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The objective of this study was to investigate the difference between vocal beauty and vocal attractiveness by determining whether perceptual ratings of vocal beauty and vocal attractiveness could be dissociated in a cohort of normal raters without a diagnosed sexual desire disorder. Twenty five gay male participants were presented with randomly-chosen samples from the Geneva Voices and Faces Database, and were asked to rate each sample in terms of beauty, attractiveness for a relationship of short duration, and attractiveness for a relationship of long duration. Responses were recorded on a visual analog scale (0–100) using a touch-screen interface. The number of stimulus repetitions and the participant response times were also recorded. Statistical analyses were done using two-way Analysis of Variance tests and independent student's t tests. P values were considered statistically significant at the P < 0.05 level. Participants rated male voices significantly higher in terms of beauty, attractiveness for a relationship of long duration, and attractiveness for a relationship of short duration (P < 0.001). Participants rated female voices significantly higher for beauty than for attractiveness for relationship of long or short duration (P < 0.001). There was no significant difference in response time between male and female voices when rating vocal beauty (P = 0.5608). Response time was significantly longer for male voices than for female voices when assessing attractiveness for a relationship of short duration (P < 0.002) but not for long duration (P < 0.3496). Attractive voices (male and female) were repeated more often, and male voices were repeated more often than female voices for both long-term and short-term attractiveness. There was no difference in stimulus replay behavior as a function of the beauty ratings. In a cohort of gay male raters without a diagnosed sexual desire disorder, vocal beauty and vocal attractiveness ratings of male and female voices are two related but distinct perceptual constructs that can, under certain circumstances, be dissociated. In general, gay men rated male voices equivalently for beauty, short-term, and long-term attractiveness, while the same ratings for female voices showed a significant difference between ratings of beauty and ratings of short-term and long-term attractiveness. [ABSTRACT FROM AUTHOR]

Office-based injection laryngoplasty (IL) has emerged as a useful procedure for otolaryngologists to correct glottic insufficiency while avoiding the costs and risks of general anesthesia. This is the first study focused on addressing the safety of bilateral IL for bilateral vocal fold (VF) atrophy. Patient records were reviewed from Emory University Hospital Midtown during the period of 2005 to 2017. Patients who underwent awake, bilateral transthyrohyoid, transoral, transcricothyroid, or transthyroid cartilage IL for bilateral VF atrophy were analyzed. All procedures, including repeat injections, were bilateral. Complication rate was used to evaluate safety. Patients with vocal cord paralysis, paresis, scar, and sulcus were excluded from the study. Total 174 procedures met inclusion criteria. There were four complications, yielding a complication rate of 2.3%. Complications included aborted cases for difficult anatomy or poor patient tolerance, injection material not resorbing, and a VF hematoma. No patients had any airway emergencies or required admission to the hospital or evaluation in the emergency room. This study illustrates a low complication rate for awake, bilateral IL in treating bilateral VF atrophy. This supports other studies that promote the safety of this procedure in the awake setting. Complications were associated with patient tolerance, unique anatomy, and in one case, anticoagulant medication. The low complication rate supports the conclusion that bilateral medialization IL is safe to perform in the office-based, awake setting. [ABSTRACT FROM AUTHOR]

Summary Objectives This study aimed to identify the changes in dosing of botulinum toxin-A for adductor spasmodic dysphonia (ADSD) over a prolonged period. Study Design This is a retrospective chart review. Methods One hundred thirteen subjects treated for ADSD from 2003 to 2013 were identified from a clinical database. Subject age, gender, and total injection dose amount were all recorded for all subjects who had at least 10 injections. Results Fifty-four subjects met criteria for inclusion. There were no age or gender differences in the starting dose for subjects. Dosing decreased significantly compared with the second dose (5.05 ± 1.623 Units), by the sixth dose (4.26 ± 1.698 Units), and continued through the 10th dose (4.08 ± 2.019 Units) ( P  < 0.005 for all). Conclusions Botulinum toxin-A dosing for ADSD decreases consistently over subsequent injections after the initial two dose titrations. [ABSTRACT FROM AUTHOR]

