VOCAL COMPLAINT, AUDITORY-PERCEPTUAL ASSESSMENT OF VOICE AND VOCAL SELF-ASSESSMENT IN WOMEN WITH MORBID OBESITY

Voice Outcomes After Bariatric Surgery: A Systematic Review

OBJECTIVE

Bariatric surgery has been documented to improve comorbidities associated with obesity. Obesity can cause deposition of excess adipose tissue, narrowing of the vocal tract, and decreased lung capacity contributing to reduced vocal quality and increased vocal effort. Limited information is available regarding the impact of bariatric surgery on voice outcomes. This review seeks to examine the role of bariatric surgery on voice outcomes.

STUDY DESIGN

Systematic review.

METHODS

A systematic review was completed using PubMed and Embase for measures of vocal change before and after bariatric surgery. Studies were reviewed by three authors, and data related to acoustic, aerodynamic, auditory-perceptual, and patient-reported outcome measures were extracted.

RESULTS

Forty-nine abstracts were identified with seven meeting criteria for analysis. Voice outcomes pre and postbariatric surgery were measured across 122 individuals. Results revealed increased fundamental frequency (F0) and increased maximum phonation time (MPT) during sustained vowel productions. Correlation coefficients for MPT for /a/ were -0.683 and -0.725 for F0, respectively, indicating a strong negative correlation between body mass index and MPT and F0. Trends toward improved auditory-perceptual ratings and improved patient-reported outcome measures were also noted. However, studies were limited by restricted patient demographics and limited use of standardized and/or comprehensive evaluation techniques.

CONCLUSION

Weight loss associated with bariatric surgery can result in improved voice outcomes; however, the mechanism by which it helps is unclear. To better understand this, otolaryngologists and speech-language pathologists may consider advocating for pre- and postsurgery voice evaluation in patients undergoing bariatric surgery.

A study of voice quality in obese Egyptian children

Background

Obesity is considered a health problem that affects many systems of the body among which the respiration and voice. The objective of the study was to analyze the impact of obesity in children on quality of their voice. Thirty obese children were included in this cross-sectional study and compared to 30 age- and sex-matched healthy children as a control group. Voice of cases and controls were assessed subjectively by auditory perceptual assessment and objectively by studying acoustic parameters using Computerized Speech Lab. Flexible laryngoscopy was done for cases with dysphonia.

Results

Dysphonia perceived in 60% of cases, voice analysis revealed increased jitter and noise to harmonic ratio with significant difference than controls.

Conclusion

The voice of children with morbid obesity reveals significant modifications pertaining to vocal characteristics in comparison to non-obese persons, so voice hygiene and voice therapy could be added to their therapy program as prophylactic or therapeutic management of voice disorder.

Does Abrupt Weight Loss Caused by Bariatric Surgery Compromise the Voice in Women?

OBJECTIVE

To evaluate vocal symptoms, voice characteristics and videolaryngoscopy in obese women before and after bariatric surgery.

METHODS

Obese patients (18 to 59 years old), candidates for bariatric surgery were recruited. Evaluation times: T1 (preoperative), T2 (after six months), T3 (after 12 months). Evaluated parameters: weight, height, body mass index, abdominal and neck circumference, vocal self-assessment, perceptual and acoustic vocal assessment, and videolaryngoscopy.

RESULTS

A total of 37 obese women were included, average age 40.8 years. There was a decrease in anthropometric measurements between the preoperative assessment and after 12 months: weight (121.18 ± 15.4 kg; 77.1 ± 11.6 kg), BMI (46.6 ± 6.95 kg/m²; 30 ± kg/m²), abdominal circumference (128 ± 16.1; 99.1 ± 12.1), and neck circumference (41.1 ± 5.85; 36.6 ± 3.02). Gastroesophageal (21.6%) and vocal symptoms (27%) prevailed. No difference was identified in vocal self-assessment between the evaluations. In the acoustic analysis, f0 increased and the soft phonation index decreased. The perceptual analysis registered lower scores for the degree of dysphonia (G) and voice instability (I). The maximum phonation time values increased without changing the s/z ratio. Videolaryngoscopies showed a posterior middle cleft and improvement in the signs of reflux.

CONCLUSIONS

Bariatric surgery led to an important and gradual decrease in anthropometric parameters. The voice became less hoarse, with higher pitch and more stable, with an improvement in maximum phonation time, however with slight breathiness. Such changes were not noticed by the patients.

