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Cureus May 2024Background Thyroidectomy is a routinely performed surgical procedure used to treat benign, malignant, and some hormonal disorders of the thyroid that are not responsive...
Background Thyroidectomy is a routinely performed surgical procedure used to treat benign, malignant, and some hormonal disorders of the thyroid that are not responsive to medical therapy. Voice alterations following thyroid surgery are well-documented and often attributed to recurrent laryngeal nerve dysfunction. However, subtle changes in voice quality can persist despite anatomically intact laryngeal nerves. This study aimed to quantify post-thyroidectomy voice changes in patients with intact laryngeal nerves, focusing on fundamental frequency, first formant frequency, shimmer intensity, and maximum phonation duration. Methodology This cross-sectional study was conducted at a tertiary referral center in central India and focused on post-thyroidectomy patients with normal vocal cord function. Preoperative assessments included laryngeal endoscopy and voice recording using a computer program, with evaluations repeated at one and three months post-surgery. Patients with normal laryngeal endoscopic findings underwent voice analysis and provided feedback on subjective voice changes. The PRAAT version 6.2 software was utilized for voice analysis. Results The study included 41 patients with normal laryngoscopic findings after thyroid surgery, with the majority being female (85.4%) and the average age being 42.4 years. Hemithyroidectomy was performed in 41.4% of patients and total thyroidectomy in 58.6%, with eight patients undergoing central compartment neck dissection. Except for one patient, the majority reported no subjective change in voice following surgery. Objective voice analysis showed statistically significant changes in the one-month postoperative period compared to preoperative values, including a 5.87% decrease in fundamental frequency, a 1.37% decrease in shimmer intensity, and a 6.24% decrease in first formant frequency, along with a 4.35% decrease in maximum phonatory duration. These trends persisted at the three-month postoperative period, although values approached close to preoperative levels. Results revealed statistically significant alterations in voice parameters, particularly fundamental frequency and first formant frequency, with greater values observed in total thyroidectomy patients. Shimmer intensity also exhibited slight changes. Comparison between hemithyroidectomy and total thyroidectomy groups revealed no significant differences in fundamental frequency, first formant frequency, and shimmer. However, maximum phonation duration showed a significantly greater change in the hemithyroidectomy group at both one-month and three-month postoperative intervals. Conclusions This study on post-thyroidectomy patients with normal vocal cord movement revealed significant changes in voice parameters postoperatively, with most patients reporting no subjective voice changes. The findings highlight the importance of objective voice analysis in assessing post-thyroidectomy voice outcomes.
PubMed: 38916010
DOI: 10.7759/cureus.60873 -
Journal of Voice : Official Journal of... Jun 2024This study aimed to determine the impact of different types of masks on the voices of healthcare professionals who had to wear masks for an extended amount of time... (Review)
Review
OBJECTIVES
This study aimed to determine the impact of different types of masks on the voices of healthcare professionals who had to wear masks for an extended amount of time during the pandemic period and had a healthy voice.
METHODS
Our research included 41 healthcare workers. The participants were separated into two groups: surgical (n = 21) and N95 mask users (n = 20). Healthcare workers evaluated masks before and after wearing them for at least 8 hours throughout the workday. All subjects had a videolaryngoscopic examination; the Voice Handicap Index-10 (VHI-10), GRBAS, acoustic voice analysis (F0, jitter%, shimmer%, noise/harmonic ratio, relative average perturbation [RAP]), aerodynamic measures (maximum phonation time, MPT), and blood oxygen saturation were evaluated.
RESULTS
Although both groups' VHI-10 scores increased after using the mask, this rise was not statistically significant in our research. According to the GRBAS classification, voice quality deterioration was identified in 9.6% (mild-moderate) of the group using surgical masks and 15% (mild) of the group wearing N95. Only the jitter and RAP values of individuals wearing both surgical and N95 masks were determined to be statistically significant. There was no significant change in MPT following mask wear in either group. Both the surgical and N95 mask-using groups showed a substantial drop in blood oxygen saturation before and after mask usage.
CONCLUSION
There was no change in voice quality between healthcare workers wearing surgical and N95 masks. It has been noticed that voice perception and quality are affected by the mask's barrier effect rather than the kind of mask.
PubMed: 38902143
DOI: 10.1016/j.jvoice.2024.05.003 -
CoDAS 2024To map the vocal risk in professional classical singers, analyzing their self-assessment of voice and self-perception of singing voice handicap and vocal fatigue.
PURPOSE
To map the vocal risk in professional classical singers, analyzing their self-assessment of voice and self-perception of singing voice handicap and vocal fatigue.
METHODS
The study sample comprised of 52 professional classical choir singers, aged 31 to 72 years. They answered an online questionnaire in Google Forms, addressing their characterization, self-assessment of voice, the Voice Handicap Index-10 (VHI-10), Classical Singing Handicap Index (CSHI), and Vocal Fatigue Index (VFI).
