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Naunheim MR, DeVore EK, Huston MN, Song PC, Franco RA, Bhattacharyya N. Increasing Prevalence of Voice Disorders in the USA: Updates in the COVID Era. Laryngoscope 2024; 134:3713-3718. [PMID: 38525993 DOI: 10.1002/lary.31409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/03/2024] [Accepted: 03/13/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE To estimate the current prevalence of voice disorders among adults in the United States; to determine the association of individual factors with voice disorders. METHODS The 2022 National Health Interview Survey (NHIS) was analyzed to identify adults reporting voice problems in the past 12 months. Demographics were assessed, as well as the duration, severity, and resolution of the voice problem. The relationship between voice problems, gender, lost workdays, and long COVID was investigated. A comparison to the 2012 NHIS was made to determine changes in voice disorder prevalence. RESULTS 29.9 million Americans (95%CI[28.3-31.5]) annually report a voice problem, representing 12.2% of the population (95%CI[11.7-12.8%]). Overall, 26.8% and 13.2% reported the severity of their voice problem as moderate or severe, respectively. Only 5.1% (95%CI[4.3-6.0%]) of respondents sought treatment. Most voice problems were resolved within 1 week (53.0%,95%CI[50.9-55.1%]). Females were more likely than males to report a voice problem (14.4% vs. 10.0%,95%CI[13.7-15.1] and [9.3-10.7], respectively). The 17.6 million Americans with long COVID symptoms were more likely to have voice complaints than those without (21.1% vs. 11.6%,95%CI[18.9-23.5%] and [11.1-12.1%], respectively). Lost workdays were not significantly higher for those with voice disorders compared to those without (17.1 vs. 12.9 days,95%CI[12.0-22.1] and [11.0-14.8], respectively). CONCLUSIONS Voice problems affect approximately 1 in 8 adults in the U.S. annually, demonstrating an alarming increased prevalence since 2012 using the same survey methodology. Relatively few individuals seek care for their voice problem, despite significant self-reported impact. Further study is required regarding the impact of COVID and changes in voice use patterns on voice disorders. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3713-3718, 2024.
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Affiliation(s)
- Matthew R Naunheim
- Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Elliana K DeVore
- Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Molly N Huston
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, U.S.A
| | - Phillip C Song
- Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Ramon A Franco
- Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Neil Bhattacharyya
- Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
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Mallinger M, Wiersma L, Spek B, Rinkel RNPM. Quality of Life in Recurrent Respiratory Papillomatosis Patients after Vocal Fold Surgery: An In-Depth Exploration. Folia Phoniatr Logop 2024:1-10. [PMID: 39004072 DOI: 10.1159/000540310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 07/08/2024] [Indexed: 07/16/2024] Open
Abstract
INTRODUCTION This study explores the quality of life among patients with recurrent respiratory papillomatosis (RRP) after vocal fold surgery as measured by the outcome scores of the Voice Handicap Index (VHI) and the Distress Thermometer and Problem List in Patients with Recurrent Respiratory Papillomatosis (DT&PL). Differences in quality of life were explored within the independent variables age, surgical frequency, weeks since last vocal fold operation, gender, HPV type, surgical location, vaccination with Gardasil©, and a patient's request to speak with a speech-language pathologist. METHODS A single-center, observational cohort study was conducted using VHI and DT&PL scores and demographic and clinical data obtained from patient files. Inclusion criteria were a confirmed HPV type, age 18 years or older, the ability to fill in both questionnaires in Dutch, and having undergone at least one surgical procedure to remove laryngeal papilloma. Relationships of the independent variables with VHI and Distress Thermometer (DT) scores were explored using univariable and multivariable regressions and linear regression models. RESULTS Of 271 RRP patients, 100 met the inclusion criteria and responded to requests to fill in both questionnaires with a minimum of 12 weeks after their last operation. Our study showed a statistically significant negative relationship between age and VHI scores (p = 0.02) in the univariable, and multiple linear regressions (p = 0.01), indicating that patients experienced fewer self-perceived functional voice disabilities with each increase in age. A parallel negative relationship is seen between the variables age (p = 0.03) and DT scores. Our results showed a statistically significant positive relationship between the number of vocal fold surgeries and DT scores (p = 0.03). CONCLUSION The results of this study show a significant relationship between age, surgical frequency, and quality of life in patients with RRP. Older patients have lower Voice Handicap Index (VHI) and Distress Thermometer (DT) scores, indicating fewer self-perceived voice and disease-related quality of life problems. Conversely, a rise in surgical frequency is significantly associated with higher DT scores, reflecting greater disease-related distress.
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Affiliation(s)
- Michelle Mallinger
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Lynke Wiersma
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Bea Spek
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Rico N P M Rinkel
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Adessa M, Kim J, Tierney WS, Benninger M. Temporomandibular Dysfunction and Voice-Related Quality of Life Impairment. Laryngoscope 2024; 134:315-317. [PMID: 37530589 DOI: 10.1002/lary.30927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/30/2023] [Accepted: 07/18/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE Muscle tension in the head and neck may co-occur with temporomandibular dysfunction (TMD) possibly leading to voice change. Several studies have reported a correlation between TMD and dysphonia. However, literature on TMD and voice-related quality of life (QOL) is scant. This study aimed to investigate the relationship between TMD and self-perceived voice-related QOL impairment. METHODS Patients from TMD clinic were prospectively surveyed on voice-related quality of life using the Voice Handicap Index (VHI) questionnaire. Patients were queried using paper and pen upon initial evaluation in dentistry clinic for temporomandibular disorders by a single dentist or dental assistant in the otolaryngology department. RESULTS A total of 53 patients completed the VHI. 80% of patients presenting to TMD clinic had VHI scores above zero, but most had minimal to mild impairment. Forty-two patients had scores between 1 and 86, (average 10.98); 11 patients had a score of zero (20.75%). Total average score: 8.70, range: 0-86, median: 4. Functional average score: 3.13, range: 0-29, median: 1. Physical average score: 3.58. range: 0-25, median: 2. Emotional average score: 1.98, range: 0-32, median: 0; these averages did not differ from historical controls. CONCLUSION The majority of patients presenting to TMD clinic also presented with some level of voice-related QOL impairment, although minimal and consistent with historical VHI controls. Data indicates that TMD disease may be primarily defined as functionally and physically uncomfortable. Incorporation of interdisciplinary care, with laryngology, speech pathology, physical therapy, counseling, and pain management may be warranted. LEVEL OF EVIDENCE 4 Laryngoscope, 134:315-317, 2024.