Summary Objectives/Hypothesis The objective of this study was to ascertain whether clinicians can reliably distinguish between spasmodic dysphonia (SD)/vocal tremor and other voice disorders by telephone, despite this modality's limited frequency response. Study Design Randomized, single-blinded, and prospective study. Methods Voice-disordered patients with (n = 22) and without (n = 17) SD and/or vocal tremor recorded standardized utterances via landline telephone. A laryngologist and two speech-language pathologists blinded to the diagnoses rated each recording as “yes” or “no” to “SD or tremor present?,” and if “yes” categorized into adductor, abductor, tremor only, or adductor with tremor subtypes. Twenty-one recordings were presented twice at random so intrarater reliability could be assessed. All ratings were compared with gold standard diagnosis by a second laryngologist who performed a full examination, including videostroboscopy, on each patient. Results For the comparison “SD or tremor” yes versus no, sensitivity, specificity, positive predictive value, and negative predictive value are 90%, 95%, 96%, and 89%, respectively. Interrater reliability (Cohen kappa) compared with the gold standard ranged from 0.70 to 0.93 (substantial to almost perfect agreement). Cronbach alpha among three raters was 0.90 for this comparison. Intrarater reliability (number matched/number inspected) was very high, ranging from 0.97 to 1.0. Comparing gold standard and telephone rating of SD/tremor subtypes, kappa ranged from 0.48 to 0.60 (moderate agreement). Cronbach alpha among three raters was 0.88 for this comparison. Intrarater reliability ranged from 0.84 to 0.97. Conclusions SD and tremor can be reliably distinguished from other voice disorders over the telephone. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Prolonged intubation may lead to medial arytenoid cartilage erosion and cricoarytenoid joint scarring with subsequent glottic insufficiency. This has been referred to as postintubation phonatory insufficiency (PIPI). Reports on treatment outcomes for this condition are lacking. Methods: A single institution retrospective chart review from January 2007 to present was preformed for PIPI diagnosis. Data were collected for intubation, symptoms, diagnosis, interventions, and outcomes. Results: Five patients with PIPI underwent treatment to improve voice. Patient 1 underwent thyroplasty with adduction arytenopexy. Patient 2 had a revision thyroplasty and subsequently two injections of the posterior defect and true vocal fold. Patient 3 underwent injection of the medial arytenoid defect. Patient 4 had injection augmentation of the anatomic deficiency and the ipsilateral true vocal fold. Patient 5 underwent thyroplasty with adduction arytenopexy. Limited to no phonatory improvement was achieved in any case. Conclusions: The management of patients with PIPI is difficult. Currently, no reliable means are available to restore cartilaginous defects in the respiratory glottis. Patients with this condition should be counseled as to the difficult nature of treatment. [Copyright &y& Elsevier]

Summary: It is a growing belief that cellular phone use may be hazardous to the voice. This study aims to assess voice production in different conversational scenarios to identify any changes in vocal production that may be specific to cellular phone use. Twenty healthy participants were randomized to seven conversational scenarios: quiet conditions face to face; quiet conditions over a landline; quiet conditions using a cellular phone (QCP); quiet conditions using cellular phone with earpiece (QCPE); noisy conditions face to face (NFF); noisy conditions using cellular phone (NCP); and noisy conditions using cellular phone with earpiece (NCPE). In each condition, participants performed spontaneous speech, a standardized reading passage, and sustained voicing. Sound pressure levels (dB SPL) and fundamental frequencies (F 0[Hz]) were measured. Subjects completed a 100-mm visual analog scale measuring vocal effort after each speaking scenario. Statistical analysis was performed using analysis of variance (ANOVA). There was a significant difference in dB SPL and F 0 between all quiet conditions relative to all noisy conditions (P <0.001). There was no difference in cellular phone use relative to any other conversational condition in mean dB SPL, respective of ambient noise. Vocal effort was rated greater for noisy conditions compared with quiet conditions. Cellular phone use does not lead to a significant change in voice production relative to other speaking conditions. Voice problems associated with cellular phone use may simply be a function of the increased amount of voice use and increased vocal loudness (Lombard effect) associated with speaking in noisy situations rather than a variable inherent to the phone. [Copyright &y& Elsevier]

Summary: To determine the effectiveness of Botox treatment for adductor spasmodic dysphonia (ADSD), the clinician and patient judge changes in voice symptoms and the effect on quality of life. Currently, there is no standard protocol for determining the effectiveness of Botox injections in treating ADSD. Therefore, clinicians use a variety of perceptual scales and patient-based self-assessments to determine patients'' impressions of severity and changes after treatments. The purpose of this study was to assess clinician-patient agreement of the effects of Botox on voice quality and quality of life in ADSD. Retrospective chart review of 199 randomly selected patients since 2004. Results indicated a weak correlation between the patient''s assessment of voice impairment (EIS) and patient''s quality of life impairment (Voice-Related Quality of Life [V-RQOL]) in the mild-moderate dysphonia severity group and the moderate-to-severe dysphonia group. There was a weak correlation between the patient''s assessment of voice impairment EIS and the clinician''s perceptual judgment of voice impairment (Consensus Auditory Perceptual Evaluation of Voice [CAPE-V]) only in the moderate to severe dysphonia group. There was a weak correlation between the patient''s quality of life impairment (V-RQOL) and the clinician''s perceptual judgment of voice impairment (CAPE-V) only in the severe to profound dysphonia group. The poor relationship among commonly used outcome measures leads us to question how best to assess the effectiveness of Botox in ADSD. Clinicians are required to document treatment outcomes, making it important to use scales that are valid, reliable, and sensitive to change. Future research directions include examining relationships between measures both before and after Botox injections, examining the specific factors that determine quality of life changes, and further research on specific parameters of the CAPE-V as well as comparing perceptual and quality of life scales with acoustic and aerodynamic measures in this population would be beneficial in the move toward more effective ways of measuring change. [Copyright &y& Elsevier]

