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German Medical Science : GMS E-journal 2024Rhinophonia aperta may result from velopharyngeal insufficiency. Neuromuscular electrical stimulation (NMES) has been discussed in the context of muscle strengthening....
INTRODUCTION
Rhinophonia aperta may result from velopharyngeal insufficiency. Neuromuscular electrical stimulation (NMES) has been discussed in the context of muscle strengthening. The aim of this study was to evaluate in healthy subjects whether NMES can change the velopharyngeal closure pattern during phonation and increase muscle strength.
METHOD
Eleven healthy adult volunteers (21-57 years) were included. Pressure profiles were measured by high resolution manometry (HRM): isolated sustained articulation of /a/ over 5 s (protocol 1), isolated NMES applied to soft palate above motor threshold (protocol 2) and combined articulation with NMES (protocol 3). Mean activation pressures (MeanAct), maximum pressures (Max), Area under curve (AUC) and type of velum reactions were compared. A statistical comparison of mean values of protocol 1 versus protocol 3 was carried out using the Wilcoxon signed rank test. Ordinally scaled parameters were analyzed by cross table.
RESULTS
MeanAct values measured: 17.15±20.69 mmHg (protocol 1), 34.59±25.75 mmHg (protocol 3) on average, Max: 37.86±49.17 mmHg (protocol 1), 87.24±59.53 mmHg (protocol 3) and AUC: 17.06±20.70 mmHg.s (protocol 1), 33.76±23.81 mmHg.s (protocol 3). Protocol 2 produced velum reactions on 32 occasions. These presented with MeanAct values of 13.58±12.40 mmHg, Max values of 56.14±53.14 mmHg and AUC values of 13.84±12.78 mmHg.s on average. Statistical analysis comparing protocol 1 and 3 showed more positive ranks for MeanAct, Max and AUC. This difference reached statistical significance (p=0.026) for maximum pressure values.
CONCLUSIONS
NMES in combination with articulation results in a change of the velopharyngeal closure pattern with a pressure increase of around 200% in healthy individuals. This might be of therapeutic benefit for patients with velopharyngeal insufficiency.
Topics: Humans; Adult; Male; Female; Phonation; Young Adult; Middle Aged; Pressure; Palate, Soft; Electric Stimulation Therapy; Manometry; Velopharyngeal Insufficiency; Muscle Strength; Healthy Volunteers
PubMed: 38651019
DOI: 10.3205/000329 -
Journal of Voice : Official Journal of... Apr 2024To verify the accuracy of the maximum phonation time of the vowel /a/ (MPT/a/), fricative /s/ (MPT/s/), number counting (MPTC), and number reached in this count (CN) to...
OBJECTIVE
To verify the accuracy of the maximum phonation time of the vowel /a/ (MPT/a/), fricative /s/ (MPT/s/), number counting (MPTC), and number reached in this count (CN) to estimate forced vital capacity (FVC) in patients with post-COVID-19 syndrome.
METHOD
Cross-sectional study involving adult patients, who were admitted to the intensive care unit and referred to the Post-COVID-19 Rehabilitation Outpatient Clinic. Voice function was assessed using a Vocal Handicap Index (VHI) self-assessment questionnaire and MPT tests. To perform the phonatory tests, the patients remained in a standing posture and were instructed to inhale as much air as possible and, during a single exhalation, at usual pitch and loudness, sustain the emission of /a/ and /s/; and in another breath, to perform the ascending numerical count, starting from the number one up to the highest number they could reach. Pulmonary function was assessed by spirometry. The receiver operating characteristic (ROC) curve was plotted, and FVC values lower than the normal limit by Z-score (fifth percentile) were classified as impaired lung function. The predictive values and likelihood ratios were calculated.
RESULTS
A total of 70 patients participated, with 20-30% having a high VHI. Approximately 24% had an FVC impairment and significantly low values of MPT/a/, MPT/s/, MPTC, and CN. The test results showed overall accuracy of 70% and the cutoff points of 9.69, 6.78, 10.60, and 13, respectively, with high sensitivity, predictive negative value and low specificity, predictive positive value, and positive likelihood ratio.
CONCLUSIONS
Our results suggest that the MPT has moderate discriminatory power for FVC impairment, indicating that it is not a reliable indicator of pulmonary function in the population studied. Therefore, in patients with an MPT of less than 10.60 seconds, or a CN lower than 13, other criteria should be added to improve the diagnostic accuracy and support the decision to perform more complex investigations.
PubMed: 38649315
DOI: 10.1016/j.jvoice.2024.04.001 -
European Journal of Oncology Nursing :... Jun 2024We aimed to evaluate the effect of voice training in patients with head and neck cancer who were undergoing radiotherapy. (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
We aimed to evaluate the effect of voice training in patients with head and neck cancer who were undergoing radiotherapy.
