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Rameau A, Tucker LH, Denham MW, Kang YJ, Choi N, Lachs M, Rosen T, Stewart M, Czaja S, Golub JS. Voice Disorders and Hearing Loss May Be Additive Risk Factors for Depression in a National Cohort. Laryngoscope 2024; 134:4060-4065. [PMID: 38804637 PMCID: PMC11305957 DOI: 10.1002/lary.31536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/18/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES Hearing loss (HL) (receptive communication impairment) is a known risk factor for depression. However, dysphonia (expressive communication impairment), has received little study. We study HL, self-reported voice disorder, and combined impairment as risk factors for depression in a large national cohort. METHODS This was a cross-sectional epidemiologic study. Data were analyzed from the Korean National Health and Nutrition Examination Survey (KNHANES) cycles 2008-2012 and 2019-2020. KNHANES uniquely contains both audiometry and voice disorder data. HL (yes/no) was defined as ≥25 dB pure tone average. Voice disorder (yes/no) was defined by self-report. Depression (yes/no) was defined by physician diagnosis. Odds ratios for depression were calculated using multivariable logistic regressions with HL and voice disorder. RESULTS 8,524 individuals aged 19 to 80 years old had complete data. The mean age was 57.3 years (SD = 13.4) and 64% were women. All regressions were controlled for age and sex. Those with HL, versus those without, had 1.27 times the odds (95% CI = 1.07-1.52, p = 0.007) of depression. Those with self-reported voice disorder, versus those without, had 1.48 times the odds (1.22-1.78, p < 0.001) of depression. Those with HL and self-reported voice disorder, versus those with neither, had 1.79 times the odds (1.27-2.48, p < 0.001) of depression. CONCLUSIONS This study demonstrates independent relationships between HL and depression and self-reported voice disorder and depression. Combined HL and self-reported voice disorder had nearly 1.8 times the odds of depression. This is likely due to the grossly additive effect of difficulty with incoming and outgoing communication streams. LEVEL OF EVIDENCE II Laryngoscope, 134:4060-4065, 2024.
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Affiliation(s)
- Anaïs Rameau
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College/NewYork-Presbyterian, Sean Parker Institute for the Voice, 240 East 59 Street, New York, NY 10022, USA
| | - Lauren H. Tucker
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center/NewYork-Presbyterian, 180 Fort Washington Avenue, HP8, New York, NY 10032, USA
| | - Michael W. Denham
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center/NewYork-Presbyterian, 180 Fort Washington Avenue, HP8, New York, NY 10032, USA
| | - Yung Jee Kang
- Department of Otolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, 81 Irwon-Ro Gangnam-gu, Seoul, Korea 06351
| | - Nayeon Choi
- Department of Otolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, 81 Irwon-Ro Gangnam-gu, Seoul, Korea 06351
| | - Mark Lachs
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College/NewYork-Presbyterian, 240 East 59 Street, New York, NY 10022, USA
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medical College/NewYork-Presbyterian, 240 East 59 Street, New York, NY 10022, USA
| | - Michael Stewart
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College/NewYork-Presbyterian, Sean Parker Institute for the Voice, 240 East 59 Street, New York, NY 10022, USA
| | - Sara Czaja
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College/NewYork-Presbyterian, 240 East 59 Street, New York, NY 10022, USA
| | - Justin S. Golub
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center/NewYork-Presbyterian, 180 Fort Washington Avenue, HP8, New York, NY 10032, USA
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Haddad R, Mattei A, Petrone C, Cachi-Pouyenne M, Bogdanski E, Galant C, Giovanni A. Alterations in Emotional Expression Through Speech in Patients With Unilateral Vocal Fold Paralysis: A Preliminary Study. J Voice 2024:S0892-1997(24)00223-6. [PMID: 39122578 DOI: 10.1016/j.jvoice.2024.07.010] [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: 04/26/2024] [Revised: 06/23/2024] [Accepted: 07/11/2024] [Indexed: 08/12/2024]
Abstract
Unilateral vocal fold paralysis (UVFP) has a known impact on patients' quality of life. One of the potentially affected domains that has not been studied yet is emotional prosody. To produce and transmit an efficient emotional prosody, several vocal parameters are modulated by the speaker, principally the fundamental frequency, the speech rate, and the voice intensity. We retrieved 300 sentences produced by 10 patients suffering from UVFP, equally in neutral, anger, and sadness. A jury of six health care voice experts was asked to hear these sentences and choose an emotion for each vocalization, between neutral, anger, and sadness. The jury mainly considered the heard sentences as being in a neutral emotion. Vocal parameters analysis of the anger and sadness sentences that were mistaken as neutral showed the absence of significant difference in their fundamental frequencies and speech rates. By being unable to modulate their vocal parameters as needed to produce emotional prosody, specifically the fundamental frequency and speech rate, patients with UVFP suffer from limitations in their capacity to produce the emotional prosody wanted, making the emotions they feel hardly transmitted to their entourage, which can explain the social barriers these patients complain of.
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Affiliation(s)
- Ralph Haddad
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, AP-HM, La Conception University Hospital, Aix-Marseille University, Marseille, France.
| | - Alexia Mattei
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, AP-HM, La Conception University Hospital, Aix-Marseille University, Marseille, France
| | - Caterina Petrone
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, AP-HM, La Conception University Hospital, Aix-Marseille University, Marseille, France
| | - Marie Cachi-Pouyenne
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, AP-HM, La Conception University Hospital, Aix-Marseille University, Marseille, France
| | - Estelle Bogdanski
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, AP-HM, La Conception University Hospital, Aix-Marseille University, Marseille, France
| | - Camille Galant
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, AP-HM, La Conception University Hospital, Aix-Marseille University, Marseille, France
| | - Antoine Giovanni
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, AP-HM, La Conception University Hospital, Aix-Marseille University, Marseille, France
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Naunheim MR, DeVore EK, Huston MN, Song PC, Franco RA, Bhattacharyya N. Increasing Prevalence of Voice Disorders in the USA: Updates in the COVID Era. Laryngoscope 2024; 134:3713-3718. [PMID: 38525993 DOI: 10.1002/lary.31409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/03/2024] [Accepted: 03/13/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE To estimate the current prevalence of voice disorders among adults in the United States; to determine the association of individual factors with voice disorders. METHODS The 2022 National Health Interview Survey (NHIS) was analyzed to identify adults reporting voice problems in the past 12 months. Demographics were assessed, as well as the duration, severity, and resolution of the voice problem. The relationship between voice problems, gender, lost workdays, and long COVID was investigated. A comparison to the 2012 NHIS was made to determine changes in voice disorder prevalence. RESULTS 29.9 million Americans (95%CI[28.3-31.5]) annually report a voice problem, representing 12.2% of the population (95%CI[11.7-12.8%]). Overall, 26.8% and 13.2% reported the severity of their voice problem as moderate or severe, respectively. Only 5.1% (95%CI[4.3-6.0%]) of respondents sought treatment. Most voice problems were resolved within 1 week (53.0%,95%CI[50.9-55.1%]). Females were more likely than males to report a voice problem (14.4% vs. 10.0%,95%CI[13.7-15.1] and [9.3-10.7], respectively). The 17.6 million Americans with long COVID symptoms were more likely to have voice complaints than those without (21.1% vs. 11.6%,95%CI[18.9-23.5%] and [11.1-12.1%], respectively). Lost workdays were not significantly higher for those with voice disorders compared to those without (17.1 vs. 12.9 days,95%CI[12.0-22.1] and [11.0-14.8], respectively). CONCLUSIONS Voice problems affect approximately 1 in 8 adults in the U.S. annually, demonstrating an alarming increased prevalence since 2012 using the same survey methodology. Relatively few individuals seek care for their voice problem, despite significant self-reported impact. Further study is required regarding the impact of COVID and changes in voice use patterns on voice disorders. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3713-3718, 2024.
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Affiliation(s)
- Matthew R Naunheim
- Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Elliana K DeVore
- Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Molly N Huston
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, U.S.A
| | - Phillip C Song
- Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Ramon A Franco
- Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Neil Bhattacharyya
- Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
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Kemfack AM, Hernández-Morato I, Moayedi Y, Pitman MJ. Transcriptome Analysis of Left Versus Right Intrinsic Laryngeal Muscles Associated with Innervation. Laryngoscope 2024; 134:3741-3753. [PMID: 38721727 PMCID: PMC11245368 DOI: 10.1002/lary.31487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVES/HYPOTHESIS Recurrent laryngeal nerve injury diagnosed as idiopathic or due to short-term surgery-related intubation exhibits a higher incidence of left-sided paralysis. While this is often attributed to nerve length, it is hypothesized there are asymmetric differences in the expression of genes related to neuromuscular function that may impact reinnervation and contribute to this laterality phenomenon. To test this hypothesis, this study analyzes the transcriptome profiles of the intrinsic laryngeal muscles (ILMs), comparing gene expression in the left versus right, with particular attention to genetic pathways associated with neuromuscular function. STUDY DESIGN Laboratory experiment. METHODS RNA was extracted from the left and right sides of the rat posterior cricoarytenoid (PCA), lateral thyroarytenoid (LTA), and medial thyroarytenoid (MTA), respectively. After high-throughput RNA-Sequencing, 88 samples were organized into 12 datasets according to their age (P15/adult), sex (male/female), and muscle type (PCA/LTA/MTA). A comprehensive bioinformatics analysis was conducted to compare the left-right ILMs across different conditions. RESULTS A total of 774 differentially expressed genes were identified across the 12 experimental groups, revealing age, sex, and muscle-specific differences between the left versus right ILMs. Enrichment analysis of Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathways implicated several genes with a left-right laryngeal muscle asymmetry. These genes are associated with neuronal and muscular physiology, immune/inflammatory response, and hormone control. CONCLUSION Bioinformatics analysis confirmed divergent transcriptome profiles between the left-right ILMs. This preliminary study identifies putative gene targets that will characterize ILM laterality. LEVEL OF EVIDENCE N/A Laryngoscope, 134:3741-3753, 2024.
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Affiliation(s)
- Angela M. Kemfack
- The Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center. New York, NY
| | - Ignacio Hernández-Morato
- The Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center. New York, NY
- Department of Anatomy and Embryology, School of Medicine, Complutense University of Madrid. Madrid (Spain)
| | - Yalda Moayedi
- The Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center. New York, NY
- Department of Neurology, Columbia University Irving Medical Center. New York, NY
- Pain Research Center, New York University College of Dentistry, New York University. New York, NY
| | - Michael J. Pitman
- The Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center. New York, NY
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Nazari MA, Saeedi S, Seifpanahi MS, Hadi N. Adaptation and Validation of the Persian Version of the Voice Handicap Index-10 (VHI-10). J Voice 2024:S0892-1997(24)00167-X. [PMID: 38960766 DOI: 10.1016/j.jvoice.2024.05.016] [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: 02/23/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVES Voice disorders can profoundly impact health, quality of life, job performance, and social interactions. Traditional evaluations have expanded to include quality-of-life assessments, emphasizing self-reported outcomes. The Voice Handicap Index (VHI) stands out among relevant questionnaires, with the VHI-10 being a concise derivative. This study was conducted to translate and validate the Voice Handicap Index-10 (VHI-10) questionnaire for Persian speakers, enhancing clinical assessments of voice disorders and quality of life. METHODS This cross-sectional study, conducted in Iran, involved (1) translating the VHI-10 into Persian, (2) confirming face and content validity using Content Validity Ratio (CVR), and Content Validity Index (CVI), and (3) evaluating its reliability through a survey. A panel of experts confirmed the validity, and reliability of the study, which was assessed using Cronbach's alpha, Spearman-Brown, and Guttman coefficients. The survey involved 225 participants, including 150 healthy people and 75 patients with voice disorders, who were selected using a convenience sampling method. RESULTS All question items demonstrated a CVI greater than 0.79 and a CVR between 0.62 and 1. Reliability analysis yielded high Cronbach's alpha values for functional, physical, and emotional domains (0.909) and total (0.961). The mean overall scores of VHI-10 for healthy and disordered groups were 18.78 and 0.74, respectively. The VHI-10 effectively discriminated between healthy and disordered groups in all domains, with an accuracy of 97.33%. The determined cut-off point was 4.5, with a strong area under the Receiver Operating Characteristic (ROC) curve (0.989). CONCLUSION This study successfully adapted and validated the Persian version of the VHI-10. The questionnaire demonstrated high reliability and validity, distinguishing between individuals with and without voice disorders. This Persian version is now a valuable tool for speech and language pathologists conducting clinical voice evaluations in Iran and also it could be applied in studies to determine the effects of voice problems on participant's quality of life.
