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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... Apr 2022Voice outcome after carbon dioxide transoral laser microsurgery (COTOLMS) for glottic cancer is of prime importance. However, a comprehensive overview according to the... (Review)
Review
Voice Outcome After Carbon Dioxide Transoral Laser Microsurgery for Glottic Cancer According to the European Laryngological Society Classification of Cordectomy Types - A Systematic Review.
BACKGROUND
Voice outcome after carbon dioxide transoral laser microsurgery (COTOLMS) for glottic cancer is of prime importance. However, a comprehensive overview according to the European Laryngological Society (ELS) classification of cordectomies is still lacking. The aim of this systematic review is to summarize data on voice outcome associated with individual types of ELS glottic cordectomy after COTOLMS.
MATERIALS AND METHODS
A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The initial search identified 936 records of which 25 publications were then included. Voice outcome data (Voice Handicap Index [VHI] version 30, grade of dysphonia [G] and maximum phonation time [MPT]) were extracted per resection type. Weighted averages were calculated.
RESULTS
Data show a gradual increase in the VHI scores although they were still similar for all cordectomy types (range 14.2 to 21.5). The grade of dysphonia showed a gradual increase with increasing resection depth (range 1.0 to 1.9). There was a gradual decrease in the MPT (range 15.2 to 7.2).
CONCLUSION
Voice outcome is related to cordectomy type with mild dysphonia characterizing ELS type I, II and III cordectomies, while more extended cordectomies (ELS type IV, V and VI) result in moderate dysphonia and shortness of breath during phonation. The voice handicap experienced by patients is limited even in the more extended cordectomies.
PubMed: 35422356
DOI: 10.1016/j.jvoice.2022.03.003 -
Journal of Voice : Official Journal of... Mar 2022This review of the methodology and results of studies involving a sustained vowel phonation task during functional Magnetic Resonance Imaging (fMRI) aims to contribute... (Review)
Review
OBJECTIVE
This review of the methodology and results of studies involving a sustained vowel phonation task during functional Magnetic Resonance Imaging (fMRI) aims to contribute to the identification of brain regions involved in phonation for healthy subjects.
DATA SOURCES
This review was performed using the PubMed electronic database.
REVIEW METHODS
A review was conducted, according to PRISMA guidelines, between September and November 2020, using the following search term pairs: "fMRI and Phonation" and "fMRI and Voice." Activation likelihood estimation analysis was performed. A qualitative analysis was also performed to specify the frequency of activation of each region, as well as the various activation clusters within a single region.
RESULTS
Seven studies were included and analyzed. Five of the seven studies were selected for the activation likelihood estimation meta-analysis which revealed significant convergent activation for only one cluster located in the left precentral gyrus (BA4). A qualitative review provides an overview of brain activation. Primary motor and premotor areas were the only activated areas in all studies included. Other regions previously considered to be implicated in phonation were often activated in sustained vowel phonation tasks. Additionally, areas generally associated with articulation or language also showed activation.
CONCLUSION
Methodological recommendations are suggested to isolate the phonatory component and reduce variability between future studies. Based on the qualitative analysis, this review does not support a distinction between regions more related to phonation and regions more related to articulation. Further research is required seeking to isolate the vocal component and to improve insight into human brain network involved in phonation.
PubMed: 35305893
DOI: 10.1016/j.jvoice.2022.02.008 -
Complementary Therapies in Clinical... May 2022While mental health care needs have increased during the global pandemic, access to care has been reduced. Easily accessible alternative interventions may supplement... (Review)
Review
BACKGROUND
While mental health care needs have increased during the global pandemic, access to care has been reduced. Easily accessible alternative interventions may supplement existing mental health services to meet the increased need of mental health care. Our review explored the evidence of two alternative interventions, religious/spiritual (R/S) singing and R/S movement (dynamic meditation and praise dance), in relation to mental health outcomes.
METHOD
After registering with PROSPERO (CRD42020189495), a systematic search of three major databases (CINAHL, MEDLINE, and PsycINFO) was undertaken using predetermined eligibility criteria. Reference lists of identified papers and additional sources such as Google Scholar were searched. Quality of studies was assessed using the Mixed Method Appraisal Tool (MMAT). Data was extracted, tabulated, and synthesised according to the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines.
