Voice quality in patients with temporomandibular disorders

OBJECTIVES

This study assessed the voice quality in TMD patients compared to healthy individuals using the Dysphonia Severity Index (DSI) and evaluated the correlation between the DSI and TMD severity.

METHODS

Patients who had TMD with Fonseca's anamnestic index were subjected to an examination based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). A sample of 35 patients with TMD and 36 healthy subjects were included in the study.

RESULTS

There were significant differences in the DSI score and its components between healthy subjects and TMD patients (p < .001). A significant correlation was found between the DSI scores and TMD severity (Spearman's rho: -0.90, p < .001).

CONCLUSION

Patients with TMD demonstrated lower DSI scores and lower voice quality compared to healthy subjects.

Individualized Dynamic Prediction Model for Patient-Reported Voice Quality in Early-Stage Glottic Cancer

OBJECTIVE

Early-stage glottic cancer (ESGC) is a malignancy of the head and neck. Besides disease control, preservation and improvement of voice quality are essential. To enable expectation management and well-informed decision-making, patients should be sufficiently counseled with individualized information on expected voice quality. This study aims to develop an individualized dynamic prediction model for patient-reported voice quality. This model should be able to provide individualized predictions at every time point from intake to the end of follow-up.

STUDY DESIGN

Longitudinal cohort study.

SETTING

Tertiary cancer center.

METHODS

Patients treated for ESGC were included in this study (N = 294). The Voice Handicap Index was obtained prospectively. The framework of mixed and joint models was used. The prognostic factors used are treatment, age, gender, comorbidity, performance score, smoking, T-stage, and involvement of the anterior commissure. The overall performance of these models was assessed during an internal cross-validation procedure and presentation of absolute errors using box plots.

RESULTS

The mean age in this cohort was 67 years and 81.3% are male. Patients were treated with transoral CO2 laser microsurgery (57.8%), single vocal cord irradiation up to (24.5), or local radiotherapy (17.5%). The mean follow-up was 43.4 months (SD 21.5). Including more measurements during prediction improves predictive performance. Including more clinical and demographic variables did not provide better predictions. Little differences in predictive performance between models were found.

CONCLUSION

We developed a dynamic individualized prediction model for patient-reported voice quality. This model has the potential to empower patients and professionals in making well-informed decisions and enables tailor-made counseling.

Clinical Utility and Validation of the Acoustic Voice Quality and Acoustic Breathiness Indexes for Voice Disorder Assessment in English Speakers

BACKGROUND

While several acoustic voice metrics are available for clinical voice assessment, there remains a significant need for reliable and ecologically valid tools. The Acoustic Voice Quality Index version 03.01 (AVQI-3) and Acoustic Breathiness Index (ABI) hold potential due to their comprehensive assessment approach, incorporating diverse voice aspects. However, these tools still need to be validated in English-speaking populations.

METHODS

This study assessed the discriminatory accuracy and validity of AVQI-3 and ABI in 197 participants, including 148 with voice disorders. Voice samples were collected, followed by AVQI-3 and ABI calculations. Additionally, auditory-perceptual assessments were conducted by a panel of speech-language pathologists.

RESULTS

AVQI-3 and ABI effectively identified disordered voice quality, evidenced by high accuracy (AUCs: 0.84, 0.89), sensitivity, and specificity (thresholds: AVQI-3 = 1.17, ABI = 2.35). Strong positive correlations were observed with subjective voice quality assessments (rs = 0.72, rs = 0.77, p < 0.001).

CONCLUSIONS

The study highlights AVQI-3 and ABI as promising instruments for clinically assessing voice disorders in U.S. English speakers, underscoring their utility in clinical practice and voice research.

[Preliminary analysis of the effect of individualized voice therapy on pediatric voice disorders]