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Affiliation(s)
- Mohammad-Amin Nazari
- Department of Speech and Language Pathology, School of Rehabilitation Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Soheila Saeedi
- Department of Health Information Technology, School of Allied Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad-Sadegh Seifpanahi
- Department of Speech and Language Pathology, School of Rehabilitation Sciences, Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Niloofar Hadi
- Department of Speech and Language Pathology, School of Rehabilitation Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
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Yaşar ÖC, Tahir E, Kemal Ö, Dünder E. Organic and functional dysphonias: comparison of Self-Assessment protocols by confirmatory factor analysis. LOGOP PHONIATR VOCO 2024; 49:75-82. [PMID: 36227585 DOI: 10.1080/14015439.2022.2130422] [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: 07/25/2021] [Revised: 08/27/2022] [Accepted: 09/26/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE This study aims to see if the effects of the sub-domains of the Voice Handicap Index-10 (VHI-10) and Voice Related Quality of Life (VRQoL) differ in organic (OD) and functional dysphonia (FD). METHOD A total of 162 patients completed the validated Turkish versions of the Voice Handicap Index-10 (VHI-10) and Voice-Related Quality of Life (VRQoL). Physical (pVHI-10), emotional (eVHI-10) and functional (fVHI-10) sub-domains of VHI-10 and physical-functional (PF-VRQoL), socio-emotional (SE-VRQoL) dimensions of VRQoL were assessed. Confirmatory factor analysis (CFA) was used to compare the sub-domains of these questionnaires between diagnostic categories. RESULTS The total and sub-domain scores of both VHI-10 and VRQoL were not statistically different between the two etiologic categories of dysphonia (MANOVA, p > .05). The total VHI-10 and total VRQoL scores were significantly and moderately correlated in both the OD and FD groups. During CFA, 4 models were constructed for the OD and FD groups for VHI-10 and VRQoL factors. There was no significant difference between OD and FD groups in terms of path coefficients of sub-domains (z test, p > .05). CONCLUSION In terms of VHI-10 and VRQoL, the sub-domains of each questionnaire are equally important in both organic and functional dysphonia. Functional disorders do not depend only on "emotional" factors, and neither do organic problems. Factor analysis should be included when performing a study on patient-reported outcome measures.
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Affiliation(s)
- Özlem Cangökçe Yaşar
- Department of Speech and Language Therapy, Ondokuz Mayıs University Faculty of Health Sciences, Samsun, Turkey
| | - Emel Tahir
- Department of Otolaryngology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Özgür Kemal
- Department of Otolaryngology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Emre Dünder
- Department of Statistics, Ondokuz Mayıs, Samsun, Turkey
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Hockey K, Kennedy E. The role and impact of voice physiotherapy: A qualitative study of service user perspectives. Physiother Theory Pract 2024:1-9. [PMID: 38860526 DOI: 10.1080/09593985.2024.2363904] [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: 03/06/2024] [Accepted: 05/30/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Physiotherapy has the potential to benefit people with voice and throat problems in conjunction with existing services. PURPOSE This study aims to explore the impact and role of physiotherapy in voice and throat care, from the perspective of people who have accessed such care. Gaining a better understanding of how physiotherapy contributes to care has the potential to improve services. METHODS An interpretive description design was used to explore participants perspectives of the impact and role of physiotherapy through individual semi-structured interviews with people who had accessed physiotherapy for voice or throat care through a single private practice. Transcripts were analyzed with a general inductive approach suitable for qualitative evaluation data. Data were analyzed from six interviews and four main themes emerged, with each theme further characterized by categories. RESULTS Two themes related to the impact of physiotherapy in voice and throat care: Offers a deeper understanding of issues affecting their voice/throat; facilitates individualized specific management. Two themes related to the role of physiotherapy in voice and throat care: Complements existing services; Valuable service. Each theme is further illustrated by categories. CONCLUSION This study indicates that physiotherapy for voice and throat problems can complement existing services while adding value, providing people with a deeper understanding of their problem and facilitating specific management. There is great potential for physiotherapy to benefit voice users. Future research should further evaluate the potential to include physiotherapy in the voice care team and consider how best to capture the broad impacts illustrated.
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Affiliation(s)
- Kristina Hockey
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Ewan Kennedy
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Kang YJ, Park SY, Chi SA, Chung MK, Jeong HS, Son YI, Choi N. Impact of Dietary Intake and Habits on Subjective Voice and Laryngeal Mucosal Diseases: Analysis From Korean National Health and Nutritional Examination Survey Between 2008 and 2021. J Voice 2024:S0892-1997(24)00141-3. [PMID: 38816300 DOI: 10.1016/j.jvoice.2024.04.024] [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: 02/20/2024] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVES Dysphonia negatively affects social communication, leading to reduced quality of life. Comprehensive research on dysphonia and laryngeal mucosal diseases using large-scale epidemiological data is lacking. Therefore, we investigated how dietary and habitual factors influence dysphonia and laryngeal mucosal diseases using data from the Korean National Health and Nutritional Examination Survey. STUDY DESIGN A population-based cross-sectional study. METHODS The study included individuals aged 19 years and older who both underwent laryngoscopic examinations and completed a dysphonia survey. Dietary and habitual factors and results of the laryngoscopic examinations were collected. Risk factors for dysphonia and laryngeal mucosal diseases were identified. RESULTS The weighted frequency of dysphonia and laryngeal mucosal diseases was 6.4% and 6.0%, respectively. In univariable analyses for dysphonia, sex, body weight change, alcohol ingestion, and various minerals and vitamins showed statistically significant associations. However, in the multivariable analysis, only age, body weight, female sex, and vitamin A intake were significantly associated with dysphonia. Age, body weight, body mass index, sex, smoking, amount of sodium intake, and alcohol intake were associated with laryngeal mucosal diseases in the univariable analyses, but in the multivariable analysis, only age, smoking, and amount of niacin intake were significant factors. CONCLUSIONS In this large-scale epidemiological analysis, subjective dysphonia and laryngeal mucosal diseases had different frequencies and risk factors. Age was a risk factor for both dysphonia and mucosal diseases, but smoking was only a risk factor for laryngeal mucosal diseases. Diet types, calories, and water and alcohol intake were not significant risk factors for either laryngeal mucosal diseases or dysphonia.
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Affiliation(s)
- Yung Jee Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Yool Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Otorhinolaryngology-Head and Neck Surgery, Inje University, College of Medicine, Busan Paik Hospital, Busan, Republic of Korea
| | - Sang Ah Chi
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young-Ik Son
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Nayeon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Che Z, Wan X, Xu J, Duan C, Zheng T, Chen J. Speaking without vocal folds using a machine-learning-assisted wearable sensing-actuation system. Nat Commun 2024; 15:1873. [PMID: 38472193 PMCID: PMC10933441 DOI: 10.1038/s41467-024-45915-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 02/06/2024] [Indexed: 03/14/2024] Open
Abstract
Voice disorders resulting from various pathological vocal fold conditions or postoperative recovery of laryngeal cancer surgeries, are common causes of dysphonia. Here, we present a self-powered wearable sensing-actuation system based on soft magnetoelasticity that enables assisted speaking without relying on the vocal folds. It holds a lightweighted mass of approximately 7.2 g, skin-alike modulus of 7.83 × 105 Pa, stability against skin perspiration, and a maximum stretchability of 164%. The wearable sensing component can effectively capture extrinsic laryngeal muscle movement and convert them into high-fidelity and analyzable electrical signals, which can be translated into speech signals with the assistance of machine learning algorithms with an accuracy of 94.68%. Then, with the wearable actuation component, the speech could be expressed as voice signals while circumventing vocal fold vibration. We expect this approach could facilitate the restoration of normal voice function and significantly enhance the quality of life for patients with dysfunctional vocal folds.
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Affiliation(s)
- Ziyuan Che
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Xiao Wan
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Jing Xu
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Chrystal Duan
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Tianqi Zheng
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Jun Chen
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
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Slavych BK, Zraick RI, Ruleman A. A Systematic Review of Voice-Related Patient-Reported Outcome Measures for Use with Adults. J Voice 2024; 38:544.e1-544.e14. [PMID: 34782227 DOI: 10.1016/j.jvoice.2021.09.032] [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: 05/31/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE This paper's purpose is to provide a resource for clinicians and researchers of select voice-related patient-reported outcome measures (PROMs) available in the English language. METHOD A systematic search for voice-related PROMs was conducted between September 2020 and July 17, 2021. Databases included APA PsychInfo, Nursing and Allied Health Source, MEDLINE via the EBSCO interface, and Science Direct. Reference lists for PROMs-related articles were mined for reference to PROMs protocols. RESULTS Thirty voice-related PROMs were identified and categorized as either developed primarily for use in the clinic (n = 12), developed primarily for use in a specific research study (n = 6), or translated into English for publication (n = 12). Twelve PROMs were summarized: Aging Voice Index, Disease Specific Self-Efficacy in Spasmodic Dysphonia, Evaluation of the Ability to Sing Easily, Evaluating Voice Disability - Quality of Life Questionnaire, Glottal Function Index, Linear Analog Scale of Assessment of Voice Quality, Quality of Life in Recurrent Respiratory Papillomatosis, Speech Disability Questionnaire, Trans Woman Voice Questionnaire, Vocal Cord Dysfunction Questionnaire, Vocal Fatigue Index, and the Vocal Tract Discomfort Scale. CONCLUSION The PROMs can be categorized into English-language voice-related PROMs developed primarily for clinical use, English-language PROMs developed primarily for research use, and English-language PROMs translated into English. The extent of reliability and validity testing completed varies in the PROMs developed primarily for clinical use. A PROM's psychometric properties as well as the language in which the PROM was tested, should guide clinicians and researchers as they consider which instrument(s) to use.
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Affiliation(s)
- Bonnie K Slavych
- Communication Disorders program, University of Central Missouri, Warrensburg, Missouri, USA.
| | - Richard I Zraick
- School of Communication Sciences and Disorders, University of Central Florida, Orlando, Florida, USA
| | - Alice Ruleman
- Communication Disorders program, University of Central Missouri, Warrensburg, Missouri, USA
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Hockey K, Kennedy E. Clinical Characteristics of Individuals Presenting to Physiotherapy for Voice and Throat Care: A Retrospective Case Notes Review. J Voice 2024:S0892-1997(24)00009-2. [PMID: 38429117 DOI: 10.1016/j.jvoice.2024.01.007] [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: 11/23/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Currently, little is known about the characteristics of individuals presenting for physiotherapy care with voice and throat problems. PURPOSE The aim of this study is to describe the demographic and clinical characteristics of individuals presenting to physiotherapy for voice and throat-related problems, and to use this information to clarify the role of physiotherapy in the management of people with voice and throat problems. METHODS A retrospective clinical case notes review was conducted of all clients who accessed physiotherapy for voice and throat problems at a private practice based in Christchurch within a 12-month period from 1st October 2020 to 1st October 2021. RESULTS Data were analyzed from 53 patient charts. The typical profile of an individual accessing physiotherapy for voice and throat problems were female (n = 37), NZ European (n = 26), singer (n = 43), with chronic problems (n = 20), of a nontraumatic origin (n = 45). Voice problems were present in 39 cases and muscle-related problems were present in 42 cases. Treatment primarily included manual therapy and various modes of exercise therapy. CONCLUSIONS The clinical characteristics described offer insight into the demographic and clinical characteristics of individuals accessing physiotherapy services for voice and throat problems. A high prevalence of muscle-related problems and wider issues were identified, consistent with the physiotherapy skill set. Physiotherapy appears to complement existing ENT or SLT services by identifying and managing muscle-related voice problems and addressing wider factors contributing to voice and throat problems.
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Eckel HNC, Nolte A, Otte MS, Shabli S, Lang-Roth R, Klußmann JP, Hansen KK. 3D-exoscopic microlaryngoscopy in phonosurgery for glottic insufficiency. Eur Arch Otorhinolaryngol 2024; 281:855-861. [PMID: 38105362 PMCID: PMC10796486 DOI: 10.1007/s00405-023-08345-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/07/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE We hypothesized that using a 3D-exoscope (3Dex) in microlaryngoscopic phonosurgery is non-inferior to using a standard operating microscope (OM). To compare the above, we utilized a 3Dex and an OM for microlaryngoscopic vocal fold augmentation with autologous fat in patients with glottic insufficiency and compared the procedure itself and the long-term impact of vocal fold augmentation on subjective and objective voice parameters in both groups. METHODS 36 patients with glottic insufficiency received microlaryngoscopic laryngeal augmentation with autologous fat. A 3Dex was utilized in 24 cases for visualization and compared to twelve cases in which an OM was used. Voice parameters were evaluated over a period of twelve months. RESULTS Comparison of operation time and voice parameters between the 3Dex and OM groups did not reveal significant differences. Significant improvement of mean voice quality in all parameters excluding roughness was observed at 3 and 6 months followed then by a slight decrease of voice quality parameters between the 6 and 12 months interval in both groups. CONCLUSION Our findings indicate no difference concerning operation time and outcome between the use of a 3Dex and an OM in phonosurgery. Our results highlight a significant voice improvement after vocal fold augmentation with autologous fat in glottic insufficiency mediated dysphonia. The smaller viewing system, better ergonomics for the primary surgeon and the assistant and a direct view for the entire surgical team make a 3Dex an interesting alternative for visualization in microlaryngoscopic phonosurgery.
