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Journal of Voice : Official Journal of... Jun 2024Several surgical techniques have been reported for the treatment of unilateral vocal fold paralysis (UVFP). Although the fenestration approach has recently been applied...
OBJECTIVE
Several surgical techniques have been reported for the treatment of unilateral vocal fold paralysis (UVFP). Although the fenestration approach has recently been applied for arytenoid adduction (AA) in some cases, long-term large-cohort studies on its usefulness are lacking. Therefore, this study aimed to evaluate the long-term voice outcomes of this technique in patients with UVFP.
STUDY DESIGN
Retrospective study.
METHODS
A total of 168 patients with UVFP underwent laryngoplasty comprising AA performed through fenestration of the thyroid ala combined with a type I thyroplasty (TPI). The maximum phonation time (MPT) and mean airflow rate (MFR) were measured before and after surgery, and voice analysis included an estimation of shimmer and jitter. Anterior and posterior surgical windows were created in the lower thyroid ala and were used for typical TPI and AA, respectively. The window locations were determined based on three-dimensional computed tomography data. AA was performed by pulling the muscular process of the arytenoid cartilage toward the lateral cricoarytenoid muscle through the posterior window without releasing the cricothyroid joint. All surgeries were performed under local anesthesia, and medialization was endoscopically confirmed.
RESULTS
Postoperative MPT >10 seconds was achieved in 156 of the 168 patients. Postoperatively, MFR improved to <250 mL/s in all but two patients, and MPT, MFR, jitter, and shimmer significantly improved in all patients. Furthermore, perceptual evaluation using the Grade, Roughness, Breathiness, Asthenia, and Strain scale revealed significant improvement in all patients.
CONCLUSIONS
The fenestration approach preserves the cricothyroid joint and does not open the cricoarytenoid joint; therefore, the laryngeal cartilage is stabilized, and no distortion of the laryngeal framework occurs. Our results showed that combined AA and TPI via the fenestration approach provided stable long-term postoperative voice improvement in patients with UVFP.
LEVEL OF EVIDENCE
Level 3.
PubMed: 38839466
DOI: 10.1016/j.jvoice.2024.04.028 -
The Laryngoscope Jun 2024The aim of the study is to compare the short-term effect of 7 versus 3 days of voice rest (VR) on objective vocal (acoustic) parameters following phonosurgery.
OBJECTIVE
The aim of the study is to compare the short-term effect of 7 versus 3 days of voice rest (VR) on objective vocal (acoustic) parameters following phonosurgery.
METHODS
A prospective randomized study conducted at a tertiary referral medical center. Patients with vocal fold nodules, polyps, or cysts and scheduled for phonosurgery were recruited from the Voice Clinic. They were randomized into groups of 7- or 3-day postoperative VR periods and their voices were recorded preoperatively and at 4-week postoperatively. A mixed linear model statistical analysis (MLMSA) was used to compare pre- and postoperative jitter, shimmer, harmonic-to-noise ratio, and maximum phonation time between the two groups.
RESULTS
Sixty-five patients were recruited, but only 34 fully complied with the study protocol, and their data were included in the final analysis (19 males, 20 females; mean age: 40.6 years; 17 patients in the 7-day VR group and 16 in the 3-day VR group). The groups were comparable in age, sex, and type of vocal lesion distribution. The preoperative MLMSA showed no significant group differences in the tested vocal parameters. Both groups exhibited significant (p < 0.05) and comparable improvement in all vocal parameters at postoperative week 4.
CONCLUSIONS
A VR duration of 7 days showed no greater benefit on the examined vocal parameters than the 3-day protocol 4-week postoperatively. Our results suggest that a 3-day VR regimen can be followed by patients who undergo phonosurgery without compromising the vocal results. Larger-scale and longer-duration studies are needed to confirm our findings.
LEVEL OF EVIDENCE
2 Laryngoscope, 2024.
PubMed: 38837365
DOI: 10.1002/lary.31556 -
Preventive Medicine Reports Jul 2024Noma is a neglected tropical disease and a global health concern. (Review)
Review
BACKGROUND
Noma is a neglected tropical disease and a global health concern.
OBJECTIVES
To elucidate the epidemiology, management, prevention, and public health implications of Noma.
METHODS
PubMed, Scopus, and Web of Science, supplemented by Google Scholar and World Health Organization databases, were searched using keywords to gather both published and grey literature from 1970 to 2023 in English.