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Affiliation(s)
- Michelle Adessa
- The Voice Center, Head & Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Jaehee Kim
- Case Western Reserve School of Medicine, Cleveland, Ohio, USA
| | - William S Tierney
- The Voice Center, Head & Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Michael Benninger
- The Voice Center, Head & Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
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Huston MN, Puka I, Naunheim MR. Prevalence of Voice Disorders in the United States: A National Survey. Laryngoscope 2024; 134:347-352. [PMID: 37530584 DOI: 10.1002/lary.30929] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/26/2023] [Accepted: 07/18/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVES The prevalence of voice disorders has not been explored in the context of recent trends in voice use, including voice assistant technology and increased use of teleconferencing for remote work. The objective of this research is (1) to determine the prevalence of voice disorders in the adult population of the United States, and (2) to understand the association of voice disorders with demographic and voice use factors, including vocal demands, and use of teleconferencing and voice assistant technology. METHODS A survey pertaining to voice disorders and voice use was developed and administered to a representative sample of US population. Demographics and information related to risk factors for voice disturbance, including high vocal demands, teleconferencing, and voice-assistant use were also analyzed. RESULTS A total of 1522 responses were included. Of these, 20.6% reported having had a voice disorder at some point in their life. This rate was higher in employed respondents, singers, and teachers (all p < 0.0001) and was notably higher in those who used teleconferencing technology and voice assistant technology (both p < 0.0001). Approximately 60% of this subset reported seeking medical care for their voice, 12.6% reported a current voice disorder, and 9.5% reported a voice problem that had recurred multiple times. CONCLUSIONS Approximately 1 in 5 Americans surveyed has had a voice disorder. Risk factors for voice disorders include use of teleconferencing technology, voice assistant use, and occupational factors. LEVEL OF EVIDENCE 3 Laryngoscope, 134:347-352, 2024.
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Affiliation(s)
- Molly N Huston
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Ira Puka
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Matthew R Naunheim
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Hortobagyi D, Grossmann T, Kirsch A, Winter C, Roblegg E, Gugatschka M. Exploring the anti-inflammatory potential of topical hyaluronic acid for vocal fold injury in a rat model. Eur Arch Otorhinolaryngol 2024; 281:301-310. [PMID: 37823895 PMCID: PMC10764393 DOI: 10.1007/s00405-023-08278-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE Vocal fold injuries are associated with fibrosis and dysphonia, which is a major obstacle to surgical treatment. The aim of this study is to evaluate the effect of topical hyaluronic acid with or without diclofenac on the inflammatory phase of vocal fold wound healing. METHODS Forty-one male Sprague-Dawley rats were randomly assigned to four groups: an uninjured control group, an injured control group without any treatment, and two intervention groups in which hyaluronic acid with or without diclofenac was applied to the injured vocal fold. Gene expression of inflammatory markers and ECM-related molecules were examined. RESULTS Vocal fold injury resulted in a significant upregulation of inflammatory parameters [Ptgs2, Il1b and Il10] and Has1. Tgfb1, Has3 and Eln gene expression were significantly downregulated by the topical application of hyaluronic acid. The combination of hyaluronic acid and diclofenac did not result in any significant changes. CONCLUSIONS Vocal fold wound healing was significantly improved by a single post-operative topical application of hyaluronic acid. The addition of diclofenac may provide no additional benefit.
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Affiliation(s)
- David Hortobagyi
- Division of Phoniatrics, ENT University Hospital, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria.
| | - Tanja Grossmann
- Division of Phoniatrics, ENT University Hospital, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
| | - Andrijana Kirsch
- Division of Phoniatrics, ENT University Hospital, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
| | - Christina Winter
- Institute of Pharmaceutical Sciences, Pharmaceutical Technology and Biopharmacy, University of Graz, Graz, Austria
| | - Eva Roblegg
- Institute of Pharmaceutical Sciences, Pharmaceutical Technology and Biopharmacy, University of Graz, Graz, Austria
| | - Markus Gugatschka
- Division of Phoniatrics, ENT University Hospital, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
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Naunheim MR, Puka E, Huston MN. Do You Like Your Voice? A Population-Based Survey of Voice Satisfaction and Voice Enhancement. Laryngoscope 2023; 133:3455-3461. [PMID: 37309825 DOI: 10.1002/lary.30822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/06/2023] [Accepted: 05/29/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Voice enhancement for patients without obvious vocal pathology or loss of function is rarely discussed clinically or in academic research. Our objectives were to: (1) determine voice satisfaction on a population level, and (2) assess willingness to consider interventions to change one's voice. METHODS A standardized questionnaire was created to assess current and past voice disorders. Questions assessed demographics, health status, prevalence of voice disorders, and questions regarding satisfaction with voice. Iterative survey testing and piloting were performed. A cohort with age, gender, and geographic distribution of the general adult population was then queried in an online survey. Qualitative analysis and both descriptive and multivariate statistics were performed. RESULTS A total of 1522 respondents were included, with an age, gender, and regional distribution reflective of the US population. A minority (38.8%) of respondents reported that they did not like the sound of their own voice in normal conversation; when asked about listening to a recording of their own voice, a majority (57.5%) reported dissatisfaction with voice. Discontent with one's voice was associated with being middle age (p = 0.005), female gender (p < 0.0001), and white race (p < 0.0001). Approximately 50.6% of respondents without a history of dysphonia would consider interventions to change their voice. Of those who indicated they may elect to change their voice, qualities regarding clarity and pitch were paramount. CONCLUSION Dissatisfaction with one's speaking voice is common. A considerable percentage of the general population without a voice disorder would consider interventions to change their voice. LEVEL OF EVIDENCE 3 Laryngoscope, 133:3455-3461, 2023.
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Affiliation(s)
- Matthew R Naunheim
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Elefteria Puka
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Molly N Huston
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Butler J, Sellstrom D, Eastwood N, Hamilton D, O'Hara J. Outcomes of an Advanced Speech and Language Therapist-Led Low-Risk 2-Week Wait Clinic for Suspected Head and Neck Cancer: A UK-Based Pilot Study. J Voice 2023:S0892-1997(23)00042-5. [PMID: 37024351 DOI: 10.1016/j.jvoice.2023.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVES To describe outcomes of a pilot Speech and Language Therapist led (SLT-led) 2-week wait (2WW) assessment clinic for head and neck cancer (HNC). STUDY DESIGN A prospective 3-month pilot clinic was conducted. All referrals were triaged by an otolaryngologist. Referrals for unilateral symptoms, palpable neck lumps and/or ear pain were excluded. SLTs performed initial assessment. All patients received oral and neck examinations, and a videolaryngoscopy, including therapy trials. All images and management plans were discussed with an otolaryngologist within one week of the clinic. Images of suspicious lesions were reviewed within 24 hours. Data were collected consecutively for all patients attending the clinic between December 2021 and March 2022. Data included demographics, smoking history, perceptual voice ratings (GRBAS), validated patient-reported outcome measures (PROMs), diagnoses, and clinical plans. Descriptive statistics were conducted within Excel and inferential statistics within SPSS. RESULTS Over 3 months, 218 patients were seen, 62% were female and the mean age was 63 years. Most patients (54%) opted for "patient initiated follow-up" and 16% received further investigations. No patients required Ear, Nose and Throat (ENT) outpatient review for second opinion. Most (65%) received a functional diagnosis. The diagnostic yield of cancer was 5% (n = 11) and high-grade dysplasia was 3% (n = 6). At the time of writing, no patients had been re-referred to the service. There was a positive relationship between risk of diagnosis and mean GRBAS score (P < 0.01), and VHI-10 score (p=0.013). Patients with higher-risk diagnoses tended to be male, older, and had a history of smoking. PROMs suggested that laryngeal symptoms, regardless of underlying pathology, affect quality of life. CONCLUSION Experienced SLTs working alongside otolaryngologists safely led assessment and directed treatment planning for patients referred to ENT on the 2WW pathway. The rate of high-risk diagnoses was low. Higher GRBAS and VHI-10 scores may be useful indicators for higher risk diagnoses.
