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Tremblay P, Sato M. Movement-related cortical potential and speech-induced suppression during speech production in younger and older adults. BRAIN AND LANGUAGE 2024; 253:105415. [PMID: 38692095 DOI: 10.1016/j.bandl.2024.105415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024]
Abstract
With age, the speech system undergoes important changes that render speech production more laborious, slower and often less intelligible. And yet, the neural mechanisms that underlie these age-related changes remain unclear. In this EEG study, we examined two important mechanisms in speech motor control: pre-speech movement-related cortical potential (MRCP), which reflects speech motor planning, and speaking-induced suppression (SIS), which indexes auditory predictions of speech motor commands, in 20 healthy young and 20 healthy older adults. Participants undertook a vowel production task which was followed by passive listening of their own recorded vowels. Our results revealed extensive differences in MRCP in older compared to younger adults. Further, while longer latencies were observed in older adults on N1 and P2, in contrast, the SIS was preserved. The observed reduced MRCP appears as a potential explanatory mechanism for the known age-related slowing of speech production, while preserved SIS suggests intact motor-to-auditory integration.
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Affiliation(s)
- Pascale Tremblay
- Université Laval, Faculté de Médecine, Département de Réadaptation, Quebec City G1V 0A6, Canada; CERVO Brain Research Center, Quebec City G1J 2G3, Canada.
| | - Marc Sato
- Laboratoire Parole et Langage, Centre National de la Recherche Scientifique, Aix-Marseille Université, Aix-en-Provence, France
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Alvarez ML, Ramos PH, Rosenbaum A, Badia P, León N, Napolitano CA. Management of Contralateral Reactive Vocal Fold Lesions, a Retrospective Study. J Voice 2024; 38:774-779. [PMID: 35279347 DOI: 10.1016/j.jvoice.2021.12.015] [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: 10/18/2021] [Revised: 12/16/2021] [Accepted: 12/19/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the anatomical and voice results of conservative management of patients diagnosed with contralateral reactive lesions (CRL) in our voice unit. METHODS A retrospective chart review was conducted of all new adult patients with benign vocal fold lesions with or without CRL, treated in the voice unit at Universidad Católica Clinical Hospital between 2015 and 2019. Patients were divided into two groups, without CRL (group A) and with CRL (group B). Analysis of preoperative and 1 month after surgery videostroboscopy, GRBASI, Voice Handicap Index-10 (VHI-10), Voice Related Quality of Life (VRQOL) surveys and management of CRL was conducted. RESULTS A total of 62 patients were included, 45 (72.6%) had CRL. When compared, bivariate and multivariate analysis revealed that age was significantly associated as a mild protective factor of presenting a CRL (P < 0.05). No significative differences were found between preoperative group A and B perceptual voice analysis or voice surveys. In terms of CRL management, 30 (66.6%) were injected, conservative management with observation was performed in 12 patients (26.7%) and, three (6.7%) were surgically resected. After 1 month follow-up, 32 (71.1%) had complete CRL resolution, eight (17.8%) had CRL persistence and, five (11.1%) had CRL recurrence. Postoperative vocal outcomes, GRBASI, VHI-10 and VRQOL showed significative improvement as compared with preoperative data for each group. No differences were seen between group A and B in terms of postoperative vocal outcomes. CONCLUSION CRL are prevalent, and their management is controversial. On our study 72.6% of BFVL presented with CRL and 93.3% of them were conservatively managed. Improvement in perceptual voice analysis and quality of life surveys were similar in both groups.
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Affiliation(s)
- Matias L Alvarez
- Otolaryngologist, Otolaryngology Department, Pontificia Universidad Católica de Santiago, Chile; Otolaryngologist, Otolaryngology Department, Hospital de la Florida
| | - Phoebe H Ramos
- Otolaryngologist, Otolaryngology Department, Pontificia Universidad Católica de Santiago, Chile
| | - Andres Rosenbaum
- Otolaryngology resident, Otolaryngology Department, Pontificia Universidad Católica de Santiago, Chile
| | - Pedro Badia
- Otolaryngologist, Otolaryngology Department, Pontificia Universidad Católica de Santiago, Chile
| | - Norma León
- Speech Therapist, Health Science Department, Pontificia Universidad Católica de Santiago, Chile
| | - Carla A Napolitano
- Otolaryngologist, Otolaryngology Department, Pontificia Universidad Católica de Santiago, Chile.
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Yiu EML, Cheng LKH, Wang F. Frequency Transmission of Oscillation from External Whole-Body Vibration Platform to the Larynx. J Voice 2024:S0892-1997(24)00093-6. [PMID: 38614894 DOI: 10.1016/j.jvoice.2024.03.024] [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: 11/19/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE This study investigates (1) the presence of frequency transmission of oscillation from an external whole-body vibration (WBV) platform to the larynx; and (2) the factors that influence this frequency transmission. METHODS Thirty participants (mean age=22.3years) with normal voice were exposed to four frequency-intensity levels of WBV (10 Hz-10%, 10 Hz-20%, 20 Hz-10%, 20 Hz-20%) and were instructed to produce the natural vowel /a/ three times during each WBV setting. The frequency was extracted from the middle 1-second of each electroglottographic (EGG) signal after passing through a Hann band filter with a range of 6-24 Hz. Linear mixed-effects models were applied to determine the factors that influenced the absolute deviation of the frequency transmission. RESULTS All participants exhibit an extracted EGG frequency that aligns with the external WBV frequency, deviating by - 0.6 to 1.2 Hz. The absolute deviation of WBV frequency transmission is consistent for both sexes across various WBV settings, except the 10 Hz-10% setting where men tend to exhibit significantly higher deviations (P = 0.018). CONCLUSION Oscillations at a specific frequency are transmitted from an external WBV platform to the larynx. This study proposes the use of a "spring" system to investigate the effect of WBV on the larynx, and recommends further research to explore the potential of WBV in managing voice disorders.
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Affiliation(s)
- E M-L Yiu
- Voice Research Laboratory, The University of Hong Kong, Pokfulam, Hong Kong
| | - L K H Cheng
- Voice Research Laboratory, The University of Hong Kong, Pokfulam, Hong Kong
| | - F Wang
- School of Humanities, Shanghai Normal University, Shanghai, China.
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Stager SV, Bielamowicz SA. Evidence of Long-Term Voice Therapy Effectiveness in Patients With Presbylarynges. J Voice 2024:S0892-1997(24)00010-9. [PMID: 38320901 DOI: 10.1016/j.jvoice.2024.01.009] [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: 11/01/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/08/2024]
Abstract
Evidence for long-term effectiveness of voice therapy (>2 years from previous clinic visit) is lacking from patients over 60 years who initially presented with voice complaints and subsequently demonstrated videostroboscopic signs of aging leading to voice therapy recommendations. Over the telephone, a certified speech-language pathologist enquired from those compliant and non-compliant, whether their voices were better, stable, or worse since their previous clinic visit, and asked them to rate Voice-Related Quality of Life, voice satisfaction, and Glottal Function Index to compare with their previous clinic visit ratings. Further questions focused on current voice satisfaction, and for those who were compliant, therapeutic experiences including home exercises. Twenty-four participated (16 complied; eight non-compliant), with a mean of 3.7 ± 1.2 years since the previous clinic visit. For those compliant, 0% reported better voices, 69% stable, and 31% worse. Most compliant participants (56%) attended between two and five therapy sessions. The most frequently reported therapy techniques were repeating nasal sounds/words; straw phonation; fewer words/breath group; and increasing pitch range. Eighty-one percent of compliant participants were given home exercises. They stopped regular practice a few months post-therapy but continued using them as rescue techniques. For those non-compliant, 88% reported better voices, 0% stable, and 12% worse. Most non-compliant participants (43%) reported lack of time as their reason for non-compliance. Most compliant participants reported stable voices, supporting voice therapy's role in maintaining voice function over time in the context of progressive aging. However, non-compliant participants were not associated with poorer voice quality over time.
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Affiliation(s)
- Sheila V Stager
- Medical Faculty Associates Voice Treatment Center, Department of Surgery, Division of Otolaryngology, The George Washington University School of Medicine, 2300 M Street N.W., Room 418, Washington, DC 20037.
| | - Steven A Bielamowicz
- Medical Faculty Associates Voice Treatment Center, Department of Surgery, Division of Otolaryngology, The George Washington University School of Medicine, 2300 M Street N.W., Room 400, Washington, DC 20037
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Almutawa D, Lagos-Villaseca A, Albathi M, Martignetti L, Masuda M, Zhu N, Li-Jessen NYK, Kost KM. Geriatric Voice: Distinctive Clinical Profiles of Working Seniors in a Tertiary Laryngology Clinic. J Voice 2024:S0892-1997(23)00410-1. [PMID: 38216385 DOI: 10.1016/j.jvoice.2023.12.018] [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: 07/29/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVES Voice disorders have been reported in up to 47% of the geriatric population. Few studies have assessed dysphonia in the elderly, with none examining vocal function in working seniors. This study aims to profile the clinical characteristics of individuals aged 65 years and older, comparing working and non-working seniors. STUDY DESIGN Retrospective cohort study. METHODS Medical charts were reviewed for patients aged 65 years and older referred to the McGill University Health Centre Laryngology Clinic (January 2018-March 2020). Variables studied included sociodemographics, comorbidities, voice complaints, lifestyle factors, diagnoses, voice acoustics [maximum phonation time (MPT), S/Z ratio, F0], GRBAS scale, Voice Handicap Index-10 (VHI-10), Reflux Symptom Index (RSI), and treatment modalities. RESULTS A total of 267 patients were included, with a mean [standard deviation (SD)] age of 74.2 (6.6) years and 61% of female patients. Occupation information was available in 148 cases, of which 31.1% were still working and 12.8% were professional voice users. The predominant voice complaint was dysphonia/hoarseness (48.8%) and the most prevalent diagnosis was presbyphonia (31.8%). The mean (SD) VHI-10 and RSI scores were 19.8 (9.0) and 18.7 (9.4) points, respectively. Voice therapy was prescribed for 155 patients (58.7%): 124 attended at least one session with significant post-treatment improvements in the GRBAS and VHI-10 scores (P < 0.01). In the univariate analysis, working seniors had a significantly more prevalent singing habit (P = 0.04) and laryngopharyngeal reflux diagnosis (P = 0.01), displaying a significantly longer MPT (P < 0.001) and lower G-B-S scores (P < 0.05). After adjusting mean differences, only MPT and the G-S scores were significantly different between both groups. CONCLUSIONS The predominant diagnosis in elders with voice complaints was presbyphonia. Voice therapy proved effective in improving the VHI-10 and GRBAS scores for geriatric patients. Almost one-third of seniors remained in the workforce, demonstrating superior vocal profiles, specifically in the MPT and the grade and strain of perceptual voice quality.
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Affiliation(s)
- Deema Almutawa
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada; Department of Otolaryngology - Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Antonia Lagos-Villaseca
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada; Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Monirah Albathi
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - Lisa Martignetti
- School of Communication Sciences and Disorders, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - Maia Masuda
- School of Communication Sciences and Disorders, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - Nanqing Zhu
- Precision Analytics, Montréal, Quebec, Canada
| | - Nicole Y K Li-Jessen
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada; School of Communication Sciences and Disorders, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada; The Centre for Research on Brain, Language and Music, McGill University, Montréal, Quebec, Canada; Department of Biomedical Engineering, McGill University, Montréal, Quebec, Canada; Research Institute of McGill University Health Center, Montréal, Quebec, Canada
| | - Karen M Kost
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada.
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Rocha MC, Nogueira BDFM, Nunes FB, de Medeiros AM. Self-perception of voice, hearing, and general health in screening for voice changes in older women. Codas 2024; 36:e20220063. [PMID: 38198297 PMCID: PMC10782509 DOI: 10.1590/2317-1782/20232022063pt] [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: 02/22/2022] [Accepted: 07/22/2022] [Indexed: 01/12/2024] Open
Abstract
PURPOSE To verify the association between sociodemographic factors, vocal behavior, morbidities, and self-perception of voice, hearing, and general health in older women with voice disorders. METHODS The sample had 95 older women aged 60 to 84 years (mean of 69,5). They were interviewed with a structured questionnaire on sociodemographic aspects, health, and vocal behavior. The Screening Protocol for Voice Disorders in Older Adults (RAVI) was used to identify the presence of voice disorders. RESULTS Participants who had finished high school and were retired predominated. The number of older women with voice disorders according to RAVI was 46.3%. Physical sensations such as dry throat, throat clearing, and itchy throat were the most common complaints. The group of older women with voice disorders had worse self-perception of voice quality, hearing, and general health and a higher frequency of upper airway infections than those without voice disorders (p ≤ 0.05). CONCLUSION The vocal self-assessment measured with RAVI was statistically associated with self-perception of voice quality, hearing, general health, sore throat, sinusitis, and respiratory allergies.