METHOD
This study used a randomized controlled trial design. IBM SPSS 26.0 was used to randomly divide 74 patients into a control group and an experimental group. The control group followed a swallowing exercises program, and the experimental group additionally received ABCLOVE voice training. Both training programs continued throughout the entire radiotherapy cycle. We compared standardized swallowing assessment (SSA), maximum phonation time (MPT), the Voice Handicap Index-10, and incidence of complications such as difficulty opening the mouth, malnutrition, and aspiration between the two groups at T1 (0 radiotherapy sessions, before radiotherapy), T2 (15-16 radiotherapy sessions, middle of radiotherapy), and T3 (30-32 radiotherapy sessions, end of radiotherapy).
RESULTS
70 participants completed this study. Swallowing function and MPT intergroup and interaction effects were statistically significant between the two groups (P < 0.05). At the end of radiotherapy (T3), the SSA score (20.77 ± 1.96) and MPT (10.98 ± 1.75) s in the experimental group were superior to those in the control group (SSA: 22.06 ± 2.38 and MPT: 9.49±1.41 s), with statistical significance (P<0.05). Moreover, the incidence of malnutrition and aspiration in the experimental group was lower than that in the control group (P < 0.05).
CONCLUSION
Voice training can improve swallowing function and MPT and reduce complications related to swallowing disorders in patients with head and neck cancer.
Topics: Humans; Male; Female; Head and Neck Neoplasms; Middle Aged; Deglutition Disorders; Voice Training; Aged; Deglutition; Adult; Treatment Outcome
PubMed: 38642524
DOI: 10.1016/j.ejon.2024.102551 -
European Review For Medical and... Apr 2024Vocal cord paralysis (VCP) is a serious complication in thyroidectomy operations; however, its management remains unclear. The present study evaluated the voice...
OBJECTIVE
Vocal cord paralysis (VCP) is a serious complication in thyroidectomy operations; however, its management remains unclear. The present study evaluated the voice parameters of patients who underwent surgery using Intraoperative Neurophysiologic Monitoring (IONM).
PATIENTS AND METHODS
A total of 52 patients (41 females and 11 males) who underwent a total thyroidectomy operation were evaluated using objective and subjective voice analysis examinations before and after surgery. Acoustic parameters, such as Fundamental Frequency (F0), Shimmer, Jitter, Noise-to-Harmonic ratio (NHR), and aerodynamic parameters, including S/Z ratio and maximum phonation time (MPT), were analyzed. Objective findings, including the VHI-10 (Voice Handicap Index) and V-RQOL (Voice-Related Quality of Life), were also analyzed. The relationship between voice parameters and IONM values was investigated.
RESULTS
The objective analysis (acoustic and aerodynamic parameters) showed no difference (p>0.05). However, the subjective analysis, which involved the VHI-10 and V-RQOL measures, revealed a significant difference before and after the operation (p<0.05). The Spearman correlation analysis showed that the NHR postoperative 1st-month parameter negatively correlated (rho=-0.317, p<0.059), while the F0 postoperative 6th-month parameter positively correlated (rho=0.347) with the amplitude difference before and after dissection (Right R2-R1 difference) for the right RLN measured in IONM.
CONCLUSIONS
Patients who are planning to undergo a thyroidectomy procedure should undergo voice assessment during both the preoperative and postoperative periods. IONM could improve voice quality outcomes.
Topics: Male; Female; Humans; Voice Quality; Thyroidectomy; Quality of Life; Acoustics; Vocal Cord Paralysis; Voice Disorders
PubMed: 38639510
DOI: 10.26355/eurrev_202404_35899 -
Scientific Reports Apr 2024Why do we prefer some singers to others? We investigated how much singing voice preferences can be traced back to objective features of the stimuli. To do so, we asked...
Why do we prefer some singers to others? We investigated how much singing voice preferences can be traced back to objective features of the stimuli. To do so, we asked participants to rate short excerpts of singing performances in terms of how much they liked them as well as in terms of 10 perceptual attributes (e.g.: pitch accuracy, tempo, breathiness). We modeled liking ratings based on these perceptual ratings, as well as based on acoustic features and low-level features derived from Music Information Retrieval (MIR). Mean liking ratings for each stimulus were highly correlated between Experiments 1 (online, US-based participants) and 2 (in the lab, German participants), suggesting a role for attributes of the stimuli in grounding average preferences. We show that acoustic and MIR features barely explain any variance in liking ratings; in contrast, perceptual features of the voices achieved around 43% of prediction. Inter-rater agreement in liking and perceptual ratings was low, indicating substantial (and unsurprising) individual differences in participants' preferences and perception of the stimuli. Our results indicate that singing voice preferences are not grounded in acoustic attributes of the voices per se, but in how these features are perceptually interpreted by listeners.
