: 10.1016/j.sjpain.2010.01.006