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Affiliation(s)
- Maria Clara Rocha
- Graduação em Fonoaudiologia, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.
| | - Bárbara de Faria Morais Nogueira
- Programa de Pós-graduação em Ciências Fonoaudiológicas, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.
| | - Flávio Barbosa Nunes
- Departamento de Otorrinolaringologia, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.
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Tremblay P, Gagnon L, Roy JP, Arseneault A. Speech Production in Healthy Older Adults With or Without Amateur Singing Experience. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:4332-4352. [PMID: 37870784 DOI: 10.1044/2023_jslhr-23-00126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
PURPOSE Amateur singing is a universal, accessible, and enjoyable musical activity that may have positive impacts on human communication. However, evidence of an impact of singing on speech articulation is still scarce, yet understanding the effects of vocal training on speech production could provide a model for treating people with speech deficits. The aim of this study was to examine speech production in younger and older adults with or without amateur singing experience. METHOD Thirty-eight amateur singers (aged 20-87 years, 23 women and 15 men) and 40 nonmusician active controls (aged 23-88 years, 19 women and 21 men) were recruited. A set of tasks were used to evaluate the oral motor sphere: two voice production tasks, a passage reading task, and a modified diadochokinetic (DDK) rates task performed at a natural rhythm and as quickly as possible. RESULTS Our results show that older age was associated with lower reading rate, lower articulation rate, and articulation rate variability in the DDK task, as well as reduced accuracy for the phonologically complex stimuli. Most importantly, our results show an advantage for singers over cognitively active nonsingers in terms of articulatory accuracy in the most challenging situations. CONCLUSION This result suggests extended maximal performance capacities in amateur singers perhaps resulting from the articulatory efforts required during singing. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24274813.
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Affiliation(s)
- Pascale Tremblay
- Département de réadaptation, Faculté de médecine, Université Laval, Québec City, Québec, Canada
- CERVO Brain Research Center, Québec City, Québec, Canada
| | - Lydia Gagnon
- Département de réadaptation, Faculté de médecine, Université Laval, Québec City, Québec, Canada
- CERVO Brain Research Center, Québec City, Québec, Canada
| | - Johanna-Pascale Roy
- Département de langues, linguistique et traduction, Faculté des lettres et des sciences humaines, Université Laval, Québec City, Québec, Canada
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Oliveira Santos A, Godoy J, Silverio K, Brasolotto A. Vocal Changes of Men and Women from Different Age Decades: An Analysis from 30 Years of Age. J Voice 2023; 37:840-850. [PMID: 34284927 DOI: 10.1016/j.jvoice.2021.06.003] [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: 03/08/2021] [Revised: 06/02/2021] [Accepted: 06/06/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To verify the modifications in auditory-perceptual and acoustic parameters of the fundamental frequency, short-term perturbation, noise, and cepstral measures of voice in young and elderly were distributed over the age of decades. METHODS The study was conducted on 265 subjects (140 females and 125 males), aged 30 to 79 years, without a history of vocal complaints or dysphonia, distributed in five age groups for females and males (30-39 years until 70-79 years). Three speech therapists voice specialists performed the perceptual-auditory analysis using a 100-mm visual analog scale, based on the overall dysphonia grade (overall grade), roughness, and breathiness from the sustained vowel /a/. The smoothed cepstral peak prominence (CPPS), average fundamental frequency (F0), standard deviation of the fundamental frequency (std-F0), jitter percentage (%), shimmer percentage (%), noise-to-harmonic ratio (NHR), voice turbulence index (VTI), and soft phonation index (SPI) were extracted for the acoustic analysis RESULTS: In the case of the auditory-perceptual characteristics, the comparison between aged groups showed that, in men, the vocal quality did not show significant differences in the overall grade, roughness, and breathiness. However, women in the 3rd decade of life presented higher breathiness than those in the 5th, 6th, and 7th decades. Men had a higher overall grade and roughness than women. In the case of the acoustic data, the cepstral measure showed that in the 3rd decade, men presented higher CPPS than females. The noise measures, in the comparison by age groups, only VTI and SPI were different for women: VTI was higher in the 7th decade than in the 4th, whereas SPI was higher in the 4th decade than in older women. In the male population, the SPI in the 4th decade was also higher than that in the older population CONCLUSION: The analysis by age groups of life allowed the identification of breathiness as a sensitive parameter in the different stages of adult life in women. The CPPS analysis showed that the 7th age decade is the period of the appearance of vocal changes for females, characterized by higher CPPS. The results related to traditional short-term perturbation and noise measurements showed that changes in F0, jitter, shimmer, and NHR were not found. Among the other noise measurements, VTI and SPI demonstrated some changes in different decades of life.
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Affiliation(s)
- Aline Oliveira Santos
- Department of Speech Hearing and Language Disorders, University of São Paulo, São Paulo.
| | - Juliana Godoy
- Department of Speech-Language Pathology and Audiology, Federal University of Rio Grande do Norte, Natal
| | - Kelly Silverio
- Department at Speech-Language Pathology and Audiology, University of São Paulo, São Paulo
| | - Alcione Brasolotto
- Department at Speech-Language Pathology and Audiology, University of São Paulo, São Paulo
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Kuo CFJ, Lin CS, Chiang KY, Barman J, Liu SC. In Vivo Automatic and Quantitative Measurement of Adult Human Larynx and Vocal Fold Images. J Voice 2023; 37:764-771. [PMID: 34175171 DOI: 10.1016/j.jvoice.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/16/2021] [Accepted: 04/08/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Qualitative laryngoscopy belongs to a diagnostic routine. Nevertheless, quantitative morphometric measurements of laryngeal structures remain challenging. This study aimed to introduce a special laser projection device that can facilitate computer-assisted digitalized analysis and provide important quantitative information for diagnostics and treatment planning. MATERIALS AND METHODS The laryngeal images were captured with our device, which contained two parallel laser beams in order to provide the scaling reference. The maximum length of the vocal fold during respiration and vibration (phonation), vocal width at midpoint, total fold area, maximum cross-sectional area of the glottic space, and maximum vocal fold angle were determined and calculated. These parameters were analyzed and compared on the basis of age, sex, body height, body weight and body mass index. RESULTS A total of 87 subjects were enrolled in this study, comprising 39 males and 48 females. The age range for all subjects was 21 to 80 years old. The maximum value of the glottic area and vocal angle showed no significant gender difference. Both the respiration and vibration vocal fold length was significantly longer in males than in females. The vocal width revealed no gender difference, but the fold area during both respiration and phonation was significantly larger in men than in women. As for the respiration-to-vibration ratio of the vocal length, there was a trend, but without statistical significance (P = 0.06), toward a higher length compression ratio in men than in women. Meanwhile, age was found to have a strong relationship with vocal width during phonation. The width of vibration vocal fold decreased with aging significantly. CONCLUSION Our innovative module can provide reference parameters, which makes it possible to directly estimate the objective absolute values of relevant laryngeal structures. Our non-invasive approach can be used during routine laryngoscopy and the findings easily documented. In future, we can extend its clinical application to measure subtle laryngeal or hypopharyngeal changes, which are difficult to objectively quantify.
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Affiliation(s)
- Chung-Feng Jeffrey Kuo
- Department of Material Science & Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan, Republic of China
| | - Chun-Shu Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center
| | - Kai-Yao Chiang
- Department of Material Science & Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan, Republic of China
| | - Jagadish Barman
- Department of Material Science & Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan, Republic of China
| | - Shao-Cheng Liu
- Department of Otolaryngology-Head and Neck Surgery Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
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Wang LH, Doan TN, Chang FC, To TL, Ho WC, Chou LW. Prevalence of Voice Disorders in Older Adults: A Systematic Review and Meta-Analysis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023:1-12. [PMID: 37285381 DOI: 10.1044/2023_ajslp-22-00393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE Voice disorders significantly impair the ability to communicate effectively and reduce the quality of life in older adults; however, its prevalence has not been well established. The aim of our research was to investigate the prevalence and associated factors of voice disorders among the older population. METHOD Five medical databases were systematically searched for studies that reported the prevalence of voice disorders in older adults. The overall prevalence was exhibited in proportions and 95% confidence intervals (CIs) utilizing random-effects models. Heterogeneity was measured using I 2 statistics. RESULTS Of 930 articles screened, 13 fulfilled the eligibility criteria, including 10 studies in community-based settings and three in institutionalized settings. An overall prevalence of voice disorders in older adults was estimated to be 18.79% (95% CI [16.34, 21.37], I 2 = 96%). Subgroup analysis showed a prevalence of 33.03% (95% CI [26.85, 39.51], I 2 = 35%) in institutionalized older adults, which was significantly higher than that in the community-based older adults with 15.2% (95% CI [12.65, 17.92], I 2 = 92%). Some factors that influenced the reported prevalence were identified, including types of survey, the definition of voice disorders, sampling methods, and the mean age of the population among included studies. CONCLUSIONS The prevalence of voice disorders in the older population depends on various factors but is relatively common in older adults. The findings of this study accentuate the necessity for researchers to standardize the protocol for reporting geriatric dysphonia as well as for older adults to express their voice-related problems so that they will receive appropriate diagnosis and treatment.
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Affiliation(s)
- Liang-Hui Wang
- Department of Speech-Language Pathology and Audiology, Hungkuang University, Taichung, Taiwan
- PhD Program for Aging, China Medical University, Taichung, Taiwan
| | - Thanh-Nhan Doan
- Department of Public Health, China Medical University, Taichung, Taiwan
- Department of Rehabilitation, Quang Nam Northern Mountainous Region General Hospital, Vietnam
| | - Fei-Chun Chang
- PhD Program for Aging, China Medical University, Taichung, Taiwan
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
| | - Thi-Lien To
- Faculty of Nursing, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Wen-Chao Ho
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Li-Wei Chou
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
- Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung, Taiwan
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Maxwell PJ, Ranjbar PA, Mishra V, Yam C, Alnouri G, Lyons K, Paknezhad H, Sataloff RT. Assessing the Prevalence and Associated Risk Factors for Presbylarynx in the Elderly Laryngology Population. J Voice 2023:S0892-1997(23)00099-1. [PMID: 37015843 DOI: 10.1016/j.jvoice.2023.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 04/06/2023]
Abstract
OBJECTIVE The primary objective of this study was to assess the prevalence of presbylarynx and its associated features in an elderly population representative of patients seen in a tertiary care laryngology practice. The secondary objective of this study was to compare laryngeal electromyography (LEMG) findings, coexisting VF conditions, medical history, surgical history, medication use, and other parameters between patients with and without presbylarynx. METHODS Adult voice patients aged 60 years and older who underwent strobovideolaryngoscopy were included in the study. Patients were assigned to one of two groups based on the majority (≥2/3) agreement of three blinded authors' (GA, KL, and HP) graded examinations of strobovideolaryngoscopy (SVL) videos for findings consistent with presbylarynx (atrophic vocal folds [VFA], vocal fold bowing [VFB], vocal process prominence [VPP] and anterior glottic insufficiency [GI]). Patient demographics, medical history, surgical history, medication use, laboratory results, and SVL videos were compiled. Statistical analysis was performed using SPSS 28.0.0.0 (IBM, Armonk, NY). All tests were performed two-tailed, and a P-value of less than 0.05 was considered statistically significant. RESULTS One hundred sixty-four patients (84 female/80 male, mean age of 68.397 ± 4.947 years) were included in this study. The prevalence of presbylarynx was 52.4% (n = 86) in the study population. The mean age of patients in the presbylarynx group was significantly higher than the nonpresbylarynx group. Additionally, there were significantly more males than females in the presbylarynx group. The presbylarynx group also was found to have a higher proportion of ACE inhibitor (ACEi) use. Further, laboratory results revealed a significantly higher proportion of patients with elevated thyroid stimulating hormone (TSH) levels in the presbylarynx group. Conversely, patients in the nonpresbylarynx group were found to have a significantly higher rate of levothyroxine use. On SVL, patients in the nonpresbylarynx cohort were found to have a significantly higher proportion of benign vocal fold lesions and vocal fold paresis. However, LEMG testing revealed no statistically significant differences in muscle recruitment between groups. Men with presbylarynx were found to have a significantly higher proportion of VFB and VPP compared to women with presbylarynx. CONCLUSION This retrospective study investigated the prevalence and risk factors associated with presbylarynx in patients representative of those treated by laryngologists. Signs consistent with presbylarynx are observable even in the presence of coexisting VF conditions. Older age, elevated TSH, the use of ACEi, and male gender was associated with signs of presbylarynx on SVL. Of those diagnosed with presbylarynx, males were identified as having higher proportions of VFB and VPP compared to females. More education regarding presbylarynx and further studies to improve standardization of the criteria for its diagnosis, as well as its relationship with other VF conditions, are encouraged to improve management of the aging voice.