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Affiliation(s)
- Hans N C Eckel
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany.
| | - Antonia Nolte
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
| | - Martin S Otte
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
| | - Sami Shabli
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
| | - Ruth Lang-Roth
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
| | - Jens P Klußmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
| | - Kevin K Hansen
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
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Gartling GJ, van Mersbergen M, Crow K, Lewandowski A, Smith LJ, Gartner-Schmidt JL. The Patient Experience: The Relationship Between Vocal Handicap, Congruency, Perceived Present Control, and Mood Across Four Voice Disorders. J Voice 2024; 38:244.e15-244.e27. [PMID: 34615615 DOI: 10.1016/j.jvoice.2021.08.007] [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: 04/29/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The potential for negative sequalae in psychosocial well-being presents clinical importance to the assessment of voice disorders. Despite the impairment voice disorders cause in the psychosocial domain, the clinical assessment of these disorders relies heavily on visual perceptual judgments of the larynx, audio-perceptual, as well as acoustic and aerodynamic measures. While these measures aid in accurate diagnosis and are necessary for standard of care, they present little insight into the patient experience of having a voice disorder. DESIGN Retrospective between-subject, non-experimental design. METHODS Data from 335 patients from the University of Pittsburgh Voice Center were collected from scores of the Voice Handicap Index-10 (VHI-10) and two recent questionnaires, the Voice Present Perceived Control scale (VPPC), and the Vocal Congruency Scale (VCS). Examining how these voice-specific scales related to three mental health screeners for stress (Perceived Stress Scale-4), anxiety (Generalized Anxiety Disorder-7) and depression (Patient Health Questionnaire-9) were also examined. Patient diagnoses included primary muscle tension dysphonia (pMTD), unilateral vocal fold paralysis (UVFP), vocal fold atrophy, and mid membranous vocal fold lesions. RESULTS There were significant differences in scores from the voice-specific scales between diagnostic groups with UVFP being the highest (worst) in VHI-10 and UVFP being the lowest (worst) in VCS compared to healthy controls. There was no significant difference in VPPC scores between diagnostic groups. Results showed statistically significant inverse relationships between the VHI-10 and the VPPC and between the VHI-10 and VCS for all diagnostic groups. A significant direct relationship was found between the VPPC and the VCS for patients diagnosed with MTD, UVFP and Lesions. In sum, patients with UVFP presented with the most frequent and sometimes strongest relationships between voice and mental health measures. DISCUSSION This study marks an initial investigation into the nuanced patient experience of having a voice disorder. Three theoretically unrelated voice constructs: handicap, perceived control, and sense of self, were measured via self-report. Results from this study describe the patient experience correlating to these constructs with weak correlations to stress, anxiety, and depression. Findings also clearly suggest that patient experience varies among diagnostic groups, as well as varying constructs. Measures of multiple constructs of patient perception provide valuable insight into a patient's experience of their voice disorder, guidance on the direction of voice treatment, and justification for such treatments.
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Affiliation(s)
- Gary J Gartling
- Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Miriam van Mersbergen
- School of Communication Sciences and Disorders, The University of Memphis, Memphis, Tennessee
| | - Karen Crow
- Louisville Center for Voice Care, Louisville, Kentucky
| | - Ali Lewandowski
- University of Pittsburgh Voice Center, Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Libby J Smith
- University of Pittsburgh Voice Center, Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jackie L Gartner-Schmidt
- Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania; University of Pittsburgh Voice Center, Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Zagzoog FH, Bukhari M, Almohizea MI, Almothahbi AS. Efficacy of platelet-rich plasma (PRP) in benign vocal fold lesions: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024; 281:13-21. [PMID: 37709923 DOI: 10.1007/s00405-023-08226-z] [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: 04/20/2023] [Accepted: 08/31/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVES To evaluate the efficacy of platelet-rich plasma (PRP) in benign vocal fold lesions. METHODS MEDLINE, Cochrane Central, Web of Science, and Scopus databases were searched in April 2023 for relevant clinical trials. Inclusion criteria were clinical trials evaluating the efficacy of PRP in benign vocal fold lesions. We conducted a comparative double-arm analysis using the pooled mean difference (MD) and 95% confidence interval (CI). Outcomes of interest included the vocal handicap index (VHI), the Jitter and Shimmer percentages, and the noise-to-harmonic ratio (NHR). RESULTS Six studies matched the inclusion criteria. The pooled analysis shows that PRP was associated with significantly lower VHI scores compared with the control (MD = - 5.06, p < 0.01). Regarding the Jitter percentage, the PRP group was not superior to the control group at 2 and 4 weeks. However, the results revealed that PRP significantly reduced the Jitter percentage at 3 months (MD = - 0.61, p = 0.0008). The overall analysis favored the PRP arm significantly (p < 0.001). As for the Shimmer percentage, the combined effect estimate favored the PRP group (MD = - 1.22, p = 0.002). Subgroup analysis according to the time did not reveal any significant differences between studies at 2 weeks, 4 weeks, and 3 months. The analysis of the NHR outcome revealed a significant difference between both groups (MD = -1.09, p = 0.01). However, at 4 weeks, the treatment group had a significantly lower NHR % compared to the control group (MD = - 0.61, p = 0.02). There was no significant difference at 3 months (MD = - 2.14, p = 0.14). CONCLUSIONS Platelet-rich plasma is effective in reducing VHI scores, Jitter and Shimmer percentages, and NHR values. This effect is more evident after follow-up, especially 3 months.
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Affiliation(s)
- Faisal H Zagzoog
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Manal Bukhari
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed I Almohizea
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ali Saeed Almothahbi
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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Gunjawate DR, Chacon AM, Nguyen DD, Madill C. Vocal tasks for acoustic and/or auditory perceptual analysis for discriminating individuals with and without voice disorders: a systematic review protocol. BMJ Open 2023; 13:e077398. [PMID: 38070900 PMCID: PMC10729179 DOI: 10.1136/bmjopen-2023-077398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE The primary objective of the present systematic review is to: (1) identify the current vocal tasks being used for acoustic and/or auditory perceptual analysis to differentiate between individuals with and without voice disorders. The secondary objectives are to: (2) evaluate the evidence of the sensitivity, specificity and accuracy of those vocal tasks for acoustic and/or auditory perceptual analysis in discriminating the individuals with voice disorders from those without; and (3) compare the values between the vocal tasks in discriminating individuals with voice disorders from those without. METHOD AND ANALYSIS We search the following electronic databases: MEDLINE, EMBASE, CINAHL, Scopus, Web of Science Core Collection, PubMed Central and Google Scholar. Grey literature searches will include ProQuest Dissertations and Theses, ClinicalTrials.gov and the Cochrane Register of Controlled Trials. Websites of professional organisations and textbooks will be hand searched for relevant information related to the research question. Study screening, selection and data extraction will be conducted independently by two reviewers. Any disagreements will be resolved by discussion or by involving a third reviewer.The methodological quality of the included studies will be appraised using the relevant Critical Appraisal Tools by JBI. The clinical guidelines and recommendations for voice assessment by professional bodies will be appraised using the Reporting Items for practice Guidelines in HealThcare (RIGHT) checklist. The findings will be presented in the form of an information matrix with the tasks identified tabulated against the nature of the task, dimensions being tested, and their accuracy, sensitivity, and specificity in identifying individuals with voice problems. ETHICS AND DISSEMINATION Formal ethics approval is not required. The findings will be presented at national and international conferences and published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42023431634.
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Affiliation(s)
- Dhanshree R Gunjawate
- Voice Research Laboratory, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Antonia Margarita Chacon
- Voice Research Laboratory, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Duy Duong Nguyen
- Voice Research Laboratory, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Catherine Madill
- Voice Research Laboratory, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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16
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Alasqah MI, Mesallam TA, Farahat M, Malki KH. Translation and Validation of an Arabic Version of the Voice Disability Coping Questionnaire. J Voice 2023:S0892-1997(23)00326-0. [PMID: 37925331 DOI: 10.1016/j.jvoice.2023.10.015] [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: 08/16/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVES/HYPOTHESES Voice disorders can significantly affect the quality of life. This study aimed to translate, culturally adapt, and validate an Arabic version of the voice disability coping questionnaire (A-VDCQ) for use in Arabic-speaking populations with dysphonia. STUDY DESIGN This was a cross-sectional study involving the translation and cultural adaptation of the VDCQ into Arabic. The validation process included reliability and validity assessments. Participants were categorized into cases (individuals with dysphonia) and controls (individuals without dysphonia) to compare coping strategies between the two groups. METHODS ccccccccThe 15-item VDCQ was translated from English into Arabic using the forward and backward translation methods. The questionnaire's reliability was assessed using Cronbach's alpha and test-retest reliability (intraclass correlation coefficient, ICC). Validity was evaluated by comparing cases and controls using the Mann-Whitney test. Differences in coping strategies across different diagnoses were examined using the Kruskal-Wallis test. RESULTS The A-VDCQ demonstrated satisfactory internal consistency (Cronbach's alpha = 0.769) and excellent test-retest reliability (ICC = 0.993). Significant differences in coping strategies between the cases and controls were also observed (P < 0.001), supporting the instrument's validity. Notably, item 4, which is related to information seeking, had the highest impact score among the cases. However, no statistically significant differences were found in coping strategies across different diagnoses (P = 0.249). CONCLUSIONS The A-VDCQ demonstrated robust psychometric properties for assessing coping strategies in individuals with voice disorders and such strategies' potential implications for clinical practice and research.
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Affiliation(s)
- Mohammad I Alasqah
- Department of Otolaryngology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Tamer A Mesallam
- Research Chair of Voice, Swallowing, and Communication Disorders, Department of Otolaryngology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed Farahat
- Research Chair of Voice, Swallowing, and Communication Disorders, Department of Otolaryngology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid H Malki
- Research Chair of Voice, Swallowing, and Communication Disorders, Department of Otolaryngology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Kemfack AM, Hernández-Morato I, Moayedi Y, Pitman MJ. Transcriptome analysis of left versus right intrinsic laryngeal muscles associated with innervation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.25.554869. [PMID: 37873132 PMCID: PMC10592802 DOI: 10.1101/2023.08.25.554869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Objectives/Hypothesis Recurrent laryngeal nerve injury diagnosed as idiopathic or due to short-term surgery-related intubation exhibits a higher incidence of left-sided paralysis. While this is often attributed to nerve length, it is hypothesized there are asymmetric differences in the expression of genes related to neuromuscular function that may impact reinnervation and contribute to this laterality phenomenon. To test this hypothesis, this study analyzes the transcriptome profiles of the intrinsic laryngeal muscles (ILMs), comparing gene expression in the left versus right, with particular attention to genetic pathways associated with neuromuscular function. Study Design Laboratory experiment. Methods RNA was extracted from the left and right sides of the rat posterior cricoarytenoid (PCA), lateral thyroarytenoid (LTA), and medial thyroarytenoid (MTA), respectively. After high-throughput RNA-Sequencing (RNA-Seq), 88 samples were organized into 12 datasets according to their age (P15/adult), sex (male/female), and muscle type (PCA/LTA/MTA). A comprehensive bioinformatics analysis was conducted to compare the left-right ILMs across different conditions. Results 774 differentially expressed genes (DEGs) were identified across the 12 experimental groups, revealing age, sex, and muscle-specific differences between the left versus right ILMs. Enrichment analysis of Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways implicated several genes with a left-right laryngeal muscle asymmetry. These genes are associated with neuronal and muscular physiology, immune/inflammatory response, and hormone control. Conclusion Bioinformatics analysis confirmed divergent transcriptome profiles between the left-right ILMs. This preliminary study identifies putative gene targets that will characterize ILM laterality. Level of Evidence N/A. LAY SUMMARY Vocal fold paralysis is more common on the left. This study shows left versus right differences in gene expression related to innervation, suggesting the increased rate of left recurrent laryngeal nerve paralysis may be associated with genetic differences, not just nerve length.
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Marchese MR, Sensoli F, Campagnini S, Cianchetti M, Nacci A, Ursino F, D’Alatri L, Galli J, Carrozza MC, Paludetti G, Mannini A. Artificial intelligence for the recognition of benign lesions of vocal folds from audio recordings. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:317-323. [PMID: 37519137 PMCID: PMC10551729 DOI: 10.14639/0392-100x-n2309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/22/2023] [Indexed: 08/01/2023]
Abstract
Objective The diagnosis of benign lesions of the vocal fold (BLVF) is still challenging. The analysis of the acoustic signals through the implementation of machine learning models can be a viable solution aimed at offering support for clinical diagnosis. Materials and methods In this study, a support vector machine was trained and cross-validated (10-fold cross-validation) using 138 features extracted from the acoustic signals of 418 patients with polyps, nodules, oedema, and cysts. The model's performance was presented as accuracy and average F1-score. The results were also analysed in male (M) and female (F) subgroups. Results The validation accuracy was 55%, 80%, and 54% on the overall cohort, and in M and F, respectively. Better performances were observed in the detection of cysts and nodules (58% and 62%, respectively) vs polyps and oedema (47% and 53%, respectively). The results on each lesion and the different patterns of the model on M and F are in line with clinical observations, obtaining better results on F and detection of sensitive polyps in M. Conclusions This study showed moderately accurate detection of four types of BLVF using acoustic signals. The analysis of the diagnostic results on gender subgroups highlights different behaviours of the diagnostic model.