RESULTS
The mean self-assessment of voice was between "Good" and "Very good" (1.2). The mean total VHI-10 score was 1.35, which is below the cutoff. The mean total CSHI score was 10.04. The mean total VFI score was 10.83, near the cutoff value. Classical singers who use their voice to give examples to students in their classes had higher scores in VHI-10 (p = 0.013), VFI voice restriction (p = 0.011), and VFI total score (p = 0.015). Besides, classical singers who already visited a Speech-Language Pathologist for voice problems had higher scores in VFI voice restriction (p = 0.040) and VFI recovery with voice rest (p = 0.019), in addition to correlations between instrument scores.
CONCLUSION
Professional classical singers did not have voice handicaps. However, their self-perception of vocal fatigue was more present when the singing voice was used, such as giving examples with their own voice in class. Having had voice problems and visited a Speech-Language Pathologist in the past led to a greater perception of vocal recovery with rest.
Topics: Humans; Voice Quality; Singing; Middle Aged; Adult; Voice Disorders; Male; Self Concept; Female; Aged; Surveys and Questionnaires; Occupational Diseases; Self-Assessment; Disability Evaluation
PubMed: 38896630
DOI: 10.1590/2317-1782/20242023088pt -
International Journal of Language &... Jun 2024SPEAK OUT! has been shown to enhance various aspects of voice such as intensity, prosody, voice quality and perception of voice. However, their impacts on expiration and...
BACKGROUND
SPEAK OUT! has been shown to enhance various aspects of voice such as intensity, prosody, voice quality and perception of voice. However, their impacts on expiration and communication effectiveness have not yet been evaluated. This study aimed to evaluate the effectiveness of the Hybrid SPEAK OUT! method on aerodynamic measurements and patient-reported outcome measures (PROMs) in individuals with Parkinson's disease (PD).
METHODS
This study included 157 participants with PD who underwent an intensive 8-week multidisciplinary treatment program. The Hybrid SPEAK OUT! method consisted of three sessions per week, including two group sessions and one individual treatment session. Voice-related aerodynamic measures included maximum phonation time (MPT), vocal cord function using the S/Z ratio, and expiratory flow measures including peak expiratory flow (PEF) and peak cough flow (PCF). Two PROMs were included: the Hebrew version of the voice handicap index-10 and communication effectiveness questionnaire.
RESULTS
The results of 111 participants were analysed. MPT duration increased, PEF and PCF increased, and better scores were found in PROMs.
CONCLUSION
These findings would appear to support the effectiveness of the Hybrid SPEAK OUT! methods improving function, activity and participation in individuals with PD. However, further research is needed.
WHAT THIS PAPER ADDS
What is already known on the subject Prior research has demonstrated the effectiveness of behavioral therapies, including the SPEAK OUT! program, in managing speech symptoms in individuals with Parkinson's disease (PD). These therapies have shown improvements in voice intensity, fundamental frequency, voice quality, and voice perception. However, the impact on aerodynamic measures, expiratory flow, and patient-reported outcome measures has not been extensively studied. What this paper adds to existing knowledge This study adds to the existing knowledge by demonstrating that a Hybrid SPEAK OUT! approach, can lead to improvements in aerodynamic measures, including maximum phonation time (MPT), expiratory and cough peak flow. In terms of motor learning, we found that two non-speech exhalation-related tasks that were not directly trained improved following the intensive speech training protocol. Furthermore, it shows positive changes in patient-reported outcome measures, with reduced voice-related disability and improved communication efficiency. What are the potential or actual clinical implications of this work? The findings of this study have important clinical implications for the management of speech symptoms in individuals with PD. The Hybrid SPEAK OUT! program, which combines group and individual sessions, can effectively improve voice, aerodynamic measurements and patient-reported outcome measures (PROMs), ultimately enhancing the overall quality of life for patients. These findings support the effectiveness of the Hybrid SPEAK OUT! methods for improving function, activity, and participation in individuals with PD.
PubMed: 38895888
DOI: 10.1111/1460-6984.13077 -
Scientific Reports Jun 2024Musical activities (MA) such as singing, playing instruments, and listening to music may be associated with health benefits. However, evidence from epidemiological...