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Affiliation(s)
- Philip J Maxwell
- Drexel University College of Medicine, Philadelphia, PA, United States
| | | | - Vibhuti Mishra
- Drexel University College of Medicine, Philadelphia, PA, United States
| | - Christopher Yam
- Drexel University College of Medicine, Philadelphia, PA, United States
| | - Ghiath Alnouri
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Karen Lyons
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Hassan Paknezhad
- Department of Otolaryngology - Head and Neck Surgery, Geisinger Commonwealth School of Medicine, Danville, PA, United States
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Lankenau Institute for Medical Research, Philadelphia, Pennsylvania.
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12
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Stager SV, Bielamowicz SA. Long-Term Voice Change in Presbylarynges Patients With and Without Intervention. J Voice 2023:S0892-1997(23)00030-9. [PMID: 36882333 DOI: 10.1016/j.jvoice.2023.01.030] [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: 07/21/2022] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE To explore long-term patient experience of treated and untreated presbylarynges patients two or more years after their previous clinic visit by their responses to a probe about the changes in voice (better, stable, or worse) and standardized rating scales either by phone or from clinic records. Congruences of rating differences between visits and probe responses were assessed. METHODS Thirty-seven participated prospectively and seven retrospectively. Better, stable, or worse probe responses and treatment follow-through were obtained. Self-rating scales, completed verbally or obtained from charts, were compared to the previous visit so differences between visits could be converted to be congruent with probe responses. RESULTS After a mean of 4.6 years, 44% (63% untreated) reported stable, 36% (38% untreated) worse, and 20% (89% untreated) better. Significantly greater proportions of untreated reported better/stable probe responses while treated reported worse (χ2; P = 0.038). Significantly better means for all ratings were found at follow-up for those with better probe responses, but mean ratings were not significantly worse for those with worse probe response. No significant congruences of rating differences between visits and probe responses were found. In untreated reporting stable probe response, a significantly greater proportion of those with previous clinic ratings within normal limits (WNL) maintained ratings WNL at follow-up (z-statistic; P = 0.0007). CONCLUSIONS Ratings WNL at the initial evaluation, especially voice-related quality of life and effort, were found to still be WNL after several years. Little congruence was found between rating differences and probe responses, especially for worse, suggesting need for developing more sensitive rating scales.
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Affiliation(s)
- Sheila V Stager
- Voice Treatment Center, Department of Surgery, Division of Otolaryngology, The George Washington University School of Medicine, Washington, DC 20037.
| | - Steven A Bielamowicz
- Voice Treatment Center, Department of Surgery, Division of Otolaryngology, The George Washington University School of Medicine, Washington, DC 20037
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13
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Santos M, Azevedo S, Sousa F, Machado AS, Santos PC, Freitas SV, Almeida E Sousa C, da Silva ÁM. Presbylarynx: Is It a Sign of the Health Status of the Elderly? J Voice 2023; 37:304.e1-304.e7. [PMID: 33461883 DOI: 10.1016/j.jvoice.2020.12.034] [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: 11/15/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Only a full understanding of how different diseases affect the same or different anatomical/functional entities, may provide a clue on how comorbidity should be taken into consideration. The aim of this study was to evaluate the chronic medical illnesses of an elderly population, in order to analyze potential correlation of specific comorbidities with presbylarynx. METHODS This case-control, prospective, observational, and cross-sectional study was carried out on consecutive subjects observed by otorhinolaryngology, in a tertiary center, from January to September 2020. The inclusion criteria were ability to report an accurate medical history and ≥65 years of age. The exclusion criteria were neurologic diagnoses, autoimmune disease, history of thoracic or head and neck surgery, cancer, radiotherapy, thyroid pathology, vocal fold mass lesions, acute laryngitis, or vocal fold paralysis. Based on videostroboscopy of the larynx, the patients were subdivided into two main groups: presbylarynx versus no presbylarynx. Health status was assessed by evaluation of chronic medical illnesses (individual diagnoses of chronic conditions plus Charlson comorbidity index [CCI]), functional status (Katz index of independence in activities of daily living and functional Ambulation ambulation classification), and emotional status (Geriatric Depression Scale). RESULTS A total of 174 subjects (60 males; 114 females) were included (mean age = 73.99 years; range 65-95 years). Presbylarynx was identified in 71 patients (41%). A statistically significant difference was found concerning diabetes mellitus type 2 (T2DM); P< 0.001), asthma or chronic obstructive pulmonary disease (COPD; P< 0.001), and psychiatric disorder (P< 0.001). The mean score of CCI between "presbylarynx" and "no presbylarynx" groups was statistically different (P= 0.021). Results showed an association between some functional dependence (P< 0.001), and mild or severe depression (P< 0.001) and the presence of presbylarynx. CONCLUSIONS Presbylarynx may be considered a sign of the health status of the elderly. Based on CCI, It was found that patients with higher probability of 10-year mortality exhibit more endoscopic signs of presbylarynx. It was also found that patients with better scores in functionality scales exhibited less endoscopic findings compatible with presbylarynx. Among chronic medical illnesses, T2DM, asthma, or COPD may be considered risk factors for noticeable endoscopic signs of presbylarynx.
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Affiliation(s)
- Mariline Santos
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.
| | - Sara Azevedo
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Francisco Sousa
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - André Sousa Machado
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Pedro Carvalho Santos
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Susana Vaz Freitas
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal; Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Porto, Portugal; LIAAD - Laboratório de Inteligência Artificial e Apoio à Decisão, INESCTEC, Porto, Portugal
| | - Cecília Almeida E Sousa
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Álvaro Moreira da Silva
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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14
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Santos M, Sousa F, Azevedo S, Casanova M, Freitas SV, E Sousa CA, da Silva ÁM. Presbylarynx: Is it Possible to Predict Glottal Gap by Cut-Off Points in Auto-Assessment Questionnaires? J Voice 2023; 37:268-274. [PMID: 33384247 DOI: 10.1016/j.jvoice.2020.12.013] [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: 10/26/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine cut-off points in auto-assessment questionnaires to predict the presence and extent of presbylarynx signs. METHOD This case control, prospective, observational, and cross-sectional study was carried out on consecutive subjects observed by Otorhinolaryngology, in a tertiary center, in 2020. Each subject underwent fiberoptic videolaryngoscopy with stroboscopy, and presbylarynx was considered when it was identified two or more of the following endoscopic findings: vocal fold bowing, prominence of vocal processes in abduction, and a spindle-shaped glottal gap. Each subject completed three questionnaires: the Voice Handicap Index (VHI), with 30 and 10 questions, and the "Screening for voice disorders in older adults questionnaire" (RAVI). RESULTS The studied population included 174 Caucasian subjects (60 males; 114 females), with a mean age of 73.99 years (standard deviation = 6.37; range 65-95 years). Presbylarynx was identified in 71 patients (41%). Among patients with presbylarynx, a glottal gap was identified in 22 patients (31%). The mean score of VHI-30 between "no presbylarynx" and "presbylarynx" groups was statistically different (P < 0.001), with a higher score for subjects with signs of presbylarynx. The presence of glottal gap was associated to a higher mean score of VHI-30 (41.64 ± 11.87) (P < 0.001). The mean score of VHI-10 between "no presbylarynx" and "presbylarynx" groups was statistically different (P < 0.001), with a higher score for subjects with signs of presbylarynx. Among patients with presbylarynx, the presence of glottal gap was associated to higher mean score of VHI-10 (14.04 ± 3.91) (P < 0.001). There was a strong positive correlation between VHI-30 and VHI-10 (rs = 0.969; P < 0.001). The mean score of RAVI between "no presbylarynx" and "presbylarynx" groups was statistically different (P < 0.001), with a higher score for subjects with signs of presbylarynx. Among patients with presbylarynx, the presence of glottal gap was associated to a higher mean score of RAVI (11.68 ± 1.61) (P < 0.001). There was a strong positive correlation not only between RAVI and VHI-30 (rs = 0.922; P < 0.001), but also between RAVI and VHI-10 (rs = 0.906; P < 0.001). The optimal cut-off points to discriminate "no presbylarynx" from "presbylarynx", obtained by the Youden' index, were 3.5 for RAVI, 4.5 for VHI-30 and 1.5 for VHI-10. RAVI had the highest sensitivity and specificity. The optimal cut-off points to predict glottal gap, obtained by the Youden' index, were 9.5 for RAVI, 21 for VHI-30 and 7.5 for VHI-10. CONCLUSION The optimal cut-off points do discriminate "no presbylarynx" from "presbylarynx" were 3.5 for RAVI, 4.5 for VHI-30 and 1.5 for VHI-10. RAVI had the highest sensitivity and specificity, probably because it was designed specifically for vocal complaints of the elderly. Among patients with presbylarynx, cut-off points of 9.5 for RAVI, 21 for VHI-30 and 7.5 for VHI-10 were determined to predict patients with and without glottal gap. It was found a strong positive correlation between RAVI, VHI-30 and VHI-10. Thus, VHI-10 can be preferred to VHI-30 to assess voice impairment in clinical practice, because for elderly patients it is easier to answer. However, to predict endoscopic signs of presbylarynx, RAVI should be preferred.
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Affiliation(s)
- Mariline Santos
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Portugal.
| | - Francisco Sousa
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Portugal
| | - Sara Azevedo
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Portugal
| | - Maria Casanova
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Portugal
| | - Susana Vaz Freitas
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Portugal; Faculdade de Ciências da Saúde - Universidade Fernando Pessoa, Porto, Portugal; LIAAD - Laboratório de Inteligência Artificial e Apoio à Decisão - INESCTEC, Porto, Portugal
| | - Cecília Almeida E Sousa
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Portugal
| | - Álvaro Moreira da Silva
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Portugal
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15
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Abur D, MacPherson MK, Shembel AC, Stepp CE. Acoustic Measures of Voice and Physiologic Measures of Autonomic Arousal During Speech as a Function of Cognitive Load in Older Adults. J Voice 2023; 37:194-202. [PMID: 33509665 PMCID: PMC8310524 DOI: 10.1016/j.jvoice.2020.12.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/01/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study was to determine the relationships among cognitive loading, autonomic arousal, and acoustic measures of voice in healthy older adults. STUDY DESIGN Prospective and observational. METHODS Twelve healthy older adults (six females) produced a sentence containing an embedded Stroop task in each of two cognitive load conditions: congruent and incongruent. Three physiologic measures of autonomic arousal (pulse volume amplitude, pulse period, and skin conductance response amplitude) and four acoustic measures of voice (cepstral peak prominence, low-to-high spectral energy ratio, fundamental frequency, and sound pressure level) were analyzed in each cognitive load condition. RESULTS A logistic regression model was used to predict the cognitive load condition using participant as a categorical predictor and the four acoustic measures and three autonomic measures as continuous predictors. Skin conductance response amplitude and pulse volume amplitude were both predictive of cognitive load; however, no acoustic measures of voice were statistically significant predictors of cognitive load for older adults. CONCLUSIONS These findings support the idea that increased cognitive load is associated with increased autonomic nervous system activity in older adults. The lack of changes in acoustic measures of voice with increased cognitive load may result from age-related changes in vocal quality and speech subsystems.
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Affiliation(s)
- Defne Abur
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - Megan K MacPherson
- Department of Communication Sciences and Disorders, Central Michigan University, Mount Pleasant, MI.
| | - Adrianna C Shembel
- NYU Langone Health, Department of Otolaryngology-Head and Neck Surgery, New York University, New York, NY
| | - Cara E Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, MA; Department of Biomedical Engineering, Boston University, Boston, MA; Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA
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16
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Santos M, Freitas SV, Almeida E Sousa C, da Silva ÁM. Presbylarynx: validation of a classification based on morphological characteristics. Eur Arch Otorhinolaryngol 2023; 280:781-788. [PMID: 36030469 DOI: 10.1007/s00405-022-07618-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/15/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Validation of a classification to stratify presbylarynx into three types. METHODS Evaluate the reproducibility of this classification. 30 video recordings of rigid laryngostroboscopies were presented to 20 otorhinolaryngologists from five tertiary hospitals: 10 residents and 10 specialists. Specialists with different differentiations were included. RESULTS Among 1200 evaluations performed (30 video recordings × 20 raters, twice), average intra-rater agreement rate was 0.847 (p < 0.001). The average inter-rater reliability was 0.67 ± 0.179 on the first evaluation, and 0.691 ± 0.131 on the second evaluation. CONCLUSIONS This study presented the validation of a classification that allows stratifying laryngeal endoscopic signs in elderly patients with presbyphonia. We believe that this classification will enrich the diagnostic protocol of the aging voice and will improve the documentation of treatment outcomes.