Objective:To determine the effectiveness of individualized voice therapy in persistent pediatric voice disorders. Methods:Thirty-eight children who were admitted to the Department of Pediatric Otolaryngology Shenzhen Hospital, Southern Medical University due to persistent voice disorder from November 2021 to October 2022 were included. All children were evaluated by dynamic laryngoscopy before voice therapy. Two voice doctors performed GRBAS score and acoustic analysis on the children's voice samples to obtain the relevant parameters including F0, Jitter, Shimmer, and MPT; All children were given personalized voice therapy for 8 weeks. Results:Among 38 children with voice disorders, 75.8%（29 cases） were diagnosed with vocal nodules, 20.6%（8 cases） were vocal polyps, and 3.4%（1 case） were vocal cysts. And in all children. And 51.7%（20 cases） had the sign of supraglottic extrusion under dynamic laryngoscopy. GRBAS scores decreased from 1.93 ± 0.62, 1.82 ± 0.55, 0.98 ± 0.54, 0.65 ± 0.48, 1.05 ± 0.52 to 0.62 ± 0.60, 0.58 ± 0.53, 0.32 ± 0.40, 0.22 ± 0.36, 0.37 ± 0.36. F0, Jitter, Shimmer decreased from（243.11±39.73） Hz, （0.85±0.99）%, （9.96±3.78）% to（225.43±43.20） Hz, （0.33±0.57）%, （7.72±4.32）%, respectively MPT was prolonged from（5.82±2.30） s to（7.87±3.21） s after treatment. All parameters changes had statistical significance. Conclusion:Voice therapy can solve children's voice problems, improve their voice quality and effectively treat children's voice disorders.

Longitudinal Patient-Reported Voice Quality in Early-Stage Glottic Cancer

OBJECTIVE

Patient-reported voice quality is an important outcome during counseling in early-stage glottic cancer. However, there is a paucity of adequate longitudinal studies concerning voice outcomes. This study aimed to investigate longitudinal trajectories for patient-reported voice quality and associated risk factors for treatment modalities such as transoral CO₂ laser microsurgery, single vocal cord irradiation, and local radiotherapy.

STUDY DESIGN

A longitudinal observational cohort study.

SETTING

Tertiary cancer center.

METHODS

Patients treated for Tcis-T1b, N0M0 glottic cancer were included in this study (N = 294). The Voice Handicap Index was obtained at baseline and during follow-up (N = 1944). Mixed-effects models were used for investigating the different trajectories for patient-reported voice quality.

RESULTS

The mean follow-up duration was 43.4 (SD 21.5) months. Patients received transoral CO₂ laser microsurgery (57.8%), single vocal cord irradiation (24.5%), or local radiotherapy (17.5%). A steeper improvement during the first year after treatment for single vocal cord irradiation (-15.7) and local radiotherapy (-12.4) was seen, compared with a more stable trajectory for laser surgery (-6.1). All treatment modalities showed equivalent outcomes during long-term follow-up. Associated risk factors for different longitudinal trajectories were age, tumor stage, and comorbidity.

CONCLUSION

Longitudinal patient-reported voice quality after treatment for early-stage glottic cancer is heterogeneous and nonlinear. Most improvement is seen during the first year of follow-up and differs between treatment modalities. No clinically significant differences in long-term trajectories were found. Insight into longitudinal trajectories can enhance individual patient counseling and provide the foundation for an individualized dynamic prediction model.

Effect of Ventral Intermediate Nucleus Deep Brain Stimulation on Vocal Tremor in Essential Tremor

Background

There is a paucity of literature examining the effect of Ventral Intermediate Nucleus (VIM) deep brain stimulation (DBS) on voice in patients with vocal tremor (VT).

Objective

Investigate the effect of unilateral and bilateral VIM DBS on voice in patients with Essential Tremor (ET) and VT.

Methods

All patients receiving VIM DBS surgery underwent voice evaluation pre- and six-months post-operatively. We collected patient-reported quality-of-life outcome measures and acoustic voice measures of sustained phonation and connected speech. Acoustic measures specific to VT included amplitude tremor intensity index (ATRI), frequency tremor intensity index (FTRI), rate and extent of F0 modulation, and rate and extent of intensity modulation.

Results

Five patients, age 72.8 ± 2.6 years, 4 female, 1 male with mean disease duration of 29 ± 26.2 years met the inclusion criteria and were included. Two subjects had bilateral procedure and three had unilateral. We observed significant improvements in measures of vocal tremor including ATRI, FTRI, rate of F0 modulation, rate of intensity modulation, and extent of intensity modulation, as well as patient reported voice-related quality of life measured by VHI-10. Bilateral VIM DBS cases showed greater improvement in VT than unilateral cases.

Conclusion

Both unilateral and bilateral VIM DBS resulted in significant improvement of VT, with more improvement demonstrated in patients having bilateral as compared to unilateral VIM DBS. In addition, patients also reported significant improvements in voice-related quality of life. If larger studies confirm our results, VIM DBS has the potential to become a treatment specifically for disabling VT.

