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Cohen W, Wynne DM. Paediatric voice disorder: who to refer and how to assess? A summary of recent literature. Curr Opin Otolaryngol Head Neck Surg 2024; 32:156-165. [PMID: 38547363 DOI: 10.1097/moo.0000000000000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to update the reader with recent advances and current opinion on the assessment and management of paediatric voice disorders. RECENT FINDINGS Access to advanced multidisciplinary paediatric voice clinics has increased over the last decade. Often the assessment is combined between speech therapy/pathology and ENT surgery. Vocal fold nodules remain the most prevalent diagnosis at a paediatric voice clinic, but significant diseases will also present, for example laryngeal papilloma. Recently, more consideration of the psychosocial aspect of voice disorders and evaluation of auditory processing disorders have shown how these can have a negative impact. There also appears to be a lack of parental and teacher awareness of paediatric voice disorders and their significance. SUMMARY We would recommend multiparametric assessment and analysis of all children with a voice disorder. Most paediatric voice conditions will respond to skilled voice therapy. However, the exact techniques and dosage requires further evaluation and research. Paediatric voice conditions are common and should not be dismissed, as they may represent significant disease, for example papilloma, vagal palsy or have a significant psychosocial impact on the child.
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Affiliation(s)
- Wendy Cohen
- University of Strathclyde, Department of Psychological Sciences and Health
| | - David M Wynne
- Royal Hospital for Children, Ear, Nose and Throat Department NHS Greater Glasgow and Clyde, Glasgow, UK
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Šimkienė R, Šiupšinskienė N, Purlys P, Žvirblis T, Lesinskas E. Adaptation and Validation of the Lithuanian Version of the Pediatric Voice Handicap Index. J Voice 2022:S0892-1997(22)00041-8. [PMID: 35361515 DOI: 10.1016/j.jvoice.2022.02.012] [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: 12/15/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to develop the Lithuanian version of the Pediatric Voice Handicap Index (pVHI) and to assess its psychometric characteristics. METHODS The Lithuanian version of the pVHI was prepared according to the standard requirements for the questionnaire translation and adaptation procedure. It also included forward and backward translations of the original questionnaire, as well as a committee review and psychometric testing of the final version of the pVHI. A total of 126 children between 4 and 13 years of age were included in the study. Two study groups were formed: a group consisting of children with dysphonia (n = 70) and a control group of children without any alterations in their voice (n = 56). The questionnaire was always completed by their parents. The results were statistically analysed to assess the reliability, validity, sensitivity and specificity of the Lithuanian version of the pVHI. RESULTS High internal consistency of the Lithuanian version of the pVHI was determined (Cronbach's α = 0.938). The test-retest analysis also showed a high correlation between the two tests (r = 0.949) for both the dysphonic and control groups. The mean overall pVHI score was significantly higher (P < 0.001) in the dysphonic group than in the control group: 26.16 ± 11.84 and 2.43 ± 2.61, respectively. Similar results were obtained for all domains of pVHI. The most sensitive and specific limiting value for discrimination between the clinical and control groups was the sum of 8 points. CONCLUSIONS The Lithuanian version of the pVHI is a reliable and valid instrument for the evaluation of the Voice Handicap Index in the pediatric population and can be easily applied in daily clinical practice.
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Affiliation(s)
- Rita Šimkienė
- Vilnius University Hospital Santaros Klinikos Center for Ear, Nose and Throat Diseases, Vilnius, Lithuania.
| | - Nora Šiupšinskienė
- Lithuanian University of Health Sciences, Medicine Academy, Department of Otorhinolaryngology, Kaunas, Lithuania; Klaipeda University, Faculty of Health Sciences, Klaipeda, Lithuania
| | | | - Tadas Žvirblis
- Vilnius Gediminas Technical University, Vilnius, Lithuania
| | - Eugenijus Lesinskas
- Vilnius University Hospital Santaros Klinikos Center for Ear, Nose and Throat Diseases, Vilnius, Lithuania
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Aoki T, Takeyama T, Sakamoto Y, Shimada A, Kondo E, Nakano S, Fukuda J, Azuma T, Sato G, Kitamura Y, Hosokawa K, Udaka J, Takeda N. Effects of vocal nodules on acoustic characteristics of voice in children : an acoustic analysis of voice. THE JOURNAL OF MEDICAL INVESTIGATION 2021; 68:276-279. [PMID: 34759144 DOI: 10.2152/jmi.68.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective : In the present study, an attempt was made to evaluate the acoustic characteristics of voice in pediatric patients with vocal nodules using acoustic analysis of voice. Methods : Thirty-five pediatric patients with vocal nodules and 32 control children without dysphonia were enrolled in this study. Their voice samples were analyzed using the Multi-Dimensional Voice Program. Acoustic parameters of voice, such as pitch period perturbation quotient (PPQ), amplitude perturbation quotient (APQ), and noise-to-harmonic ratio (NHR), were measured. Results : In phonation at a loudness of over 80 dBA, the PPQ, APQ, and NHR values of the voice significantly increased in children with vocal nodules than in the control children without dysphonia. The sensitivities and specificities of PPQ, APQ, and NHR for prediction of vocal nodules in children were 62.86% and 84.38%, 74.29% and 75.00%, and 31.43% and 93.75%, respectively. Discussion : The present findings suggest that vocal nodules affect vocal fold vibration, resulting in impaired control of pitch and loudness leading to increased noise components. NHR could be used to evaluate the efficacy of treatment, such as voice rehabilitation, in pediatric patients with vocal nodules because of its high specificity for prediction of vocal nodules in children. J. Med. Invest. 68 : 276-279, August, 2021.