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Affiliation(s)
- Mariline Santos
- Serviço de Otorrinolaringologia do Centro Hospitalar Universitário do Porto e Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Largo Professor Abel Salazar, 4100-099, Porto, Portugal.
| | - Susana Vaz Freitas
- Serviço de Otorrinolaringologia do Centro Hospitalar Universitário do Porto e Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Largo Professor Abel Salazar, 4100-099, Porto, Portugal.,Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Porto, Portugal
| | - Cecília Almeida E Sousa
- Serviço de Otorrinolaringologia do Centro Hospitalar Universitário do Porto e Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Largo Professor Abel Salazar, 4100-099, Porto, Portugal
| | - Álvaro Moreira da Silva
- Serviço de Cuidados Intensivos do Centro Hospitalar Universitário do Porto e Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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17
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Albuquerque L, Oliveira C, Teixeira A, Sa-Couto P, Figueiredo D. A Comprehensive Analysis of Age and Gender Effects in European Portuguese Oral Vowels. J Voice 2023; 37:143.e13-143.e29. [PMID: 33293174 DOI: 10.1016/j.jvoice.2020.10.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 01/11/2023]
Abstract
The knowledge about the age effects in speech acoustics is still disperse and incomplete. This study extends the analyses of the effects of age and gender on acoustics of European Portuguese (EP) oral vowels, in order to complement initial studies with limited sets of acoustic parameters, and to further investigate unclear or inconsistent results. A database of EP vowels produced by a group of 113 adults, aged between 35 and 97, was used. Duration, fundamental frequency (f0), formant frequencies (F1 to F3), and a selection of vowel space metrics (F1 and F2 range ratios, vowel articulation index [VAI] and formant centralization ratio [FCR]) were analyzed. To avoid the arguable division into age groups, the analyses considered age as a continuous variable. The most relevant age-related results included: vowel duration increase in both genders; a general tendency to formant frequencies decrease for females; changes that were consistent with vowel centralization for males, confirmed by the vowel space acoustic indexes; and no evidence of F3 decrease with age, in both genders. This study has contributed to knowledge on aging speech, providing new information for an additional language. The results corroborated that acoustic characteristics of speech change with age and present different patterns between genders.
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Affiliation(s)
- Luciana Albuquerque
- Institute of Electronics and Informatics Engineering of Aveiro, University of Aveiro, Aveiro, Portugal; Center for Health Technology and Services Research, University of Aveiro, Aveiro, Portugal; Department of Electronics Telecommunications and Informatics, University of Aveiro, Aveiro, Portugal; Department of Education and Psychology, University of Aveiro, Aveiro, Portugal.
| | - Catarina Oliveira
- Institute of Electronics and Informatics Engineering of Aveiro, University of Aveiro, Aveiro, Portugal; School of Health Science, University of Aveiro, Aveiro, Portugal
| | - António Teixeira
- Institute of Electronics and Informatics Engineering of Aveiro, University of Aveiro, Aveiro, Portugal; Department of Electronics Telecommunications and Informatics, University of Aveiro, Aveiro, Portugal
| | - Pedro Sa-Couto
- Center for Research and Development in Mathematics and Applications, University of Aveiro, Aveiro, Portugal; Department of Mathematics, University of Aveiro, Aveiro, Portugal
| | - Daniela Figueiredo
- Center for Health Technology and Services Research, University of Aveiro, Aveiro, Portugal; School of Health Science, University of Aveiro, Aveiro, Portugal
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18
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Santos M, Freitas SV, Sousa CAE, da Silva ÁM. Stratifying Presbylarynx: Characterization of its Three Types. J Voice 2022:S0892-1997(22)00289-2. [PMID: 36266223 DOI: 10.1016/j.jvoice.2022.09.019] [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: 08/15/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 03/07/2023]
Abstract
OBJECTIVES To describe the clinical characteristics of each type of glottal configuration proposed in a classification that allows stratifying presbylarynx into three types: Type 0: there is no significant morphological alteration in glottal configuration. Type 1: two or more of the following endoscopic signs are present: atrophic vocal folds, vocal fold bowing, prominence of vocal processes, supraglottal hyperactivity, decreased amplitude (vocal fold edge stiffness without evidence of vocal post-traumatic scar), and tremor of laryngeal structures. Type 2: elderly patients with type 1 plus glottal insufficiency. METHODS Prospective, observational, and cross-sectional study. Data regarding age, gender, type of glottal configuration, self-assessment regarding vocal complaints, as well as acoustic and audio-perceptive examination were collected. RESULTS The study population included 306 subjects (180 females), and the mean age was 73.85. Type 0 was the most frequent (61%). A statistically significant association was found between type 0 and female subjects, as well as type 2 and male subjects. The mean age of the patients with type 0 was statistically lower than the mean age of the patients with type 1 or type 2. The mean score of self-assessment questionnaires of patients with type 2 was statistically higher than the mean score registered for patients with type 0 and type 1. The mean score of Jitter, Shimmer, and HNR in type 2 were statistically higher than in type 0 or type 1 (P < 0.05). The mean score of Maximum Phonation Time in type 2 was statistically lower than in type 0 or 1 (P < 0.001). Based on vocal complaints, 115 subjects (38%) had presbyphonia (46 males; 69 females), and the mean age was 75.97 years (SD = 6.98; range 65 - 97). Among subjects without presbyphonia (n = 191), type 0 was the most frequent (84%), followed by type 1 (15%) and type 2 (1%). Among subjects with presbyphonia (n = 115), type 1 was the most frequent (58%), followed by type 0 (23%) and type 2 (19%). CONCLUSIONS This study presented the clinical characterization of a classification that allows stratifying endoscopic laryngeal signs in elderly patients with presbyphonia. We believe this classification will enrich the diagnostic protocol of the aging voice and will improve the documentation of treatment outcomes.
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Affiliation(s)
- Mariline Santos
- Serviço de Otorrinolaringologia do Centro Hospitalar Universitário do Porto e Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Porto, Portugal.
| | - Susana Vaz Freitas
- Serviço de Otorrinolaringologia do Centro Hospitalar Universitário do Porto e Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Porto, Portugal; Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Porto, Porto, Portugal
| | - Cecília Almeida E Sousa
- Serviço de Otorrinolaringologia do Centro Hospitalar Universitário do Porto e Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Porto, Portugal
| | - Álvaro Moreira da Silva
- Serviço de Cuidados Intensivos do Centro Hospitalar Universitário do Porto e Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Porto, Portugal
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Fuentes C, Biermann C. Diferencias en el comportamiento glótico y supraglótico y en la estructura de los pliegues vocales entre mujeres con odinofonía y asintomáticas. REVISTA DE INVESTIGACIÓN EN LOGOPEDIA 2022. [DOI: 10.5209/rlog.77880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
El estudio de la odinofonía ha sido escasamente abordado por las disciplinas vinculadas a la terapéutica vocal. La comprensión de aspectos esenciales para su terapéutica, como el comportamiento glótico y supraglótico, aún es emergente. El objetivo de este trabajo fue comparar el comportamiento glótico y supraglótico y la estructura de los pliegues vocales entre mujeres con odinofonía yasintomáticas. Se trabajó con 50 mujeres con voces profesionales, cuya edad promedio fue de 25,78 ± 3,50 años. Se formaron dos grupos, G1 (asintomáticas) y G2 (con odinofonía). Se utilizó un videolaringoscopio con luz continua para examinar la conducta supraglótica y la estructura cordal, y un electroglotógrafo para analizar el comportamiento de los pliegues vocales. En el comportamiento supraglótico, el 64 % de las participantes de G2 exhibió mayor compresión supraglótica en comparación a G1. El acortamiento anteroposterior en conjunto a la compresión medial fue la configuración más frecuente en G2, mientras que el acortamiento anteroposterior en solitario, correspondió a la configuración supraglótica más frecuente en G1. En el 60 y 84 % de las participantes de G2 se observó prominencia del proceso vocal y ventrículo espacioso junto a un pliegue vocal adelgazado, respectivamente. En la electroglotografía se evidenció que en G1 el cociente de contacto fue de 0,50 ± 0,34 y en G2, de 0,41 ± 0,31 (p < 0,05). En conclusión, en las mujeres que sufren de odinofonía se observaron signos de atrofia cordal, mientras que en oscilación se evidenciaron compresiones supraglóticas compensatorias y anomalías vinculadas a la aproximación o aducción cordal.
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Riolo V, Pizzorni N, Guanziroli E, Agostinis B, Confortola M, Schettino N, Gilardone G, Schindler A, Molteni F. Cross-cultural adaptation into Italian and validation of the Frenchay dysarthria assessment - 2. Eur J Phys Rehabil Med 2022; 58:342-351. [PMID: 34498832 PMCID: PMC9980487 DOI: 10.23736/s1973-9087.21.07029-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A comprehensive evaluation of dysarthria is required to make an accurate differential diagnosis with other communication disorders and plan effective rehabilitation programs. The Frenchay Dysarthria Assessment-2 (FDA-2) is a valid, reliable and widely used protocol for the assessment of dysarthria. An Italian version of the FDA-2 is currently lacking. AIM To perform a cross-cultural adaptation of the FDA-2 in Italian and to validate the Italian version of the FDA-2. DESIGN Validation study. SETTING Inpatient rehabilitation center. POPULATION 69 patients with dysarthria and 112 healthy controls. METHODS The FDA-2 was translated and cross-culturally adapted to Italian. The validation study was carried out in 4 steps: (1) 42 audio-recorded samples of FDA-2 items from 11 patients with dysarthria were independently assessed by 7 speech and language pathologists for interrater reliability and re-assessed after 6 weeks for intrarater reliability; (2) 11 patients were simultaneously assessed by 3 speech and language therapists for interrater reliability of the whole Italian version of the FDA-2 and re-assessed within 24 hours for test-retest reliability; (3) the Italian version of the FDA-2 was administered to 112 healthy volunteers to gain normative data; (4) 49 patients with different types of dysarthria were assessed using the Italian version of the FDA-2, the Therapy Outcome Measure impairment scale and the Robertson Profile for the validity analysis. RESULTS Interrater and intrarater reliability ranged from good to excellent (ICC >0.75) except for 3 audio-recorded items. The overall protocol demonstrated excellent (ICC >0.9) inter-rater and test-retest reliability for all the sections and the total score. Normative data were gained for 6 age groups. For the validity analysis, a statistically significant difference was found between dysarthric patients and healthy subjects for all sections and the total score. The FDA-2 significantly correlated to the therapy outcome measure (r=0.75) and the Robertson Profile (r=0.81). CONCLUSIONS The Italian version of the FDA-2 yield satisfactory reliability and validity, comparable to the psychometric properties of the original version. CLINICAL REHABILITATION IMPACT Speech and language pathologists can rely on a valid and reliable tool in Italian for the assessment of dysarthria in both clinical and research practice.
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Affiliation(s)
- Valentina Riolo
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Nicole Pizzorni
- Department of Biomedical and Clinical Sciences "Luigi Sacco, " University of Milan, Milan, Italy -
| | - Eleonora Guanziroli
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | | | - Megghi Confortola
- Unit of Childhood and Adolescent Neuropsychiatry, ASST Valtellina e Alto Lario, Sondrio, Italy
| | | | - Giulia Gilardone
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "Luigi Sacco, " University of Milan, Milan, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
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Santos M, Sousa CA, Freitas SV, Almeida E Sousa C, da Silva ÁM. Presbylarynx: How Easy Is It To Recognize The Aging Signs? A Prospective Study With Inter- And Intra-Rater Reliability In Laryngoscopic Evaluation. J Voice 2022:S0892-1997(22)00109-6. [PMID: 35641383 DOI: 10.1016/j.jvoice.2022.04.004] [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: 02/07/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine if recognition of presbylarynx is easy and straightforward. METHOD First, a systematic review regarding the structural features of the geriatric larynx through laryngostroboscopy was performed, and its results were presented to the raters in an educational session. Then, video recordings of rigid laryngostroboscopies were randomly selected and presented to a panel of otorhinolaryngologists. Intra- and inter-rater reliability were determined. RESULTS Based on the main findings of the systematic review, raters were invited to consider the diagnosis of presbylarynx when one or more of the following endoscopic signs were present: atrophic vocal folds (VF), VF bowing, prominence of vocal processes, or spindle-shaped glottal gap. Twenty otorhinolaryngologists from five tertiary hospitals participated in this study (residents and specialists). Among 300 evaluations performed (15 video recordings x 20 raters), the intra-rater agreement was 93.0%. The Cohen´s Kappa for intra-rater reliability was higher than 0.600 for all the raters except for two residents. Cohen´s Kappa was higher among specialists (0.893) than among residents (0.826). The highest Cohen´s Kappa was registered for evaluations performed by specialists with differentiation in laryngology (0.933). Presbylarynx was identified mostly in laryngostroboscopic recordings of subjects older than 65 years. CONCLUSION we consider the answer to "Presbylarynx: How easy is it to recognize the aging signs" to be "After education on signs of presbylarynx, it is easy." This answer is supported by the high rate of intra- and inter-rater agreement, in a blinded and randomized presentation of laryngostroboscopic recordings, and by the fact that the diagnosis of presbylarynx was mostly attributed to videos regarding subjects aged 65 years and older. It proves that is not difficult to recognize aging signs in the larynx. Thus, in the future, more education regarding presbylarynx and further studies to improve criteria for its diagnosis may improve the management of the aging voice.