RESULTS
Approximately 30,000-40,000 cases occur annually, with varying incidences across various African countries, such as Nigeria, Niger, and Chad. Incidence in Nigerian and Ethiopian states range from 0.6 to 3300 and 1.64 to 13.4 per 100,000 population, respectively. Mortality is approximately 8.5% in Niger. Risk factors include malnutrition, immunocompromised status, poor dental hygiene, inadequate sanitation, gingival lesions, low socioeconomic status, chronic and infectious diseases, low birth weight, high parity, diarrhoea, and fever. Diagnosis is primarily made based on clinical signs/symptoms and accordingly staging of disease is done. Stage I, II and II presents with acute necrotizing gingivitis, facial edema with halitosis, and necrotizing stomatitis, respectively. If the patient survives acute stages, the progress to Stage IV and Stage V manifests as trismus, difficulty in deglutition and phonation, and facial disfigurement, with increased severity in last stage. Treatment encompasses antibiotic therapy (amoxicillin, metronidazole, chlorhexidine, ampicillin, gentamicin), surgical interventions, wound management (honey dressing, ketamine), and nutritional support. Prevention strategies include oral hygiene, vaccination, health education, and community-based interventions.
CONCLUSION
Noma's recent inclusion in WHO list of neglected tropical diseases is a milestone in recognizing the importance of prevention and early intervention to globally enhance health outcomes.
PubMed: 38826589
DOI: 10.1016/j.pmedr.2024.102764 -
Journal of Speech, Language, and... May 2024This study aimed to investigate the acoustic and electroglottographic (EGG) profiles of Mandarin deception, including global characteristics and the influence of gender.
PURPOSE
This study aimed to investigate the acoustic and electroglottographic (EGG) profiles of Mandarin deception, including global characteristics and the influence of gender.
METHOD
Thirty-six Mandarin speakers participated in an interactive interview game in which they provided both deceptive and truthful answers to 14 biographical questions. Acoustic and EGG signals of the participants' responses were simultaneously recorded; 20 acoustic and 14 EGG features were analyzed using binary logistic regression models.
RESULTS
Increases in fundamental frequency (0) mean, intensity mean, first formant (F1), fifth formant (F5), contact quotient (CQ), decontacting-time quotient (DTQ), and contact index (CI) as well as decreases in jitter, shimmer, harmonics-to-noise ratio (HNR), and fourth formant (F4) were significantly correlated with global deception. Cross-gender features included increases in intensity mean and F5 and decreases in jitter, HNR, and F4, whereas gender-specific features encompassed increases in 0 mean, shimmer, F1, third formant, and DTQ, as well as decreases in 0 maximum and CQ for female deception, and increases in CQ and CI and decreases in shimmer for male deception.
CONCLUSIONS
The results suggest that Mandarin deception could be tied to underlying pragmatic functions, emotional arousal, decreased glottal contact skewness, and more pressed phonation. Disparities in gender-specific features lend support to differences in the use of pragmatics, levels of deception-induced emotional arousal, skewness of glottal contact patterns, and phonation types.
PubMed: 38820240
DOI: 10.1044/2024_JSLHR-23-00288 -
PLOS Digital Health May 2024Detecting voice disorders from voice recordings could allow for frequent, remote, and low-cost screening before costly clinical visits and a more invasive laryngoscopy...
Detecting voice disorders from voice recordings could allow for frequent, remote, and low-cost screening before costly clinical visits and a more invasive laryngoscopy examination. Our goals were to detect unilateral vocal fold paralysis (UVFP) from voice recordings using machine learning, to identify which acoustic variables were important for prediction to increase trust, and to determine model performance relative to clinician performance. Patients with confirmed UVFP through endoscopic examination (N = 77) and controls with normal voices matched for age and sex (N = 77) were included. Voice samples were elicited by reading the Rainbow Passage and sustaining phonation of the vowel "a". Four machine learning models of differing complexity were used. SHapley Additive exPlanations (SHAP) was used to identify important features. The highest median bootstrapped ROC AUC score was 0.87 and beat clinician's performance (range: 0.74-0.81) based on the recordings. Recording durations were different between UVFP recordings and controls due to how that data was originally processed when storing, which we can show can classify both groups. And counterintuitively, many UVFP recordings had higher intensity than controls, when UVFP patients tend to have weaker voices, revealing a dataset-specific bias which we mitigate in an additional analysis. We demonstrate that recording biases in audio duration and intensity created dataset-specific differences between patients and controls, which models used to improve classification. Furthermore, clinician's ratings provide further evidence that patients were over-projecting their voices and being recorded at a higher amplitude signal than controls. Interestingly, after matching audio duration and removing variables associated with intensity in order to mitigate the biases, the models were able to achieve a similar high performance. We provide a set of recommendations to avoid bias when building and evaluating machine learning models for screening in laryngology.