Musical activities (MA) such as singing, playing instruments, and listening to music may be associated with health benefits. However, evidence from epidemiological studies is still limited. This study aims at describing the relation between MA and both sociodemographic and health-related factors in a cross-sectional approach. A total of 6717 adults (50.3% women, 49.7% men, median age: 51 years (IQR 43-60) were recruited from the study center Berlin-Mitte of the German National Cohort (NAKO), a population-based prospective study. This study is based on a sample randomly selected from the population registry of Berlin, Germany, aged 20 to 69 years. 53% of the participants had been musically active at least once in their life (56.1% women, 43.9% men). Playing keyboard instruments (30%) and singing (21%) were the most frequent MA. Participants listened to music in median 90 min per day (IQR 30.0-150.0). Musically active individuals were more likely to have a higher education, higher alcohol consumption, were less likely to be physically active, and had a lower BMI compared to musically inactive individuals. This large population-based study offers a comprehensive description of demographic, health, and lifestyle characteristics associated with MA. Our findings may aid in assessing long-term health consequences of MA.
Topics: Humans; Middle Aged; Female; Male; Music; Adult; Germany; Aged; Prospective Studies; Cross-Sectional Studies; Singing; Young Adult; Cohort Studies; Life Style
PubMed: 38890477
DOI: 10.1038/s41598-024-64773-3 -
Journal of Voice : Official Journal of... Jun 2024This research aims to identify acoustic features which can distinguish patients with Parkinson's disease (PD patients) and healthy speakers.
PURPOSE
This research aims to identify acoustic features which can distinguish patients with Parkinson's disease (PD patients) and healthy speakers.
METHODS
Thirty PD patients and 30 healthy speakers were recruited in the experiment, and their speech was collected, including three vowels (/i/, /a/, and /u/) and nine consonants (/p/, /pʰ/, /t/, /tʰ/, /k/, /kʰ/, /l/, /m/, and /n/). Acoustic features like fundamental frequency (F0), Jitter, Shimmer, harmonics-to-noise ratio (HNR), first formant (F1), second formant (F2), third formant (F3), first bandwidth (B1), second bandwidth (B2), third bandwidth (B3), voice onset, voice onset time were analyzed in our experiment. Two-sample independent t test and the nonparametric Mann-Whitney U (MWU) test were carried out alternatively to compare the acoustic measures between the PD patients and healthy speakers. In addition, after figuring out the effective acoustic features for distinguishing PD patients and healthy speakers, we adopted two methods to detect PD patients: (1) Built classifiers based on the effective acoustic features and (2) Trained support vector machine classifiers via the effective acoustic features.
RESULTS
Significant differences were found between the male PD group and the male health control in vowel /i/ (Jitter and Shimmer) and /a/ (Shimmer and HNR). Among female subjects, significant differences were observed in F0 standard deviation (F0 SD) of /u/ between the two groups. Additionally, significant differences between PD group and health control were also found in the F3 of /i/ and /n/, whereas other acoustic features showed no significant differences between the two groups. The HNR of vowel /a/ performed the best classification accuracy compared with the other six acoustic features above found to distinguish PD patients and healthy speakers.
CONCLUSIONS
PD can cause changes in the articulation and phonation of PD patients, wherein increases or decreases occur in some acoustic features. Therefore, the use of acoustic features to detect PD is expected to be a low-cost and large-scale diagnostic method.
PubMed: 38890016
DOI: 10.1016/j.jvoice.2024.05.018 -
American Journal of Speech-language... Jun 2024Prior studies have shown that bilingual children who do not stutter (CWNS) exhibit a high number of disfluencies in both languages, increasing the risk of...
PURPOSE
Prior studies have shown that bilingual children who do not stutter (CWNS) exhibit a high number of disfluencies in both languages, increasing the risk of misidentification by speech-language pathologists as children who stutter (CWS). Conversely, there is a risk of misidentifying CWS with a relatively low incidence of disfluencies as CWNS. This study aims to explore the qualitative and quantitative distinctions in speech disfluency profiles between CWNS and CWS. The assessment covers both the dominant and nondominant language to examine the impact of language dominance on disfluency patterns.
METHOD
A total of 92 Lebanese bilinguals (70 CWNS and 22 CWS) from 4;06 to 7;06 (years;months) were included. Language dominance was determined based on parental assessments. Spontaneous and narrative speech samples were collected for each child in both languages and all stuttering-like disfluencies (SLD) and other disfluencies (OD) were coded.
RESULTS
On average, CWNS showed a significantly lower percentage of total SLD, weighted SLD, SLD subtypes, and iterations compared to CWS. However, the number of disfluencies of CWNS exceeded monolingual clinical standards. Language dominance did not impact SLD and OD percentages, but some differences for SLD subtypes emerged. Binary logistic regression analyses showed that repetitions and dysrhythmic phonations are good predictors for correct CWS or CWNS classification, in contrast to OD. A combination of predictors from both languages led to better classification than using predictors from either language alone.
CONCLUSIONS
The current study shows that speech disfluency percentages in bilingual CWNS typically surpass monolingual standards and can be at par with those of CWS. However, through careful consideration of disfluency characteristics, ideally in both languages, an accurate differential diagnosis of stuttering in bilingual children can be achieved.