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Affiliation(s)
- Toshihito Aoki
- Department of Otolaryngology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.,Udaka ENT Clinic, Tokushima, Japan
| | - Takaaki Takeyama
- Department of Otolaryngology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.,Udaka ENT Clinic, Tokushima, Japan
| | - Yuki Sakamoto
- Department of Otolaryngology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Aki Shimada
- Department of Otolaryngology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Eiji Kondo
- Department of Otolaryngology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Seiichi Nakano
- Department of Otolaryngology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Junya Fukuda
- Department of Otolaryngology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Takahiro Azuma
- Department of Otolaryngology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Go Sato
- Department of Otolaryngology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoshiaki Kitamura
- Department of Otolaryngology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kiyohito Hosokawa
- Department of Otolaryngology-Head and Neck Surgery, Osaka University School of Medicine, Osaka, Japan
| | - Jiro Udaka
- Department of Otolaryngology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.,Udaka ENT Clinic, Tokushima, Japan
| | - Noriaki Takeda
- Department of Otolaryngology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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Assessment of Dysphonia in Children with Pompe Disease Using Auditory-Perceptual and Acoustic/Physiologic Methods. J Clin Med 2021; 10:jcm10163617. [PMID: 34441913 PMCID: PMC8396833 DOI: 10.3390/jcm10163617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/07/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022] Open
Abstract
Bulbar and respiratory weakness occur commonly in children with Pompe disease and frequently lead to dysarthria. However, changes in vocal quality associated with this motor speech disorder are poorly described. The goal of this study was to characterize the vocal function of children with Pompe disease using auditory-perceptual and physiologic/acoustic methods. High-quality voice recordings were collected from 21 children with Pompe disease. The Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale was used to assess voice quality and ratings were compared to physiologic/acoustic measurements collected during sustained phonation tasks, reading of a standard passage, and repetition of a short phrase at maximal volume. Based on ratings of grade, dysphonia was present in 90% of participants and was most commonly rated as mild or moderate in severity. Duration of sustained phonation tasks was reduced and shimmer was increased in comparison to published reference values for children without dysphonia. Specific measures of loudness were found to have statistically significant relationships with perceptual ratings of grade, breathiness, asthenia, and strain. Our data suggest that dysphonia is common in children with Pompe disease and primarily reflects impairments in respiratory and laryngeal function; however, the primary cause of dysphonia remains unclear. Future studies should seek to quantify the relative contribution of deficits in individual speech subsystems on voice quality and motor speech performance more broadly.
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Measurement Reliability of Laryngeal Resistance and Mean Flow Rate in Pediatric Subjects. J Voice 2020; 34:590-597. [DOI: 10.1016/j.jvoice.2019.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 11/22/2022]
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McAlister S, Yanushevskaya I. Voice assessment practices of speech and language therapists in Ireland. CLINICAL LINGUISTICS & PHONETICS 2019; 34:29-53. [PMID: 31068022 DOI: 10.1080/02699206.2019.1610798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/17/2019] [Accepted: 04/19/2019] [Indexed: 06/09/2023]
Abstract
Evidence supports the need for a multiparametric voice assessment incorporating objective and subjective assessment types. European guidelines and the American Speech-Language-Hearing Association recommend a comprehensive voice assessment protocol; however, currently in Ireland, no national standards exist. This study investigates voice assessment practices of speech and language therapists (SLTs) in Ireland, with a particular interest in the use of objective instrumentation. It further elucidates what may act as barriers to the use of instrumental techniques, which has not been addressed in earlier studies. An online questionnaire was distributed to SLTs who work with voice disordered clients, via social media outlets of the Irish Association of Speech and Language Therapy (IASLT) and the Voice Special Interest Group to obtain both qualitative and quantitative data. Forty-five questionnaires were returned; the results of 33 completed questionnaires are presented here. The results suggest that subjective measures (auditory assessment protocols) are more commonly used by SLTs in Ireland than instrumental techniques. Limited access to equipment, the cost of equipment and low prioritization of voice clients in a large caseload were most frequently named as barriers to the use of instrumental assessment. The SLTs acknowledged the need for and expressed interest in more training on the use of instrumental techniques in the assessment of voice disorders. The results provoke discussion surrounding evidence-based practice in voice assessment and have implications for how instrumental techniques are incorporated in the curriculum of SLT training courses and in the continual professional development.