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Affiliation(s)
- Jen Butler
- Northumbria Healthcare NHS Foundation Trust, With Academic Funding From Health Education England/National Institute for Health Research.
| | - Diane Sellstrom
- Newcastle upon Tyne Hospitals - Newcastle Upon Tyne, United Kingdom
| | - Natalie Eastwood
- Newcastle upon Tyne Hospitals - Newcastle Upon Tyne, United Kingdom
| | - David Hamilton
- Newcastle upon Tyne Hospitals - Newcastle Upon Tyne, United Kingdom
| | - James O'Hara
- Newcastle University - Newcastle Upon Tyne, United Kingdom
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Kim JM, Yoo SD, Park EJ. Nutritional Biomarkers as Predictors of Dysphonia Severity in Patients with Ischemic Stroke. Nutrients 2023; 15:nu15030652. [PMID: 36771359 PMCID: PMC9919533 DOI: 10.3390/nu15030652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/18/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
Dysphonia and malnutrition are major problems in patients who have suffered an ischemic stroke. Tools to assess dysphonia severity include the dysphonia severity index (DSI) and maximum phonation time (MPT). This study aimed to investigate whether the nutritional biomarkers transferrin, albumin, and prealbumin could be predictors of dysphonia severity. A retrospective analysis was conducted between January 2018 and October 2022. A total of 180 patients who had suffered an ischemic stroke were included. Serum transferrin, albumin, and prealbumin levels were significantly correlated with DSI and MPT levels. In a multiple regression analysis, prealbumin and transferrin were significant predictors of DSI, whereas only prealbumin was a significant predictor of MPT. Serum transferrin, albumin, and prealbumin levels in patients who have suffered an ischemic stroke may correlate with dysphonia severity as assessed using DSI and MPT. These results may provide objective evidence that nutritional biomarkers affect dysphonia severity.
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Affiliation(s)
- Ji Min Kim
- Department of Rehabilitation Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
- Department of Medicine, AgeTech-Service Convergence Major, Kyung Hee University, Seoul 05278, Republic of Korea
| | - Eo Jin Park
- Department of Rehabilitation Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
- Correspondence: ; Tel.: +82-2-440-7246
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Naunheim MR, Huston MN, Bhattacharyya N. Voice Disorders Associated With the Use of Inhaled Corticosteroids. Otolaryngol Head Neck Surg 2023; 168:1034-1037. [PMID: 36939522 DOI: 10.1002/ohn.198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Inhaled corticosteroids (ICS) have been demonstrated to be associated with voice changes. The goal was to determine the strength of the association between ICS use and a diagnosis of dysphonia made by an otolaryngologist and to determine whether inhaler particle type or medication type influenced this risk. STUDY DESIGN A case-control study from 2018 to 2020. SETTING Urban academic medical system. METHODS Adult patients with dysphonia diagnosed by an otolaryngologist, and control patients matched on age, gender, race, and health status, were included. Exposure to ICS was assessed, and the odds ratio (OR) of the association of ICS with dysphonia was calculated. RESULTS A total of 6551 cases and 6551 matched controls were included. We found that ICS use was significantly associated with dysphonia (OR: 5.11, 95% confidence interval: 4.23-6.17, p < .001). Subset analyses demonstrated no significant differences between inhaler particle types or specific active medications. CONCLUSION This study emphasizes the importance of identifying ICS use in the evaluation and treatment of patients with dysphonia.
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Affiliation(s)
- Matthew R Naunheim
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Molly N Huston
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri, USA
| | - Neil Bhattacharyya
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Hidalgo Lopez JC, Sandeep S, Wright M, Wandell GM, Law AB. Quantifying and Improving the Performance of Speech Recognition Systems on Dysphonic Speech. Otolaryngol Head Neck Surg 2023; 168:1130-1138. [PMID: 36939576 DOI: 10.1002/ohn.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/30/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE This study seeks to quantify how current speech recognition systems perform on dysphonic input and if they can be improved. STUDY DESIGN Experimental machine learning methods based on a retrospective database. SETTING Single academic voice center. METHODS A database of dysphonic speech recordings was created and tested against 3 speech recognition platforms. Platform performance on dysphonic voice input was compared to platform performance on normal voice input. A custom speech recognition model was trained on voice from patients with spasmodic dysphonia or vocal cord paralysis. Custom model performance was compared to base model performance. RESULTS All platforms performed well on normal voice, and 2 platforms performed significantly worse on dysphonic speech. Accuracy metrics on dysphonic speech returned values of 84.55%, 88.57%, and 93.56% for International Business Machines (IBM) Watson, Amazon Transcribe, and Microsoft Azure, respectively. The secondary analysis demonstrated that the lower performance of IBM Watson and Amazon Transcribe was driven by performance on spasmodic dysphonia and vocal fold paralysis. Thus, a custom model was built to increase the accuracy of these pathologies on the Microsoft platform. Overall, the performance of the custom model on dysphonic voices was 96.43% and on normal voices was 97.62%. CONCLUSION Current speech recognition systems generally perform worse on dysphonic speech than on normal speech. We theorize that poor performance is a consequence of a lack of dysphonic voices in each platform's original training dataset. We address this limitation with transfer learning used to increase the performance of these systems on all dysphonic speech.
