Diagnostic Value of Acoustic and Aerodynamic Measurements in Vocal Fold Movement Disorders and their Correlation with Laryngeal Electromyography and Voice Handicap Index

The Characterization of Normal Male and Female Voice from Surface Electromyographic Parameters

Currently, there is no consensus on the characterization of the human voice. The objective of the present study is to describe the myoelectric behavior of the extrinsic musculature of the larynx in 146 people with normal voice (Spanish speakers), aged between 20 and 50 years old. Different vocal tasks were recorded using a surface electromyograph (SEMG). In all vocal tasks, it was observed that women had higher activation (µV) in the suprahyoid and sternocleidomastoid muscles than men, while men had higher activation in the infrahyoid muscles. SEMG is a valid procedure to help define normal vocal characteristics in the studied population, providing reference values during clinical examination. However, it is necessary to adopt a universal system of assessment tasks and standardized measurement techniques to allow for comparisons with future studies.

LEMG Findings of Vocal Fold Paresis in Voice Patients Who Play or Played Wind Instruments

In a musical wind instrument, sound is produced by vibration of air, typically created by the player blowing into the instrument. Many researchers believe that wind instrumentalists have vocal and laryngeal problems related to playing their instruments. In this study, wind instrumentalists were defined as those who had a history (1 year or more) of studying a wind instrument (flute, clarinet, saxophone, oboe, bassoon, trumpet, trombone, tuba, or French horn) at any time in their lives. Laryngeal electromyography (L EMG) had been obtained because vocal fold paresis was suspected clinically. Data analysis indicated that wind instrument players appear to experience greater levels of decreased nerve recruitment than non-instrumentalist singers do who present with paresis.

METHODOLOGY

Voice patients who underwent laryngeal EMG for clinically suspected vocal fold paresis between 2019 and 2021 were included in the study. Subjects were divided into two groups depending on history of playing wind instruments. Only patients with insufficient information in their medical records were excluded. All data were reviewed retrospectively. Percentage of nerve recruitment, the recruitment rating scale used in previous studies, wind instrument played, gender, age, and laryngeal Myasthenia Gravis diagnosis were variables included in the descriptive statistics, correlational, and regression analyses used for statistical analysis.

RESULTS

Data analysis indicated that in the 103 subjects included (47 wind instrumentalists and 56 non-wind instrumentalists) that wind instrument players, past and present, experience levels of greater decreased nerve recruitment that non-instrumentalist singers do when presenting with paresis. Kind of wind instrument played was statistically significant but moderately correlated to the RRS (Recruitment Rating Scale) of the left PCA. Sex was correlated moderately and statistically significantly with right CT recruitment.

CONCLUSION

Playing wind instruments in voice patients diagnosed with paresis might be associated with increased severity of laryngeal nerve damage. Further research is needed to confirm or refute these findings.

The Degree of Change and Relationship in Self-perceived Handicap and Acoustic Voice Quality Associated With Voice Therapy

INTRODUCTION

Outcome measures describing acoustic voice quality and self-perceived vocal handicap are commonly used in clinical voice practice. Previous reports of the relationship between acoustic and self-perceived measures have found only limited associations, but it is unclear if acoustic measures associated with voice quality and self-perceived voice handicap change in a similar manner over the course of voice treatment. The current study, therefore, considered the relationship between the degree of change in Acoustic Voice Quality Index (AVQI) and Voice Handicap Index (VHI-30 and VHI-10) in dysphonic patients receiving treatment in a private practice voice clinic.

METHODS

Data were collected retrospectively from patient records of a private practice voice clinic over 80 consecutive months. For each patient, their voice disorder diagnosis, age, and biological sex were collected as well as pre-and post-treatment measures of the AVQI and VHI-30 or VHI-10 depending on which version was used. Correlations were calculated between the AVQI and VHI-30 and the AVQI and VHI-10 before and after treatment as well as for the percentage change of AVQI and VHI-30/VHI-10. Friedman and Kruskal-Wallis tests were used to determine the pre-and post-treatment effect and group differences respectively.

RESULTS

Seventy-eight patients were included in the analyses. The scores of the AVQI (χ²[1] = 24.01, P < 0.001), VHI-30 (χ²[1] = 18.00, P < 0.001), and VHI-10 (χ²[1] = 38.35, P < 0.001) all improved significantly after treatment. However, correlations between the AVQI and VHI-30, and the AVQI and VHI-10 were all non-significant, except for a moderate correlation between the AVQI and VHI-10 before treatment (r[43] = 0.31, P = 0.04). The percentage change of the AVQI and the VHI-30/VHI-10 did not correlate significantly.