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Affiliation(s)
- Sarah McAlister
- Discipline of Speech and Language Therapy, National Univerisity of Ireland Galway, Galway, Ireland
| | - Irena Yanushevskaya
- Discipline of Speech and Language Therapy, National Univerisity of Ireland Galway, Galway, Ireland
- School of Linguistic, Speech and Communication Sciences, Trinity College Dublin, Dublin, Ireland
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Faoury M, Frampton S, Allen D, Burgess A, Heathcote K, Ismail-Koch H. Non-selective laryngeal reinnervation in a child with unilateral left vocal fold palsy utilizing laryngeal electromyography. J Surg Case Rep 2019; 2019:rjz039. [PMID: 30800273 PMCID: PMC6380072 DOI: 10.1093/jscr/rjz039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/10/2019] [Accepted: 01/31/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction The impact of unilateral vocal fold palsy (UVFP) on quality of life cannot be underestimated. Management may be complicated by difficulty in determining prognosis. Currently, there is no standardized management pathway for UVFP. Surgery is considered when speech and language therapy has not been successful or when there is significant aspiration and dysphonia. Surgical options for UVFP include injection laryngoplasty, thyroplasty and laryngeal reinnervation. Methods We report the case of a 6-year-old girl with a left UVFP sustained following PDA ligation. She suffered significant voice issues, aspiration and intermittent stridor limiting activities. Following multidisciplinary team reassessment including videofluoroscopy and perceptual and objective voice measures, laryngotracheobronchoscopy (LTB) and laryngeal electromyography (LEMG) with injection of Radiesse into the left vocal fold was undertaken. Consequently, she underwent non-selective laryngeal reinnervation with the aim of providing a permanent solution by the formation of an anastomosis between the ansa cervicalis and the main stump of the recurrent laryngeal nerve (RLN) resulting in improved muscle tone. Results LEMG indicated no spontaneous recovery. The laryngeal injection allowed for temporary improvement of voice and feeding. Consequently non-selective left laryngeal reinnervation using ansa cervicalis and repeat vocal cord injection was performed. Twelve months following surgery her voice remain greatly improved and there are no feeding issues or aspiration. Conclusion In this case so far the use of LEMG and laryngeal reinnervation has proved successful. Non-selective laryngeal reinnervation techniques for UVFP may provide a permanent solution and should be considered in children as a management option in suitable cases.
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Affiliation(s)
- Morad Faoury
- Department of Otorhinolaryngology, University Hospital Southampton NHS Foundation Trust, Tremona Rd, Southampton, SO16 6YD, UK
| | - Steven Frampton
- Department of Otorhinolaryngology, University Hospital Southampton NHS Foundation Trust, Tremona Rd, Southampton, SO16 6YD, UK
| | - David Allen
- Department of Neurophysiology, University Hospital Southampton NHS Foundation Trust, Tremona Rd, Southampton, SO16 6YD, UK
| | - Andrea Burgess
- Department of Otorhinolaryngology, University Hospital Southampton NHS Foundation Trust, Tremona Rd, Southampton, SO16 6YD, UK
| | - Kate Heathcote
- Department of Otorhinolaryngology, Poole Hospital NHS Foundation Trust, Longfleet Rd, Poole, BH15 2JB, UK
| | - Hasnaa Ismail-Koch
- Department of Otorhinolaryngology, University Hospital Southampton NHS Foundation Trust, Tremona Rd, Southampton, SO16 6YD, UK
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Esen Aydinli F, Özcebe E, İncebay Ö. Use of cepstral analysis for differentiating dysphonic from normal voices in children. Int J Pediatr Otorhinolaryngol 2019; 116:107-113. [PMID: 30554679 DOI: 10.1016/j.ijporl.2018.10.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Cepstral measures have mainly been evaluated by studies conducted on dysphonic and healthy adults, and many of these studies have reported the advantages of using cepstral measures for the evaluation of dysphonia however there is a paucity regarding to the cepstral analyses' results in dysphonic children. In this present study, it is hypothesized that cepstral peak prominence (CPP) and some other parameters of cepstral analysis would differ in children with vocal nodules when compared with the same parameters of cepstral analysis of healthy children. METHODS In this present study, totally 54 children aged between 5 years old to 12 years and 7 months participated. The study group consisted of 20 males and 7 females diagnosed with vocal nodules. The control group consisted of an equal number of age- and