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Affiliation(s)
| | - Shelly Sandeep
- Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Grace M Wandell
- Department of Otolaryngology-Head & Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Anthony B Law
- Emory University School of Medicine, Atlanta, Georgia, USA
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Ostermann TA, Fuchs M, Hinz A, Engel C, Berger T. Associations of Personality, Physical and Mental Health with Voice Range Profiles. J Voice 2023:S0892-1997(22)00377-0. [PMID: 36599716 DOI: 10.1016/j.jvoice.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES There is evidence in the literature that voice characteristics are linked to mental and physical health. The aim of this explorative study was to determine associations between voice parameters measured by a voice range profile (VRP) and personality, mental and physical health. STUDY DESIGN Cross-sectional population-based study. METHODS As part of the LIFE-Adult-Study, 2639 individuals aged 18-80 years, randomly sampled from the general population, completed both speaking and singing voice tasks and answered questionnaires on depression, anxiety, life satisfaction, personality and quality of life. The voice parameters used were fundamental frequency, sound pressure level, their ranges and maximum phonation time. The associations were examined with the help of correlation and regression analyses. RESULTS Wider ranges between the lowest and highest frequency, between the lowest and highest sound pressure level and longer maximum phonation time were significantly correlated with extraversion and quality of life in both sexes, as well as openness and agreeableness in women. Smaller ranges and shorter maximum phonation time were significantly correlated with depression. Neuroticism in men was inversely correlated with the maximum phonation time. In the speaking VRP, the associations for sound pressure level were more pronounced than for the fundamental frequency. The same was true in reverse for the singing VRP. Few associations were found for anxiety, life satisfaction and conscientiousness. CONCLUSIONS Weak associations between voice parameters derived from the VRP and mental and physical health, as well as personality were seen in this exploratory study. The results indicate that the VRP measurements in a clinical context are not significantly affected by these parameters and thus are a robust measurement method for voice parameters.
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Affiliation(s)
- Thomas A Ostermann
- Phoniatrics and Audiology, Department of Otorhinolaryngology, University of Leipzig, Leipzig, Germany; LIFE Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany; Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Michael Fuchs
- Phoniatrics and Audiology, Department of Otorhinolaryngology, University of Leipzig, Leipzig, Germany; LIFE Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Andreas Hinz
- LIFE Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany; Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Christoph Engel
- LIFE Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany; Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Thomas Berger
- Phoniatrics and Audiology, Department of Otorhinolaryngology, University of Leipzig, Leipzig, Germany; LIFE Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.
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González-Gamboa M, Segura-Pujol H, Oyarzún PD, Rojas S. Are Occupational Voice Disorders Accurately Measured? A Systematic Review of Prevalence and Methodologies in Schoolteachers to Report Voice Disorders. J Voice 2022:S0892-1997(22)00348-4. [PMID: 36496306 DOI: 10.1016/j.jvoice.2022.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Different measuring instruments have been described to determine the prevalence of voice disorders in schoolteachers. However, the heterogeneity of prevalence figures has made it difficult in determining the impact of voice disorders in this group. This investigation aims to review and identify scientific evidence of methodological analysis of voice disorders in teachers, the relevance of measuring instruments, the prevalence of dysphonia, and the impact on the development of vocal health prevention programs. METHODS A systematic review was conducted by searching six important scientific databases. Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines were carried out. Articles were included whether they presented data related to the prevalence of dysphonia and the impact of therapy programs on teachers. RESULTS Twenty articles out of 8,998 were selected. The cross-sectional design type was predominant throughout the investigations. Differences were observed in the number of participants across studies, leading to heterogeneous prevalence figures - which ranged from 10.5% to 69.1%. The assessment instruments are not standardly used to effectively determine the disease burden. Despite the fact of the extensive evidence of the effectiveness of programs that address dysphonia in teachers, the scarcity of literature is yet evident on systematic programs promoted by either the government or educational institutions. CONCLUSION Findings suggest that future investigations should consider the consensus of a global definition for occupational dysphonia in teachers in order to develop accurately measuring instruments and to assist with voice care programs and treatment approaches in this population. This might be crucial since it could also assist with the implementation of Delphi-type studies that could support the development of further evidence-based agreements around these programs (voice care and treatment approaches) in schoolteachers.
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Affiliation(s)
| | - Hugo Segura-Pujol
- Escuela de Fonoaudiología, Facultad de Salud, Universidad Santo Tomás, Chile
| | - Patricia D Oyarzún
- Escuela de Fonoaudiología, Facultad de Salud, Universidad Santo Tomás, Chile
| | - Sandra Rojas
- Escuela de Fonoaudiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile
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13
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Miles ER, Krishna PD, Dehom S, Hahn R, LaTour D, Murry T, Crawley BK. Voice and Airway Outcomes of Montgomery T-tube Placement in Laryngotracheal Stenosis. J Voice 2022:S0892-1997(22)00161-8. [PMID: 35859059 DOI: 10.1016/j.jvoice.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To describe voice and airway outcomes and complications experienced by patients with laryngotracheal stenosis following Montgomery T-tube placement. METHODS Retrospective chart review of all patients with laryngotracheal stenosis and Montgomery T-tube placement treated at a tertiary referral center from 2012 to 2021. RESULTS Eighteen patients met criteria with laryngotracheal stenosis, seven including the level of the glottis and 11 without glottal involvement. Eleven were completely aphonic before T-tube placement and the remainder had severe dysphonia. There was improvement of Voice Handicap Index-10, Reflux Symptom Index, and GRBAS grade following T-tube placement in patients compared to their preoperative values. Improvement of grade was greater in patients without glottal involvement. Complications of chronic indwelling T-tube included granulation in 14 patients (78%), tracheitis in two patients (11%), and mucus plugging in three patients (17%) with one T-tube related mortality. Five patients were eventually decannulated, six returned to tracheostomy tube, and seven retained the T-tube at last follow-up (average: 30 months, range: 4-80 months). CONCLUSIONS Montgomery T-tube placement improves voice in patients with severe dysphonia secondary to laryngotracheal stenosis with and without glottal involvement though the degree of improvement is greater in patients without glottal involvement. T-tube can help reestablish long-term laryngotracheal continuity in patients with no other surgical options. The potential benefits in phonation should be weighed against the possibility of rare but serious adverse events.