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Affiliation(s)
- Maria Raffaella Marchese
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Federico Sensoli
- Institute of Biorobotics, Scuola Superiore Sant’Anna, Pontedera, Italy
| | - Silvia Campagnini
- Institute of Biorobotics, Scuola Superiore Sant’Anna, Pontedera, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Firenze, Italy
| | - Matteo Cianchetti
- Institute of Biorobotics, Scuola Superiore Sant’Anna, Pontedera, Italy
| | - Andrea Nacci
- U.O. Otorinolaringoiatria Audiologia e Foniatria, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Francesco Ursino
- Istituto Nazionale di Ricerche in Foniatria “G. Bartalena”, Pisa, Italy
| | - Lucia D’Alatri
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Otorinolaringoiatria, Dipartimento Universitario Testa-Collo e Organi di Senso, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jacopo Galli
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Otorinolaringoiatria, Dipartimento Universitario Testa-Collo e Organi di Senso, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Gaetano Paludetti
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Sezione di Otorinolaringoiatria, Dipartimento Universitario Testa-Collo e Organi di Senso, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Mannini
- Institute of Biorobotics, Scuola Superiore Sant’Anna, Pontedera, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Firenze, Italy
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Selvarajan G, Jeyabalakrishnan S, Aishwarya G, Anand P M. A Study on Efficacy of Differences in Speech Therapy Duration in Vocal Outcomes of Benign Lesions of Vocal Cords After Conventional Microlaryngeal Surgery. Indian J Otolaryngol Head Neck Surg 2023; 75:2049-2053. [PMID: 37636628 PMCID: PMC10447775 DOI: 10.1007/s12070-023-03780-8] [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: 08/25/2022] [Accepted: 04/04/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction: Benign laryngeal lesions usually disrupt the microstructure in the vocal cords causing hoarseness of voice. This study analyses the success rate of voice therapy and factors contributing to better outcomes in surgical treatment of benign vocal fold lesions. Methods: Forty consecutive patients with benign vocal cord lesions complying with the inclusion and exclusion criteria were enrolled and divided into two groups A and B, such that one received speech therapy post surgery for 6 weeks and the other received speech therapy for 12 weeks respectively. Preoperatively all the patients were evaluated by voice fatigue index, GRBAS scale and videolaryngoscopy. Vocal fold relaxation exercises were given preoperatively for patients of both groups. After undergoing conventional microlaryngeal excision surgery, both groups of patients underwent subjective analysis by voice fatigue index, perceptual analysis by GRBAS scale and videolaryngoscopy in regular intervals. Speech therapy was started after 1 week of complete voice rest post operatively and patients were followed up at the end of 1 week, 2 months and 4 months from the date of surgery. Results: There is no statistical difference in characteristics of patients between the two groups. Improvement in the Voice fatigue index and GRBAS scale score is statistically the same in groups A and B. Conclusion: Speech therapy is an important part of voice rehabilitation following microlaryngeal surgery. The misconception that longer speech therapy duration leads to better outcomes did not hold true in this study. Speech therapy postoperatively with proper voice hygiene practices is sufficient to obtain a near normal voice. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03780-8.
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Affiliation(s)
- G Selvarajan
- Department of Otorhinolaryngology, SRM Medical College Hospital and Research Centre, SRM Nagar, Potheri, Chengalpattu, Tamilnadu 603203 India
| | - Shivapriya Jeyabalakrishnan
- Department of Otorhinolaryngology, SRM Medical College Hospital and Research Centre, SRM Nagar, Potheri, Chengalpattu, Tamilnadu 603203 India
| | - G Aishwarya
- Department of Otorhinolaryngology, SRM Medical College Hospital and Research Centre, SRM Nagar, Potheri, Chengalpattu, Tamilnadu 603203 India
| | - Mithun Anand P
- Department of Otorhinolaryngology, SRM Medical College Hospital and Research Centre, SRM Nagar, Potheri, Chengalpattu, Tamilnadu 603203 India
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Kenny HL, Friedman L, Blake Simpson C, McGarey PO. Vocal Fold Polyps: A Scoping Review. J Voice 2023:S0892-1997(23)00180-7. [PMID: 37433709 DOI: 10.1016/j.jvoice.2023.06.007] [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: 04/07/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE This review aims to summarize the current understanding of vocal fold polyp etiology, pathophysiology, and prognosis, as well as recent developments in management. STUDY DESIGN Scoping literature review. REVIEW METHODS OVID Medline, PubMed, Google Scholar, Conference Papers Index, and Cochrane Library were searched for publications within the last 5 years using terms including "vocal," "cord," "fold," and "polyp." All abstracts were screened. Relevant studies pertaining to the etiology, pathophysiology, diagnosis, management, and prognosis of vocal fold polyps (VFPs) were included for review. RESULTS Eight-hundred and sixty-five citations resulted from database review. Seven-hundred and thirty citations remained after the exclusion of duplicates. One hundred and ninety-three papers underwent abstract review, with 73 citations undergoing full-text review. Fifty-nine papers were included in the review. CONCLUSIONS VFPs are one of the most common subtypes of benign vocal fold lesions. Phonotrauma contributes significantly to the development of these lesions, with laryngopharyngeal reflux and smoking also contributing. Correct diagnosis relies on a careful history, stroboscopy, response to voice therapy, and, in some cases, intraoperative findings. Phonosurgery is a definitive means of treatment, though more recently, in-office procedures have demonstrated efficacy and are potentially less costly and less invasive treatment options. Treatment modalities can be tailored based on the type and size of the lesion, the patient's vocal needs, medical comorbidities, and initial response to voice therapy. Voice specialists can anticipate greater emphasis placed on minimally invasive office-based procedures for the management of vocal pathology.
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Affiliation(s)
- Hannah L Kenny
- University of Virginia School of Medicine, Charlottesville, Virginia; Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Lisa Friedman
- Department of Pathology, University of Virginia Health System, Charlottesville, Virginia
| | - C Blake Simpson
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, Alabama
| | - Patrick O McGarey
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia.
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Khoddami SM, Aghadoost S, Aghajanzadeh M, Molazeinal Y. The Health-related Quality of Life and Voice Handicap Index in Recovered COVID-19 Patients in Comparison to Healthy Subjects. J Voice 2023:S0892-1997(23)00155-8. [PMID: 37400351 DOI: 10.1016/j.jvoice.2023.05.003] [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: 03/16/2023] [Revised: 05/07/2023] [Accepted: 05/08/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION COVID-19 has various long-lasting effects on different aspects of health and life. This study aimed to evaluate the general health and voice-related quality of life (QOL) and assess their correlation in patients with COVID-19 compared to healthy people. STUDY DESIGN This was a cross-sectional study. METHODS Sixty-eight subjects (with a mean age of 40.07 ± 5.62 years) participated in two groups including 34 recovered-COVID-19 patients and 34 healthy subjects. All participants completed the Persian version of Short Form 36 (SF-36) and Voice Handicap Index (VHI). The patients were assessed two months after recovery when they were discharged from the hospital. RESULTS The results showed the COVID-19 patients got significantly lower scores in all subcategories and two main components of SF-36 compared to the healthy group (P < 0.005). Also, the patients held significantly higher results in VHI and its subscales (P < 0.005). A significant correlation was observed between the physical and mental component summary (PCS and MCS) of SF-36 with a total score of VHI in the COVID-19 patients. CONCLUSION COVID-19 has negative consequences on various aspects of general health and voice-related QOL. Two months after recovery from COVID-19, the patients had the worst scores in all subscales of SF-36 and also, decreased physical, emotional, and functional voice-related QOL which reveals the persistent effect of COVID-19 even after recovery. The general health and voice-related QOL had a noticeable correlation in recovered COVID-19 patients that demonstrates the effect of voice quality in different aspects of life.
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Affiliation(s)
- Seyyedeh Maryam Khoddami
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Aghadoost
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mahshid Aghajanzadeh
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Yasamin Molazeinal
- MSc at School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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22
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Raj CK, Kim I, Reyes Orozco F, Ma HJ, Herrera K, Hur K. Impact of Age and Gender on Quality of Life Among General Otolaryngology Patients. Laryngoscope 2023; 133:801-806. [PMID: 35833627 DOI: 10.1002/lary.30295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/26/2022] [Accepted: 06/29/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The combined effects of age and gender on health-related quality of life (HRQoL) in otolaryngology patients are unclear. This study tested the hypothesis that the effect of age on HRQoL differs by gender in otolaryngology patients. METHODS Patients seen in a general otolaryngology clinic were included in this retrospective chart review. HRQoL was measured by the SF-6D score. Patient characteristics, including demographics and category of chief otolaryngology complaint, were extracted from medical records. A multivariable linear regression analysis was used to analyze the combined effect of age and gender on HRQoL. The model was adjusted for race, ethnicity, number of complaint categories, and number of medications. RESULTS The study included 728 patients (age mean = 52, SD = 18; 48% male). Multivariable linear regression models found a significant interaction effect between age and gender (β = 0.213, p < 0.05). For younger patients, female gender was protective; however, at age greater than 35 years, female gender was a risk factor for decreased HRQoL. Compared to Black patients, Asian and other race patients reported significantly greater HRQoL (β = 0.207, p < 0.05 for Asian; β = 0.126, p < 0.05 for other races). Additionally, an antagonistic interaction effect was found between age and number of category of otolaryngology complaints in moderating HRQoL (β = 0.468, p < 0.001). CONCLUSION Age affects HRQoL differently in men than in women. Among otolaryngology patients, women experience a greater decrease in HRQoL as they age. LEVEL OF EVIDENCE 4 Laryngoscope, 133:801-806, 2023.
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Affiliation(s)
- Christine K Raj
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Ian Kim
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Francis Reyes Orozco
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Harrison J Ma
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Kevin Herrera
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Kevin Hur
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
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23
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Chen Z, Zhu P, Qiu W, Guo J, Li Y. Deep learning in automatic detection of dysphonia: Comparing acoustic features and developing a generalizable framework. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:279-294. [PMID: 36117378 DOI: 10.1111/1460-6984.12783] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Auditory-perceptual assessment of voice is a subjective procedure. Artificial intelligence with deep learning (DL) may improve the consistency and accessibility of this task. It is unclear how a DL model performs on different acoustic features. AIMS To develop a generalizable DL framework for identifying dysphonia using a multidimensional acoustic feature. METHODS & PROCEDURES Recordings of sustained phonations of /a/ and /i/ were retrospectively collected from a clinical database. Subjects contained 238 dysphonic and 223 vocally healthy speakers of Chinese Mandarin. All audio clips were split into multiple 1.5-s segments and normalized to the same loudness level. Mel frequency cepstral coefficients and mel-spectrogram were extracted from these standardized segments. Each set of features was used in a convolutional neural network (CNN) to perform a binary classification task. The best feature was obtained through a five-fold cross-validation on a random selection of 80% data. The resultant DL framework was tested on the remaining 20% data and a public German voice database. The performance of the DL framework was compared with those of two baseline machine-learning models. OUTCOMES & RESULTS The mel-spectrogram yielded the best model performance, with a mean area under the receiver operating characteristic curve of 0.972 and an accuracy of 92% in classifying audio segments. The resultant DL framework significantly outperformed both baseline models in detecting dysphonic subjects on both test sets. The best outcomes were achieved when classifications were made based on all segments of both vowels, with 95% accuracy, 92% recall, 98% precision and 98% specificity on the Chinese test set, and 92%, 95%, 90% and 89%, respectively, on the German set. CONCLUSIONS & IMPLICATIONS This study demonstrates the feasibility of DL for automatic detection of dysphonia. The mel-spectrogram is a preferred acoustic feature for the task. This framework may be used for vocal health screening and facilitate automatic perceptual evaluation of voice in the era of big data. WHAT THIS PAPER ADDS What is already known on this subject Auditory-perceptual assessment is the current gold standard in clinical evaluation of voice quality, but its value may be limited by the rater's reliability and accessibility. DL is a new method of artificial intelligence that can overcome these disadvantages and promote automatic voice assessment. This study explored the feasibility of a DL approach for automatic detection of dysphonia, along with a quantitative comparison of two common sets of acoustic features. What this study adds to existing knowledge A CNN model is excellent at decoding multidimensional acoustic features, outperforming the baseline parameter-based models in identifying dysphonic voices. The first 13 mel-frequency cepstral coefficients (MFCCs) are sufficient for this task. The mel-spectrogram results in greater performance, indicating the acoustic features are presented in a more favourable way than the MFCCs to the CNN model. What are the potential or actual clinical implications of this work? DL is a feasible method for the detection of dysphonia. The current DL framework may be used for remote vocal health screening or documenting voice recovery after treatment. In future, DL models may potentially be used to perform auditory-perceptual tasks in an automatic, efficient, reliable and low-cost manner.