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Affiliation(s)
- Mariline Santos
- Serviço de Otorrinolaringologia do Centro Hospitalar Universitário do Porto e Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.
| | - Clara Alves Sousa
- Serviço de Otorrinolaringologia do Centro Hospitalar Universitário do Porto e Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Susana Vaz Freitas
- Serviço de Otorrinolaringologia do Centro Hospitalar Universitário do Porto e Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal; Faculdade de Ciências da Saúde, Universidade Fernando Pessoa
| | - Cecília Almeida E Sousa
- Serviço de Otorrinolaringologia do Centro Hospitalar Universitário do Porto e Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Álvaro Moreira da Silva
- Serviço de Cuidados Intensivos do Centro Hospitalar Universitário do Porto e Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto
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Vojtech JM, Stepp CE. Effects of Age and Parkinson's Disease on the Relationship between Vocal Fold Abductory Kinematics and Relative Fundamental Frequency. J Voice 2022:S0892-1997(22)00070-4. [PMID: 35393167 PMCID: PMC9532464 DOI: 10.1016/j.jvoice.2022.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE This study reports on two experiments to examine vocal fold abduction and its relationship with relative fundamental frequency (RFF), considering two attributes that have been shown to elicit group differences in RFF: age (Experiment 1) and Parkinson's disease (PD; Experiment 2). METHODS For both experiments, simultaneous acoustic and nasendoscopic recordings were collected as participants produced the utterance, /ifi/. RFF values were computed from the acoustic signal, whereas abduction duration and glottic angle at voicing offset were identified from the laryngoscopic images. In Experiment 1, 50 speakers with typical voices (18-83 years) were analyzed to examine (1A) the effects of speaker age on individual outcome measures (RFF, abduction duration, glottic angle) via Pearson's correlation coefficients, and (1B) the effects of abductory measures and age on RFF via an analysis of covariance. In Experiment 2, 20 speakers with PD and 20 matched controls were analyzed to examine (2A) the effects of group (with/without PD) on outcome measures via an analysis of variance, and (2B) the relationship of RFF with abduction duration, glottic angle, and age when considering group via an analysis of covariance. RESULTS Age demonstrated a significant, negative relationship with glottic angle (1A) but was not a significant factor when examining the relationship of vocal fold abduction and RFF (1B). Speaker group (with/without PD) demonstrated a significant effect on measures of RFF and abduction duration (2A) but was not a significant factor when examining the relationship of vocal fold abduction and RFF (2B). CONCLUSIONS RFF is sensitive to changes in vocal fold abductory patterns during devoicing, irrespective of speaker age or PD status.
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Affiliation(s)
- Jennifer M Vojtech
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts; Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts; Delsys, Inc., Natick, Massachusetts; Altec, Inc., Natick, Massachusetts.
| | - Cara E Stepp
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts; Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts; Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts
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A Longitudinal Study of Speech Acoustics in Older French Females: Analysis of the Filler Particle euh across Utterance Positions. LANGUAGES 2021. [DOI: 10.3390/languages6040211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aging in speech production is a multidimensional process. Biological, cognitive, social, and communicative factors can change over time, stay relatively stable, or may even compensate for each other. In this longitudinal work, we focus on stability and change at the laryngeal and supralaryngeal levels in the discourse particle euh produced by 10 older French-speaking females at two times, 10 years apart. Recognizing the multiple discourse roles of euh, we divided out occurrences according to utterance position. We quantified the frequency of euh, and evaluated acoustic changes in formants, fundamental frequency, and voice quality across time and utterance position. Results showed that euh frequency was stable with age. The only acoustic measure that revealed an age effect was harmonics-to-noise ratio, showing less noise at older ages. Other measures mostly varied with utterance position, sometimes in interaction with age. Some voice quality changes could reflect laryngeal adjustments that provide for airflow conservation utterance-finally. The data suggest that aging effects may be evident in some prosodic positions (e.g., utterance-final position), but not others (utterance-initial position). Thus, it is essential to consider the interactions among these factors in future work and not assume that vocal aging is evident throughout the signal.
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Stager SV, Gupta S, Amdur R, Bielamowicz SA. Objective Laryngoscopic Measures From Older Patients With Voice Complaints and Signs of Aging. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4705-4717. [PMID: 34735274 DOI: 10.1044/2021_jslhr-21-00095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE The purpose of this study was to use objective measures of glottal gap, bowing, and supraglottic compression from selected images of laryngoscopic examinations from adults over 60 years of age with voice complaints and signs of aging to test current hypotheses on whether degree of severity impacts treatment recommendations and potential follow-through with treatment. METHOD Records from 108 individuals 60 years or older with voice complaints and signs of aging were reviewed. Three objective measures (normalized glottal gap area [NGGA], total bowing index, and normalized true vocal fold width) were derived. Each measure was subsequently divided into three categories by severity: absence, small degree, or large degree. Nonparametric statistics tested associations between severity and treatment recommendations as well as potential follow-through. RESULTS Noninvasive treatments (observation/voice therapy) were marginally associated with no glottal gap (p = .09). More invasive treatments (injection/bilateral thyroplasty) were associated with glottal gaps being present (p = .026), but bilateral thyroplasty recommendations were not significantly associated with the largest gaps. Treatment modalities were not characterized by specific severity categories for any of the objective measures. No significant differences were found for any of the three objective measures between those who followed through with recommended treatment and those who did not. DISCUSSION Results demonstrated some support for current hypotheses on how degrees of severity of objective measures relate to treatment recommendations. Of the three measures, NGGA appears to be more informative regarding treatment recommendations and follow-through, but due to low power, larger sample sizes are needed to confirm clinical relevance.
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Affiliation(s)
- Sheila V Stager
- Medical Faculty Associates Voice Treatment Center, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, The George Washington University School of Medicine & Health Sciences
| | - Simran Gupta
- The George Washington University School of Medicine & Health Sciences
| | - Richard Amdur
- Department of Surgery, The George Washington University School of Medicine & Health Sciences
| | - Steven A Bielamowicz
- Medical Faculty Associates Voice Treatment Center, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, The George Washington University School of Medicine & Health Sciences
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Zamponi V, Mazzilli R, Mazzilli F, Fantini M. Effect of sex hormones on human voice physiology: from childhood to senescence. Hormones (Athens) 2021; 20:691-696. [PMID: 34046877 PMCID: PMC8594207 DOI: 10.1007/s42000-021-00298-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/10/2021] [Indexed: 11/08/2022]
Abstract
The aim of the present literature review is to describe the influence of sex hormones on the human voice in physiological conditions. As a secondary sexual organ, the larynx is affected by sex hormones and may change considerably over the lifespan. In the current review, sex hormone-related voice modifications occurring during childhood, puberty, the menstrual cycle, pregnancy and senescence are described. The roles of sex hormones (including gonadotropins, testosterone, estrogen, androstenedione, dehydroepiandrosterone, and dehydroepiandrosterone-sulfate) underlying physiological voice changes are discussed, the main differences between males and females are explained and clinical implications are taken into account.
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Affiliation(s)
- Virginia Zamponi
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University, Rome, Italy.
| | - Rossella Mazzilli
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Fernando Mazzilli
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Marco Fantini
- Head and Neck Oncology Unit, Candiolo Cancer Institute, FPO IRCCS, Candiolo, Turin, Italy
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26
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Presbylarynx: is diabetes mellitus a risk factor for vocal atrophy? A prospective case control study. The Journal of Laryngology & Otology 2021; 136:871-874. [PMID: 34819185 DOI: 10.1017/s0022215121003637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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On the Primary Influences of Age on Articulation and Phonation in Maximum Performance Tasks. LANGUAGES 2021. [DOI: 10.3390/languages6040174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Maximum performance tasks have been identified as possible domains where incipient signs of neurological disease may be detected in simple speech and voice samples. However, it is likely that these will simultaneously be influenced by the age and sex of the speaker. In this study, a comprehensive set of acoustic quantifications were collected from the literature and applied to productions of sustained [a] productions and Alternating Motion Rate diadochokinetic (DDK) syllable sequences made by 130 (62 women, 68 men) healthy speakers, aged 20–90 years. The participants were asked to produce as stable (sustained [a] and DDK) and fast (DDK) productions as possible. The full set of features were reduced to a functional subset that most efficiently modeled sex-specific differences between younger and older speakers using a cross-validation procedure. Twelve measures of [a] and 16 measures of DDK sequences were identified across men and women and investigated in terms of how they were altered with increasing age of speakers. Increased production instability is observed in both tasks, primarily above the age of 60 years. DDK sequences were slower in older speakers, but also altered in their syllable and segment level acoustic properties. Increasing age does not appear to affect phonation or articulation uniformly, and men and women are affected differently in most quantifications investigated.
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Rodrigues Dias D, Santos M, Sousa F, Azevedo S, Sousa E Castro S, Freitas S, Almeida E Sousa C, Moreira da Silva Á. How do presbylarynx and presbycusis affect the Voice Handicap Index and the emotional status of the elderly? A prospective case-control study. J Laryngol Otol 2021; 135:1-6. [PMID: 34579801 DOI: 10.1017/s0022215121002528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the influence of presbylarynx and presbycusis on Voice Handicap Index and emotional status. METHODS A case-control, prospective, observational, cross-sectional study was conducted of patients aged 65 years or older referred to an otorhinolaryngology department from January to September 2020. Presbycusis was assessed by pure tone and vocal audiometry. Each subject underwent fibre-optic videolaryngoscopy with stroboscopy, and presbylarynx was considered when two or more of the following endoscopic findings were identified: vocal fold bowing, prominence of vocal processes in abduction, and a spindle-shaped glottal gap. Each subject completed two questionnaires: Voice Handicap Index and Geriatric Depression Scale (short-form). RESULTS The studied population included 174 White European subjects, with a mean age of 73.99 years, of whom 22.8 per cent presented both presbylarynx and presbycusis. Multivariate linear regression revealed that only presence and severity of presbylarynx had an influence on Voice Handicap Index-30 scores. However, both spindle-shaped glottal gap and presbycusis influenced Geriatric Depression Scale scores. CONCLUSION Presbylarynx has a strong association with the impact of voice on quality of life. Presbylarynx and presbycusis seem to have a cumulative effect on emotional status.
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Affiliation(s)
- D Rodrigues Dias
- Department of Otolaryngology - Head and Neck Surgery, Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Porto, Portugal
| | - M Santos
- Department of Otolaryngology - Head and Neck Surgery, Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Porto, Portugal
| | - F Sousa
- Department of Otolaryngology - Head and Neck Surgery, Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Porto, Portugal
| | - S Azevedo
- Department of Otolaryngology - Head and Neck Surgery, Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Porto, Portugal
| | - S Sousa E Castro
- Department of Otolaryngology - Head and Neck Surgery, Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Porto, Portugal
| | - S Freitas
- Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Porto, Portugal
| | - C Almeida E Sousa
- Department of Otolaryngology - Head and Neck Surgery, Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Porto, Portugal
| | - Á Moreira da Silva
- Department of Intensive Care Unit, Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar - Universidade do Porto, Porto, Portugal
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Soumya M, Narasimhan SV. Correlation Between Subjective and Objective Parameters of Voice in Elderly Male Speakers. J Voice 2020; 36:823-831. [PMID: 33092948 DOI: 10.1016/j.jvoice.2020.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/31/2020] [Accepted: 10/06/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Literature review suggests that the analysis of acoustic, cepstral, and spectral parameters of voice offers excellent discrimination between the normal and pathological voices and strongly correlates with the perception of voice quality. Although the correlation between the subjective and objective voice measures can facilitate the clinician to distinguish pathological voices from normal voices, only a handful of investigations have examined the relationship between these measures in aging voices. OBJECTIVES To investigate the differences in the subjective and objective parameters (acoustic, spectral, and cepstral parameters) of the voice in elderly male speakers with and without symptoms of dysphonia, and to document the correlation between the subjective and objective parameters in the voice of elderly male speakers. STUDY DESIGN Retrospective standard group comparison study. METHODS Phonation and speech samples were collected from 30 elderly male participants having no vocal symptoms related to dysphonia and 30 elderly male participants with the self-reported presence of vocal symptoms related to dysphonia. The subjective, acoustic, spectral, and cepstral parameters were analyzed from all the voice samples. RESULTS Results revealed significant differences in subjective, acoustic, cepstral, and spectral parameters of voice between the voice samples of the elderly individuals with and without dysphonic symptoms. Perceptual parameters showed a weak and moderate correlation with acoustic parameters and a strong correlation with spectral and cepstral parameters of voice. CONCLUSION Further studies on the correlation between the subjective and objective parameters of voice in elderly male speakers with various types of laryngeal pathologies would throw light on distinguishing the voice of normal aging from the impact of any associated laryngeal pathology to make diagnostic distinctions.