Recurrent Respiratory Papillomatosis: Quality of Life Data from an International Patient Registry

OBJECTIVES

Quality of life studies in recurrent respiratory papillomatosis (RRP) have traditionally relied upon clinician-designed survey instruments. This study's objective is to report quality of life outcomes from a patient-designed questionnaire.

METHODS

Patients who provided health information and completed a quality of life questionnaire were identified from the RRPF-CoRDS patient registry. Demographic, clinical, and quality of life measures were collected. Means and standard deviations were calculated for continuous data, and frequencies and percentages were calculated for categorical data. Outcomes for patients with juvenile-onset RRP (JORRP) and adult-onset RRP (AORRP) were compared using Student's t-tests for continuous data and χ² analyses for categorical data.

RESULTS

Seventy-three patients with RRP were identified (JORRP: 32; AORRP: 41). Common clinical symptoms included raspy voice (78.1%) and dyspnea (61.6%). The majority (97.3%) of patients reported feeling debilitated by their diagnosis, and 94.5% of patients reported avoiding participation in career and/or social activities due to their voice quality. Due to their RRP, 65.7% reported missing at least five work days each month. Social anxiety was reported in 79.5% of patients, though only 28.8% of the cohort reported utilizing mental health services. The median (range) lifetime number of surgeries received was 20 (1 - 3). Most patients (57.5%) reported paying at least 5% of their annual income towards RRP-related medical care.

CONCLUSION

RRP presents high mental and fiscal burden. Our results highlight data from a quality of life questionnaire designed by RRP patients, and may help to elucidate potential disconnects between what clinicians and RRP patients consider most impactful.

LEVEL OF EVIDENCE

4 Laryngoscope, 2022.

Does neuromonitoring affect voice quality in patients subjected to a complete thyroidectomy ?

Voice dysfunction is the most common complication of thyroid surgery. The use of intraoperative neuromonitoring (IONM) is to protect the recurrent laryngeal nerves, the damage of which causes voice dysfunction. The aim of the study was to evaluate voice quality in patients who underwent complete thyroidectomy operated on with the application of IONM as well as a group of patients operated on with only macroscopic nerve visualization. In the analysis, clinical voice assessment was performed with particular focus on voice efficiency using the Voice Handicap Index (VHI), Vocal Tract Discomfort (VTD) and GRBAS scale. The study group consisted of 205 patients operated on with IONM. The control group consisted of 162 patients subjected to surgery only with macroscopic visualization of recurrent laryngeal nerves, without IONM. During the follow-up period from 2 to 10 years after surgery, checkups were performed. Each patient who came for a checkup was subjected to perceptual voice evaluation with the use of the GRBAS scale, indirect laryngoscopy procedure and voice selfevaluation with two questionnaires (VHI and VTD). The frequency of vocal fold palsy did not differ significantly statistically in the study group and the control group. Both in the study group and in the control group, patients with vocal fold paralysis had statistically significantly higher results in the VHI and VTD questionnaires as well as in the GRBAS study. Patients with recurrent laryngeal nerve injury show significant differences in the scope of voice handicap, both in the voice quality assessment with the use of the GRBAS scale, and self-evaluation questionnaires: VHI and VTD. All voice disorders evaluated with self-assessment are medium voice disability.

Acoustic Identification of the Voicing Boundary during Intervocalic Offsets and Onsets based on Vocal Fold Vibratory Measures

Methods for automating relative fundamental frequency (RFF)-an acoustic estimate of laryngeal tension-rely on manual identification of voiced/unvoiced boundaries from acoustic signals. This study determined the effect of incorporating features derived from vocal fold vibratory transitions for acoustic boundary detection. Simultaneous microphone and flexible nasendoscope recordings were collected from adults with typical voices (N=69) and with voices characterized by excessive laryngeal tension (N=53) producing voiced-unvoiced-voiced utterances. Acoustic features that coincided with vocal fold vibratory transitions were identified and incorporated into an automated RFF algorithm ("aRFF-APH"). Voiced/unvoiced boundary detection accuracy was compared between the aRFF-APH algorithm, a recently published version of the automated RFF algorithm ("aRFF-AP"), and gold-standard, manual RFF estimation. Chi-square tests were performed to characterize differences in boundary cycle identification accuracy among the three RFF estimation methods. Voiced/unvoiced boundary detection accuracy significantly differed by RFF estimation method for voicing offsets and onsets. Of 7721 productions, 76.0% of boundaries were accurately identified via the aRFF-APH algorithm, compared to 70.3% with the aRFF-AP algorithm and 20.4% with manual estimation. Incorporating acoustic features that corresponded with voiced/unvoiced boundaries led to improvements in boundary detection accuracy that surpassed the gold-standard method for calculating RFF.