PubMed: 38814939
DOI: 10.1371/journal.pdig.0000516 -
Frontiers in Public Health 2024The domination of the Contemporary Commercial Music (CCM) industry in music markets has led to a significant increase in the number of CCM performers. Performing in a...
BACKGROUND
The domination of the Contemporary Commercial Music (CCM) industry in music markets has led to a significant increase in the number of CCM performers. Performing in a wide variety of singing styles involves exposing CCM singers to specific risk factors potentially leading to voice problems. This, in turn, necessitates the consideration of this particular group of voice users in the Occupational Health framework. The aim of the present research was threefold. First, it sought to profile the group of Polish CCM singers. Second, it was designed to explore the prevalence of self-reported voice problems and voice quality in this population, in both speech and singing. Third, it aimed to explore the relationships between voice problems and lifetime singing involvement, occupational voice use, smoking, alcohol consumption, vocal training, and microphone use, as potential voice risk factors.
MATERIALS AND METHODS
The study was conducted in Poland from January 2020 to April 2023. An online survey included socio-demographic information, singing involvement characteristics, and singers' voice self-assessment. The prevalence of voice problems was assessed by the Polish versions of the Vocal Tract Discomfort Scale (VTDS) and the Singing Voice Handicap Index (SVHI). Also, a self-reported dysphonia symptoms protocol was applied. The perceived overall voice quality was assessed by a Visual Analogue Scale (VAS) of 100 mm.
RESULTS
412 singers, 310 women and 102 men, completed the survey. Nearly half of the studied population declared lifetime singing experience over 10 years with an average daily singing time of 1 or 2 h. 283 participants received vocal training. For 11.4% of respondents, singing was the primary income source, and 42% defined their career goals as voice-related. The median scores of the VTDS were 11.00 (0-44) and 12.00 (0-40) for the Frequency and Severity subscales, respectively. The median SVHI score of 33 (0-139) was significantly higher than the normative values determined in a systematic review and meta-analysis (2018). Strong positive correlations were observed between SVHI and both VTD subscales: Frequency ( = 0.632, < 0.001) and Severity ( = 0.611, < 0.001). The relationships between most of the other variables studied were weak or negligible.
CONCLUSION
The examined CCM singers exhibited substantial diversity with regard to musical genre preferences, aspirations pertaining to singing endeavors, career affiliations, and source of income. Singing voice assessment revealed a greater degree of voice problems in the examined cohort than so far reported in the literature, based on the SVH and VTDS.
Topics: Humans; Poland; Singing; Male; Female; Adult; Cross-Sectional Studies; Middle Aged; Music; Voice Quality; Voice Disorders; Self-Assessment; Surveys and Questionnaires; Prevalence; Risk Factors; Young Adult; Speech
PubMed: 38813421
DOI: 10.3389/fpubh.2024.1256152 -
Plastic and Reconstructive Surgery Jun 2024Magnetic resonance imaging (MRI) is the only imaging modality capable of directly visualizing the levator veli palatini (LVP) muscles: the primary muscles responsible...
BACKGROUND
Magnetic resonance imaging (MRI) is the only imaging modality capable of directly visualizing the levator veli palatini (LVP) muscles: the primary muscles responsible for velopharyngeal closure during speech. MRI has been used to describe normal anatomy and physiology of the velopharynx in research studies, but there is limited experience with use of MRI in the clinical evaluation of patients with velopharyngeal insufficiency (VPI).
METHODS
MRI was used to evaluate the velopharyngeal mechanism in patients presenting for VPI management. The MRI followed a fully awake, nonsedated protocol with phonation sequences. Quantitative and qualitative measures of the velopharynx were obtained and compared with age- and sex-matched individuals with normal speech resonance.
RESULTS
MRI was completed successfully in 113 of 118 patients (96%). Compared with controls, patients with VPI after cleft palate repair had a shorter velum (P < 0.001), higher incidence of LVP discontinuity (P < 0.001), and shorter effective velar length (P < 0.001). Among patients with persistent VPI after pharyngeal flap placement, findings included a pharyngeal flap base located inferior to the palatal plane [11 of 15 (73%)], shorter velum (P < 0.001), and higher incidence of LVP discontinuity (P = 0.014). Patients presenting with noncleft VPI had a shorter (P = 0.004) and thinner velum (P < 0.001) and higher incidence of LVP discontinuity (P = 0.014).
CONCLUSIONS
MRI provides direct evidence of LVP muscle anomalies and quantitative evaluation of both velar length and velopharyngeal gap. This information is unavailable with traditional VPI imaging tools, suggesting that MRI may be a useful tool for selecting surgical procedures to address patient-specific anatomic differences.