RESULTS
Seven of the 259 identified studies met inclusion criteria. Three studies considered R/S singing, while four considered R/S movement. In R/S movements, three studies considered dynamic meditation while one investigated praise dance. Although moderate to poor in quality, included studies indicated a positive trend for the effectiveness of R/S singing and movement in dealing with mental health concerns.
CONCLUSION
While R/S singing and R/S movement (praise dance and dynamic meditation) may be of value as mental health strategies, findings of the review need to be considered with caution due to methodological constraints. The limited number and poor quality of included studies highlight the need for further quality research in these R/S practices in mental health.
Topics: Humans; Meditation; Mental Health; Movement; Pandemics; Singing
PubMed: 35257992
DOI: 10.1016/j.ctcp.2022.101567 -
The Laryngoscope Jan 2023To compare the results of a voice handicap index (VHI) scale and acoustic parameters in patients who underwent microlaryngeal surgery followed by either short-duration... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To compare the results of a voice handicap index (VHI) scale and acoustic parameters in patients who underwent microlaryngeal surgery followed by either short-duration (voice rest for <7 days) or long-duration (≥7 days) voice rest.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
The PubMed, Embase, and Cochrane Library databases were systematically searched for articles published before March 1, 2021. Randomized controlled trials (RCTs) that measured the voice outcomes of patients after different durations and extents of postoperative voice restriction were included in the meta-analysis.
RESULTS
Four RCTs comprising 112 patients were included in the quantitative meta-analysis. Compared with the long-duration voice rest group, the short-duration group exhibited comparable VHI scores (mean difference [MD], -7.01; 95% CI, -16.12 to 2.09; p = 0.13), maximum phonation time (MD, -2.58; 95% CI, -5.42 to 0.26; p = 0.07), and acoustic variables of jitter (MD, -1.25; 95% CI, -3.43 to 0.94; p = 0.26) and shimmer (MD, -0.79; 95% CI, -2.08 to 0.51; p = 0.24). Subgroup analysis for benign pathology and cold instruments studies demonstrated significantly better VHI scores (MD, -14.45; 95% CI, -26.19 to -2.72; p = 0.02 and MD, -15.98; 95% CI, -28.52 to -3.44; p = 0.01, respectively) in the short-duration group.
CONCLUSIONS
The limited evidence does not demonstrate benefit in voice outcomes from long-duration voice rest and suggests potential unfavorable effects on compliance and quality of life, providing a rationale for short-duration voice rest after microlaryngeal surgery. More studies are required to determine the optimal duration and extent of postoperative voice rest.
LEVEL OF EVIDENCE
1 Laryngoscope, 133:154-161, 2023.
Topics: Humans; Voice Quality; Phonation; Laryngeal Diseases; Disability Evaluation; Voice Disorders
PubMed: 35218027
DOI: 10.1002/lary.30082 -
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 -
Journal of Voice : Official Journal of... May 2024This integrative review aims to determine the quality level of evidence on using surface electromyography (sEMG) as a diagnostic tool in identifying muscle tension...
OBJECTIVE
This integrative review aims to determine the quality level of evidence on using surface electromyography (sEMG) as a diagnostic tool in identifying muscle tension dysphonia.
METHOD
Two independent reviewers used one search engine and five databases to identify sEMG studies published between January 1980 and December 2020, using a set of specified search terms related to muscle tension dysphonia. The selected articles were systematically evaluated by two independent raters using a modified critical appraisal of diagnostic evidence (m-CADE) form.
RESULTS
Nine articles that satisfied the inclusion criteria were selected from among 576 studies for evaluation. These nine studies showed varied methodological approaches in sEMG measurements, including electrode configuration and position, tasks used in sEMG data collection, outcome measure, and normalization procedures. Five studies showed relatively high m-CADE scores, which were indicative of "suggestive validity and compelling importance". Two studies were rated as "suggestive validity and importance", while two remaining studies were rated as "less suggestive or equivocal validity and importance".