Imitating dysphonic voice: a suitable technique to create speech stimuli for spoken language processing tasks?

PURPOSE

The aim of this study was to assess the suitability of imitated dysphonic voice samples for their application in listening tasks investigating the impact of speakers' voice quality on spoken language processing.

METHODS

A female voice expert recorded speech samples (sustained vowels and connected speech) in her normal voice and while imitating a dysphonic voice. Voice characteristics, authenticity, and consistency of the two voice qualities were evaluated by means of acoustic measurements (Acoustic Voice Quality Index [AVQI], jitter, shimmer, harmonics-to-noise ratio [HNR]) and perceptual evaluation (GRBAS scale, consistency, and authenticity rated by five speech-language pathologists).

RESULTS

Based on acoustic and perceptual assessments, the degree of voice impairment for the imitated dysphonic voice was found to be moderate to severe. Roughness and asthenia were the predominant perceptual features. The perceptual rating indicated a high consistency and acceptable authenticity of the imitated dysphonic voice.

CONCLUSIONS

Results suggest that an imitation of dysphonic voice quality may resemble the voice characteristics typically found in dysphonic patients.

IMPLICATIONS

The voice samples validated here shall be applied in future listening tasks and may promote our understanding of how dysphonic speech is processed.

Community listeners' perceptions of voice function post-radiotherapy for laryngeal cancer

PURPOSE

Successful communication is influenced by communication partners, the community and communication environment. This study examines community members' perceptions of voice function following laryngeal cancer management compared to ratings by clinicians and patients.

METHOD

Sixty-six (Tis-T3) laryngeal cancer patients post-radiotherapy, 10 community members and three speech-language pathologists (clinicians) were recruited. Patients completed voice recordings and self-rated voice quality and acceptability, six months post-radiotherapy. Community members and clinicians rated patient voice recordings using (a) Voice Quality/Acceptability questionnaire, (b) Communicative Suitability Scale (voice function in different vocally demanding environments) and (c) a gender perception question.

RESULT

Ratings for voice quality differed significantly (p < 0.001) between community members and clinicians and approached significance (p= 0.08) between community members and patients. No significant difference for voice acceptability was noted between community members and clinicians/patients. Community members rated the irradiated voice significantly different (p ≤ 0.02) across communication environments with more vocally demanding environments being rated as "Barely Sufficient". Incorrect sex identification (gender perception) occurred with 25% of females.

CONCLUSION

Community communication partners identify functional voice impairments post-radiotherapy, particularly across more vocally demanding environments and for female speakers. Implications for voice rehabilitation including appropriate patient selection is highlighted.

Preliminary study of Novafon local vibration voice therapy for dysphonia treatment

Background: The objective of this study was to explore the effectiveness of a five-week Novafon local vibration voice therapy (NLVVT) program for dysphonia treatment.Methods: Eleven dysphonic subjects participated in this specific program.Results: Treatment effects were assessed during (i.e. weekly) and after NLVVT. Large and significant treatment effects were revealed in acoustics (i.e. spectrography), and multiparametric indices (i.e. Acoustic Voice Quality Index (AVQI), and Dysphonia Severity Index (DSI)) during and after NLVVT (all p values < .01). Additionally, self-evaluation (i.e. Voice Handicap Index (VHI)) showed a significant improvement after NLVVT (p < .01). Gender independent voice range profile parameters (i.e. acoustics) only showed significant effects after treatment (p ≤ .01), but not during the treatment. Finally, aerodynamic measurement (i.e. phonation quotient) showed low treatment effects after NLVVT, which were not significant (p > .05).Conclusions: The preliminary results showed that NLVVT might be successful in voice treatment. Large treatment effects might be expected in AVQI, DSI, spectrography and VHI after using NLVVT. Other voice characteristics showed smaller treatment effects (i.e. voice range profile parameters) or no meaningful treatment effects (i.e. phonation quotient).

Validation of an Algorithm for Semi-automated Estimation of Voice Relative Fundamental Frequency

OBJECTIVES

Relative fundamental frequency (RFF) has shown promise as an acoustic measure of voice, but the subjective and time-consuming nature of its manual estimation has made clinical translation infeasible. Here, a faster, more objective algorithm for RFF estimation is evaluated in a large and diverse sample of individuals with and without voice disorders.