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Affiliation(s)
- Ethan R Miles
- School of Medicine, Loma Linda University, Loma Linda, California.
| | - Priya D Krishna
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda Voice and Swallowing Center Loma Linda University, Loma Linda, California
| | - Salem Dehom
- School of Nursing, Loma Linda University, Loma Linda, California
| | - Rachel Hahn
- School of Medicine, Loma Linda University, Loma Linda, California
| | - Donn LaTour
- School of Medicine, Loma Linda University, Loma Linda, California
| | - Thomas Murry
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda Voice and Swallowing Center Loma Linda University, Loma Linda, California
| | - Brianna K Crawley
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda Voice and Swallowing Center Loma Linda University, Loma Linda, California
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14
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Feng S, Weng C, Cai S, Yang Z, Wu M, Kang N. The prevalence and risk factors for perceived voice disorders in public school teachers. Laryngoscope Investig Otolaryngol 2022; 7:790-798. [PMID: 35734057 PMCID: PMC9195021 DOI: 10.1002/lio2.803] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/16/2022] [Accepted: 04/13/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives The aim of this study was to explore the prevalence and risk factors in public kindergarten and elementary school teachers in the Jimei district in Xiamen. We took particular interest in the relationship between work-related factors and voice disorders. Study Design A cross-sectional investigation; a General Investigation. Methods This study was conducted from September 14 to 18, 2020 at public kindergarten and elementary schools in Xiamen, China. A total of 3140 teachers were separated into a perceived voice disorder group (PVD) and no perceived voice disorder group (NPVD) according to the Voice Handicap Index. The chi-square test was applied to explore the differences between the PVD and NPVD groups. The univariate logistic regression models were used to identify the risk factors in terms of unadjusted odds ratio and 95% confidence interval. Stepwise logistic regression was then used to ascertain independent determinants. Results We found that the prevalence of PVD was 47.52%. The results showed that risk factors of PVD included being female (OR = 1.574), middle-rank technical title and higher (OR = 2.199), continuous lecturing for more than 3 classes (OR = 3.034), lectured more than 10 classes a week (OR = 1.436) and taught art or physical education (OR = 1.742). Conclusions Teachers' work-related characteristics were associated with PVD. This proves that a preventive voice care program for teachers, administered by the school or education bureau, is urgent. This could include components such as the reasonable arrangement of timetables and recruitment of a sufficient number of kindergarten and elementary school teachers.Level of evidence: Case-series.
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Affiliation(s)
- Shuxiu Feng
- From the Second Affiliated Hospital of Xiamen Medical CollegeXiamenFujianChina
| | | | - Shaofang Cai
- From the Second Affiliated Hospital of Xiamen Medical CollegeXiamenFujianChina
| | - Zijiang Yang
- From the Second Affiliated Hospital of Xiamen Medical CollegeXiamenFujianChina
| | - Meina Wu
- From the Second Affiliated Hospital of Xiamen Medical CollegeXiamenFujianChina
| | - Ning Kang
- From the Second Affiliated Hospital of Xiamen Medical CollegeXiamenFujianChina
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15
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Enin K, Parikh A, Kallogjeri D, Naunheim MR, Huston MN. Correlation Between a Diagnosis of Anxiety or Depression and Initial VHI-10 Scores in Benign Dysphonia. Otolaryngol Head Neck Surg 2022; 167:725-730. [PMID: 35104179 DOI: 10.1177/01945998221074994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Anxiety and depression have demonstrated a positive correlation with vocal handicap among patients with benign causes of dysphonia. Our objective is to explore differences in initial Vocal Handicap Index-10 (VHI-10) scores between patients with a mental health history of anxiety or depression and those without. STUDY DESIGN Retrospective cohort study. SETTING Demographic data, diagnoses, and initial VHI-10 scores were collected for patients presenting with dysphonia to 2 tertiary laryngology clinics. METHODS A Kruskal-Wallis test and subsequent Mann-Whitney U test for pairwise comparisons were used to compare distribution of VHI-10 scores among patients with anxiety, depression, anxiety and depression, and no such conditions. Bonferroni correction was used to control for multiple comparisons. Robust regression was used for multivariable analysis. RESULTS A total of 620 cases of benign dysphonia were analyzed. Forty-two percent of the patient cohort had a preexisting diagnosis of anxiety (n = 121, 20%), depression (n = 64, 10%), or anxiety and depression (n = 74, 12%). VHI-10 scores were higher in patients with depression than in those without anxiety or depression (median difference, 4 [95% CI, 1-8]; P = .005) but did not differ significantly among the other groups. The effects of depression and anxiety status on initial VHI-10 scores among the causes of benign dysphonia varied. CONCLUSIONS Patients with a history of depression who presented with dysphonia had worse vocal handicap than those without anxiety/depression history. Future studies may clarify how optimization of anxiety and depression can affect patient-reported vocal handicap.
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Affiliation(s)
- Kwasi Enin
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Ayush Parikh
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Matthew R Naunheim
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Molly N Huston
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
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16
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Recurring exposure to low humidity induces transcriptional and protein level changes in the vocal folds of rabbits. Sci Rep 2021; 11:24180. [PMID: 34921171 PMCID: PMC8683398 DOI: 10.1038/s41598-021-03489-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 11/24/2021] [Indexed: 11/08/2022] Open
Abstract
Voice disorders are an important human health condition. Hydration is a commonly recommended preventive measure for voice disorders though it is unclear how vocal fold dehydration is harmful at the cellular level. Airway surface dehydration can result from exposure to low humidity air. Here we have induced airway surface dehydration in New Zealand White rabbits exposed to a recurring 8-h low humidity environment over 15 days. This model mimics an occupational exposure to a low humidity environment. Exposure to moderate humidity was the control condition. Full thickness soft-tissue samples, including the vocal folds and surrounding laryngeal tissue, were collected for molecular analysis. RT-qPCR demonstrated a significant upregulation of MUC4 (mucin 4) and SCL26A9 (chloride channel) and a large fold-change though statistically non-significant upregulation of SCNNA1 (epithelial sodium channel). Proteomic analysis demonstrated differential regulation of proteins clustering into prospective functional groups of muscle structure and function, oxidative stress response, and protein chaperonin stress response. Together, the data demonstrate that recurring exposure to low humidity is sufficient to induce both transcriptional and translational level changes in laryngeal tissue and suggest that low humidity exposure induces cellular stress at the level of the vocal folds.