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Affiliation(s)
- Mahesh Soumya
- MASLP, JSS Institute of Speech & Hearing, Mysore, Karnataka, India
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Acoustic Characteristics of the Voice for Brazilian Portuguese Speakers Across the Life Span. J Voice 2020; 36:876.e17-876.e26. [PMID: 33041178 DOI: 10.1016/j.jvoice.2020.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Vocal changes occur across the life span and can be reflected in acoustic measurements. OBJECTIVE To investigate the characteristics of voice production of the Brazilian Portuguese speakers across the life span based on acoustic measures of Fundamental Frequency (fo) and noise-to-harmonic ratio (NHR) and to verify the differences in these measures between men and women. METHODS A total of 526 recordings from Brazilian Portuguese speakers aged 5-93 years were included. Voices from these speakers were judged with normal vocal quality for their age using the G parameter of the GRBAS scale. The recordings were divided into 12 age groups (5-7 years; 8-9; 10-11; 12; 13-15; 16-18; 19-29; 30-39; 40-49; 50-59; 60-69 and, 70-93 years old). Acoustic analysis was conducted, extracting the parameters fo and NHR through Multi-Dimensional Voice Programsoftware. RESULTS For women, there was a gradual decrease in fo from childhood to older age. Older women (60-93 years old) showed a lower fo than age groups up to 19-29 years (P< 0.00). For men, there was a decrease in fo up to the age group of 13-15 years (P< 0.00) and, then, it remained stable. Differences between sexes occurred from 12 years old, with higher fo values for women than men (P< 0.00). The NHR parameter remained stable across the life span for women while higher values for older subjects were found for men (P< 0.04). Regarding sex, men showed a higher NHR value than women (P< 0.002). CONCLUSION Vocal changes occur across the life span and are reflected in the acoustic measure of fo for men and women. The beginning of vocal changes occurs from 12 years old with differences between sexes. The NHR measure was sensitive to indicate changes over a lifetime for men, with higher values for older subjects.
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Young VN. Patients’ Attitudes Regarding Treatment for Vocal Fold Atrophy. J Voice 2020; 34:763-768. [DOI: 10.1016/j.jvoice.2019.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
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Siqueira LTD, Silverio KCA, Berretin-FÉlix G, Genaro KF, Fukushiro AP, Brasolotto AG. Influence of vocal and aerodynamics aspects on the voice-related quality of life of older adults. J Appl Oral Sci 2020; 28:e20200052. [PMID: 32813841 PMCID: PMC7433863 DOI: 10.1590/1678-7757-2020-0052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/29/2020] [Indexed: 11/21/2022] Open
Abstract
The pursuit for quality of life urged a better understanding of aspects involved in ageing to minimize its consequences. Although many studies investigated older adults’ voice, aspects affecting this population voice-related quality of life have not yet been explored.
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Affiliation(s)
| | - Kelly Cristina Alves Silverio
- Departament of Speech-Language Pathology, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brasil
| | - Giédre Berretin-FÉlix
- Departament of Speech-Language Pathology, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brasil
| | - Kátia Flores Genaro
- Departament of Speech-Language Pathology, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brasil
| | - Ana Paula Fukushiro
- Departament of Speech-Language Pathology, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brasil
| | - Alcione Ghedini Brasolotto
- Departament of Speech-Language Pathology, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brasil
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Lin FC, Chien HY, Chen SH, Kao YC, Cheng PW, Wang CT. Voice Therapy for Benign Voice Disorders in the Elderly: A Randomized Controlled Trial Comparing Telepractice and Conventional Face-to-Face Therapy. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:2132-2140. [PMID: 32579859 DOI: 10.1044/2020_jslhr-19-00364] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Previous studies have reported that voice therapy via telepractice is useful for patients with nodules and muscle tension dysphonia. Nevertheless, telepractice for elderly patients with voice disorders has not yet been investigated. We conducted this study to examine the hypothesis that voice therapy via telepractice is not inferior to conventional voice therapy. Method Eighty patients with dysphonia aged more than 55 years participated in this study from September 2016 to June 2018. After screening the inclusion and the exclusion criteria, 69 patients were randomized into telepractice (33 patients) and conventional (36 patients) groups. The outcome measurements included Voice Handicap Index-10, videolaryngostroboscopy, maximum phonation time, auditory-perceptual evaluation, and acoustic analysis. Paired t test, Wilcoxon signed-ranks test, and repeated measures analysis of variance were used to examine treatment outcomes. Results The diagnoses of voice disorders included atrophy (n = 33), unilateral vocal paralysis (n = 13), muscle tension dysphonia (n = 7), nodules (n = 6), and polyps (n = 10). No significant differences were observed in age, sex, and baseline measurements between the two groups. Twenty-five patients in the telepractice group and 24 patients in the control group completed at least four weekly sessions. Significant improvements were observed for all the outcome measures (p < .05) in both groups. Improvements in Voice Handicap Index-10 in the telepractice group (24.84 ± 5.49 to 16.80 ± 8.94) were comparable to those in the conventional group (22.17 ± 7.29 to 13.46 ± 9.95, p = .764). Other parameters also showed comparable improvements between the two groups without statistically significant differences. Conclusions This is the first randomized controlled trial comparing telepractice and conventional voice therapy in elderly patients with voice disorders. The results showed that the effectiveness of voice therapy via telepractice was not inferior to that of conventional voice therapy, indicating that telepractice can be used as an alternative to provide voice care for elderly patients with vocal disorders.
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Affiliation(s)
- Feng-Chuan Lin
- Department of Otolaryngology-Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
- Department of Special Education, University of Taipei, Taipei, Taiwan
| | - Hsin-Yu Chien
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan
| | - Sheng Hwa Chen
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan
| | - Yi-Chia Kao
- Department of Otolaryngology-Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
- Department of Special Education, University of Taipei, Taipei, Taiwan
| | - Po-Wen Cheng
- Department of Otolaryngology-Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Chi-Te Wang
- Department of Otolaryngology-Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan
- Department of Special Education, University of Taipei, Taipei, Taiwan
- Department of Electric Engineering, Yuan Ze University, Taoyuan, Taiwan
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Stager SV, Sparks AD, Bielamowicz SA, Edgar JD. The Role of Choral Singing in Speaking Voice Preservation of Aging Adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:2099-2114. [PMID: 32569498 DOI: 10.1044/2020_jslhr-19-00347] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose This descriptive cohort pilot study, using a convenience sample, examined whether evidence from vocal function measures, auditory-perceptual ratings, and/or endoscopic signs of aging supported singing in senior chorales as a possible intervention to preserve the speaking voice in aging adults. Method Thirteen singers and five nonsinging controls, all over 65 years of age, participated. They were assessed at two visits, 15-20 months apart. Vocal function measures and auditory-perceptual ratings of estimated age and the presence of voice disorders were compared across singing status and visit. Changes in the presence and degree of laryngeal signs of aging between visits were compared across singing status. Results Using an alpha of .2, deemed acceptable for pilot studies, vocal function measures supported choral singing as an intervention to preserve the speaking voice as less noise energy between 2 and 3 kHz (p = .01) and lower phonation threshold pressures (PTPs) were present (p = .09) for singers compared to nonsinging controls. Greater flows at comfortable pitch (p = .04) and high pitch (p = .06) as well as lower cepstral peak prominence smoothed (CPPS) for the vowel /a/ (p < .01) were found at Visit 2 for both groups, but singers demonstrated lower flows at Visit 2 than nonsinging controls at comfortable pitch (p = .06). Auditory-perceptual ratings did not support preservation of speaking voice, although a larger percentage of listeners rated nonsinging controls as voice disordered at Visit 2. Endoscopic ratings supported preservation, as singers were more likely than nonsinging controls to be rated as having laryngeal signs of aging absent at both visits (p = .02). Conclusion The findings from this pilot study provide evidence that regular singing in senior chorales may assist in preserving older adults' speaking voices.
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Affiliation(s)
- Sheila V Stager
- Medical Faculty Associates Voice Treatment Center, Department of Surgery, Division of Otolaryngology, The George Washington University School of Medicine, Washington, DC
| | - Andrew D Sparks
- Department of Surgery, The George Washington University School of Medicine, Washington, DC
| | - Steven A Bielamowicz
- Medical Faculty Associates Voice Treatment Center, Department of Surgery, Division of Otolaryngology, The George Washington University School of Medicine, Washington, DC
| | - Julia D Edgar
- Department of Communication Disorders, Truman State University, Kirksville, MO
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The Aging Voice. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00285-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wong HYK, Ma EPM. Self-Perceived Voice Problems in a Nontreatment Seeking Older Population in Hong Kong. J Voice 2020; 35:597-603. [PMID: 31911022 DOI: 10.1016/j.jvoice.2019.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/17/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the prevalence of self-perceived voice problems and voice-related quality of life in a nontreatment seeking older population in Hong Kong. STUDY DESIGN Prospective, cross-sectional survey. METHODS One hundred and one older individuals aged 65 years or above were recruited from senior citizen community centers in Hong Kong. Each participant received a face-to-face interview with the researcher. The participants were asked to report the presence of voice problems and the voice symptoms that they experienced. They were also asked to complete the Cantonese version of the Voice Handicap Index to ascertain their voice-related quality of life. RESULTS Over one-fourth (27.7%) of participants reported having current voice problems. Perceived voice problems were found to pose significant negative impacts on the older individuals' voice-related quality of life. The prevalence of voice problems and extent of impacts of voice-related quality of life were similar across the young-old, old-old, and the oldest-old groups of participants. CONCLUSION The results suggest that voice problems are common in the older population and should not be underestimated. The study urges the need to allocate more resources to provide voice-related services from the young-old group for promoting positive aging.
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Affiliation(s)
- Heidi Y-K Wong
- Voice Research Laboratory, Faculty of Education, The University of Hong Kong, Pokfulam, Hong Kong
| | - Estella P-M Ma
- Voice Research Laboratory, Faculty of Education, The University of Hong Kong, Pokfulam, Hong Kong.
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Santos M, Vaz Freitas S, Santos P, Carvalho I, Coutinho M, Moreira da Silva Á, Almeida E Sousa C. Unilateral Vocal Fold Paralysis and Voice Therapy: Does Age Matter? A Prospective Study With 100 Consecutive Patients. EAR, NOSE & THROAT JOURNAL 2019; 100:489S-494S. [PMID: 31619079 DOI: 10.1177/0145561319882116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To use a multidimensional assessment to analyze potential influence of "aging" in the functional outcomes achieved by a group of patients with recent onset of unilateral vocal fold paralysis (UVFP) who underwent voice therapy. DESIGN Prospective, observational, and cross-sectional study. SETTING Otolaryngology department, Centro Hospitalar do Porto. PARTICIPANTS Patients with UVFP who underwent voice therapy. MAIN OUTCOME MEASURES Data regarding gender, age, side and position of the paralyzed vocal fold, etiology, comorbidities, and Voice Handicap Index (VHI)-30 questions, before and after voice therapy, were collected. Glottal insufficiency was also evaluated, by endoscopic laryngoscopy, before and after voice therapy. RESULTS A total of 100 patients (76 females and 24 males) with UVFP were included. Mean age was 61.04 years (range: 21-88 years). The mean score of VHI, before and after voice therapy, was statistically different (P < .001) with a lower score after therapy. The score of VHI was not influenced by age (P = .717). However, for each 10-year increase in age, the score of VHI, before and after voice therapy, increased 1.91 and 2.86 units, respectively. As concerns endoscopic findings, 80% of patients exhibited better glottis closure after voice therapy (P < .001), and this was not influenced by age. Nevertheless, for each 10-year increase in age, the chance of endoscopic improvement reduced 3%. CONCLUSIONS A clear and significant improvement was visible in the endoscopic and self-assessment ratings after rehabilitation by isolated voice therapy. Despite possible anatomical and physiological aging changes in the phonatory system, age did not compromise the successful rate obtained by voice therapy.