Topics: Humans; Singing; Voice Quality; Voice; Music; Acoustics
PubMed: 38637516
DOI: 10.1038/s41598-024-58924-9 -
Articulatory and acoustic differences between lyric and dramatic singing in Western classical music.The Journal of the Acoustical Society... Apr 2024Within the realm of voice classification, singers could be sub-categorized by the weight of their repertoire, the so-called "singer's Fach." However, the opposite pole...
Within the realm of voice classification, singers could be sub-categorized by the weight of their repertoire, the so-called "singer's Fach." However, the opposite pole terms "lyric" and "dramatic" singing are not yet well defined by their acoustic and articulatory characteristics. Nine professional singers of different singers' Fach were asked to sing a diatonic scale on the vowel /a/, first in what the singers considered as lyric and second in what they considered as dramatic. Image recording was performed using real time magnetic resonance imaging (MRI) with 25 frames/s, and the audio signal was recorded via an optical microphone system. Analysis was performed with regard to sound pressure level (SPL), vibrato amplitude, and frequency and resonance frequencies as well as articulatory settings of the vocal tract. The analysis revealed three primary differences between dramatic and lyric singing: Dramatic singing was associated with greater SPL and greater vibrato amplitude and frequency as well as lower resonance frequencies. The higher SPL is an indication of voice source changes, and the lower resonance frequencies are probably caused by the lower larynx position. However, all these strategies showed a considerable individual variability. The singers' Fach might contribute to perceptual differences even for the same singer with regard to the respective repertoire.
Topics: Singing; Music; Voice Quality; Acoustics
PubMed: 38634661
DOI: 10.1121/10.0025751 -
Trauma Case Reports Jun 2024Tapia syndrome (TS) is a rare condition characterized by unilateral hypoglossal and recurrent laryngeal nerve palsy, leading to tongue deviation, swallowing difficulty...
BACKGROUND
Tapia syndrome (TS) is a rare condition characterized by unilateral hypoglossal and recurrent laryngeal nerve palsy, leading to tongue deviation, swallowing difficulty and dysphonia.
CASE REPORT
We describe a case of a 17-year-old boy who reported a bilateral TS following head and neck trauma with Hangman's fracture and right common carotid artery dissection. The confirmation occurred only after complete cognitive and motor recovery, verifying the inability to protrude the tongue and swallow, associated with complete paralysis of the vocal cords, diagnosed with fiber optic laryngoscopy.An initial recovery of tongue motility and phonation occurred after just over a month of rehabilitation.
CONCLUSION
In addition to the lack of awareness due to the rarity of the syndrome, the diagnosis of TS may be delayed in patients who are unconscious or who have slow cognitive recovery following head trauma. The case we present may help to increase awareness and avoid unnecessary diagnostic investigations.
PubMed: 38633379
DOI: 10.1016/j.tcr.2024.101029 -
Otolaryngologia Polska = the Polish... Apr 2024<b><br>Introduction:</b> Electromyography (EMG) of the larynx provides information on the electrophysiological condition of laryngeal muscles and...
<b><br>Introduction:</b> Electromyography (EMG) of the larynx provides information on the electrophysiological condition of laryngeal muscles and innervation. Integration of information obtained from the EMG exams with the clinical parameters as obtained by other methods for laryngeal assessment (endoscopy, perceptual and acoustic analysis, voice self-assessment) provides a multidimensional picture of dysphonia, which is of particular importance in patients with vocal fold (VF) mobility disorders accompanied by glottic insufficiency.</br> <b><br>Aim:</b> The aim of this study was to evaluate laryngeal EMG records acquired in subjects with unilateral vocal fold immobilization with signs of atrophy and glottic insufficiency.</br> <b><br>Material and methods:</b> From the available material of 74 EMG records of patients referred for the exam due to unilateral laryngeal paralysis, records of 17 patients with endoscopic features suggestive of complete laryngeal muscle denervation were selected. The EMG study of thyroarytenoid muscles of mobile and immobile VFs was evaluated qualitatively and quantitatively at rest and during volitional activity involving free phonation of vowel /e/ [ε].</br> <b><br>Results:</b> In all patients, the EMG records from mobile VFs were significantly different from those from immobile VFs. Despite endoscopic features of paralysis, no VF activity whatsoever was observed in as few as 2 patients so as to meet the neurophysiological definition of paralysis. In 88% of cases, electromyographic activity of the thyroarytenoid muscle was observed despite immobilization and atrophy of the vocal fold. In these patients, neurogenic type of record was observed with numerous high- -amplitude mobility units. On the basis of the results, quantitative features of EMG records indicative of paralysis and residual activity of the thyroarytenoid muscle were determined.</br> <b><br>Conclusions:</b> Qualitative and quantitative analysis of laryngeal EMG records provides detailed information on the condition of vocal fold muscles and innervation. EMG records of mobile vs immobile VFs differ significantly from each other. Endoscopic evaluation does not provide sufficient basis for the diagnosis of complete laryngeal muscle denervation.</br>.