gender-matched healthy peers. Analysis of Dysphonia in Speech and Voice software (CSL Model 4500 equipment, Kay Elemetrics Group) was used to gather speech sample recordings according to the Consensus Auditory-Perceptual Evaluation of Voice/Turkish protocol. Cepstral measures of all the six CAPE-V sentences and sustained/a/sample were calculated. CPP, CPP fundamental frequency, CPP standard deviation (CPP SD), Low_high spectral ratio (L/H ratio), L/H ratio standard deviation parameters were taken into account when statistical analyses were completed. In addition to the descriptive statistics of ceptral measures for both groups, the differences between the study and control groups according to the gender were documented. RESULTS It was found that for both genders CPP and CPP SD values were significantly higher for the control group for vowel-weighted sample, all voiced-weighted sample, glottal attack-weighted sample, nasal weighted sample, and voiceless-weighted sample. In the vowel-weighted sample, CPP and CPP SD were significantly higher for the control group in males. In females, a difference was only observed on the CPP parameter for the same sentence. In terms of the CPP value of the sustained phonation sample, a significant difference was only detected for males, whereas no difference was detected for females. CONCLUSIONS In conclusion, present study found that cepstral analysis can be used to determine the difference between dysphonic and healthy voices of children and indicated that cepstral analysis should be a compulsory component of routine clinical voice evaluation of children. In addition, this present study indicates that of the cepstral analysis of sentences appear to be more sensitive to dysphonia than the analysis of vowel samples. In future studies, normative values of the CAPE-V/Turkish sentences and cutoff values for differentiating dysphonia from normal voice should be evaluated using a larger sample size.
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Affiliation(s)
- Fatma Esen Aydinli
- Speech and Language Pathology, Department of Speech and Language Therapy, Hacettepe University Faculty of Health Sciences, Sıhhiye, 06100, Ankara, Turkey.
| | - Esra Özcebe
- Speech and Language Pathology, Department of Speech and Language Therapy, Hacettepe University Faculty of Health Sciences, Sıhhiye, 06100, Ankara, Turkey.
| | - Önal İncebay
- Speech and Language Pathology, Department of Speech and Language Therapy, Hacettepe University Faculty of Health Sciences, Sıhhiye, 06100, Ankara, Turkey.
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Hoffman MR, Scholp AJ, Hedberg CD, Lamb JR, Braden MN, McMurray JS, Jiang JJ. Measurement reliability of phonation threshold pressure in pediatric subjects. Laryngoscope 2018; 129:1520-1526. [PMID: 30408173 DOI: 10.1002/lary.27418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/10/2018] [Accepted: 06/04/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Phonation threshold pressure (PTP), the minimum subglottal pressure (Ps ) required for phonation, is sensitive to changes in laryngeal biomechanics and is often elevated with pathology. Little is reported on PTP in children; challenges with task performance and measurement reliability represent barriers to routine clinical assessment. STUDY DESIGN Pilot study evaluating PTP and Ps measurement reliability in children using labial and mechanical interruption. METHODS Twenty-two subjects aged 4 to 17 years (10.7 ± 3.9 years) participated. Ten trials were performed for each method; task order was randomized. For labial interruption, subjects produced /pα/ five times at softest (onset PTP) and comfortable amplitude. For mechanical interruption, subjects produced a sustained /α/ while a balloon valve interrupted phonation five times for 250 ms each; mechanical interruption was performed with a mouthpiece and mask. PTP was recorded as the difference between Ps and supraglottal pressure at phonation cessation (offset PTP). Mean PTP and Ps and intrasubject coefficients of variation were compared. Correlations with age were evaluated. RESULTS Mean PTP (P < .001) and Ps (P = .005) were higher for labial interruption. Intrasubject coefficients of variation for PTP (P = .554) and Ps (P = .305) were similar across methods. Coefficient of variation was related to age for mechanical-mask trials only (r = -0.628, P = .00175). CONCLUSIONS Differences in means are likely related to differences in task and PTP hysteresis effect. Reliability is comparable with all methods; using a mouthpiece may be preferable to a mask for mechanical interruption. Measurement of PTP is noninvasive, reliable, and may be a useful adjunct in pediatric voice assessment. LEVEL OF EVIDENCE 3b Laryngoscope, 129:1520-1526, 2019.