METHODS

Acoustic recordings were collected from 154 individuals with voice disorders and 36 age- and sex-matched controls with typical voices. These recordings were split into training and 2 testing sets. Using an algorithm tuned to the training set, semi-automated RFF estimates in the testing sets were compared to manual RFF estimates derived from 3 trained technicians.

RESULTS

The semi-automated RFF estimations were highly correlated ( r = 0.82-0.91) with the manual RFF estimates.

CONCLUSIONS

Fast and more objective estimation of RFF makes large-scale RFF analysis feasible. This algorithm allows for future work to optimize RFF measures and expand their potential for clinical voice assessment.

[Study on development of rehabilitation therapy for voice problems of hearing impaired children]

The production of voice is related to the coordinated operation of respiratory system,phonation system and resonance system.Sonic wave which is produced by the vibration of vocal fold goes through the resonating cavities to bring the voice out.Hearing and voice are two kinds of functions which are very related.Hearing impaired children have a very strong tendency to be in communication with people by improving the volume of their voice(Lombard's effect).To summarize the reasons,the methods of assessment and therapy of voice problems of hearing impaired children.Review 32 literature related to voice problems of hearing impaired children in the near past 12 years.Hearing intervention and improper way of phonation have great effect on the voice health of hearing impaired children.There are few studies on the therapy efficiency and auditory feedback training of voice problems of hearing impaired children,which are expecting our further study.

Voice outcomes following reoperative central neck dissection for recurrent/persistent thyroid cancer

OBJECTIVES/HYPOTHESIS

We aimed to assess voice outcomes following reoperative central neck dissection (RCND) to characterize postoperative voice difficulties experienced, determine the natural progression of vocal recovery, and identify risk factors for the development of voice disorders postoperatively.

STUDY DESIGN

Prospective cohort study.

METHODS

Consecutive patients with recurrent/persistent thyroid cancer who were deemed appropriate candidates for RCND were eligible for participation in this study. A battery of voice evaluation measures was administered both preoperatively and 2 to 4 weeks postoperatively.

RESULTS

Twenty consecutive patients were included. Postoperatively, six (30%) new incidents of vocal fold motion impairment (VFMI) were identified, with two (10%) being due to intentional recurrent laryngeal nerve (RLN) transection. On 1-year follow-up, two patients had full restoration of vocal fold mobility and four had persistent VFMI. No preoperative voice/laryngeal exam factors were predictive of postoperative VFMI. Clinically relevant change in postoperative Voice Handicap Index score was absent in all patients without VFMI and present in five of six patients with VFMI (P=.0004). Patients with VFMI had significantly poorer overall dysphonia grade, less glottic closure, and elevated jitter in contrast to those individuals without VFMI. Patients with malignant tissue in the remnant thyroid were four times more likely to develop VFMI than those with central neck lymph node metastases alone (P=.06).

CONCLUSION

Patients undergoing RCND are at risk for postoperative VFMI, even when the RLN is anatomically preserved, with subsequent impact on quality of life. Presence of malignant disease in the remnant thyroid appears to be the best predictor for postoperative VFMI.

LEVEL OF EVIDENCE

2b.

Phase asymmetries in normophonic speakers: visual judgments and objective findings

PURPOSE

To ascertain the amount of phase asymmetry of the vocal fold vibration in normophonic speakers via visualization techniques and compare findings for habitual and pressed phonations.

METHOD

Fifty-two normophonic speakers underwent stroboscopy and high-speed videoendoscopy (HSV). The HSV images were further processed into 4 visual displays: HSV playbacks, digital kymography (DKG) playbacks, mucosal wave kymography playbacks, and static kymographic images of the medial line from the DKG playback. Two types of phase asymmetries, left-right and anterior-posterior, were rated on a scale from 1 to 5. Objective measures of left-right phase asymmetry were obtained.

RESULTS

The majority of normophonic speakers (81%) were noted to display anterior-posterior asymmetry; however, 66% of those were characterized as mild. Seventy-nine percent of participants were noted to display left-right asymmetry; however, 72% of those were mild. A moderate relationship between the objective measures and subjective ratings was found.

CONCLUSIONS

Most normophonic speakers exhibit mild left-right and anterior-posterior asymmetries for both habitual and pressed phonations. Asymmetries were noted more often during habitual than pressed phonations, and when visualized by HSV and kymography than stroboscopy. Differences between objective measures and visual judgments support the need to quantify vocal fold vibratory features.