Topics: Humans; Velopharyngeal Insufficiency; Magnetic Resonance Imaging; Female; Male; Child; Adolescent; Child, Preschool; Adult; Young Adult; Palate, Soft; Pharynx; Cleft Palate; Pharyngeal Muscles; Case-Control Studies; Surgical Flaps
PubMed: 38810162
DOI: 10.1097/PRS.0000000000010798 -
Brain Sciences Apr 2024Primary progressive apraxia of speech (PPAOS) is a neurodegenerative syndrome characterized by the progressive and initially isolated or predominant onset of...
Primary progressive apraxia of speech (PPAOS) is a neurodegenerative syndrome characterized by the progressive and initially isolated or predominant onset of difficulties in the planning/programming of movements necessary for speech production and can be accompanied by dysarthria. To date, no study has used an evidence-based treatment to address phonation control in patients with PPAOS. The aim of this study was to evaluate the feasibility and efficacy of LSVT LOUD as a treatment for phonatory control in speakers with PPAOS. Three speakers with PPAOS received LSVT LOUD therapy, and changes in phonatory control, voice quality and prosody were measured immediately, and one, four and eight weeks after the end of the treatment. Overall, the results suggest that the treatment is feasible and could improve voice quality, intensity, and control in some patients with PPAOS. The generalization of the results is also discussed.
PubMed: 38790396
DOI: 10.3390/brainsci14050417 -
Bioengineering (Basel, Switzerland) May 2024In voice analysis, the electroglottographic (EGG) signal has long been recognized as a useful complement to the acoustic signal, but only when the vocal folds are...
In voice analysis, the electroglottographic (EGG) signal has long been recognized as a useful complement to the acoustic signal, but only when the vocal folds are actually contacting, such that this signal has an appreciable amplitude. However, phonation can also occur without the vocal folds contacting, as in breathy voice, in which case the EGG amplitude is low, but not zero. It is of great interest to identify the transition from non-contacting to contacting, because this will substantially change the nature of the vocal fold oscillations; however, that transition is not in itself audible. The magnitude of the cycle-normalized peak derivative of the EGG signal is a convenient indicator of vocal fold contacting, but no current EGG hardware has a sufficient signal-to-noise ratio of the derivative. We show how the textbook techniques of spectral thresholding and static notch filtering are straightforward to implement, can run in real time, and can mitigate several noise problems in EGG hardware. This can be useful to researchers in vocology.
PubMed: 38790346
DOI: 10.3390/bioengineering11050479 -
Esophagus : Official Journal of the... Jul 2024Postoperative pneumonia in patients with esophageal cancer occurs due to swallowing dysfunction and aspiration. Recently, maximum phonation time (MPT) assessment and...
BACKGROUND
Postoperative pneumonia in patients with esophageal cancer occurs due to swallowing dysfunction and aspiration. Recently, maximum phonation time (MPT) assessment and repetitive saliva swallowing test (RSST) have been focused on as swallowing function assessment methods that can identify patients as high risk for pneumonia. We aimed to evaluate the clinical utility of MPT assessment and RSST in patients undergoing oncological esophagectomy.
METHODS
In total, 47 consecutive patients who underwent esophagectomy for esophageal cancer between August 2020 and July 2023 were eligible. The perioperative changes in MPTs and RSST scores were examined. In addition, univariate and multivariate analyses were performed to identify the predictive factors of postoperative pneumonia.
RESULTS
The median MPTs before surgery and on postoperative days (PODs) 3, 6, and 10 were 18.4, 7.2, 10.6, and 12.4 s, respectively; postoperative MPTs were significantly lower than preoperative MPT. In addition, the MPT of POD 6 was significantly longer than that of POD 3 (P < 0.05). Meanwhile, there were no significant changes in perioperative RSST scores. Overall, 8 of 47 patients (17.0%) developed pneumonia postoperatively. A short MPT on POD 6 was one of the independent predictive factors for the incidence of postoperative pneumonia (odds ratio: 12.6, 95% confidence interval: 1.29-123, P = 0.03) in the multivariate analysis.
CONCLUSIONS
The MPT significantly decreased after esophagectomy. However, the RSST score did not. The MPT on POD6 can be a predictor of postoperative pneumonia.
Topics: Humans; Esophagectomy; Male; Female; Aged; Middle Aged; Esophageal Neoplasms; Postoperative Complications; Deglutition Disorders; Saliva; Deglutition; Phonation; Risk Factors; Pneumonia; Retrospective Studies; Predictive Value of Tests; Postoperative Period; Aged, 80 and over
PubMed: 38787481
DOI: 10.1007/s10388-024-01065-9