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Affiliation(s)
- Matthew R Hoffman
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Austin J Scholp
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Calvin D Hedberg
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Jim R Lamb
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Maia N Braden
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - J Scott McMurray
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Jack J Jiang
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
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Cohen W, Lloyd S, Wynne DM, Townsley RB. Perceptual Evaluation of Voice Disorder in Children Who Have Had Laryngotracheal Reconstruction Surgery and the Relationship Between Clinician Perceptual Ratingof Voice Quality and Parent Proxy/Child Self-Report of Voice-Related Quality of Life. J Voice 2018; 33:945.e27-945.e35. [PMID: 30146234 DOI: 10.1016/j.jvoice.2018.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 11/27/2022]
Abstract
Reliability of the GRBAS tool for perceptual evaluation of paediatric voice disorder is measured in this study of children with a history of laryngotracheal reconstruction surgery (LTR). Additionally, the relationship between parent proxy/child self-report of voice-related quality of life with clinician perceptual rating of voice quality is analysed. Eleven children with a history of LTR provided voice recordings following the stimuli set by the CAPE-V protocol. Subjective impact of voice quality on life was measured using the paediatric voice-related quality of life questionnaire. Four trained judges rated the sound files according to both the GRBAS and CAPE-V protocol. Intra-class correlation coefficients were high for both intra-rater and inter-rater judgments across all parameters of the GRBAS protocol, and a strong correlation was found between the grade rating of the GRBAS and the overall severity rating of the CAPE-V. Some elements of parent proxy reporting of voice-related quality of life were significantly negatively correlated with clinician perceptual rating of voice quality, while there was no significant relationship between child self-report and clinician perceptual rating.
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Affiliation(s)
- Wendy Cohen
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom.
| | - Susan Lloyd
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - David M Wynne
- Royal Hospital for Children, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Richard B Townsley
- University Hospital Crosshouse, NHS Ayrshire and Arran, Kilmarnock, United Kingdom
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11
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Brockmann-Bauser M, Bohlender JE, Mehta DD. Acoustic Perturbation Measures Improve with Increasing Vocal Intensity in Individuals With and Without Voice Disorders. J Voice 2018; 32:162-168. [PMID: 28528786 PMCID: PMC7053781 DOI: 10.1016/j.jvoice.2017.04.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/13/2017] [Accepted: 04/17/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In vocally healthy children and adults, speaking voice loudness differences can significantly confound acoustic perturbation measurements. This study examines the effects of voice sound pressure level (SPL) on jitter, shimmer, and harmonics-to-noise ratio (HNR) in adults with voice disorders and a control group with normal vocal status. STUDY DESIGN This is a matched case-control study. METHODS We assessed 58 adult female voice patients matched according to approximate age and occupation with 58 vocally healthy women. Diagnoses included vocal fold nodules (n = 39, 67.2%), polyps (n = 5, 8.6%), and muscle tension dysphonia (n = 14, 24.1%). All participants sustained the vowel /a/ at soft, comfortable, and loud phonation levels. Acoustic voice SPL, jitter, shimmer, and HNR were computed using Praat. The effects of loudness condition, voice SPL, pathology, differential diagnosis, age, and professional voice use level on acoustic perturbation measures were assessed using linear mixed models and Wilcoxon signed rank tests. RESULTS In both patient and normative control groups, increasing voice SPL correlated significantly (P < 0.001) with decreased jitter and shimmer, and increased HNR. Voice pathology and differential diagnosis were not linked to systematically higher jitter and shimmer. HNR levels, however, were statistically higher in the patient group than in the control group at comfortable phonation levels. Professional voice use level had a significant effect (P < 0.05) on jitter, shimmer, and HNR. CONCLUSIONS The clinical value of acoustic jitter, shimmer, and HNR may be limited if speaking voice SPL and professional voice use level effects are not controlled for. Future studies are warranted to investigate whether perturbation measures are useful clinical outcome metrics when controlling for these effects.