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Affiliation(s)
- Mariline Santos
- Centro Hospitalar do Porto e Instituto de Ciências Biomédicas Abel Salazar, 26706Universidade do Porto, Porto, Portugal
| | - Susana Vaz Freitas
- Centro Hospitalar do Porto e Instituto de Ciências Biomédicas Abel Salazar, 26706Universidade do Porto, Porto, Portugal
| | - Pedro Santos
- Centro Hospitalar do Porto e Instituto de Ciências Biomédicas Abel Salazar, 26706Universidade do Porto, Porto, Portugal
| | - Isabel Carvalho
- Centro Hospitalar do Porto e Instituto de Ciências Biomédicas Abel Salazar, 26706Universidade do Porto, Porto, Portugal
| | - Miguel Coutinho
- Centro Hospitalar do Porto e Instituto de Ciências Biomédicas Abel Salazar, 26706Universidade do Porto, Porto, Portugal
| | - Álvaro Moreira da Silva
- Centro Hospitalar do Porto e Instituto de Ciências Biomédicas Abel Salazar, 26706Universidade do Porto, Porto, Portugal
| | - Cecília Almeida E Sousa
- Centro Hospitalar do Porto e Instituto de Ciências Biomédicas Abel Salazar, 26706Universidade do Porto, Porto, Portugal
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Godoy J, Silverio K, Brasolotto A. Effectiveness of Vocal Therapy for the Elderly When Applying Conventional and Intensive Approaches: A Randomized Clinical Trial. J Voice 2019; 33:809.e19-809.e26. [DOI: 10.1016/j.jvoice.2018.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/26/2018] [Indexed: 11/16/2022]
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Hosokawa K, von Latoszek BB, Ferrer-Riesgo CA, Iwahashi T, Iwahashi M, Iwaki S, Kato C, Yoshida M, Umatani M, Miyauchi A, Matsushiro N, Inohara H, Ogawa M, Maryn Y. Acoustic Breathiness Index for the Japanese-Speaking Population: Validation Study and Exploration of Affecting Factors. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:2617-2631. [PMID: 31296106 DOI: 10.1044/2019_jslhr-s-19-0077] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Objectives The purposes of this study were to validate the Acoustic Breathiness Index (ABI) for the Japanese-speaking population and to determine whether it is independent of factors such as sex, age, and perceptual ratings of roughness. Method First, the concurrent validity of the ABI for perceptual breathiness was evaluated on the concatenations of continuous speech and sustained vowels from 288 patients with varying degrees of dysphonia. The diagnostic accuracy was examined on 343 samples with 55 additional normophonic speakers. Second, the validity related to responsiveness-to-change was estimated on 222 samples obtained before and after interventions for 111 voice-disordered patients. Third, the relationships between the ABI and other variables (i.e., perceptual hoarseness/breathiness/roughness, sex, and age) were explored using bivariate and multivariate analyses for the 288 patients. Results First, the concurrent validity and the responsiveness-to-change validity were confirmed by strong correlation coefficients of .890 and .878, respectively. Second, the receiver operating characteristic analysis showed the area under the curve to be 0.939, indicating excellent accuracy. The ABI of 3.44 exhibited a sensitivity of 76.3% and a specificity of 94.1%. Third, although bivariate analyses revealed a weak relationship between ABI and roughness and an ABI difference by age, multiple regression analyses showed a strong relation between only ABI and breathiness, without a meaningful contribution from roughness, sex, and age factors. Conclusion The study confirmed that the ABI is an accurate and specific tool to estimate breathiness levels in the Japanese-speaking population and neither roughness, sex, nor age significantly affects the ABI.
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Affiliation(s)
- Kiyohito Hosokawa
- Department of Otorhinolaryngology, Japan Community Health Care Organization, Osaka Hospital, Japan
- Department of Otorhinolaryngology, Osaka Police Hospital, Japan
- Department of Otorhinolaryngology and Head & Neck Surgery, Osaka University Graduate School of Medicine, Japan
| | | | - Carlos Ariel Ferrer-Riesgo
- Informatics Research Center, Central University of Las Villas, Santa Clara, Cuba
- Department of Computer Science, Friedrich-Alexander University Erlangen-Nürnberg, Germany
| | - Toshihiko Iwahashi
- Department of Otorhinolaryngology and Head & Neck Surgery, Osaka University Graduate School of Medicine, Japan
| | | | - Shinobu Iwaki
- Department of Otorhinolaryngology and Head & Neck Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Chieri Kato
- Department of Otorhinolaryngology and Head & Neck Surgery, Osaka University Graduate School of Medicine, Japan
| | - Misao Yoshida
- Department of Rehabilitation, Nishinomiya Kaisei Hospital, Hyogo, Japan
| | - Masanori Umatani
- Department of Otorhinolaryngology and Head & Neck Surgery, Osaka University Graduate School of Medicine, Japan
| | | | - Naoki Matsushiro
- Department of Otorhinolaryngology, Osaka Police Hospital, Japan
- Department of Otorhinolaryngology and Head & Neck Surgery, Osaka University Graduate School of Medicine, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology and Head & Neck Surgery, Osaka University Graduate School of Medicine, Japan
| | - Makoto Ogawa
- Department of Otorhinolaryngology, Japan Community Health Care Organization, Osaka Hospital, Japan
- Department of Otorhinolaryngology and Head & Neck Surgery, Osaka University Graduate School of Medicine, Japan
| | - Youri Maryn
- Speech-Language Pathology, SRH University of Applied Health Sciences, Gera, Thuringia, Germany
- European Institute for ORL, Sint-Augustinus Hospital, Antwerp, Belgium
- Faculty of Education, Health & Social Work, University College Ghent, Belgium
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Stachler RJ, Francis DO, Schwartz SR, Damask CC, Digoy GP, Krouse HJ, McCoy SJ, Ouellette DR, Patel RR, Reavis CCW, Smith LJ, Smith M, Strode SW, Woo P, Nnacheta LC. Clinical Practice Guideline: Hoarseness (Dysphonia) (Update) Executive Summary. Otolaryngol Head Neck Surg 2019; 158:409-426. [PMID: 29494316 DOI: 10.1177/0194599817751031] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective This guideline provides evidence-based recommendations on treating patients presenting with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia. Purpose The primary purpose of this guideline is to improve the quality of care for patients with dysphonia, based on current best evidence. Expert consensus to fill evidence gaps, when used, is explicitly stated and supported with a detailed evidence profile for transparency. Specific objectives of the guideline are to reduce inappropriate variations in care, produce optimal health outcomes, and minimize harm. For this guideline update, the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of advanced practice nursing, bronchoesophagology, consumer advocacy, family medicine, geriatric medicine, internal medicine, laryngology, neurology, otolaryngology-head and neck surgery, pediatrics, professional voice, pulmonology, and speech-language pathology. Action Statements The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should assess the patient with dysphonia by history and physical examination to identify factors where expedited laryngeal evaluation is indicated. These include but are not limited to recent surgical procedures involving the head, neck, or chest; recent endotracheal intubation; presence of concomitant neck mass; respiratory distress or stridor; history of tobacco abuse; and whether the patient is a professional voice user. (2) Clinicians should advocate voice therapy for patients with dysphonia from a cause amenable to voice therapy. The guideline update group made recommendations for the following KASs: (1) Clinicians should identify dysphonia in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces quality of life (QOL). (2) Clinicians should assess the patient with dysphonia by history and physical examination for underlying causes of dysphonia and factors that modify management. (3) Clinicians should perform laryngoscopy, or refer to a clinician who can perform laryngoscopy, when dysphonia fails to resolve or improve within 4 weeks or irrespective of duration if a serious underlying cause is suspected. (4) Clinicians should perform diagnostic laryngoscopy, or refer to a clinician who can perform diagnostic laryngoscopy, before prescribing voice therapy and document/communicate the results to the speech-language pathologist (SLP). (5) Clinicians should advocate for surgery as a therapeutic option for patients with dysphonia with conditions amenable to surgical intervention, such as suspected malignancy, symptomatic benign vocal fold lesions that do not respond to conservative management, or glottic insufficiency. (6) Clinicians should offer, or refer to a clinician who can offer, botulinum toxin injections for the treatment of dysphonia caused by spasmodic dysphonia and other types of laryngeal dystonia. (7) Clinicians should inform patients with dysphonia about control/preventive measures. (8) Clinicians should document resolution, improvement or worsened symptoms of dysphonia, or change in QOL of patients with dysphonia after treatment or observation. The guideline update group made a strong recommendation against 1 action: (1) Clinicians should not routinely prescribe antibiotics to treat dysphonia. The guideline update group made recommendations against other actions: (1) Clinicians should not obtain computed tomography (CT) or magnetic resonance imaging (MRI) for patients with a primary voice complaint prior to visualization of the larynx. (2) Clinicians should not prescribe antireflux medications to treat isolated dysphonia, based on symptoms alone attributed to suspected gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR), without visualization of the larynx. (3) Clinicians should not routinely prescribe corticosteroids in patients with dysphonia prior to visualization of the larynx. The policy level for the following recommendation about laryngoscopy at any time was an option: (1) Clinicians may perform diagnostic laryngoscopy at any time in a patient with dysphonia. Differences from Prior Guideline (1) Incorporating new evidence profiles to include the role of patient preferences, confidence in the evidence, differences of opinion, quality improvement opportunities, and any exclusion to which the action statement does not apply (2) Inclusion of 3 new guidelines, 16 new systematic reviews, and 4 new randomized controlled trials (3) Inclusion of a consumer advocate on the guideline update group (4) Changes to 9 KASs from the original guideline (5) New KAS 3 (escalation of care) and KAS 13 (outcomes) (6) Addition of an algorithm outlining KASs for patients with dysphonia.
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Affiliation(s)
| | | | | | | | - German P Digoy
- 5 Oklahoma State University, Oklahoma City, Oklahoma, USA
| | - Helene J Krouse
- 6 University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | | | | | | | | | - Libby J Smith
- 11 University of Pittsburgh Medical, Pittsburgh, Pennsylvania, USA
| | - Marshall Smith
- 12 University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Peak Woo
- 14 Icahn School of Medicine at Mt Sinai, New York, New York, USA
| | - Lorraine C Nnacheta
- 15 Department of Research and Quality, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Ning LH. The effects of age and pitch level on electroglottographic measures during sustained phonation. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2019; 146:640. [PMID: 31370629 DOI: 10.1121/1.5119127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/03/2019] [Indexed: 06/10/2023]
Abstract
The aim of the present study was to use electroglottography (EGG) to explore the effects of age and pitch level on sustained vowel phonation. Thirty female individuals (10 young, 10 middle-aged, and 10 older speakers) without voice disorders or training in singing participated in this study. Eight EGG parameters were measured during sustained vowel production with a high, mid, or low pitch: fundamental frequency, contact quotient, contacting-time quotient, decontacting-time quotient, speed quotient with a midslope criterion (SQ-mid), jitter, shimmer, and the harmonics-to-noise ratio. Age was found to be a significant factor in fundamental frequency, contact quotient, contacting-time quotient, decontacting-time quotient, and SQ-mid. With increasing age, the mean fundamental frequency decreased while the contact quotient increased. The middle-aged and older speakers had more asymmetrical vocal fold vibratory patterns than the young speakers. As for pitch level, the high pitch had a significantly less decontacting-time quotient and greater SQ-mid than low and mid pitches. The lack of significant interaction between age and pitch level indicates that the effects of age and pitch level could be additive. Finally, the discriminant analyses show that contact quotient is an important factor in predicting the age of a voice.
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Affiliation(s)
- Li-Hsin Ning
- Department of English, National Taiwan Normal University, 162 Heping East Road, Daan District, Taipei City 106, Taiwan
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Choi YH, Kim SH, Kim IG, Lee JH, Kwon SK. Injectable basic fibroblast growth factor-loaded alginate/hyaluronic acid hydrogel for rejuvenation of geriatric larynx. Acta Biomater 2019; 89:104-114. [PMID: 30849562 DOI: 10.1016/j.actbio.2019.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 01/01/2023]
Abstract
Increase in the geriatric population has led to an increase in the number of elderly patients with laryngeal atrophy and dysfunction. Symptoms of voice change, dysphagia, and aspiration pneumonia negatively influence patient's health status, quality of life, and life span. Injection laryngoplasty used to treat laryngeal dysfunctions does not recover intrinsic functions of the larynx. Thus, we fabricated an injectable basic fibroblast growth factor (bFGF)-loaded alginate (ALG)/hyaluronic acid (HA) hydrogel for inducing rejuvenation of geriatric laryngeal muscles. Optimal in situ-forming bFGF-loaded ALG/HA hydrogel for injection laryngoplasty was prepared and the release profile of bFGF was analyzed. For in vivo analysis, the bFGF-loaded ALG/HA hydrogel was injected into the laryngeal muscles of 18-month-old Sprague-Dawley rats. The rejuvenation efficacy of bFGF-loaded ALG/HA hydrogel in geriatric laryngeal muscle tissues 4- and 12-weeks post-injection was evaluated by quantitative polymerase chain reaction (qPCR), histology, immune-fluorescence staining and functionality analysis. The bFGF-loaded ALG/HA hydrogel induced an increase in the expression of myogenic regulatory factor-related genes, hypertrophy of muscle fiber, proliferation of muscle satellite cells, and angiogenesis and decreased interstitial fibrosis. Administration of the bFGF-loaded ALG/HA hydrogel caused successful glottal gap closure. Thus, the bFGF-loaded ALG/HA hydrogel could be a promising candidate for laryngoplasty aimed at rejuvenating geriatric larynx. STATEMENT OF SIGNIFICANCE: In this manuscript, optimal in situ-forming bFGF-loaded ALG/HA hydrogel for injection laryngoplasty was prepared and the release profile of bFGF was analyzed. Herein, we introduced the materials and methods of injection laryngoplasty for geriatric rat experiment. In addition, we studied effects of bFGF-loaded ALG/HA hydrogel on the therapeutic rejuvenation of geriatric rat larynx. The bFGF-loaded ALG/HA hydrogel induced an increase in the expression of myogenic regulatory factor-related genes, hypertrophy of muscle fiber, proliferation of muscle satellite cells, and angiogenesis and decreased interstitial fibrosis. Furthermore, our functional analysis through the high-speed camera setup demonstrated that the administration of the bFGF-loaded ALG/HA hydrogel induced successful glottal gap closure. Thus, the bFGF-loaded ALG/HA hydrogel could be a promising candidate for injection laryngoplasty with therapeutic effects.