Influence of the Voice Sample Length in Perceptual and Acoustic Voice Quality Analysis

OBJECTIVE

To analyze the variations that different voice sample length (VSL) has on the perceived degree of voice quality deviation and on the Acoustic Voice Quality Index (AVQI) accuracy.

METHODS

Voices of 71 subjects (53 dysphonic; 18 vocally health) were recorded: numbers 1-20 (42 syllables) + vowel/a/. Three different VSL were edited: VSL_long, 1-20 + 3 seconds vowel/a/; VSL_cust, customized length, were voiced-segments of the continuous speech had the same length of the vowel (mean = 18.73 syllables corresponding to 3 seconds of only-voiced segments) + 3 seconds vowel/a/; VSL_short, 1-10 (15 syllables) + 3 seconds vowel/a/. Three voice specialists perceptually judged the overall voice quality (G); 3 sessions were performed to evaluate each VSL variant. AVQI's precision and Spearman correlation were assessed.

RESULTS

The intra-rater reliability was "almost perfect" (kappa >0.826) for all evaluators in VSL_short; "substantial" (0.684) and "almost perfect" (0.897) in VSL_cust and "fair" (0.447) to "almost perfect" (1.000) in VSL_long. The inter-rater reliability was "moderate" (0.554) for VSL_long, "substantial" (0.622 and 0.618) for VSL_cust and VSL_short. The Gmean and AVQI_mean were perceived as more severe for longer samples and less severe for shorter samples. Considering the AVQI, VSL_short (r = 0.665) presented the higher correlation. VSL_cust presented the best area under the ROC curve (0.821). VSL_long and VSL_cust specificity was 100%, VSL_short specificity was 75%; higher sensitivity was observed for VSL_short (74%).

CONCLUSION

The voice quality outcomes changes for different VSLs. Longer VSLs seem to be perceived as more deviated, shorter VSLs seem to be more reliable and have better correlation with the acoustic analysis. The AVQI best accuracy was found at a customized length. Thus, to increase the voice analysis reliability, standardized procedure must be followed, including a precise speech material control allowing comparison among clinics and voice-centers.

Translation, Cross-Cultural Validation of the Voice Handicap Index (VHI-30) in Slovak Language

PURPOSE

The objective of the study is to verify the psychometric properties of Voice Handicap Index (VHI-30) in Slovak language.

METHODS

Original VHI-30 has been translated into the Slovak language. Fifty-two dysphonic individuals and 104 individuals of the control group without voice disorders were included in the study. Item to total correlation, internal consistency (Cronbach's alpha coefficient α and split-half coefficient), test-retest reliability (correlation coefficient), and validity of VHI 30 (Kruskal-Wallis test) were analyzed.

RESULTS

Item analysis proved that questionnaire items have a good to excellent correlation to the total score (0.42-0.87, P < 0.05). Good internal consistency was proved by calculating Cronbach's alpha coefficient (0.88, P < 0.05) and split-half correlation for the Total score in VHI (0.997, P < 0.05). Test-retest reliability was found to be strong (0.86, P < 0.05). Validity results of Slovak VHI suggests that total mean scores of control group were significantly lower than total mean scores of dysphonic groups (structural, neurogenic, inflammatory, functional, and nonspecified). Total mean scores indicated no statistically significant difference between dysphonic groups (P < 0.05). The cut-off value of 21 points was determined by Receiver Operating Characteristics (ROC) analysis.

CONCLUSION

The results of the study proved that the Slovak VHI-30 is a reliable and valid tool. It is useful for assessing disadvantage related to voice disorders from the patient's perspective.

Vocal Characteristics of Patients With Morbid Obesity

INTRODUCTION

Obesity modifies vocal characteristics, causing abnormal fat deposition in the abdominal region and upper airways. For some authors the voice of the obese is not different from nonobese and the vocal symptoms are scarce; for others dysphonia in obese is reported by 70% of them and the voice becomes hoarse, breathy, and unstable.

OBJECTIVE

To characterize the voice of patients with morbid obesity.

METHODS

Two groups were included: Obese (n-27), aged between 26 and 59 years, selected for bariatric surgery; Control (n-27), matched in age, with ideal weight for height.

PARAMETERS

Vocal self-assessment (Vocal Disadvantage Index-IDV and Quality of Life and Voice-QVV); Perceptual-auditory vocal evaluation (GRBASI scale), maximum phonation time; Acoustic vocal analysis and Videolaryngoscopic exams.