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17
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Regan J, Walshe M, Lavan S, Horan E, Murphy PG, Healy A, Langan C, Malherbe K, Murphy BF, Cremin M, Hilton D, Cavaliere J, Curley J, Moloney A, Flanagan G, Whyte A. Dysphagia, Dysphonia, and Dysarthria Outcomes Among Adults Hospitalized With COVID-19 Across Ireland. Laryngoscope 2021; 132:1251-1259. [PMID: 34622966 PMCID: PMC8662217 DOI: 10.1002/lary.29900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/15/2021] [Accepted: 10/05/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To investigate the presence, degree, predictors, and trajectory of dysphagia, dysphonia, and dysarthria among adults hospitalized with COVID-19 across the Republic of Ireland (ROI) during the first wave of the pandemic. STUDY DESIGN Prospective observational cohort study. METHODS Adults with confirmed COVID-19 who were admitted into 14 participating acute hospitals across ROI and referred to speech and language therapy between March 1st and June 30th, 2020 were recruited. Outcomes obtained at initial SLT evaluation and at discharge were oral intake status (Functional Oral Intake Scale), perceptual voice quality (GRBAS), and global dysarthria rating (Dysarthria Severity Scale). RESULTS Data from 315 adults were analyzed. At initial SLT assessment, 84% required modified oral diets, and 31% required tube feeding. There were high rates of dysphonia (42%) and dysarthria (23%). History of intubation (OR 19.959, 95% CI 6.272, 63.513; P = .000), COVID-19 neurological manifestations (OR 3.592, 95% CI 1.733, 7.445; P = .001), and age (OR 1.034; 95% CI 1.002, 1.066; P = .036) were predictive of oral intake status. History of intubation was predictive of voice quality (OR 4.250, 95% CI 1.838, 9.827; P = .001) and COVID-19 neurological manifestations were predictive of dysarthria (OR 2.275; 95% CI 1.162, 4.456; P = .017). At discharge, there were significant improvements in oral intake (Z = -7.971; P = .000), voice quality (Z = -5.971; P = .000), and dysarthria severity (Z = -2.619; P = .009), although need for modified oral intake (59%), dysphonia (23%), and dysarthria (14%) persisted. CONCLUSION Dysphagia, dysphonia, and dysarthria were widespread among adults hospitalized with COVID-19 and they persisted for many at discharge. Prompt SLT evaluation is required to minimize complications. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Sarah Lavan
- Speech and Language Therapy Department, St. James' Hospital, Dublin, Ireland
| | - Eanna Horan
- Speech and Language Therapy Department, Tallaght University Hospital, Dublin, Ireland
| | - Patricia Gillivan Murphy
- Speech and Language Therapy Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Anne Healy
- Speech and Language Therapy Department, Beaumont Hospital, Dublin, Ireland
| | - Caoimhe Langan
- Speech and Language Therapy Department, St. Vincent's University Hospital, Dublin, Ireland
| | - Karen Malherbe
- Speech and Language Therapy Department, Galway University Hospital, Galway, Ireland
| | - Breda Flynn Murphy
- Speech and Language Therapy Department, Midland Regional Hospital Tullamore & Portlaoise, Offaly, Ireland
| | - Maria Cremin
- Speech and Language Therapy Department, University Hospital Kerry, Kerry, Ireland
| | - Denise Hilton
- Speech and Language Therapy Department, Cavan General Hospital, Cavan, Ireland
| | - Jenni Cavaliere
- Speech and Language Therapy Department, University Hospital Waterford, Waterford, Ireland
| | - Jacinta Curley
- Speech and Language Therapy Department, Wexford General Hospital, Wexford, Ireland
| | - Andrea Moloney
- Speech and Language Therapy Department, St. Luke's Hospital, Kilkenny, Ireland
| | - Grace Flanagan
- Speech and Language Therapy Department, Sligo University Hospital, Sligo, Ireland
| | - Alice Whyte
- Speech and Language Therapy Department, Naas General Hospital, Kildare, Ireland
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18
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Nuyen B, Kandathil C, McDonald D, Thomas J, Most SP. The impact of living with transfeminine vocal gender dysphoria: Health utility outcomes assessment. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 24:99-107. [PMID: 36713148 PMCID: PMC9879186 DOI: 10.1080/26895269.2021.1919277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background: The voice signals a tremendous amount of gender cues. Transfeminine individuals report debilitating quality-of-life deficits as a result of their vocal gender dysphoria.Aims: We aimed to quantify the potential impact of this dysphoria experienced with quality-adjusted life years (QALYs), as well as associated treatments, through validated health utility measures. Methods: Peri-operative phonometric audio recordings of a consented transfeminine patient volunteer with a history of vocal gender dysphoria aided in the description of two transfeminine health states, pre- and post-vocal feminization gender dysphoria; monocular and binocular blindness were health state controls. Survey responses from general population adults rate these four health states via visual analogue scale (VAS), standard gamble (SG), and time tradeoff (TTO). Results: Survey respondents totaled 206 with a mean age of 35.8 years. Through VAS measures, these general adult respondents on average perceived a year of life with transfeminine vocal gender dysphoria as approximately three-quarters of a life-year of perfect health. Respondents also on average would have risked a 15%-20% chance of death on SG analysis and would have sacrificed 10 years of their remaining life on TTO measures to cure the condition. The QALY scores for the post-gender affirming treatments for vocal gender dysphoria (+0.09 VAS, p < 0.01) were significantly higher compared to the pretreatment state. There were no differences in the severity of these QALY scores by survey respondent's political affiliation or gender identity. Conclusions: To our knowledge, this study is the first to quantify how the general population perceives the health burden of vocal gender dysphoria experienced by transfeminine patients. Feminization treatments including voice therapy with feminization laryngoplasty appear to significantly increase health utility scores.
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Affiliation(s)
- Brian Nuyen
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Cherian Kandathil
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Daniella McDonald
- Medical Scientist Training Program, University of California, San Diego School of Medicine, La Jolla, California, USA
| | - James Thomas
- Clinic for Voice Disorders, Portland, Oregon, USA
| | - Sam P. Most
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, USA
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19
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Hurtado-Ruzza R, Iglesias ÓÁC, Becerro-de-Bengoa-Vallejo R, Calvo-Lobo C, San-Antolín M, Losa-Iglesias ME, Romero-Morales C, López-López D. Self-Perceived Handicap Associated With Dysphonia and Health-Related Quality of Life of Asthma and Chronic Obstructive Pulmonary Disease Patients: A Case-Control Study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:433-443. [PMID: 33465320 DOI: 10.1044/2020_jslhr-20-00473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The association between voice alterations, health-related quality of life (HRQL), and chronic respiratory diseases, such as asthma and chronic obstructive pulmonary disease (COPD), has previously been reported. The aim of this study was to test the hypothesis that HRQL and dysphonia-associated handicap of patients diagnosed with asthma or COPD are worse than healthy controls. Method A case-control study in which participants were recruited by a consecutive sampling method from a single institution was conducted. Three groups were created: (a) asthma (51 patients), (b) COPD (52 patients), and (c) 50 healthy controls. Self-reported handicap associated with dysphonia was assessed using the 30-item Voice Handicap Index (VHI-30); meanwhile, HRQL was tested via the European Quality of Life (EQ) Questionnaire and the EQ-visual analog scale. Also, aerodynamic assessment applied to phonation was assessed, and maximum phonation time and s/e index were registered. Results VHI scores were higher for asthma and COPD (7.19 ± 8.31 and 11.80 ± 15.18, respectively) than in the control group (3.72 ± 6.78). The EQ index was lower in asthma and COPD patients than in controls. The EQ-visual analog scale showed lower scores in asthma and COPD than in the controls. Conclusions HRQL was worse in COPD patients than in asthma patients. Even though the patient groups showed worse VHI and HRQL scores than the healthy controls, the scores fell within the normal variation range. No significant variations in the maximum phonation time index between groups were noted.