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Affiliation(s)
- Zhen Chen
- Department of Rehabilitation Sciences, East China Normal University, Shanghai, China
- Department of Otolaryngology-Head & Neck Surgery, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Peixi Zhu
- Hilderbrand Department of Petroleum and Geosystems Engineering, University of Texas at Austin, Austin, TX, USA
| | - Wei Qiu
- Hangzhou Chenqing Heye Technology Co., Ltd, Hangzhou, Zhejiang, China
| | - Jiajie Guo
- State Key Laboratory of Digital Manufacturing Equipment and Technology, School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yike Li
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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24
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Barmak E, Atila Çağlar N, Altan E, Çıldır B, Çadallı Tatar E. Investigation of Validity and Reliability of Voice Activity and Participation Profile-Turkish Version (VAPP-TR). J Voice 2022:S0892-1997(22)00354-X. [PMID: 36543609 DOI: 10.1016/j.jvoice.2022.11.005] [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: 09/28/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 12/23/2022]
Abstract
A voice activity and participation profile (VAPP) is a self-assessment tool used to measure activity and participation limitations resulting from voice disorders. This study aims to demonstrate the adaptation, validity, and reliability of the Turkish version of the VAPP scale. A total of 231 individuals, 155 with voice disorders (patient group) and 76 without voice disorders (normal group), were included in this study. With reliability, internal consistency, and test-retest methods; validity was evaluated with criterion and convergent validity methods. The Cronbach α coefficient calculated for internal consistency was found to be 0.985 for the VAPP total and between 0.914 and 0.978 for the subsections. Intraclass Correlation Coefficient was found to be 0.974 for the VAPP total and between 0.800 and 0.981 for the subsections. Total and subsection scores of the VAPP scale had correlation coefficients ranged between 0.725 and 0.903 with VHIT and V-RQOLT in the whole sample (all P<0.001). The cut-off point was determined as ≥ 8 by ROC curve analysis for criterion validity. VAPP-TR is a valid and reliable tool that can be used to evaluate the quality of life of Turkish patients with voice disorders, particularly those with activity limitations and participation restrictions.
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Affiliation(s)
- Elife Barmak
- Department of Speech and Language Therapy, Ankara Yıldırım Beyazıt University, Ankara, Turkey.
| | - Nazmiye Atila Çağlar
- Department of Speech and Language Therapy, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Esma Altan
- Department of Otolaryngology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Bünyamin Çıldır
- Department of Speech and Language Therapy, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Emel Çadallı Tatar
- Department of Otolaryngology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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25
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Ramachandran J, Zhou W, Bardenhagen AE, Nasr T, Yates ER, Zorn AM, Ji H, Vokes SA. Hedgehog regulation of epithelial cell state and morphogenesis in the larynx. eLife 2022; 11:e77055. [PMID: 36398878 PMCID: PMC9718526 DOI: 10.7554/elife.77055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 11/18/2022] [Indexed: 11/19/2022] Open
Abstract
The larynx enables speech while regulating swallowing and respiration. Larynx function hinges on the laryngeal epithelium which originates as part of the anterior foregut and undergoes extensive remodeling to separate from the esophagus and form vocal folds that interface with the adjacent trachea. Here we find that sonic hedgehog (SHH) is essential for epithelial integrity in the mouse larynx as well as the anterior foregut. During larynx-esophageal separation, low Shh expression marks specific domains of actively remodeling epithelium that undergo an epithelial-to-mesenchymal transition (EMT) characterized by the induction of N-Cadherin and movement of cells out of the epithelial layer. Consistent with a role for SHH signaling in regulating this process, Shh mutants undergo an abnormal EMT throughout the anterior foregut and larynx, marked by a cadherin switch, movement out of the epithelial layer and cell death. Unexpectedly, Shh mutant epithelial cells are replaced by a new population of FOXA2-negative cells that likely derive from adjacent pouch tissues and form a rudimentary epithelium. These findings have important implications for interpreting the etiology of HH-dependent birth defects within the foregut. We propose that SHH signaling has a default role in maintaining epithelial identity throughout the anterior foregut and that regionalized reductions in SHH trigger epithelial remodeling.
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Affiliation(s)
- Janani Ramachandran
- Department of Molecular Biosciences, The University of Texas at AustinAustinUnited States
| | - Weiqiang Zhou
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public HealthBaltimoreUnited States
| | - Anna E Bardenhagen
- Department of Molecular Biosciences, The University of Texas at AustinAustinUnited States
| | - Talia Nasr
- Center for Stem Cell and Organoid Medicine (CuSTOM), Division of Developmental Biology, and Perinatal Institute, Cincinnati Children’s Hospital Medical CenterCincinnatiUnited States
- Department of Pediatrics, University of Cincinnati College of MedicineCincinnatiUnited States
| | - Ellen R Yates
- Department of Molecular Biosciences, The University of Texas at AustinAustinUnited States
| | - Aaron M Zorn
- Center for Stem Cell and Organoid Medicine (CuSTOM), Division of Developmental Biology, and Perinatal Institute, Cincinnati Children’s Hospital Medical CenterCincinnatiUnited States
- Department of Pediatrics, University of Cincinnati College of MedicineCincinnatiUnited States
| | - Hongkai Ji
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public HealthBaltimoreUnited States
| | - Steven A Vokes
- Department of Molecular Biosciences, The University of Texas at AustinAustinUnited States
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26
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Chen AWG, Chen CH, Lin TM, Chang ACH, Tsai TP, Chang SY. Office-Based Structural Autologous Fat Injection Laryngoplasty for Unilateral Vocal Fold Paralysis. J Clin Med 2022; 11:jcm11164806. [PMID: 36013042 PMCID: PMC9410197 DOI: 10.3390/jcm11164806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/11/2022] [Accepted: 08/13/2022] [Indexed: 11/16/2022] Open
Abstract
Unilateral vocal fold paralysis (UVFP) is a common cause of incomplete glottic closure, leading to significant somatic and social disabilities. Office-based autologous fat injection laryngoplasty (AFIL) has been proposed as an effective treatment for glottic insufficiency but has not been well-studied for UVFP. We enrolled 23 patients who underwent office-based structural AFIL due to unilateral vocal paralysis at our institution between February 2021 and January 2022. In the procedure, autologous fat was harvested and injected into the vocal fold under the guidance of flexible digital endoscopy for structural fat grafting. The voice handicap index-10 (VHI-10) score and perceptual voice measurements were collected before the operation, 2 weeks postoperatively, and 3 months postoperatively. Twenty-two patients were followed-up for at least 3 months. The VHI-10 score improved significantly from 29.65 ± 8.52 preoperatively to 11.74 ± 7.42 at 2 weeks (p < 0.0001) and 5.36 ± 6.67 at 3 months (p < 0.0001). Significant improvements in grades of dysphonia (p < 0.0001), breathiness (p < 0.0001), and asthenia (p = 0.004) were also noted at 3 months postoperatively when perceptual measurements were investigated. Office-based structural AFIL is an effective treatment for improving voice-related disability for UVFP patients.
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Affiliation(s)
- Andy Wei-Ge Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Chih-Hua Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Tsai-Ming Lin
- Charming Institute of Aesthetic and Regenerative Surgery, Kaohsiung 807, Taiwan
- Department of Plastic Surgery, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Angela Chih-Hui Chang
- Voice Center, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei 114, Taiwan
| | - Tzu-Pei Tsai
- Department of Speech, Language and Hearing Sciences, Indiana University Bloomington, Bloomington, IN 47408, USA
| | - Shyue-Yih Chang
- Voice Center, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei 114, Taiwan
- Correspondence: ; Tel.: +886-2-28264400
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27
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The role of platelet-rich plasma in microlaryngeal surgery: a randomised, controlled trial. The Journal of Laryngology & Otology 2022; 136:737-741. [DOI: 10.1017/s0022215121004564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectivePlatelet-rich plasma has gained interest over the two last decades, mainly because of its role in regenerative medicine. This work aimed to assess the role of intra-operative local application of platelet-rich plasma gel in the improvement of quality of voice after microlaryngeal surgery.MethodThis was a prospective comparative study that included 40 patients undergoing microlaryngeal surgery for benign vocal fold lesions. There were two groups divided equally into study group A and control group B. The assessment of voice was performed by videostroboscopy and acoustic analysis pre-operatively and at two weeks and one and three months post-operatively.ResultsThe data demonstrated that all the stroboscopic and acoustic parameters showed significant improvement in both groups. Group A showed significant improvement regarding acoustic parameters at the third post-operative follow up when compared with group B.ConclusionPlatelet-rich plasma has a beneficial effect on voice quality following microlaryngeal surgery based in particular on acoustic parameters.
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28
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Cialente F, Torsello M, Meucci D, Tropiano ML, Salvati A, Trozzi M. Pediatric Voice Handicap Index (pVHI): A Tool for Evaluating the Reliability and Validity of Voice Therapy in Children With Benign Vocal Fold Nodules. J Voice 2022:S0892-1997(22)00156-4. [PMID: 35817625 DOI: 10.1016/j.jvoice.2022.06.002] [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: 02/21/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES benign vocal fold lesions (BVFLs) represent the most common etiology of voice disorders in paediatric population, cause of dysphonia by preventing full vocal fold closure and modifying vibratory characteristics. Of those pathologies, vocal fold nodules represent almost 63% of the cases in children between 0-14 years. Management may include a combination of phonosurgery, voice therapy and pharmacological treatment, but almost 95% of otolaryngologists recommend voice therapy as primary treatment. The Pediatric Voice Handicap Index (pVHI) is nowadays widely used and accepted in the evaluation and monitoring of paediatric patients with dysphonia. The aim of our study was to demonstrate the reliability and validity of PVHI in the evaluation of the effects of voice therapy as treatment of vocal fold nodules in the paediatric population. PATIENTS AND METHOD in this retrospective chart review twenty-seven (27) dysphonic patients with bilateral vocal fold nodules were treated with behavioral voice therapy approaches, and the PVHI surveys was administered to each patient parent's before and after therapy. The age of the patients ranged from 4 to 14 years (mean age 8.7 y-o); 17 (63%) were male and 10 (37%) females. RESULTS according to our results, behavioral voice therapy effectively improved pVHI scores from pre- to post-treatment in paediatric patients with bilateral vocal fold nodules.
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Affiliation(s)
- Fabrizio Cialente
- Airway Surgery Unit, Department of Surgical Specialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Miriam Torsello
- Airway Surgery Unit, Department of Surgical Specialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Duino Meucci
- Airway Surgery Unit, Department of Surgical Specialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Luisa Tropiano
- Airway Surgery Unit, Department of Surgical Specialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonio Salvati
- Airway Surgery Unit, Department of Surgical Specialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marilena Trozzi
- Airway Surgery Unit, Department of Surgical Specialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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29
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Fernandes-Taylor S, Damico-Smith C, Arroyo N, Wichmann M, Zhao J, Feurer ID, Francis DO. Multicenter Development and Validation of the Vocal Cord Paralysis Experience (CoPE), a Patient-Reported Outcome Measure for Unilateral Vocal Fold Paralysis-Specific Disability. JAMA Otolaryngol Head Neck Surg 2022; 148:756-763. [PMID: 35797026 DOI: 10.1001/jamaoto.2022.1545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Unilateral vocal fold paralysis (UVFP) is a common and life-changing complication of cancer, trauma, and an estimated 500 000 head, neck, and chest surgeries performed annually in the US, among other causes (eg, idiopathic). Consequent disabilities are profound and often permanent and can include severe voice, swallowing, and breathing dysfunction and concomitant anxiety, isolation, and fear. Physiological measures often correlate poorly with patient-reported disability. The measure described herein was designed to be a comprehensive, psychometrically sound UVFP-specific patient-reported outcome measure (PROM) for use in clinical trials or at point of care. Objective To evaluate the reliability and validity of the CoPE (vocal Cord Paralysis Experience) PROM in a nationally representative sample for both clinical and research use. Design, Setting, and Participants This survey validation study was performed at 34 tertiary care centers across the US and included English-speaking adults with unilateral vocal fold immobility confirmed via laryngoscopy. Main Outcomes and Measures Reliability (internal consistency, alternate form, and test-retest) and validity (convergent and known-group). Results In total, 613 patients (mean [SD] age, 58 [15.3] years; 394 [64.5%] women) were recruited, and 555 (92.3%) completed surveys for all time points. Internal consistency was high in the overall 22-item PROM and psychosocial, swallow, and voice subscales (Cronbach α > 0.91). Intraclass correlations for individuals between the baseline and 2-week administrations were moderate for the overall score and subscales (intraclass correlations range, 0.66-0.80). There were significant differences between the online and 2-week paper administrations for the overall score and voice and psychosocial subscales (overall scale mean: 54.4 [95% CI, 49.7-59.1] vs 48.9 [95% CI, 43.7-54.0] at 2 weeks). The confirmatory model was found to be suitably fitted based on average r2 values 0.5 or greater for subscale and overall scores. Correlations between subscales and existing PROMs (Voice-Related Quality of Life, Eating Assessment Tool, and Communication Participation Item Bank) were all greater than 0.69, and mean PROM subscale scores were significantly different across known quartiles of existing PROMs. Conclusions and Relevance The findings of this survey validation study suggest that the CoPE PROM could serve as a psychometrically sound, comprehensive measure of UVFP-attributed disability suitable for use in clinical and research settings to assess within-person changes. The results will inform a user manual to facilitate use in clinical trials comparing the effectiveness and durability of treatments including behavioral (speech therapy), temporary (eg, injection augmentation), and permanent surgical treatments for UVFP.