RESULTS

In obese, the most frequent symptoms were gastroesophageal and hoarseness. The vocal self-evaluation did not record any relevant complaints in both groups. In obese, the perceptual-auditory voice evaluations indicated significant changes in R (roughness), B (breathiness), I (instability), and S (tension) parameters. Acoustic vocal analysis recorded changes in the noise-harmonic ratio (NHR) and soft phonation index (SPI) parameters. The videolaryngoscopy examinations showed, in control and obese groups, respectively: normal: 92.5% and 55.5%; posterior pachydermia: 11.1% and 33.3%; mid-posterior bowing: 0% and 7.4%; edema/congestion: 0% and 7.40%.

CONCLUSION

The voice of the obese becomes discreetly hoarse, breathless, and unstable. The most frequent videolaryngoscopic findings in obese patients are hyperemia and edema of vocal folds and posterior pachydermia, related to acid laryngitis, secondary to gastroesophageal reflux.

TRUNK BODY MASS INDEX: A NEW REFERENCE FOR THE ASSESSMENT OF BODY MASS DISTRIBUTION

BACKGROUND

Body mass index (BMI) has some limitations for nutritional diagnosis since it does not represent an accurate measure of body fat and it is unable to identify predominant fat distribution.

AIM

To develop a BMI based on the ratio of trunk mass and height.

METHODS

Fifty-seven patients in preoperative evaluation to bariatric surgery were evaluated. The preoperative anthropometric evaluation assessed weight, height and BMI. The body composition was evaluated by bioimpedance, obtaining the trunk fat free mass and fat mass, and trunk height. Trunk BMI (tBMI) was calculated by the sum of the measurements of the trunk fat free mass (tFFM) and trunk fat mass (tFM) in kg, divided by the trunk height squared (m2)). The calculation of the trunk fat BMI (tfBMI) was calculated by tFM, in kg, divided by the trunk height squared (m2)). For the correction and adjustment of the tBMI and tfBMI, it was calculated the relation between trunk extension and height, multiplying by the obtained indexes.

RESULTS

The mean data was: weight 125.3±19.5 kg, height 1.63±0.1 m, BMI was 47±5 kg/m2) and trunk height was 0.52±0,1 m, tFFM was 29.05±4,8 kg, tFM was 27.2±3.7 kg, trunk mass index was 66.6±10.3 kg/m², and trunk fat was 32.3±5.8 kg/m². In 93% of the patients there was an increase in obesity class using the tBMI. In patients with grade III obesity the tBMI reclassified to super obesity in 72% of patients and to super-super obesity in 24% of the patients.

CONCLUSION

The trunk BMI is simple and allows a new reference for the evaluation of the body mass distribution, and therefore a new reclassification of the obesity class, evidencing the severity of obesity in a more objectively way.

Does Body Mass Index Interfere in the Formation of Speech Formants?

Introduction  Studies in the fields of voice and speech have increasingly focused on the vocal tract and the importance of its structural integrity, and changes in the anatomy and configuration of the vocal tract determine the variations in phonatory and acoustic measurements, especially in the formation of the formants (Fs). Recent studies have revealed the functional consequences arising from being overweight and having an accumulation of fat in the pharyngeal region, including obstructive sleep apnea syndrome (OSAS) and impacts on the voice.

Objectives  To assess the relationship between body mass index (BMI) and analysis of the speech.

Methods  This study was approved by the Ethics Committee of the Universidade Federal de São Paulo (no. 288,430). The cohort consisted of 124 individuals aged between 18 and 45 with full permanent dentition and selected randomly. The participants underwent a brief medical history taking, BMI assessments and recording emissions of the sustained vowels /a/, /ε/, /i/, and /u/ by acoustic program PRAAT (v. 5.3.85, Boersma and Weenink, Amsterdam, Netherlands). Recordings were taken using a unidirectional microphone headset (model Karsect HT-9, Guangdong, China), with a condenser connected to an external sound card (USB-SA 2.0, model Andrea, PureAudio™, Pleasant Grove, UT, USA), to reduce noise.

Results  There was a significant correlation between BMI and formant 3 (F3) vowel /a/; however, there was a low degree of correlation intensity.

Conclusions  We did not observe a correlation between the BMI and the speech formants, but we believe there is a trend in this correlation that leads to changes in speech patterns with increases in BMI.