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Affiliation(s)
- M Brockmann-Bauser
- Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland.
| | - J E Bohlender
- Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
| | - D D Mehta
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, One Bowdoin Square, 11th Floor, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts; MGH Institute of Health Professions, Boston, Massachusetts
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Cohen W, Wynne DM, Lloyd S, Townsley RB. Cross-sectional follow-up of voice outcomes in children who have a history of airway reconstruction surgery. Clin Otolaryngol 2017; 43:645-651. [PMID: 29210179 DOI: 10.1111/coa.13045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study reports vocal function in a cross-section of children with subglottic stenosis. Each child had a history of laryngotracheal reconstruction and/or cricotracheal resection surgery. Vocal function was measured using laryngoscopy, acoustic analysis, perceptual evaluation and impact of voice on quality of life. DESIGN All patients aged >5 years with history of laryngotracheal reconstruction and/or cricotracheal resection surgery at the Scottish National Complex Airways service were invited to participate. SETTING Data were gathered in the Royal Hospital for Children in Glasgow in a single outpatient appointment. PARTICIPANTS Twelve of 56 former patients (aged 5-27) provided a voice sample and eleven consented to awake laryngoscopy. All consented for detailed evaluation of their medical records. MAIN OUTCOME MEASURES Acoustic analysis of fundamental frequency and pitch perturbation was conducted on sustained vowel [a]. Perceptual evaluation was conducted by 4 trained listeners on a series of spoken sentences. Impact on quality of life was measured using the paediatric voice-related quality of life questionnaire. Laryngeal function was descriptively evaluated. RESULTS Four children had normal voice acoustically, perceptually and in relation to voice-related quality of life. One of these had vocal fold nodules unrelated to surgical history. Two other children had "near normal" vocal function, defined where most voice measurements fell within the normal range. CONCLUSIONS Normal or "near normal" voice is a possible outcome for children who have had this surgery. Where there is an ongoing complex medical condition, voice outcome may be poorer.
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Affiliation(s)
- W Cohen
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - D M Wynne
- Otolaryngology/Airway Surgery, Royal Hospital for Children, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - S Lloyd
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - R B Townsley
- NHS Ayrshire and Arran, Crosshouse Hospital, Kilmarnock, UK
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Kenny C. Assessment practices of Irish speech and language therapists in the evaluation of voice disorders. LOGOP PHONIATR VOCO 2017; 42:12-21. [PMID: 28049390 DOI: 10.3109/14015439.2015.1121291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
It is commonly accepted that the evaluation of voice disorders ought to include extensive perceptual, psychometric, and instrumental measurements. This serves to encapsulate the wide-reaching effects of such a disorder, from the physical impairment in voice production to the psycho-social impact of having a dysphonic voice. In spite of this, no international gold standard exists by which voice disorders should be evaluated, and so speech and language therapists (SLTs) are often tasked with developing an assessment battery for use in their own clinics. The purpose of this study is to determine whether the evaluation of voice disorders by Irish SLTs on a national scale is suitably comprehensive, with particular reference to the guidelines published by the European Laryngological Society. A total of 49 SLTs working in a variety of settings responded anonymously to an electronic survey regarding their assessment practices. Results indicate that therapists are comprehensive in non-instrumental evaluation of voice, but lack both access to and training in instrumental assessment techniques.
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Affiliation(s)
- Ciarán Kenny
- a Speech and Language Therapy Department , Tallaght Hospital , Dublin , Ireland
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Brockmann-Bauser M, Beyer D, Bohlender JE. Reliable acoustic measurements in children between 5;0 and 9;11 years: Gender, age, height and weight effects on fundamental frequency, jitter and shimmer in phonations without and with controlled voice SPL. Int J Pediatr Otorhinolaryngol 2015; 79:2035-42. [PMID: 26412461 DOI: 10.1016/j.ijporl.2015.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/02/2015] [Accepted: 09/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Current pediatric voice assessment guidelines include instrumental measurements of fundamental frequency (F0) and the perturbation indices jitter and shimmer. In children below 10 years, gender, age, height and weight effects on these parameters have been inconsistently characterized. Recent research in healthy children showed, that differences in habitual speaking voice intensity (voice SPL) under the usual assessment procedure significantly affect jitter and shimmer. These effects were reduced in phonations with controlled voice SPL >80dBA. Reliable measurement methods and description of physiologic influencing factors are essential to identify pathologic voices. OBJECTIVE This cross-sectional single cohort study investigates in children between 5;0 and 9;11 years how gender, age, height and weight affect voice F0, jitter and shimmer in phonations at individually "medium" voice intensity (modeling the usual clinical practice) and with controlled voice SPL >80dBA. SUBJECTS AND METHODS 68 vocally healthy children (39 f/29 m) aged 5;0-9;11 years provided 3 prolonged phonations of/a/at individually "medium" and controlled voice intensity at ">80dBA" (visual feedback, 10cm distance). F0 (Hz), jitter (%), shimmer (%) and voice SPL (dBA) were determined with PRAAT. Gender, age, height and weight effects without and with controlled voice SPL were assessed by descriptive statistics, Analysis of Variance and Linear Mixed Models. RESULTS F0 (Hz), jitter (%), shimmer (%) and voice SPL (dBA) were significantly different in medium voice compared to >80dBA (p<0.01). In medium phonations girls had a higher F0 than boys (girls: 276.7(50.7), boys: 261.5(33.7)), but with >80dBA this difference was only minimal (girls: 328.9(52.2), boys 327.9(51.2)). Mean jitter (0.27(0.10)) and shimmer (4.34(1.68)) were smaller and showed less spread (jitter: 0.5(0.26); shimmer: 9.47(3.47)) with >80dBA. Gender, age, height and weight had no significant effects on F0, jitter, shimmer and voice SPL in both phonation types (p-range=0.42-0.99). CONCLUSIONS Neither without nor with controlled voice SPL there were systematic gender, age, height or weight effects on voice F0, jitter and shimmer. Gender related F0 discrepancies were equalized in phonations with >80dBA. In children below 10 years gender related acoustic voice differences may be mainly linked to behavior, which should be considered in future works regarding physiologic voice development.