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Affiliation(s)
- Rafael Hurtado-Ruzza
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Spain
- ENT Department, Complexo Hospitalario Universitario de Ourense, Spain
| | - Óscar Álvarez-Calderón Iglesias
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Spain
- ENT Department, Complexo Hospitalario Universitario de Ourense, Spain
| | | | - César Calvo-Lobo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Spain
| | - Marta San-Antolín
- Department of Psychology, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | | | - Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Spain
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20
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Huwyler C, Merchant M, Jiang N. Disparities in Speech Therapy for Voice Disorders Between English- and Non-English-Speaking Patients. Laryngoscope 2021; 131:E2298-E2302. [PMID: 33559902 DOI: 10.1002/lary.29429] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/15/2021] [Accepted: 01/26/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate whether language of choice affects compliance with speech therapy for voice disorders. STUDY DESIGN Retrospective chart review. METHODS A retrospective study was performed at Kaiser Permanente Northern California to compare compliance with referrals to speech therapy for voice disorders between English- and non-English-speaking patients. Patients referred from January 2012 through December 2017 were included. Logistic regression models were used to calculate the adjusted odds ratios (aOR) and to determine social and demographic factors affecting compliance. RESULTS Of 7,333 patients referred to speech therapy for a voice disorder, 7,171 were identified as English speaking and 162 as non-English speaking. The two cohorts were similar in terms of gender and proportion over 65 years of age, although non-English-speaking individuals were more likely to be Hispanic or Asian than English speakers, who were more likely to be White or African American. Overall compliance was lower among non-English-speaking patients than English speakers (63% vs 74%) (P = .0011). Logistic regression showed that the need for an interpreter was significantly associated with higher noncompliance (aOR 1.56, 95% CI 1.11-2.18), as was age less than 65 and income less than the study aggregate median income. Being multiracial or having a voice disorder of neurologic origin was associated with better compliance. CONCLUSION This study demonstrates significant noncompliance with speech therapy for a variety of voice disorders. This problem is exacerbated for patients who do not speak English and who are younger, of lower income, or are referred for functional voice disorders. In-person interpreters or multilingual speech therapists may help to improve compliance. LEVEL OF EVIDENCE IV Laryngoscope, 131:E2298-E2302, 2021.
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Affiliation(s)
- Camille Huwyler
- Department of Head and Neck Surgery, Kaiser Permanente, Oakland Medical Center, Oakland, California, USA
| | - Maqdooda Merchant
- Division of Research, Biostatistical Consulting Unit, Oakland, California, USA
| | - Nancy Jiang
- Department of Head and Neck Surgery, Kaiser Permanente, Oakland Medical Center, Oakland, California, USA
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21
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Tan JJ, Wang L, Mo TT, Dai YF, Lu J, Liu X, Chen HH, Tian WD, Li XP. Establishment of Immortalized Laryngeal Epithelial Cells Transfected with Bmi1. Cell Transplant 2021; 29:963689720908198. [PMID: 32249592 PMCID: PMC7444206 DOI: 10.1177/0963689720908198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Primary laryngeal epithelial cells are essential to exploring the
mechanisms of laryngeal and voice disorders; however, they are
difficult to study and apply because of their limited life span. The
purpose of this study was to develop a stable and reliable in
vitro model for the comprehensive study of the
pathogenesis of laryngeal and voice diseases. The pLVTHM-Bmi1 plasmid
was constructed and used to immortalize primary laryngeal epithelial
cells by lentiviral infection. The expressions of Bmi1, human
telomerase reverse transcriptase (hTERT), p53, and pRB pathway
proteins were detected by western blotting. Functional characteristics
of the immortalized cell lines were verified by cell senescence
β-galactosidase staining, 5-ethynyl-2′-deoxyuridine cell proliferation
test, and flow cytometry. We successfully introduced Bmi into human
subglottic (hSG) cells and human ventricle (hV) cells. Both the human
immortalized subglottic Bmi1 (hSG-Bmi1) cell line and the human
immortalized ventricle Bmi1 (hV-Bmi1) cell line maintained normal
epithelial morphology and divided successfully after more than 20
culture passages. As Bmi1 was overexpressed in these cells, the
expression of human telomerase reverse transcriptase (hTERT) and
phosphorylated Rb increased while p16 and p21 decreased. Following
Bmi1-mediated immortalization, cell senescence decreased
significantly, and cell proliferation was accelerated. Tumor formation
was not observed for hSG, hV, or hSG-Bmi1, and hV-Bmi1 cells in nude
mice. hSG-Bmi1 cells dominated by stratified squamous epithelium and
hV-Bmi1 cells dominated by columnar cells were established. The new
cell lines lay a foundation for the study of the pathogenic mechanisms
of laryngeal and voice diseases.
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Affiliation(s)
- Jia-Jie Tan
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Both the authors are co-first authors and contributed equally to this article
| | - Lu Wang
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Otolaryngology, Head and Neck Surgery, Shenzhen University General Hospital, Shenzhen, Guangdong, China.,Both the authors are co-first authors and contributed equally to this article
| | - Ting-Ting Mo
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yuan-Feng Dai
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Juan Lu
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiong Liu
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Huai-Hong Chen
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wen-Dong Tian
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiang-Ping Li
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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22
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Swallowing and Voice Outcomes in Patients Hospitalized With COVID-19: An Observational Cohort Study. Arch Phys Med Rehabil 2021; 102:1084-1090. [PMID: 33529610 PMCID: PMC7846878 DOI: 10.1016/j.apmr.2021.01.063] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/31/2022]
Abstract
Objective To evaluate the presentations and outcomes of inpatients with coronavirus disease 2019 (COVID-19) presenting with dysphonia and dysphagia to investigate trends and inform potential pathways for ongoing care. Design Observational cohort study. Setting An inner-city National Health Service Hospital Trust in London, United Kingdom. Participants All adult inpatients hospitalized with COVID-19 (N=164) who were referred to Speech and Language Therapy (SLT) for voice and/or swallowing assessment for 2 months starting in April 2020. Interventions SLT assessment, advice, and therapy for dysphonia and dysphagia. Main Outcome Measures Evidence of delirium, neurologic presentation, intubation, tracheostomy, and proning history were collected, along with type of SLT provided and discharge outcomes. Therapy outcome measures were recorded for swallowing and tracheostomy pre- and post-SLT intervention and Grade Roughness Breathiness Asthenia Strain Scale for voice. Results Patients (N=164; 104 men) aged 56.8±16.7 years were included. Half (52.4%) had a tracheostomy, 78.7% had been intubated (mean, 15±6.6d), 13.4% had new neurologic impairment, and 69.5% were delirious. Individualized compensatory strategies were trialed in all and direct exercises with 11%. Baseline assessments showed marked impairments in dysphagia and voice, but there was significant improvement in all during the study (P<.0001). On average, patients started some oral intake 2 days after initial SLT assessment (interquartile range [IQR], 0-8) and were eating and drinking normally on discharge, but 29.3% (n=29) of those with dysphagia and 56.1% (n=37) of those with dysphonia remained impaired at hospital discharge. A total of 70.9% tracheostomized patients were decannulated, and the median time to decannulation was 19 days (IQR, 16-27). Among the 164 patients, 37.3% completed SLT input while inpatients, 23.5% were transferred to another hospital, 17.1% had voice, and 7.8% required community follow-up for dysphagia. Conclusions Inpatients with COVID-19 present with significant impairments of voice and swallowing, justifying responsive SLT. Prolonged intubations and tracheostomies were the norm, and a minority had new neurologic presentations. Patients typically improved with assessment that enabled treatment with individualized compensatory strategies. Services preparing for COVID-19 should target resources for tracheostomy weaning and to enable responsive management of dysphagia and dysphonia with robust referral pathways.