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Affiliation(s)
- Young Hwan Choi
- Department of Otorhinolaryngology-Head and Neck, Seoul National University Hospital, Seoul 03080, Republic of Korea; School of Chemical and Biological Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Sae Hyun Kim
- Department of Advanced Materials and Chemical Engineering, Hannam University, Daejeon 34054, Republic of Korea
| | - In Gul Kim
- Department of Otorhinolaryngology-Head and Neck, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Jin Ho Lee
- Department of Advanced Materials and Chemical Engineering, Hannam University, Daejeon 34054, Republic of Korea.
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck, Seoul National University Hospital, Seoul 03080, Republic of Korea; Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Lenell C, Sandage MJ, Johnson AM. A Tutorial of the Effects of Sex Hormones on Laryngeal Senescence and Neuromuscular Response to Exercise. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:602-610. [PMID: 30950744 PMCID: PMC6802894 DOI: 10.1044/2018_jslhr-s-18-0179] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Purpose The purpose of this tutorial is to summarize how sex hormones affect both laryngeal senescence and neuromuscular response to exercise, highlighting the importance of considering sex differences in developing treatment for the senescent voice. Conclusion Men and women's voices are sexually dimorphic throughout the life span, including during the laryngeal adaptations observed during senescence. Therefore, presbyphonia (age-related dysphonia) likely clinically manifests differently for men and women due to differences in how the male and the female larynx change in response to aging. Because sexual dimorphism is evident in both laryngeal aging and response to exercise, voice therapy programs aimed at treating the typical and disordered aged voice should consider sex differences in their design.
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Affiliation(s)
- Charles Lenell
- Department of Communicative Sciences and Disorders, New York University, New York
| | - Mary J. Sandage
- Department of Communication Disorders, Auburn University, AL
| | - Aaron M. Johnson
- Department of Communicative Sciences and Disorders, New York University, New York
- New York University Voice Center, Department of Otolaryngology—Head & Neck Surgery, New York University School of Medicine, New York
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Applebaum J, Harun A, Davis A, Hillel AT, Best SRA, Akst LM. Geriatric Dysphonia: Characteristics of Diagnoses in Age-Based Cohorts in a Tertiary Voice Clinic. Ann Otol Rhinol Laryngol 2019; 128:384-390. [DOI: 10.1177/0003489419826133] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: An aging population has increased focus on geriatric otolaryngology. Those ≥65 years old are not a uniform population, however, and recent gerontology literature recognizes important physiologic differences between the young-old (ages 65-74 years), middle-old (75-84), and old-old (≥85). This study evaluates differences within these groups among dysphonia patients ≥65 years relative to diagnosis and voice-related quality of life (V-RQOL). Methods: Chart review of all new patients ≥65 years presenting to the Johns Hopkins Voice Center between April 2015 and March 2017 identified chief complaint, diagnosis, and self-reported voice handicap. Etiology of dysphonia diagnoses were classified. Diagnostic categories and V-RQOL were evaluated as functions of patient age and gender. Results: Of 839 new patients ≥65 years, 463 (55.2%) reported chief complaint of dysphonia, with the most common etiologies being vocal fold immobility (28.3%) and atrophy (21.6%). Younger cohorts were more likely to present with benign vocal fold lesion and vocal fold immobility, while older cohorts were more likely to present with atrophy ( P = .016). The odds of having a diagnosis of vocal fold atrophy increased 7% with each year of life (odds ratio = 1.07; 95% CI, 1.03-1.11). V-RQOL scores were similar across gender and age categorization. Conclusion: Dysphonia patients ≥65 years are not a uniform group, and important differences exist in terms of diagnosis as a function of age. Knowledge of these differences may inform further investigations in the growing field of geriatric otolaryngology.
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Affiliation(s)
- Jeremy Applebaum
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Aisha Harun
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ashley Davis
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Alexander T. Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Simon R. A. Best
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lee M. Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
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The Influence of Sleep Disorders on Voice Quality. J Voice 2018; 32:771.e1-771.e13. [DOI: 10.1016/j.jvoice.2017.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/31/2017] [Accepted: 08/09/2017] [Indexed: 11/15/2022]
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Fabron EMG, Silvério KCA, Berretin-Felix G, Andrade EC, Salles PF, Moreira PAM, Brasolotto AG. Voice therapy for the elderly with progression of intensity, frequency, and phonation time: case reports. Codas 2018; 30:e20170224. [PMID: 30379196 DOI: 10.1590/2317-1782/20182017224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 04/17/2018] [Indexed: 11/22/2022] Open
Abstract
This study aims to verify the immediate and medium-term effects of an intensive voice therapy, with progression of vocal intensity and frequency and phonation time, on the voice and larynx of two elderly. A 79-year-old male and an 82-year-old female with vocal complaints and presbylarynx characteristics underwent 12 sessions of intensive voice therapy, with progression of voice intensity and frequency and phonation time, for three weeks. To analyze the therapeutic effects, the following assessments were performed pre-, post-immediately, and one month after voice therapy: auditory-perceptual analyses of the voice, acoustic analysis, and evaluation of maximum phonation time (MPT), self-reference voice-related quality of life, and laryngeal behavior. Most results of these measurements indicated positive changes immediately after voice therapy. There was reduction in the measures of vocal quality deviation, perturbation, and harmonics-to-noise pre-, post-immediately, and one month after voice therapy, which indicates vocal improvement. There was increase in fundamental frequency, maximum phonation time and self-reference voice-related quality of life. Assessment of the laryngeal images showed no consistent difference. One month after voice therapy, worsening of some results was observed compared with the post-immediate assessment, but improvements were maintained in relation to the initial evaluation. The results of this therapeutic proposal are promising, and their effects should be investigated in controlled clinical trials to verify their efficacy.
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Affiliation(s)
- Eliana Maria Gradim Fabron
- Departamento de Fonoaudiologia, Faculdade de Filosofia e Ciências - UNESP - Marília (SP), Brasil.,Departamento de Fonoaudiologia, Faculdade de Odontologia de Bauru - USP - Bauru (SP), Brasil
| | | | - Giédre Berretin-Felix
- Departamento de Fonoaudiologia, Faculdade de Odontologia de Bauru - USP - Bauru (SP), Brasil
| | | | - Polyana Ferreira Salles
- Departamento de Fonoaudiologia, Faculdade de Odontologia de Bauru - USP - Bauru (SP), Brasil
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Spazzapan EA, Cardoso VM, Fabron EMG, Berti LC, Brasolotto AG, Marino VCDC. Acoustic characteristics of healthy voices of adults: from young to middle age. Codas 2018; 30:e20170225. [PMID: 30365649 DOI: 10.1590/2317-1782/20182017225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 04/17/2018] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Characterize voices of adult individuals without vocal complaints and verify the effect of gender and age with the use of acoustic measures. METHODS One-hundred and seventy-six voice recordings belonging to adults between 19 and 59 years old, divided into four age groups, for decade, recorded in a database were analyzed. All voices analyzed were classified with no deviation in vocal quality. Acoustic analysis of the parameters was performed: Fundamental Frequency (sustained vowel and connected speech), Jitter, Shimmer and Noise-to-Harmonic Ratio through Multi Dimension Voice Program (KayPentax) software. The effect of gender, age and possible interactions were verified through the Factorial Anova test. When necessary, post hoc was performed with the Least Significant Difference test. RESULTS There were changes in the voice as a function of age, with a decrease in the Fundamental Frequency in the vowel and connected speech modalities in women and in the Fundamental Frequency of the speech in men. In men, an increase in shimmer measure was observed with the advancing age. Differences between genders were found in the measures of Fundamental Frequency, Jitter and Noise to Harmonic Ratio. CONCLUSION Vocal changes due to advancing age can be identified acoustically at the end of adulthood, and in women, these changes can be marked previously to the menopausal period.
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Mathew AS, Shilpa H. Geriatric Dysphonia: Etiological Analysis in a Rural Hospital in India. Indian J Otolaryngol Head Neck Surg 2018; 71:218-224. [PMID: 31275834 DOI: 10.1007/s12070-018-1507-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/26/2018] [Indexed: 11/26/2022] Open
Abstract
To establish the prevalence of etiological factors for dysphonia in elderly individuals in rural India. Hundred adults aged ≥ 65 years, who presented with dysphonia for ≥ 4 weeks and underwent detailed clinical evaluation including videolaryngoscopic assessment and other appropriate investigations/evaluation, were included in a retrospective cohort clinical study. Patients were classified into eight groups for further descriptive statistical analysis based on standard diagnostic criteria/guidelines i.e. benign vocal cord lesions, inflammatory disorders of the larynx, laryngeal and hypopharyngeal neoplasms, isolated vocal cord palsy/paresis, presbylaryngis, central neurological disorders affecting laryngeal function, impaired pulmonary function and non specific dysphonia. Mean age was 70.73 ± 4.29 years. 58% were aged between 65 and 69 years. Overall, the common causes for dysphonia were laryngopharyngeal reflux disease (23%), carcinoma larynx (12%) and presbylaryngis (8%). Inflammatory disorders of the larynx, benign vocal cord lesions and laryngeal/hypopharyngeal malignancies were the commonest causes for dysphonia in individuals aged between 65 and 74 years. Presbylaryngis and systemic causes were the commonest among individuals aged 75-89 years. 63 males and 37 females met the inclusion criteria. The most common cause for dysphonia among females was laryngopharyngeal reflux disease (17%), followed by vocal palsy (5%) and spasmodic dysphonia (4%). Carcinoma larynx (12%) was the most common cause for dysphonia among males, followed by laryngopharyngeal reflux (6%) and presbylaryngis (6%). Geriatric dysphonia is an often overlooked symptom of greater underlying disease as evidenced in this study. With its impact on the quality of life in this age group and life expectancy in the rural population, dysphonia requires early detection, prompt evaluation and appropriate management.
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Affiliation(s)
- Amrita Suzanne Mathew
- Department of Otorhinolaryngology, MVJ Medical College and Research Hospital, Bangalore, Karnataka 562114 India
| | - H Shilpa
- Department of Otorhinolaryngology, MVJ Medical College and Research Hospital, Bangalore, Karnataka 562114 India
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Guzman M, Saldivar P, Pérez R, Muñoz D. Aerodynamic, Electroglottographic, and Acoustic Outcomes after Tube Phonation in Water in Elderly Subjects. Folia Phoniatr Logop 2018; 70:149-155. [DOI: 10.1159/000492326] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 07/19/2018] [Indexed: 11/19/2022] Open
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Samlan RA, Kunduk M, Ikuma T, Black M, Lane C. Vocal Fold Vibration in Older Adults With and Without Age-Related Dysphonia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:1039-1050. [PMID: 29931255 DOI: 10.1044/2018_ajslp-17-0061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 03/25/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE The purpose of this study was to identify the extent to which 7 measures of glottal area timing and regularity differ between older adults with and without age-related dysphonia (ARD). METHOD Laryngeal high-speed videoendoscopy was completed at 4,000 frames per second for 42 adults aged 70 years and older (ARD: 9 female, 5 male; control group: 15 female, 13 male). Relative glottal gap, open quotient, speed index, maximum area declination rate, harmonics-to-noise ratio, harmonic richness factor, and standard deviation of fundamental frequency were measured from a 0.5-s segment of the glottal area waveform. Eta squared (η2) was computed to estimate group effect. RESULTS Small effect sizes (η2 = .18-.35) were present for relative glottal gap, open quotient, maximum area declination rate, harmonic richness factor, and standard deviation of fundamental frequency. Speed index and glottal harmonics-to-noise ratio did not explain group membership (η2 = .001 and .05, respectively). CONCLUSION These findings provide evidence that vocal fold vibration in ARD is different than in normal aging, whereas the overlap in values for every measure is consistent with the concept that normal aging and ARD exist as a continuum of health and disease.
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Affiliation(s)
- Robin A Samlan
- Department of Speech, Language, & Hearing Sciences, University of Arizona, Tucson
- Department of Otolaryngology Head & Neck Surgery, University of Arizona College of Medicine, Tucson
| | - Melda Kunduk
- Department of Communication Sciences & Disorders, Louisiana State University, Baton Rouge
| | - Takeshi Ikuma
- Department of Otolaryngology-Head & Neck Surgery, Louisiana State University Health Sciences Center, New Orleans
| | - Mindy Black
- Department of Otolaryngology Head & Neck Surgery, University of Arizona College of Medicine, Tucson
| | - Christianne Lane
- Division of Biostatistics, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
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