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Affiliation(s)
- Meike Brockmann-Bauser
- Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland.
| | - Denis Beyer
- Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland.
| | - Jörg Edgar Bohlender
- Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland.
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Cohen W, Wynne DM. Parent and Child Responses to the Pediatric Voice-Related Quality-of-Life Questionnaire. J Voice 2015; 29:299-303. [PMID: 25619466 DOI: 10.1016/j.jvoice.2014.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 08/11/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES When assessing pediatric dysphonia, there are different approaches that can be taken in gathering a subjective view of the impact voice difficulties have on a child. Most valid questionnaires require parent-proxy reporting, although it has become increasingly important to gather the views of children themselves. This study reports a pilot study of an adaptation to the Pediatric Voice-Related Quality-of-Life Questionnaire (PVRQoL). METHODS A total of 24 parent and child dyads were recruited from a tertiary pediatric voice clinic. Children were aged between 3 years and 8 months and 15 years and 3 months. Parents completed the existing PVRQoL questionnaire, whereas their children were given a child-adapted version. Follow-up completion of the child questionnaire was conducted after a 2-week period. RESULTS There was a good correlation between the two time periods when children completed the adapted PVRQoL and also between parent and child responses. Of particular interest, however, was the different ratings on individual items by parents and their children with parents tending to overestimate the extent to which their children may be emotionally affected by their voice disorder. CONCLUSIONS This study shows that children have much to tell about their own voice-related quality of life, so our conclusion is that they should also be self-assessed. The PVRQoL when adapted for use with children offers an additional insight that can be gathered in a relatively short timeframe and be considered with other assessments of vocal function.
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Affiliation(s)
- Wendy Cohen
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland.
| | - David McGregor Wynne
- Ear, Nose and Throat Department, Royal Hospital for Sick Children, Yorkhill Hospitals, Glasgow, Scotland
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Brockmann-Bauser M, Beyer D, Bohlender JE. Clinical relevance of speaking voice intensity effects on acoustic jitter and shimmer in children between 5;0 and 9;11 years. Int J Pediatr Otorhinolaryngol 2014; 78:2121-6. [PMID: 25441603 DOI: 10.1016/j.ijporl.2014.09.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 09/17/2014] [Accepted: 09/19/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Current voice assessment recommendations for dysphonic children comprise instrumental acoustic measurements of the perturbation parameters jitter and shimmer. In healthy adults and children changes in speaking voice sound pressure level (voice SPL) have significant confounding effects on both parameters. In adults these effects were considerably reduced in phonations with controlled voice SPL >80dBA (10cm distance). However, it is unclear if these findings apply to children and if children are able to control for their own voice intensity. OBJECTIVE This cross-sectional single cohort study investigates voice SPL effects on jitter and shimmer in children between 5;0 and 9;11 years phonating at individually "medium" (modeling "comfortable" loudness of the usual clinical protocol), "soft" and "loud" voice and a prescribed intensity level of ">80dBA" (10cm distance, with visual control). Further both their ability to phonate at a prescribed voice intensity level and the effect on SPL related confounding effects were studied. SUBJECTS AND METHODS A total of 68 healthy children (39 f/29m) aged 5;0 to 9;11 years were included. All phonated the vowel/a/for 5s, three times at four defined voice intensity levels (soft/medium/loud/>80dBA) each. Jitter (%), shimmer (%) and voice SPL (dBA) were determined using PRAAT. Voice intensity level effects were assessed by descriptive statistics, Analysis of Variance (ANOVA) and Linear Mixed Models (LMM). RESULTS There were significant differences for jitter and shimmer between all voice tasks (p<.01). Jitter and shimmer were lowest and showed the smallest spread in controlled phonations ">80dBA". 19 children below 7;0 years could not perform the voice tasks and were excluded from the study. CONCLUSIONS This practical study demonstrated a significant effect of voice loudness and task on jitter and shimmer in children. Since the observed confounding effects were large compared to treatment effects, jitter and shimmer may not be meaningful without adequate control of voice SPL. In phonations at ">80dBA" (10cm distance) voice SPL related effects were considerably reduced. However, this assessment protocol was suitable only for children above 7;0 years. Application of this task to future studies of dysphonic children may yield clinically valuable information.