Summary: Contemporary commercial music (CCM) performers rely heavily on their voice, yet may not be aware of the importance of proactive voice care. This investigation intends to identify perceptions and barriers to seeking voice care among CCM artists. This cross-sectional observational study used a 10-item Likert-based response questionnaire to assess current perceptions regarding voice care in a population of randomly selected participants of professional CCM conference. Subjects (n=78) were queried regarding their likelihood to seek medical care for minor medical problems and specifically problems with their voice. Additional questions investigated anxiety about seeking voice care from a physician specialist, speech language pathologist, or voice coach; apprehension regarding findings of laryngeal examination, laryngeal imaging procedures; and the effect of medical insurance on the likelihood of seeking medical care. Eighty-two percent of subjects reported that their voice was a critical part of their profession; 41% stated that they were not likely to seek medical care for problems with their voice; and only 19% were reluctant to seek care for general medical problems (P <0.001). Anxiety about seeking a clinician regarding their voice was not a deterrent. Most importantly, 39% of subjects do not seek medical attention for their voice problems due to medical insurance coverage. The CCM artists are less likely to seek medical care for voice problems compared with general medical problems. Availability of medical insurance may be a factor. Availability of affordable voice care and education about the importance of voice care is needed in this population of vocal performers. [Copyright &y& Elsevier]

Summary: Hemorrhagic polyps are the most common benign lesions surgically removed from the vocal folds. Although this modality does offer satisfactory results in most of the cases, there is a subset of polyps that seems to resolve with conservative therapy. This study was performed to examine this subset of polyps. Thirty-four consecutive subjects diagnosed with hemorrhagic polyps of the true vocal fold were retrospectively reviewed to determine the incidence of spontaneous resolution of the lesions with nonsurgical therapy. Sixteen subjects began conservative therapy, consisting of voice therapy and proper vocal hygiene, often while awaiting an optimal personal time for surgical intervention. Of these subjects, nine (56.3%) experienced a resolution of their lesion and symptoms without undergoing surgical therapy. Surgical removal of hemorrhagic polyps is often considered the standard of treatment for these benign lesions. However, these observations support a regimen of voice therapy and observation in select cases. [Copyright &y& Elsevier]

Summary Objective To determine the value of narrow band imaging (NBI) in visualizing laryngeal papillomatosis (LP), specifically in the awake patient. Study Design Retrospective chart review followed by trial of intervention. Methods Ten patients treated for LP in the awake setting were included in the study. Still shots of the same diseased region of the larynx were taken from each procedure, one under white light and one under NBI. The 10 pairs of pictures were then sent to multiple fellowship-trained laryngologists, along with a questionnaire designed to evaluate visualization with NBI versus white light. Results Raters concluded that NBI improved visualization of diseased tissue 90.0% of the time and showed areas of diseased tissue unappreciated by halogen light in 46.7% of the procedures. They believed that NBI better defined the borders of diseased tissue in 76.7% of the photo sets, and that in 70.0% of the sets, NBI was the better visualization technique in general. However, it was found that 16.7% of the time it was more difficult to visualize areas of diseased tissue with NBI. Conclusion This study suggests that NBI may provide some benefit in the visualization and treatment of LP in the awake patient. Further work should be done to evaluate its utility in pathology of the larynx. [ABSTRACT FROM AUTHOR]

Summary: Introduction: There is evidence supporting an association between depression and anxiety in patients with chronic disease. Spasmodic dysphonia (SD) is a chronic, incurable, and disabling voice disorder. Reported rates of depression and anxiety in SD range from 7.1% to 72%, with a maximum number of 18 patients. The goal of this study was to define the coprevalence of depression and anxiety with SD. Materials and Methods: A single-institution case-control study was performed from May to July 2010. Consecutive patients with SD and benign voice disorders were enrolled prospectively. On enrollment, patients were asked to fill out a questionnaire that reviewed the duration of the voice disorder and personal history of anxiety and depression, including current and lifetime diagnosis. Results: One hundred forty-six controls with benign voice disorders and 128 patients with SD were enrolled. Patients with SD were no more likely to be diagnosed with depression or anxiety than those of the control group (odds ratio [OR]=0.985, 95% confidence interval [CI]=0.59–1.63; and OR=1.314; 95% CI=0.75–2.3, respectively). Additionally, duration of disease was a risk factor for depression in both the SD group and the control group, and the association was not significantly different between groups. Conclusion: Patients with SD were no more likely to have depression or anxiety than those with other voice disorders. It is important for otolaryngologists to be aware of the increased rates of depression in patients diagnosed with chronic diseases, including voice disorders, and to refer to a psychiatrist when appropriate. [Copyright &y& Elsevier]