Topics: Humans; Vocal Cords; Vocal Cord Paralysis; Electromyography; Laryngeal Muscles; Endoscopy; Dysphonia; Atrophy
PubMed: 38623857
DOI: 10.5604/01.3001.0053.8704 -
Journal of Oral Rehabilitation Jul 2024Maximum phonation time (MPT) is used to assess speech and other oral rehabilitation-related issues. Various factors contribute to MPT decline in older individuals....
BACKGROUND
Maximum phonation time (MPT) is used to assess speech and other oral rehabilitation-related issues. Various factors contribute to MPT decline in older individuals. Although the impact of physical frailty on MPT has been suggested, this has not been conclusively determined.
OBJECTIVE
To examine the relationship between MPT and physical frailty in community-dwelling individuals aged ≥60 years who were independently mobile. MPT-associated factors were investigated.
METHODS
This cross-sectional study analysed the clinical data of 122 patients (age [interquartile range]: 80.0 [74.0-83.0] years) without dementia who visited a neurology department between 1 February 2021 and 31 January 2023. Investigated factors included age, sex, weight, height, body mass index, smoking history, grip strength, functional independence measure, vital capacity, oral diadochokinesis, MPT and the Japanese Cardiovascular Health Study score. Physical frailty was assessed based on the total score from five items (weight loss, weakness, exhaustion, slowness and low physical activity). The relationship between MPT and physical frailty was examined using Spearman's rank correlation coefficient and hierarchical multiple regression analysis.
RESULTS
The MPT was negatively correlated with age (r = -0.347, p < .01) and physical frailty (r = -0.681, p < .01) and positively correlated with vital capacity (r = 0.474, p < .01) and height (r = 0.248, p < .01). The hierarchical multiple regression analysis, conducted with MPT as the dependent variable, demonstrated that physical frailty (β = -.59, 95% confidence interval: -0.74 to 0.43, p < .001) had a strong influence on MPT.
CONCLUSION
In older individuals, MPT is associated with physical frailty. When assessing MPT in clinical settings, it is advisable to perform a concurrent assessment of physical frailty.
Topics: Humans; Male; Female; Aged; Cross-Sectional Studies; Independent Living; Aged, 80 and over; Phonation; Frailty; Geriatric Assessment; Frail Elderly; Middle Aged; Ambulatory Care Facilities
PubMed: 38616536
DOI: 10.1111/joor.13698 -
Journal of Voice : Official Journal of... Apr 2024This study investigates (1) the presence of frequency transmission of oscillation from an external whole-body vibration (WBV) platform to the larynx; and (2) the factors...
PURPOSE
This study investigates (1) the presence of frequency transmission of oscillation from an external whole-body vibration (WBV) platform to the larynx; and (2) the factors that influence this frequency transmission.
METHODS
Thirty participants (mean age=22.3years) with normal voice were exposed to four frequency-intensity levels of WBV (10 Hz-10%, 10 Hz-20%, 20 Hz-10%, 20 Hz-20%) and were instructed to produce the natural vowel /a/ three times during each WBV setting. The frequency was extracted from the middle 1-second of each electroglottographic (EGG) signal after passing through a Hann band filter with a range of 6-24 Hz. Linear mixed-effects models were applied to determine the factors that influenced the absolute deviation of the frequency transmission.
RESULTS
All participants exhibit an extracted EGG frequency that aligns with the external WBV frequency, deviating by - 0.6 to 1.2 Hz. The absolute deviation of WBV frequency transmission is consistent for both sexes across various WBV settings, except the 10 Hz-10% setting where men tend to exhibit significantly higher deviations (P = 0.018).
CONCLUSION
Oscillations at a specific frequency are transmitted from an external WBV platform to the larynx. This study proposes the use of a "spring" system to investigate the effect of WBV on the larynx, and recommends further research to explore the potential of WBV in managing voice disorders.
PubMed: 38614894
DOI: 10.1016/j.jvoice.2024.03.024