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Affiliation(s)
- Meike Brockmann-Bauser
- Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
| | - Denis Beyer
- Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
| | - Jörg Edgar Bohlender
- Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
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Abstract
BACKGROUND Prevalence of paediatric voice disorders has been reported as 6-9% in children of school age. The appropriate diagnosis and management of paediatric voice disorders is essential for progress in education and psychosocial development. This paper presents a review of a UK tertiary paediatric voice clinic experience of referral patterns, diagnosis, management and socioeconomic variations. METHODS An audit of 195 consecutive appointments (154 were new patients) between October 2009 and September 2013 at a monthly paediatric voice clinic based at the Royal Hospital for Sick Children in Glasgow. RESULTS Of the 154 new patients, 86 were male and 68 were female. The age at first clinic appointment shows a trimodal peak at ages 5, 8 and 11 years. General practitioners were the main referral source (46%). Vocal cord nodules accounted for 52% of diagnoses with a male predominance. Clinic attendance was most common from Scottish Index of Multiple Deprivation groups 1 (most deprived) and 5 (least deprived). Analysis of the muscle tension dysphonia group indicates that they are more likely to come from social groups 4 or 5 (69%) and an older age group (mean age 10.4 years). DISCUSSION A dedicated paediatric voice clinic is the optimal method for assessment, diagnosis and management of these patients. Diagnosis is possible on the majority of the patients in clinic, with the predominant pathology being vocal cord nodules that receive speech and language therapy. Socioeconomic group appears to have an influence on paediatric voice particularly vocal cord nodules and muscle tension dysphonia.
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Affiliation(s)
- Ian Smillie
- Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Glasgow, UK
| | - Kirsy McManus
- Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Glasgow, UK
| | - Wendy Cohen
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Elizabeth Lawson
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - David MacGregor Wynne
- Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Glasgow, UK
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Cohen SM, Thomas S, Roy N, Kim J, Courey M. Frequency and factors associated with use of videolaryngostroboscopy in voice disorder assessment. Laryngoscope 2014; 124:2118-24. [PMID: 24659429 DOI: 10.1002/lary.24688] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/19/2014] [Accepted: 03/21/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Videolaryngostroboscopy (VLS) is considered an important diagnostic tool in the evaluation of patients with laryngeal/voice disorders. We evaluated the frequency of, diagnoses associated with, and factors related to VLS use in the evaluation of outpatients with laryngeal/voice disorders. STUDY DESIGN Retrospective analysis of a large, national administrative U.S. claims database. METHODS Patients with a laryngeal disorder based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes from January 1, 2004, to December 31, 2008, seen by an otolaryngologist were included. Patient age, gender, geographic region, laryngeal diagnosis, comorbid conditions, and whether laryngoscopy or VLS was performed during the outpatient otolaryngology visit were collected. RESULTS A total of 168,444 unique patients saw an otolaryngologist for 272,112 outpatient visits. Of those, 6.2% of outpatient otolaryngology visits had a VLS performed. Patient age was related to VLS use, with lower odds in the elderly (≥ 65 years of age) and those 0 to 17 years of age. Geographic variation was noted, with higher odds of VLS use in urban versus rural areas and greater odds in the Northeast versus the South. Laryngeal diagnosis was associated with VLS use with greatest odds for patients with multiple diagnoses, vocal fold paralysis, and paresis-followed by nonspecific dysphonia and benign vocal fold/laryngeal pathology and followed by acute and chronic laryngitis and laryngeal cancer. Patients with gastro-esophageal reflux (GER) had greater odds of VLS use than patients without GER. CONCLUSIONS VLS was used in 6.2% of outpatient otolaryngology outpatient visits; and its use was influenced by multiple factors.
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Affiliation(s)
- Seth M Cohen
- Duke Voice Care Center, Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, North Carolina
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Wynne D, Cohen W. The paediatric voice clinic: our experience of 81 children referred over 28 months. Clin Otolaryngol 2012; 37:318-20. [DOI: 10.1111/j.1749-4486.2012.02497.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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