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Affiliation(s)
| | | | | | | | - Jiwei Zhao
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison
| | - Irene D Feurer
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David O Francis
- Division of Otolaryngology, Department of Surgery, University of Wisconsin-Madison.,Endoscopy and Laryngology Section Editor, JAMA Otolaryngology-Head & Neck Surgery
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30
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Kaba S, Kawai Y, Tanigami Y, Ohnishi H, Kita T, Yoshimatsu M, Omori K, Kishimoto Y. Peroxisome Proliferator-Activated Receptor-γ Agonist Attenuates Vocal Fold Fibrosis in Rats via Regulation of Macrophage Activation. THE AMERICAN JOURNAL OF PATHOLOGY 2022; 192:771-782. [PMID: 35189097 DOI: 10.1016/j.ajpath.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/19/2022] [Accepted: 02/07/2022] [Indexed: 12/30/2022]
Abstract
Macrophages aid in wound healing by changing their phenotype and can be a key driver of fibrosis. However, the contribution of macrophage phenotype to fibrosis following vocal fold injury remains unclear. Peroxisome proliferator-activated receptor-γ (PPARγ) is expressed mainly by macrophages during early wound healing and regulates the macrophage phenotype. This study aimed to evaluate the effects of pioglitazone (PIO), a PPARγ agonist, on the macrophage phenotype and fibrosis following vocal fold injury in rats. PIO was injected into the rat vocal folds on days 1, 3, 5, and 7 after injury, and the vocal fold lamina propria was evaluated on days 4 and 56 after injury. Moreover, THP-1-derived macrophages were treated with PIO, and the expression of proinflammatory cytokines under lipopolysaccharide/interferon-γ stimulation was analyzed. PIO reduced the expression of Ccl2 both in vivo and in vitro. Furthermore, PIO decreased the density of inducible nitric oxide synthase+ CD68+ macrophages and inhibited the expression of fibrosis-related factors on day 4 after injury. On day 56 after injury, PIO inhibited fibrosis, tissue contracture, and hyaluronic acid loss in a PPARγ-dependent manner. These results indicate that PPARγ activation could inhibit accumulation of inflammatory macrophages and improve tissue repair. Taken together, these findings imply that inflammatory macrophages play a key role in vocal fold fibrosis.
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Affiliation(s)
- Shinji Kaba
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Otolaryngology, Kyoto Katsura Hospital, Kyoto, Japan
| | - Yoshitaka Kawai
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuki Tanigami
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroe Ohnishi
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoko Kita
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masayoshi Yoshimatsu
- Department of Otolaryngology, Head and Neck Surgery, Field of Sensory Organology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Koichi Omori
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yo Kishimoto
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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31
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White SW, Bock JM, Blumin JH, Friedland DR, Adams JA, Tong L, Osinski K, Luo J. Analysis of socioeconomic factors in laryngology clinic utilization for treatment of dysphonia. Laryngoscope Investig Otolaryngol 2022; 7:202-209. [PMID: 35155799 PMCID: PMC8823153 DOI: 10.1002/lio2.715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/08/2021] [Accepted: 11/16/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To evaluate the association between patient socioeconomic and demographic factors and tertiary care utilization for dysphonia in a localized metropolitan area of the American Midwest. METHODS Multivariate regression analysis was used to correlate patient demographics and population level data (e.g., age, gender, race, insurance, median income, education level) with tertiary laryngology utilization for dysphonia care at our institution between 2000 and 2019. Initial analyses characterized tertiary laryngology utilization rates for all regional ZIP codes and correlated these data with census information for household income and education. Dysphonia patient demographics were compared among populations cared for in our entire academic Otolaryngology department, our health system, and the regional population. RESULTS Among 1,365,021 patients in our health system, there were 7066 tertiary laryngology visits with a diagnosis of dysphonia. Dysphonia patients as compared to the overall health system were older (62.0 vs. 50.8 years), more likely to be female (63.7 vs. 50.2%) and more likely to have insurance (98.4 vs. 87.5%, all p < .001). Patient and population-level factors including insurance status, education, and black race showed positive correlation with laryngology utilization while median income did not. CONCLUSIONS AND RELEVANCE Insurance status, education level, and race correlated with utilization of tertiary laryngology services for the evaluation of dysphonia in our community, while median income did not. Black patients utilized tertiary laryngology care at higher rates compared to departmental and regional population utilization data. These results underscore important demographic and disease-specific factors that may affect utilization of subspecialty care in Otolaryngology. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Shane W. White
- Department of Otolaryngology and Communication SciencesMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Jonathan M. Bock
- Department of Otolaryngology and Communication SciencesMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Joel H. Blumin
- Department of Otolaryngology and Communication SciencesMedical College of WisconsinMilwaukeeWisconsinUSA
| | - David R. Friedland
- Department of Otolaryngology and Communication SciencesMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Jazzmyne A. Adams
- Department of Otolaryngology and Communication SciencesMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Ling Tong
- Department of Health Informatics and AdministrationUniversity of Wisconsin – MilwaukeeMilwaukeeWisconsinUSA
| | - Kristen Osinski
- Clinical and Translational Science InstituteMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Jake Luo
- Department of Health Informatics and AdministrationUniversity of Wisconsin – MilwaukeeMilwaukeeWisconsinUSA
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Koyuncu H, Fidan V, Toktas H, Binay O, Celik H. Effect of ketogenic diet versus regular diet on voice quality of patients with Parkinson's disease. Acta Neurol Belg 2021; 121:1729-1732. [PMID: 32892250 DOI: 10.1007/s13760-020-01486-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/26/2020] [Indexed: 11/24/2022]
Abstract
Diets that have effects on health problems can vary in their composition. Whilst following a regular diet (RD) a person typically consumes about 30% of calories from fat. Ketogenic diet (KD) is a form of diet whereby a person consumes as much as 90% of calories from fat. KD has been trialed as a treatment for neurological diseases and obesity. Parkinson's disease (PD) is a neurologic disease that impacts the quality of voice. Voice Handicap Index (VHI) is a test that gives information to clinical and physiological assessment about voice. We assessed the impact of KD and RD on voice quality (VQ). Seventy-four patients with PD who reported a voice disorder related to their disease were randomly assigned to the KD or RD groups. We investigated the VHI change of subjects before and 3 months after diet. Sixty-eight PD patients completed the study. Baseline VHI values did not differ significantly between groups. All mean VHI parameters improved in KD group (p˂ 0.001). Currently there are different therapies that address speech and voice disorders in patients with PD. As such KD may be an alternative therapy to improve VQ of patients with PD. A larger sample size is necessary to determine the role and pathophysiology of KD on VQ of PD patients.
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Affiliation(s)
- Handan Koyuncu
- Department of Otorhinolaryngology, Eskisehir Gov Hosp, Cavdarlar Street, Eskisehir, 26080, Turkey
| | - Vural Fidan
- Department of Otorhinolaryngology, Eskisehir Gov Hosp, Cavdarlar Street, Eskisehir, 26080, Turkey.
| | - Hayal Toktas
- Department of Neurology, Atasehir Memorial Hospital, Istanbul, Turkey
| | - Omer Binay
- Department of Otorhinolaryngology, Corlu State Hospital, Tekirdag, Turkey
| | - Hamit Celik
- Department of Neurology, Buhara Hospital, Erzurum, Turkey
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Resolution of a vocal fold polyp treated with Chinese herbal medicine: One case report with literature review. J Herb Med 2021. [DOI: 10.1016/j.hermed.2021.100486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Wulff NB, Møller PR, Christensen KB, Pedersen SG, Wessel I, Dalton SO, Homøe P. The Voice-Related Quality of Life (V-RQOL) Instrument: Cross-Cultural Translation and Test of Validity and Reliability of the Danish Version. J Voice 2021; 35:806.e7-806.e14. [DOI: 10.1016/j.jvoice.2020.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 11/25/2022]
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Chung TK, Hu A, Sardesai MG, Wilcox H, Jiang L, Meyer TK. Evaluating the Effect of Recurrent Respiratory Papillomatosis on Work Productivity. Ann Otol Rhinol Laryngol 2021; 131:709-714. [PMID: 34416839 DOI: 10.1177/00034894211040900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Patients with recurrent respiratory papillomatosis (RRP) have significant vocal dysfunction which affects their performance at work. This study aimed to evaluate voice-related work productivity before and after ablative treatment for RRP. METHODS This is a prospective case series conducted at 2 academic laryngology outpatient clinics. Adult employed patients with RRP completed the Work Productivity & Activity Impairment instrument (WPAI), Voice Handicap Index (VHI-10), WorkHoarse, Hospital Anxiety and Depression Scale (HADS), and a demographics questionnaire immediately before and 1 month after ablative treatment of papilloma. The primary outcome measure was the change in work productivity impairment domain of the WPAI, and changes in ratings before and after ablation were compared using a Wilcoxon Signed-Rank test. RESULTS The 32 participants (mean age 45, 84% male) had a median (interquartile range) voice-related work productivity impairment score of 48.8% (30.0) at baseline which was improved to 5.0% (10.0) at 1 month after surgical ablation of papillomata (difference 30.0% (30.0) improvement). For the secondary outcome measures, there were significant improvements in VHI-10 (P < .001), self-reported voice quality (P = .002), and Workhoarse (P = .001), but no significant change in HADS. CONCLUSION Patients with RRP experience significant voice-related work productivity impairment, and ablation of papillomata significantly improves work productivity.
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Affiliation(s)
- Thomas K Chung
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Amanda Hu
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Maya G Sardesai
- Department of Otolaryngology Head and Neck Surgery, University of Washington, Seattle, WA, USA
| | - Haley Wilcox
- Department of Otolaryngology Head and Neck Surgery, University of Washington, Seattle, WA, USA
| | - Lan Jiang
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt Medical Center, Nashville, TN, USA
| | - Tanya K Meyer
- Department of Otolaryngology Head and Neck Surgery, University of Washington, Seattle, WA, USA
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Weerathunge HR, Segina RK, Tracy L, Stepp CE. Accuracy of Acoustic Measures of Voice via Telepractice Videoconferencing Platforms. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:2586-2599. [PMID: 34157251 PMCID: PMC8632479 DOI: 10.1044/2021_jslhr-20-00625] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/19/2020] [Accepted: 03/23/2021] [Indexed: 05/31/2023]
Abstract
Purpose Telepractice improves patient access to clinical care for voice disorders. Acoustic assessment has the potential to provide critical, objective information during telepractice, yet its validity via telepractice is currently unknown. The current study investigated the accuracy of acoustic measures of voice in a variety of telepractice platforms. Method Twenty-nine voice samples from individuals with dysphonia were transmitted over six video conferencing platforms (Zoom with and without enhancements, Cisco WebEx, Microsoft Teams, Doxy.me, and VSee Messenger). Standard time-, spectral-, and cepstral-based acoustic measures were calculated. The effect of transmission condition on each acoustic measure was assessed using repeated-measures analyses of variance. For those acoustic measures for which transmission condition was a significant factor, linear regression analysis was performed on the difference between the original recording and each telepractice platform, with the overall severity of dysphonia, Internet speed, and ambient noise from the transmitter as predictors. Results Transmission condition was a statistically significant factor for all acoustic measures except for mean fundamental frequency (f o). Ambient noise from the transmitter was a significant predictor of differences between platforms and the original recordings for all acoustic measures except f o measures. All telepractice platforms affected acoustic measures in a statistically significantly manner, although the effects of platforms varied by measure. Conclusions Overall, measures of f o were the least impacted by telepractice transmission. Microsoft Teams had the least and Zoom (with enhancements) had the most pronounced effects on acoustic measures. These results provide valuable insight into the relative validity of acoustic measures of voice when collected via telepractice. Supplemental Material https://doi.org/10.23641/asha.14794812.
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Affiliation(s)
- Hasini R. Weerathunge
- Department of Biomedical Engineering, Boston University, MA
- Department of Speech, Language and Hearing Sciences, Boston University, MA
| | - Roxanne K. Segina
- Department of Speech, Language and Hearing Sciences, Boston University, MA
| | - Lauren Tracy
- Department of Otolaryngology—Head & Neck Surgery, Boston University School of Medicine, MA
| | - Cara E. Stepp
- Department of Biomedical Engineering, Boston University, MA
- Department of Speech, Language and Hearing Sciences, Boston University, MA
- Department of Otolaryngology—Head & Neck Surgery, Boston University School of Medicine, MA
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Concurrent YAP/TAZ and SMAD signaling mediate vocal fold fibrosis. Sci Rep 2021; 11:13484. [PMID: 34188130 PMCID: PMC8241934 DOI: 10.1038/s41598-021-92871-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/10/2021] [Indexed: 01/17/2023] Open
Abstract
Vocal fold (VF) fibrosis is a major cause of intractable voice-related disability and reduced quality of life. Excision of fibrotic regions is suboptimal and associated with scar recurrence and/or further iatrogenic damage. Non-surgical interventions are limited, putatively related to limited insight regarding biochemical events underlying fibrosis, and downstream, the lack of therapeutic targets. YAP/TAZ integrates diverse cell signaling events and interacts with signaling pathways related to fibrosis, including the TGF-β/SMAD pathway. We investigated the expression of YAP/TAZ following vocal fold injury in vivo as well as the effects of TGF-β1 on YAP/TAZ activity in human vocal fold fibroblasts, fibroblast-myofibroblast transition, and TGF-β/SMAD signaling. Iatrogenic injury increased nuclear localization of YAP and TAZ in fibrotic rat vocal folds. In vitro, TGF-β1 activated YAP and TAZ in human VF fibroblasts, and inhibition of YAP/TAZ reversed TGF-β1-stimulated fibroplastic gene upregulation. Additionally, TGF-β1 induced localization of YAP and TAZ in close proximity to SMAD2/3, and nuclear accumulation of SMAD2/3 was inhibited by a YAP/TAZ inhibitor. Collectively, YAP and TAZ were synergistically activated with the TGF-β/SMAD pathway, and likely essential for the fibroplastic phenotypic shift in VF fibroblasts. Based on these data, YAP/TAZ may evolve as an attractive therapeutic target for VF fibrosis.