PubMed: 38889203
DOI: 10.1044/2024_AJSLP-23-00311 -
JASA Express Letters Jun 2024Singing is socially important but constrains voice acoustics, potentially masking certain aspects of vocal identity. Little is known about how well listeners extract...
Singing is socially important but constrains voice acoustics, potentially masking certain aspects of vocal identity. Little is known about how well listeners extract talker details from sung speech or identify talkers across the sung and spoken modalities. Here, listeners (n = 149) were trained to recognize sung or spoken voices and then tested on their identification of these voices in both modalities. Learning vocal identities was initially easier through speech than song. At test, cross-modality voice recognition was above chance, but weaker than within-modality recognition. We conclude that talker information is accessible in sung speech, despite acoustic constraints in song.
Topics: Humans; Singing; Male; Female; Adult; Speech Perception; Voice; Young Adult; Recognition, Psychology; Speech
PubMed: 38888432
DOI: 10.1121/10.0026385 -
Journal of Voice : Official Journal of... Jun 2024Airway glottic insufficiency, or glottal gap, may lead to a breathy voice quality. It is hypothesized that a glottal gap may be a source of nonlinearity in speech...
OBJECTIVE
Airway glottic insufficiency, or glottal gap, may lead to a breathy voice quality. It is hypothesized that a glottal gap may be a source of nonlinearity in speech production. This study aims to gain a chaotic and acoustic profile of glottal gap voice provided by phonation of excised larynges subjected to the insertion of a metal shim in the posterior glottis.
STUDY DESIGN
Nonrandomized quasi-experimental study.
METHODS
Posterior glottal gap varied from 0 to 3.5 mm in 0.5 mm intervals. Each treatment was investigated independently in a sample population of eight excised canine larynges. Phonation of the larynges for each treatment was recorded and analyzed for the cepstral peak prominence (CPP), harmonics-to-noise ratio (HNR), and correlation dimension.
RESULTS
Kruskal-Wallis rank-sum tests yielded significant differences across shim groups for all parameters. Dunn-Bonferroni post-hoc tests revealed that the control group differed significantly from the 1.5, 2, 2.5, 3, and 3.5 mm groups for all metrics. Moreover, Kendall correlation tests indicated a moderately positive correlation between glottal gap size and correlation dimension, a moderately negative correlation between glottal gap size and CPP and between glottal gap size and the HNR.
CONCLUSIONS
Glottic insufficiency provides a source of nonlinearity in phonation. Nonlinear dynamic analysis provides quantitative insight into glottal gap voice. This study encourages future studies to further evaluate the relationship between glottal gap and correlation dimension.
PubMed: 38886137
DOI: 10.1016/j.jvoice.2024.05.014 -
Acta Neurochirurgica Jun 2024Velopharyngeal insufficiency (VPI) is a known complication of transoral surgery, with a reported incidence of 8.1%. The main factor related to VPI is the split of the...
BACKGROUND
Velopharyngeal insufficiency (VPI) is a known complication of transoral surgery, with a reported incidence of 8.1%. The main factor related to VPI is the split of the soft palate. However, dead space resulting from transoral decompression may play a pivotal role in the pathogenesis of the dysfunction. In our experience, functionally significant dead space is almost constantly present after transoral decompression. This is probably due to malformation in children and postoperative scarring, thus configuring a nosological entity that we could define as "syndrome of the nasopharyngeal dead space." Palatal prosthesis and pharyngoplasty have been proposed, though these surgical procedures are technically tricky and with possible complications, such as OSA symptoms, snoring, and nasopharyngeal stenosis.
METHODS
We proposed an effortless and minimally invasive procedure to treat this condition based on lipofilling the nasopharynx posterior wall endoscopically. To test the procedure's functional result, the submucosa of the nasopharynx posterior wall was initially filled with resorbable material, namely fibrin glue and autologous blood. The result was optimal but regressed after one month. Then, we repeated the procedure by lipofilling with autologous abdominal fat, resulting in a more stable anatomical and functional outcome at six months follow-up.
RESULTS
The patient had a prompt significant improvement of his complaints (rhinolalia and oronasal regurgitation) and a correct projection of the nasopharynx posterior wall, with correct closure during phonation and absence of oronasal reflux.
CONCLUSIONS
The "syndrome of the nasopharyngeal dead space" should be correctly identified after transoral surgery. It can be effectively treated with lipofilling of the posterior nasopharyngeal wall, a simple and minimally invasive procedure.
Topics: Humans; Male; Adipose Tissue; Endoscopy; Nasopharynx; Palate, Soft; Postoperative Complications; Treatment Outcome; Velopharyngeal Insufficiency; Child
PubMed: 38880842
DOI: 10.1007/s00701-024-06160-5