CONCLUSIONS
The review found a moderate level of evidence that sEMG can be a potentially useful tool with diagnostic value in identifying muscle tension dysphonia. However, evidence is not yet available to determine the diagnostic accuracy of sEMG for muscle tension dysphonia. More studies are needed, and it is recommended that future studies involving sEMG and reference measurements should be undertaken using a blinding procedure in order to control any subjective biases. Details of the population that the sEMG has been tested on should be outlined clearly so that spectrum bias could be eliminated or minimized in the application process. Furthermore, it is suggested that a reliable and valid protocol in collecting sEMG data during speech should be developed to minimize the variability of sEMG measures in assessing muscle activities during speech.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Young Adult; Dysphonia; Electromyography; Laryngeal Muscles; Muscle Tonus; Phonation; Predictive Value of Tests; Reproducibility of Results; Voice Quality
PubMed: 34903394
DOI: 10.1016/j.jvoice.2021.10.006 -
The Laryngoscope Aug 2022Lipoinjection is one of the available treatments for unilateral vocal fold paralysis. (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Lipoinjection is one of the available treatments for unilateral vocal fold paralysis.
OBJECTIVE
To evaluate lipoinjection predictability, and analyze the differences in safety and efficacy of the different techniques.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS AND RESULTS
A systematic review on Medline, Cochrane, and Scopus databases included 49 articles analyzing the data of 1,166 patients, concerning technical details and voice parameters changes. Lipoinjection used a mean volume of 1.3 mL, 95% confidence interval (CI) (0.92, 1.69)-average overcorrection of 30%. Meta-analysis of pre- and postoperative voice parameters' means showed a significant improvement at 6 months of mean phonation time (preoperative: 5.12, 95% CI [4.48, 5.76]-6 months: 10.46, 95% CI [9.18, 11.75]), Jitter (preoperative: 2.71, 95% CI [2.08, 3.33])-6 months: 1.37, 95% CI [1.05, 1.70]), Shimmer (preoperative: 4.55, 95% CI [3.04, 6.07]-6 months: 2.57, 95% CI [1.69, 3.45]), grade (preoperative: 2.15, 95% CI [1.73, 2.57]-6 months: 0.12, 95% CI [0.97, 1.43]), breathiness (preoperative: 2.012, 95% CI [1.48, 2.55]-6 months: 0.99, 95% CI [0.58, 1.40]), and asthenia (preoperative: 1.90, 95% CI [1.33, 2.47]-6 months: 0.75, 95% CI [0.17, 1.33]) of GRBAS (Grade, Roughness, Breathiness, Asthenia and Strain), and Voice Handicap Index-30 (preoperative: 72.06, 95% CI [54.35, 89.76]-6 months: 26.24, 95% CI [19.58, 32.90]). Subgroup analysis by harvesting technique concluded in no statistically significant difference between them. Few complications were reported. Reintervention was only required for 86 patients.
CONCLUSION
Lipoinjection seems a safe therapeutic option for unilateral vocal fold paralysis, with available data showing an efficacy lasting 6 months to 1 year. Laryngoscope, 132:1630-1640, 2022.
Topics: Asthenia; Humans; Laryngoplasty; Phonation; Treatment Outcome; Vocal Cord Paralysis; Vocal Cords
PubMed: 34894158
DOI: 10.1002/lary.29965 -
International Journal of Environmental... Nov 2021Parkinson's disease can be approached from various points of view, one of which is music therapy-a complementary therapy to a pharmacological one. This work aims to... (Review)
Review
Parkinson's disease can be approached from various points of view, one of which is music therapy-a complementary therapy to a pharmacological one. This work aims to compile the scientific evidence published in the last five years (2015-2020) on the effects of music therapy in patients with Parkinson's disease. A systematic review has been performed using the Web of Science and Scopus databases with the descriptors "music therapy" and "Parkinson's disease". A total of 281 eligible articles were identified, which, after applying the inclusion and exclusion criteria, were reduced to 58 papers. The results display a great diversity of evidence, confirming positive effects on various spheres. All mentioned patients with Parkinson's disease had experienced different music therapy programs. Some studies focused on the motor component, which can be addressed through listening, body rhythm, and rhythmic auditory stimulation. Other studies confirm effects on communication, swallowing, breathing, and the emotional aspect through programs that focus on singing, either individually or in groups, in order to improve the quality of life of people with PD. It was concluded that music therapy programs can achieve improvements in various areas of patients with Parkinson's.