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Hu HC, Chang SY, Wang CH, Li KJ, Cho HY, Chen YT, Lu CJ, Tsai TP, Lee OKS. Deep Learning Application for Vocal Fold Disease Prediction Through Voice Recognition: Preliminary Development Study. J Med Internet Res 2021; 23:e25247. [PMID: 34100770 PMCID: PMC8241431 DOI: 10.2196/25247] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 04/06/2021] [Accepted: 04/25/2021] [Indexed: 01/17/2023] Open
Abstract
Background Dysphonia influences the quality of life by interfering with communication. However, a laryngoscopic examination is expensive and not readily accessible in primary care units. Experienced laryngologists are required to achieve an accurate diagnosis. Objective This study sought to detect various vocal fold diseases through pathological voice recognition using artificial intelligence. Methods We collected 189 normal voice samples and 552 samples of individuals with voice disorders, including vocal atrophy (n=224), unilateral vocal paralysis (n=50), organic vocal fold lesions (n=248), and adductor spasmodic dysphonia (n=30). The 741 samples were divided into 2 sets: 593 samples as the training set and 148 samples as the testing set. A convolutional neural network approach was applied to train the model, and findings were compared with those of human specialists. Results The convolutional neural network model achieved a sensitivity of 0.66, a specificity of 0.91, and an overall accuracy of 66.9% for distinguishing normal voice, vocal atrophy, unilateral vocal paralysis, organic vocal fold lesions, and adductor spasmodic dysphonia. Compared with the accuracy of human specialists, the overall accuracy rates were 60.1% and 56.1% for the 2 laryngologists and 51.4% and 43.2% for the 2 general ear, nose, and throat doctors. Conclusions Voice alone could be used for common vocal fold disease recognition through a deep learning approach after training with our Mandarin pathological voice database. This approach involving artificial intelligence could be clinically useful for screening general vocal fold disease using the voice. The approach includes a quick survey and a general health examination. It can be applied during telemedicine in areas with primary care units lacking laryngoscopic abilities. It could support physicians when prescreening cases by allowing for invasive examinations to be performed only for cases involving problems with automatic recognition or listening and for professional analyses of other clinical examination results that reveal doubts about the presence of pathologies.
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Affiliation(s)
- Hao-Chun Hu
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Shyue-Yih Chang
- Voice Center, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Chuen-Heng Wang
- Muen Biomedical and Optoelectronic Technologist Inc, Taipei, Taiwan
| | - Kai-Jun Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Hsiao-Yun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.,Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yi-Ting Chen
- Muen Biomedical and Optoelectronic Technologist Inc, Taipei, Taiwan
| | - Chang-Jung Lu
- Voice Center, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Tzu-Pei Tsai
- Voice Center, Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Oscar Kuang-Sheng Lee
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan.,Stem Cell Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
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Erickson-DiRenzo E, Singh SP, Martinez JD, Sanchez SE, Easwaran M, Valdez TA. Cigarette smoke-induced changes in the murine vocal folds: a Raman spectroscopic observation. Analyst 2021; 145:7709-7717. [PMID: 32996925 DOI: 10.1039/d0an01570a] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Raman spectroscopic methods are being projected as novel tools to study the early invisible molecular level changes in a label-free manner. In the present study, we have used Raman spectroscopy to explore the earliest biochemical changes in murine vocal folds in response to time-bound cigarette smoke exposure. Mice were exposed to cigarette smoke for 2 or 4-weeks through a customized smoke inhalation system. The larynx was collected and initial evaluations using standard methods of analysis such as histopathology and immunofluorescence was performed. Concurrent unstained sections were used for Raman imaging. Two common pathological features of vocal fold disorders including alterations in collagen content and epithelial hypercellularity, or hyperplasia, were observed. The mean spectra, principal component analysis, and Raman mapping also revealed differences in the collagen content and hypercellularity in the smoke exposed tissues. The differences in 2-week exposed tissues were found to be more prominent as compared to 4-week. This was attributed to adaptive responses and the already reported biphasic effects, which suggest that collagen synthesis is significantly reduced at higher cigarette smoke concentrations. Overall findings of the study are supportive of the prospective application of Raman imaging in monitoring changes due to cigarette smoke in the vocal folds.
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Affiliation(s)
- Elizabeth Erickson-DiRenzo
- Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Cukic O. Office-Based Removal of Vocal Fold Polyp During the COVID-19 Pandemic. Laryngoscope 2021; 132:103-106. [PMID: 33955551 PMCID: PMC8242618 DOI: 10.1002/lary.29615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/15/2021] [Accepted: 05/01/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Ognjen Cukic
- Department of Otorhinolaryngology with Maxillofacial Surgery, Clinical Hospital Center Zemun, Zemun, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
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Nguyen-Feng VN, Frazier PA, Roy N, Cohen S, Misono S. Perceived Control, Voice Handicap, and Barriers to Voice Therapy. J Voice 2021; 35:326.e13-326.e19. [PMID: 31604609 PMCID: PMC7138698 DOI: 10.1016/j.jvoice.2019.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To characterize the associations of perceived control with voice outcomes and self-reported likelihood of attending voice therapy using a national practice-based research network. STUDY DESIGN Cross-sectional study of prospectively enrolled adult patients seen for dysphonia. SETTING Creating Healthcare Excellence through Education and Research (CHEER) network of community and academic practice sites. SUBJECTS AND METHODS Data collected included patient-reported demographics, outcome measures of voice (Voice Handicap Index-10), perceived control (present control subscale of voice-specific Perceived Control over Stressful Events Scale), personality (Ten Item Personality Inventory), likelihood of attending voice therapy if recommended, and barriers to attending voice therapy. RESULTS Patients (N = 247) were enrolled over 12 months from 10 sites, of whom 170 received a recommendation for voice therapy. The majority (85%) of this group planned to attend voice therapy. Voice-specific perceived control and VHI-10 were inversely related (r = -0.31, P < 0.001), even when controlling for personality. No study variables were associated with self-reported likelihood of attending voice therapy, but perceived control was the most consistent correlate of specific barriers to attending voice therapy (eg, "hard to translate into everyday use") and was inversely related to these barriers. CONCLUSIONS Patients scoring higher on a voice-specific measure of perceived control reported less voice handicap, independent of personality, and higher perceived control was associated with having fewer concerns about voice therapy goals and process. Perceived control is a potential target for intervention in patients with voice disorders.
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Affiliation(s)
| | - Patricia A Frazier
- Department of Psychology, College of Liberal Arts, University of Minnesota Twin Cities, Minneapolis, Minnesota
| | - Nelson Roy
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, Utah
| | - Seth Cohen
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina
| | - Stephanie Misono
- Department of Otolaryngology - Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota.
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Endoscopic laryngeal findings in patients undergoing thyroid and parathyroid surgery. The Journal of Laryngology & Otology 2021; 135:264-268. [PMID: 33632350 DOI: 10.1017/s0022215121000529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This study aimed to report the pre- and post-operative laryngeal endoscopic findings in patients referred by non-otolaryngologists who are undergoing thyroid and/or parathyroid surgery, and to determine the number and nature of referrals before and after the release of the clinical practice guideline for improving voice outcomes after thyroid surgery. METHODS This retrospective cohort study, conducted at a tertiary care academic hospital, comprised adult patients referred by the endocrine surgery service for laryngoscopy from 2007 to 2018 (n = 166). Data regarding patient demographics, reason for referral and endoscopic findings were recorded. RESULTS The number of referrals increased significantly after the release of the practice guideline. The most common indication for referral pre- and post-operatively was voice change. The most common finding during laryngoscopy was normal examination findings (pre-operatively) and unilateral vocal fold immobility (post-operatively). CONCLUSION Peri-operative thyroid and/or parathyroid patients have laryngoscopic findings other than vocal fold immobility. Laryngoscopy to detect structural and functional pathology is warranted.
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Hurtado-Ruzza R, Iglesias ÓÁC, Becerro-de-Bengoa-Vallejo R, Calvo-Lobo C, San-Antolín M, Losa-Iglesias ME, Romero-Morales C, López-López D. Self-Perceived Handicap Associated With Dysphonia and Health-Related Quality of Life of Asthma and Chronic Obstructive Pulmonary Disease Patients: A Case-Control Study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:433-443. [PMID: 33465320 DOI: 10.1044/2020_jslhr-20-00473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The association between voice alterations, health-related quality of life (HRQL), and chronic respiratory diseases, such as asthma and chronic obstructive pulmonary disease (COPD), has previously been reported. The aim of this study was to test the hypothesis that HRQL and dysphonia-associated handicap of patients diagnosed with asthma or COPD are worse than healthy controls. Method A case-control study in which participants were recruited by a consecutive sampling method from a single institution was conducted. Three groups were created: (a) asthma (51 patients), (b) COPD (52 patients), and (c) 50 healthy controls. Self-reported handicap associated with dysphonia was assessed using the 30-item Voice Handicap Index (VHI-30); meanwhile, HRQL was tested via the European Quality of Life (EQ) Questionnaire and the EQ-visual analog scale. Also, aerodynamic assessment applied to phonation was assessed, and maximum phonation time and s/e index were registered. Results VHI scores were higher for asthma and COPD (7.19 ± 8.31 and 11.80 ± 15.18, respectively) than in the control group (3.72 ± 6.78). The EQ index was lower in asthma and COPD patients than in controls. The EQ-visual analog scale showed lower scores in asthma and COPD than in the controls. Conclusions HRQL was worse in COPD patients than in asthma patients. Even though the patient groups showed worse VHI and HRQL scores than the healthy controls, the scores fell within the normal variation range. No significant variations in the maximum phonation time index between groups were noted.
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Affiliation(s)
- Rafael Hurtado-Ruzza
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Spain
- ENT Department, Complexo Hospitalario Universitario de Ourense, Spain
| | - Óscar Álvarez-Calderón Iglesias
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Spain
- ENT Department, Complexo Hospitalario Universitario de Ourense, Spain
| | | | - César Calvo-Lobo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Spain
| | - Marta San-Antolín
- Department of Psychology, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | | | - Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Spain
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Rao Mv A, Yamini BK, Ketan J, Preetie Shetty A, Pal PK, Shivashankar N, Ghosh PK. Automatic Classification of Healthy Subjects and Patients With Essential Vocal Tremor Using Probabilistic Source-Filter Model Based Noise Robust Pitch Estimation. J Voice 2021; 37:314-321. [PMID: 33579623 DOI: 10.1016/j.jvoice.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 11/18/2022]
Abstract
Essential voice tremor (EVT) is a voice disorder resulting from dyscoordination within the laryngeal musculature. A low-frequency fluctuations of fundamental voice frequency or the strength of excitation amplitude is the main consequence of the disorder. The automatic classification of healthy control and EVT is useful tool for the clinicians. A typical automatic EVT classification involves three steps. The first step is to compute the pitch contour from the speech. The second step is to compute the features from the pitch contour, and the final step is to use a classifier to classify the features into healthy or EVT. It is shown that a high-resolution pitch contour estimated from the glottal closure instants (GCIs) is useful for EVT classification. The HPRC estimation can be very poor in the presence of noise. Hence, a probabilistic source filter model based noise robust GCI detection is used for HPRC estimation. The Empirical mode decomposition based feature extraction is used followed by a support vector machine classifier. The EVT classification performance is evaluated using recordings from 45 subjects. The proposed method is found to perform better than the baseline techniques in eight different additive noise conditions with six SNR levels.
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Affiliation(s)
- Achuth Rao Mv
- Electrical Engineering, Indian Institute of science (IISc), Bangalore, 560012, India.
| | - B K Yamini
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - J Ketan
- Department of Neurology, University of South Florida, Tampa, 33620, USA
| | - A Preetie Shetty
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - N Shivashankar
- Speech Pathology and Audiology, Apollo Hospital, Jayanagar, Bangalore, 560029, India
| | - Prasanta Kumar Ghosh
- Speech Pathology and Audiology, Apollo Hospital, Jayanagar, Bangalore, 560029, India
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Huwyler C, Merchant M, Jiang N. Disparities in Speech Therapy for Voice Disorders Between English- and Non-English-Speaking Patients. Laryngoscope 2021; 131:E2298-E2302. [PMID: 33559902 DOI: 10.1002/lary.29429] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/15/2021] [Accepted: 01/26/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate whether language of choice affects compliance with speech therapy for voice disorders. STUDY DESIGN Retrospective chart review. METHODS A retrospective study was performed at Kaiser Permanente Northern California to compare compliance with referrals to speech therapy for voice disorders between English- and non-English-speaking patients. Patients referred from January 2012 through December 2017 were included. Logistic regression models were used to calculate the adjusted odds ratios (aOR) and to determine social and demographic factors affecting compliance. RESULTS Of 7,333 patients referred to speech therapy for a voice disorder, 7,171 were identified as English speaking and 162 as non-English speaking. The two cohorts were similar in terms of gender and proportion over 65 years of age, although non-English-speaking individuals were more likely to be Hispanic or Asian than English speakers, who were more likely to be White or African American. Overall compliance was lower among non-English-speaking patients than English speakers (63% vs 74%) (P = .0011). Logistic regression showed that the need for an interpreter was significantly associated with higher noncompliance (aOR 1.56, 95% CI 1.11-2.18), as was age less than 65 and income less than the study aggregate median income. Being multiracial or having a voice disorder of neurologic origin was associated with better compliance. CONCLUSION This study demonstrates significant noncompliance with speech therapy for a variety of voice disorders. This problem is exacerbated for patients who do not speak English and who are younger, of lower income, or are referred for functional voice disorders. In-person interpreters or multilingual speech therapists may help to improve compliance. LEVEL OF EVIDENCE IV Laryngoscope, 131:E2298-E2302, 2021.