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Bailey TW, Dos Santos AP, do Nascimento NC, Xie S, Thimmapuram J, Sivasankar MP, Cox A. RNA sequencing identifies transcriptional changes in the rabbit larynx in response to low humidity challenge. BMC Genomics 2020; 21:888. [PMID: 33308144 PMCID: PMC7733274 DOI: 10.1186/s12864-020-07301-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 12/04/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Voice disorders are a worldwide problem impacting human health, particularly for occupational voice users. Avoidance of surface dehydration is commonly prescribed as a protective factor against the development of dysphonia. The available literature inconclusively supports this practice and a biological mechanism for how surface dehydration of the laryngeal tissue affects voice has not been described. In this study, we used an in vivo male New Zealand white rabbit model to elucidate biological changes based on gene expression within the vocal folds from surface dehydration. Surface dehydration was induced by exposure to low humidity air (18.6% + 4.3%) for 8 h. Exposure to moderate humidity (43.0% + 4.3%) served as the control condition. Ilumina-based RNA sequencing was performed and used for transcriptome analysis with validation by RT-qPCR. RESULTS There were 103 statistically significant differentially expressed genes identified through Cuffdiff with 61 genes meeting significance by both false discovery rate and fold change. Functional annotation enrichment and predicted protein interaction mapping showed enrichment of various loci, including cellular stress and inflammatory response, ciliary function, and keratinocyte development. Eight genes were selected for RT-qPCR validation. Matrix metalloproteinase 12 (MMP12) and macrophage cationic peptide 1 (MCP1) were significantly upregulated and an epithelial chloride channel protein (ECCP) was significantly downregulated after surface dehydration by RNA-Seq and RT-qPCR. Suprabasin (SPBN) and zinc activated cationic channel (ZACN) were marginally, but non-significantly down- and upregulated as evidenced by RT-qPCR, respectively. CONCLUSIONS The data together support the notion that surface dehydration induces physiological changes in the vocal folds and justifies targeted analysis to further explore the underlying biology of compensatory fluid/ion flux and inflammatory mediators in response to airway surface dehydration.
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Affiliation(s)
- Taylor W Bailey
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN, 47907, USA.,Department of Public Health, Purdue University, West Lafayette, IN, 47907, USA
| | | | | | - Shaojun Xie
- Bioinformatics Core, Purdue University, West Lafayette, Indiana, 47907, USA
| | - Jyothi Thimmapuram
- Bioinformatics Core, Purdue University, West Lafayette, Indiana, 47907, USA
| | - M Preeti Sivasankar
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN, 47907, USA
| | - Abigail Cox
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN, 47907, USA.
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Naunheim MR, Dai JB, Rubinstein BJ, Goldberg L, Weinberg A, Courey MS. A visual analog scale for patient-reported voice outcomes: The VAS voice. Laryngoscope Investig Otolaryngol 2020; 5:90-95. [PMID: 32128435 PMCID: PMC7042645 DOI: 10.1002/lio2.333] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/04/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Although patient-reported outcome measures (PROMs) can be useful for assessing quality of life, they can be complex and cognitively burdensome. In this study, we prospectively evaluated a simple patient-reported voice assessment measure on a visual analog scale (VAS voice) and compared it with the Voice Handicap Index (VHI-10). STUDY DESIGN Prospective survey. METHODS An abbreviated voice measure was designed by a team of otolaryngologists, speech pathologists, and patients that consisted of four VAS questions related to (a) a global question of voice disturbance, (b) physical function of voice, (c) functional issues, and (d) emotional handicap. All English-speaking patients presenting to an academic laryngology clinic for a voice complaint were included. Internal consistency and validity were assessed with comparison to the VHI-10. RESULTS A total of 209 patients were enrolled. Ninety-two percent of patients reported understanding the survey. The four-item VAS survey was highly correlated with VHI-10 score (Pearson correlation .81, P < .0001), and the Cronbach's alpha between all four VAS questions was .94. Age, gender, and diagnosis were not associated with either the global VAS or VHI-10 tool. CONCLUSION Reducing the complexity of instruments assessing voice-related quality of life is feasible, and the VAS voice correlated with existing measures. Simplified assessments may offer advantages compared to more cumbersome PROMs. LEVEL OF EVIDENCE 2c.
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Affiliation(s)
- Matthew R. Naunheim
- Massachusetts Eye and EarBostonMassachusetts
- Harvard Medical SchoolBostonMassachusetts
| | | | | | | | - Alan Weinberg
- Icahn School of Medicine at Mount SinaiNew YorkNew York
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Managing Otolaryngologic Complications in Cardiothoracic Surgery. Ann Thorac Surg 2020; 110:676-683. [PMID: 31982445 DOI: 10.1016/j.athoracsur.2019.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/05/2019] [Accepted: 12/07/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cardiothoracic procedures are often lifesaving operations, and because of their complexity they are not without complications. Although major complications are often recognized and treated immediately, there are many less commonly identified complications that can and frequently should be addressed by otolaryngology colleagues during a patient's hospital course. METHODS This comprehensive review describes otolaryngologic complications of cardiac and thoracic surgery. RESULTS Dysphonia, dysphagia, stridor, tracheotomy hemorrhage, and pharyngeal tear are all complications of cardiothoracic procedures. Indications for treatment and treatment options are reviewed. The impact on quality of life and long-term morbidity is also discussed. CONCLUSIONS Otolaryngologic complications are common after cardiothoracic procedures. An otolaryngologist should be asked to evaluate a patient with dysphonia, dysphagia, or stridor while the patient is an inpatient. Patients experiencing persistent or nonacute problems should be referred to otolaryngologists to discuss more long-term interventions.
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