Topics: Acoustic Stimulation; Humans; Music; Music Therapy; Parkinson Disease; Quality of Life; Singing
PubMed: 34770129
DOI: 10.3390/ijerph182111618 -
The Cochrane Database of Systematic... Oct 2021Inability to communicate in a manner that can be understood causes extreme distress for people requiring an artificial airway and has implications for care quality and... (Review)
Review
BACKGROUND
Inability to communicate in a manner that can be understood causes extreme distress for people requiring an artificial airway and has implications for care quality and patient safety. Options for aided communication include non-vocal, speech-generating, and voice-enabling aids.
OBJECTIVES
To assess effectiveness of communication aids for people requiring an artificial airway (endotracheal or tracheostomy tube), defined as the proportion of people able to: use a non-vocal communication aid to communicate at least one symptom, need, or preference; or use a voice-enabling communication aid to phonate to produce at least one intelligible word. To assess time to communication/phonation; perceptions of communication; communication quality/success; quality of life; psychological distress; length of stay and costs; and adverse events.
SEARCH METHODS
We searched the Cochrane Library (Wiley version), MEDLINE (OvidSP), Embase (OvidSP), three other databases, and grey literature from inception to 30 July 2020.
SELECTION CRITERIA
We included randomised controlled trials (RCTs), quasi-RCTs, cluster-RCTs, controlled non-randomised parallel group, and before-after studies evaluating communication aids used in adults with an artificial airway.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures recommended by Cochrane. Two review authors independently performed data extraction and assessment of risk of bias.
MAIN RESULTS
We included 11 studies (1931 participants) conducted in intensive care units (ICUs). Eight evaluated non-vocal communication aids and three voice-enabling aids. Usual care was the comparator for all. For six studies, this comprised no aid; usual care in the remaining five studies comprised use of various communication aids. Overall, our confidence in results regarding effectiveness of communication interventions was very low due to imprecision, measurement heterogeneity, inconsistency in results, and most studies at high or unclear risk of bias across multiple domains. No non-vocal aid studies reported our primary outcome. We are uncertain of the effects of early use of a voice-enabling aid compared to routine use on ability to phonate at least one intelligible word (risk ratio (RR) 3.03, 95% confidence interval (CI) 0.18 to 50.08; 2 studies; very low-certainty evidence). Compared to usual care without aids, we are uncertain about effects of a non-vocal aid (communication board) on patient satisfaction (standardised mean difference (SMD) 2.92, 95% CI 1.52 to 4.33; 4 studies; very low-certainty evidence). No studies of non-vocal aids reported quality of life. Low-certainty evidence from two studies suggests early use of a voice-enabling aid may have no effect on quality of life (MD 2.27, 95% CI -7.21 to 11.75). Conceptual differences in measures of psychological distress precluded data pooling; however, intervention arm participants reported less distress suggesting there might be benefit, but our certainty in the evidence is very low. Low-certainty evidence suggest voice-enabling aids have little or no effect on ICU length of stay; we were unable to determine effects of non-vocal aids. Three studies reported different adverse events (physical restraint use, bleeding following tracheostomy, and respiratory parameters indicating respiratory decompensation). Adverse event rates were similar between arms in all three studies. However, uncertainty remains as to any harm associated with communication aids.
AUTHORS' CONCLUSIONS
Due to a lack of high-quality studies, imprecision, inconsistency of results, and measurement heterogeneity, the evidence provides insufficient information to guide practice as to which communication aid is more appropriate and when to use them. Understanding effectiveness of communication aids would benefit from development of a core outcome measurement set.
Topics: Adult; Bias; Communication; Humans; Intensive Care Units; Quality of Life; Ventilators, Mechanical
PubMed: 34637143
DOI: 10.1002/14651858.CD013379.pub2