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Affiliation(s)
- Camille Huwyler
- Department of Head and Neck Surgery, Kaiser Permanente, Oakland Medical Center, Oakland, California, USA
| | - Maqdooda Merchant
- Division of Research, Biostatistical Consulting Unit, Oakland, California, USA
| | - Nancy Jiang
- Department of Head and Neck Surgery, Kaiser Permanente, Oakland Medical Center, Oakland, California, USA
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Dassé R, De Monès Del Pujol E. First-line treatment of exudative vocal fold-lesions by in-office local corticosteroid injection: A literature review. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:169-175. [PMID: 33191161 DOI: 10.1016/j.anorl.2020.09.001] [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: 11/25/2022]
Abstract
OBJECTIVES There are emerging reports of the effectiveness of in-office awake vocal-fold corticosteroid injection in the treatment of exudative vocal-fold lesions. The aim of this study was to review this therapy and specify indications, practical modalities and outcomes. STUDY DESIGN Systematic review of the literature without meta-analysis. METHODS A systematic review by PubMed search for the period January 2000 to December 2018 was carried out. RESULTS Nine articles were included, for a total of 502 lesions: nodules (46.4%), polyps (31.7%), and Reinke's edema (21.9%). Submucosal injection of low-dose triamcinolone acetonide (0.1 to 0.3mL) was transoral, transcutaneous or transnasal via flexible endoscope with operating channel. Lesion volume was significantly reduced in more than 90% of cases, with significant vocal improvement in all studies. Relapse rates ranged between 4% and 31%, with time to relapse of 1 to 40 months. CONCLUSIONS First-line treatment of exudative glottic lesions by submucosal corticosteroid injection provides at least transient significant reduction in lesion volume and vocal improvement. It is consensually reserved to moderate-sized mainly exudative lesions without fibrosis. In-office injection provides an immediate therapeutic response in case of vocal impairment, enabling surgery under general anesthesia to be postponed.
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Affiliation(s)
- R Dassé
- Service ORL et chirurgie cervico-faciale, CHU de Bordeaux-Pellegrin, place Amélie Rabat-Léon, 33000 Bordeaux, France.
| | - E De Monès Del Pujol
- Service ORL et chirurgie cervico-faciale, CHU de Bordeaux-Pellegrin, place Amélie Rabat-Léon, 33000 Bordeaux, France
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Moya-Mendez ME, Madden LL, Ruckart KW, Downes KM, Cook JF, Snively BM, Brashear A, Haq IU. Auditory-perceptual voice and speech evaluation in ATP1A3 positive patients. J Clin Neurosci 2020; 81:133-138. [PMID: 33222902 PMCID: PMC7683823 DOI: 10.1016/j.jocn.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/27/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Bulbar symptoms are frequent in patients with rapid-onset dystonia-parkinsonism (RDP). RDP is caused by ATP1A3 mutations, with onset typically within 30 days of stressor exposure. Most patients have impairments in speech (dysarthria) and voice (dysphonia). These have not been quantified. We aimed to formally characterize these in RDP subjects as compared to mutation negative family controls. METHODS We analyzed recordings in 32 RDP subjects (male = 21, female = 11) and 29 mutation negative controls (male = 15, female = 14). Three raters, blinded to mutation status, rated speech and vocal quality. Dysarthria was classified by subtype. Dysphonia was rated via the GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) scale. We used general neurological exams and the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) to assess dysarthria, dystonia, and speech/swallowing dysfunction. RESULTS The presence of dysarthria was more frequent in RDP subjects compared to controls (72% vs. 17%, p < 0.0001). GRBAS voice ratings were worse in the RDP cohort across nearly all categories. Dysarthria in RDP was associated with concordant cranial nerve 9-11 dysfunction (54%, p = 0.048), speech/swallowing dysfunction (96%, p = 0.0003); and oral dystonia (88%, p = 0.001). CONCLUSIONS Quantitative voice and speech analyses are important in assessing RDP. Subjects frequently experience dysarthria and dysphonia. Dystonia is not the exclusive voice abnormality present in this population. In our analysis, RDP subjects more frequently experienced bulbar symptoms than controls. GRBAS scores are useful in quantifying voice impairment, potentially allowing for better assessments of progression or treatment effects. Future directions include using task-specific diagnostic and perceptual voice evaluation tools to further assess laryngeal dystonia.
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Affiliation(s)
- Mary E Moya-Mendez
- Department of Neurology Duke University School of Medicine Durham, North Carolina, United States
| | - Lyndsay L Madden
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine Winston-Salem, NC, United States
| | - Kathryn W Ruckart
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine Winston-Salem, NC, United States
| | - Karen M Downes
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine Winston-Salem, NC, United States
| | - Jared F Cook
- Department of Psychology, Wake Forest School of Medicine Winston-Salem, NC, United States
| | - Beverly M Snively
- Department of Biostatistics and Data Science, Wake Forest School of Medicine Winston-Salem, NC, United States
| | - Allison Brashear
- Department of Neurology, University of California at Davis, Sacramento, CA, United States
| | - Ihtsham U Haq
- Department of Neurology, Wake Forest School of Medicine Winston-Salem, NC, United States.
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Lim KWR, Zambare W, Rubin BR, Tracy LF. Barriers to Voice Therapy Attendance in a Language-Diverse Population. Laryngoscope 2020; 131:1835-1839. [PMID: 33001456 DOI: 10.1002/lary.29149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/26/2020] [Accepted: 09/16/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Voice therapy is an effective treatment for many voice disorders, but success depends on attendance and adherence. Many factors hinder treatment attendance, and language discordance with the provider may present an additional obstacle to attending therapy. This study evaluates factors associated with voice therapy attendance at a language-diverse, safety-net hospital. STUDY DESIGN Retrospective chart review. METHODS Retrospective review of adult patients referred to speech language pathology for treatment of voice disorders from January, 2018 to April, 2019. Primary spoken language, interpreter collaboration, and patient demographics were obtained from medical records. Multivariate analysis compared patient factors with voice therapy attendance versus nonattendance. RESULTS Of 422 patients, 219 (52%) attended at least one therapy session, whereas 203 (48%) did not attend (n = 120) or schedule therapy (n = 83). In multivariate analysis, only the association between public insurance and nonattendance was statistically significant (P = .016). After adjusting for interpreter use and interval between referral and first appointment, patients with private health insurance were 2.35 times more likely to attend therapy compared to those with public insurance (95% confidence interval: 1.18-4.71). Non-English language; interpreter collaboration; distance from hospital; and patient demographics, including age, gender, ethnicity, and birthplace, did not significantly correlate with attendance. CONCLUSIONS In a culturally and language-diverse cohort of dysphonic patients, individuals with public health insurance were significantly less likely to attend voice therapy. Language-discordant therapy and interpreter collaboration was not a statistically significant barrier to therapy attendance. Additional investigation is warranted to optimize allocation of voice therapy resources for those with public health insurance and for diverse speakers of all languages. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1835-1839, 2021.
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Affiliation(s)
| | - Wini Zambare
- Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Batsheva R Rubin
- Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Lauren F Tracy
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center; Boston University School of Medicine, Boston, Massachusetts, U.S.A
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Dhillon VK, Randolph GW, Stack BC, Lindeman B, Bloom G, Sinclair CF, Woodson G, Brooks JA, Childs LF, Esfandiari NH, Evangelista L, Guardiani E, Quintanilla-Dieck L, Naunheim MR, Shindo M, Singer M, Tolley N, Angelos P, Kupfer R, Banuchi V, Liddy W, Tufano RP. Immediate and partial neural dysfunction after thyroid and parathyroid surgery: Need for recognition, laryngeal exam, and early treatment. Head Neck 2020; 42:3779-3794. [PMID: 32954575 DOI: 10.1002/hed.26472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Laryngeal dysfunction after thyroid and parathyroid surgery requires early recognition and a standardized approach for patients that present with voice, swallowing, and breathing issues. The Endocrine Committee of the American Head and Neck Society (AHNS) convened a panel to define the terms "immediate vocal fold paralysis" and "partial neural dysfunction" and to provide clinical consensus statements based on review of the literature, integrated with expert opinion of the group. METHODS A multidisciplinary expert panel constructed the manuscript and recommendations for laryngeal dysfunction after thyroid and parathyroid surgery. A meta-analysis was performed using the literature and published guidelines. Consensus was achieved using polling and a modified Delphi approach. RESULTS Twenty-two panelists achieved consensus on five statements regarding the role of early identification and standardization of evaluation for patients with "immediate vocal fold paralysis" and "partial neural dysfunction" after thyroid and parathyroid surgery. CONCLUSION After endorsement by the AHNS Endocrine Section and Quality of Care Committee, it received final approval from the AHNS Council.
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Affiliation(s)
- Vaninder K Dhillon
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University National Capital Region, Bethesda, Maryland, USA
| | - Gregory W Randolph
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Brendan C Stack
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Brenessa Lindeman
- Department of General Surgery, Surgical Oncology, University of Alabama, Birmingham, Alabama, USA
| | - Gary Bloom
- ThyCa: Thyroid Cancer Survivors' Association, Inc., Olney, Maryland, USA
| | - Catherine F Sinclair
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai West Hospital, New York, New York, USA
| | - Gayle Woodson
- Department of Otolaryngology-Head and Neck Surgery, Drexel University, Philadelphia, Pennsylvania, USA
| | - Jennifer A Brooks
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lesley F Childs
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nazanene H Esfandiari
- Department of Internal Medicine, Metabolism, Endocrinology & Diabetes (MEND), University of Michigan, Ann Arbor, Michigan, USA
| | - Lisa Evangelista
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, California, USA
| | - Elizabeth Guardiani
- Department of Otolaryngology-Head and Neck Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Lourdes Quintanilla-Dieck
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Oregon, Portland, USA
| | - Matthew R Naunheim
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Maisie Shindo
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Oregon, Portland, USA
| | - Michael Singer
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Neil Tolley
- Department of Otolaryngology-Head and Neck Surgery, Imperial College NHS Trust, London, UK
| | - Peter Angelos
- Department of Surgery, University of Chicago School of Medicine, Chicago, Illinois, USA
| | - Robbi Kupfer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Victoria Banuchi
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell School of Medicine, New York, New York, USA
| | - Whitney Liddy
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, Illinois, USA
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
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Rohlfing ML, Buckley DP, Piraquive J, Stepp CE, Tracy LF. Hey Siri: How Effective are Common Voice Recognition Systems at Recognizing Dysphonic Voices? Laryngoscope 2020; 131:1599-1607. [PMID: 32949415 DOI: 10.1002/lary.29082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Interaction with voice recognition systems, such as Siri™ and Alexa™, is an increasingly important part of everyday life. Patients with voice disorders may have difficulty with this technology, leading to frustration and reduction in quality of life. This study evaluates the ability of common voice recognition systems to transcribe dysphonic voices. STUDY DESIGN Retrospective evaluation of "Rainbow Passage" voice samples from patients with and without voice disorders. METHODS Participants with (n = 30) and without (n = 23) voice disorders were recorded reading the "Rainbow Passage". Recordings were played at standardized intensity and distance-to-dictation programs on Apple iPhone 6S™, Apple iPhone 11 Pro™, and Google Voice™. Word recognition scores were calculated as the proportion of correctly transcribed words. Word recognition scores were compared to auditory-perceptual and acoustic measures. RESULTS Mean word recognition scores for participants with and without voice disorders were, respectively, 68.6% and 91.9% for Apple iPhone 6S™ (P < .001), 71.2% and 93.7% for Apple iPhone 11 Pro™ (P < .001), and 68.7% and 93.8% for Google Voice™ (P < .001). There were strong, approximately linear associations between CAPE-V ratings of overall severity of dysphonia and word recognition score, with correlation coefficients (R2 ) of 0.609 (iPhone 6S™), 0.670 (iPhone 11 Pro™), and 0.619 (Google Voice™). These relationships persisted when controlling for diagnosis, age, gender, fundamental frequency, and speech rate (P < .001 for all systems). CONCLUSION Common voice recognition systems function well with nondysphonic voices but are poor at accurately transcribing dysphonic voices. There was a strong negative correlation with word recognition scores and perceptual voice evaluation. As our society increasingly interfaces with automated voice recognition technology, the needs of patients with voice disorders should be considered. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1599-1607, 2021.
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Affiliation(s)
- Matthew L Rohlfing
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Daniel P Buckley
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center Boston University School of Medicine, Boston, Massachusetts, U.S.A.,Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts, U.S.A
| | - Jacquelyn Piraquive
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Cara E Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts, U.S.A
| | - Lauren F Tracy
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center Boston University School of Medicine, Boston, Massachusetts, U.S.A
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