CONCLUSIONS

Voice therapy significantly improved acoustic and self-perceived vocal outcome measures. However, there was no significant relationship between these measures before or after treatment, nor was there a relationship in their degree of change. Results support the notion that VHI and AVQI measure unique constructs and that voice therapy can have a positive impact on both.

Voice Telerehabilitation in Iatrogenic Unilateral Vocal Fold Paralysis: From Necessity to Opportunity in the COVID-19 Time

OBJECTIVE

To evaluate results of telerehabilitation (TR) during the coronavirus disease 2019 pandemic for the treatment of dysphonia caused by permanent post-thyroidectomy unilateral vocal fold paralysis (UVFP).

METHODS

Forty subjects with post-thyroidectomy UVFP (onset <1 month) underwent TR. Videostrobolaryngoscopy, acoustic and perceptual voice analysis and patient self-assessment were carried out in person before, at the end of TR and 6 months later.

RESULTS

Twenty-five subjects spontaneously recovered full vocal fold motility at some time during follow-up, whereas 15 had a permanent UVFP at the end of the follow-up period. These subjects constituted our study group. At the early posttherapy control 10/15 subjects (66.6%) showed a complete glottal closure, while in 5/15 (33.3%) a glottal gap remained (P = 0.03). These results did not change 6 months after TR. At the late posttherapy control the maximum phonation time improved significantly (P = 0.02). Both post-therapy Voice Handicap Index scores were significantly lower than the pre-therapy ones (P = 0.04). Grade, Breathiness, and Asthenia parameters of the Grade-Roughness-Breathiness-Asthenia-Strain scale improved 6 months after TR (P < 0.05). The number of voice signals suitable for acoustic analysis increased significantly after therapy. Finally, 87% of patients were satisfied with TR.

CONCLUSIONS

With careful patient selection, TR may be considered as a promising method for voice therapy in postthyroidectomy UVFP.

The effectiveness of voice therapy on voice-related handicap: A network meta-analysis

BACKGROUND

Treatment approaches for voice therapy are diverse, yet their differential effects are not well understood. Evaluations of treatment effects across approaches are important for clinical guidance and evidence-based practice.

OBJECTIVE OF REVIEW

To quantify the evidence of treatment effectiveness on the outcome measure Voice Handicap Index with the 30-items (VHI-30) from existing randomised controlled/clinical trials (RCT) of voice therapy using the statistical approach of a network meta-analysis (NMA) with a random effects model.

TYPE OF REVIEW

Meta-analysis.

SEARCH STRATEGY

We searched in MEDLINE (PubMed, 1950 to 2019), Embase (1974 to 2019) and Science Citation Index (1994 to 2019) using five key terms. The inclusion criteria were reports of randomised controlled/clinical trials (RCTs) published in English or German which evaluated the effectiveness of a specific voice therapy treatment using VHI-30 as an outcome measure in adult participants with non-organic or organic voice disorders. Studies were excluded if participants had been diagnosed with neurological motor speech disorders or who were vocally healthy. Furthermore, no medical, pharmacological or instrumental (eg voice amplification) treatments were considered.

EVALUATION METHOD

The primary outcome variable was VHI-30 with a score from 0 to 120. The pre-post treatment change in VHI-30 scores was an average score of 13 points related to various VHI-30 test-retest results.

RESULTS

We retrieved 464 publications (ie with duplicates) and included 13 RCTs, which evaluated nine interventions, in the final analysis. The most effective intervention with a significant and clinically relevant effect was Stretch-and-Flow Phonation (SFP) (mean pre-post difference -28.37, 95% confidence interval [CI], -43.05 to-13.68). Resonant Voice (RV), the Comprehensive Voice Rehabilitation Program (CVRP) and Vocal Function Exercises (VFE) also demonstrated significant improvements.

CONCLUSIONS

Of the nine voice interventions identified with the present NMA, SFP, RVT, CVRP, and VFE effectively improved VHI-30 scores from pre- to post-treatment. SFP proved to be the most significant and clinically relevant treatment. Further contributions of high-quality intervention studies are needed to support evidence-based practice in vocology.