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An urgent task of otorhinolaryngology (phoniatry) is the diagnosis and treatment of disorders of voice function in voice professionals or persons of voice-speech professions. An undiagnosed laryngeal disease worsens the quality of life of patients, creates difficulties in communication and can even lead to professional unfitness, because the patient does not withstand the necessary vocal load. The leading role in the modern diagnosis of laryngeal diseases belongs to endoscopic research methods video endoscopy and video endostroboscopy. All disorders of voice function are classified as functional and organic. Recent studies have shown that from 30.5 to 40% of voice professionals who have applied for phoniatric care suffer from functional disorders. Functional changes are understood to mean changes in which laryngoscopic examination does not always reveal any visible pathology. But with the help of special research methods, such as stroboscopy (videostroboscopy), spectral analysis of the voice, pathognomonic changes can be determined, and the patient presents characteristic complaints. More often than others, hypotonic and hypo-hypertonic dysphonia are diagnosed. Organic laryngeal diseases are characteristic of 69.5% of patients with dysphonia. They are represented by various nosological forms. Certain difficulties arise in the diagnosis of professional laryngitis and vascular pathology of the larynx. The lecture presents pathognomonic clinical changes of the larynx in voice professionals, knowledge of which is necessary for practical doctors to make a diagnosis.

Objective: Functional dysphonia can impair the language expression ability and adversely affect the career development of some patients. Therefore, an active exploration of effective treatment options is imperative. This study investigated the effect of Akson therapy on acoustic parameters in patients with functional dysphonia. Materials and Methods: In this retrospective analysis, 79 patients with functional dysphonia who received conventional voice correction training from June 2020 to June 2021 were included in the reference group (RG). Our hospital has implemented Akson therapy since July 2021. Correspondingly, 72 patients with functional dysphonia who underwent Akson therapy from July 2021 to July 2022 were enrolled in the observation group (OG). The acoustic parameters such as fundamental frequency (F0), jitter, shimmer, and normalized noise energy (NNE); the aerodynamic parameters including maximum phonation time (MPT), mean airflow rate (MFR), and Voice Handicap Index-10 (VHI-10) score; and the Grade, Roughness, Breathiness, Asthenia, and Strain scale (GRBAS) score were measured before and after treatment and compared between the two groups. Results: The F0, jitter, shimmer, NNE, MPT, and MFR values as well as the VHI-10 score and the grade (G), roughness (R), and breathiness (B) scores on the GRBAS did not significantly differ between the two groups before treatment (P > 0.05). However, significantly lower F0, jitter, shimmer, NNE, and MFR values and higher MPT levels were found in the OG compared to the RG after treatment (P < 0.001). Furthermore, the VHI-10 score and the G, R, and B scores were significantly lower in the OG than in the RG after treatment (P<0.001), whereas the asthenia (A) and strain (S) scores remained at 0 before and after treatment. Conclusion: Akson therapy can improve the acoustic parameters of patients with functional dysphonia to a certain extent, indicating its potential application value. [ABSTRACT FROM AUTHOR]

Studies show that functional dysphonia among teachers can lead to emotional stress, high rates of sickness and negative effects on their students' learning success. The study's aim was to examine the effects of using a silicone tube on both subjective and receptive voice assessment. The study had a pre-/post-test design and involved 36 primary school teachers. They performed daily vocal exercises with a flexible silicone tube for 6 minutes. The participants filled out the Voice Handicap Index (VHI) for subjective voice assessment and the RBH scale was used for receptive voice assessment. The results showed a significant improvement in the VHI results and the number of handicaps sank by 25 %. The scale value of the RBH scale improved in general. Based on the results, the exercises are suitable for daily use and could assist in preventing functional dysphonia among teachers. Further studies should look at objective acoustic changes in the voice and consider long-term effects. [ABSTRACT FROM AUTHOR]

Objective. This study aimed to evaluate the efficacy and safety of lysozyme-based oral antiseptic in the therapy of non-infectious sore throat in teachers. Materials and Methods. A non-interventional, prospective, pilot study was conducted with two examinations. The first was performed as part of a general medical examination. If a non-infectious sore throat was confirmed by clinical checkup and all other inclusion and non-exclusion criteria confirmed, patients were offered to be enrolled in the study. After signing the informed consent form, patients were advised to use lysozyme-based lozenges, six times a day, for a period of five days. A telephone call follow-up examination was performed within 24 hours from the therapy completion. Results. This was a pilot study involving 25 adult patients of both genders. Lysozyme-based lozenges showed positive effects in relieving the symptoms of non-infectious sore throat in teachers. At the same time, the lozenges showed excellent tolerability, and no side effects were reported during the study. 92% of patients confirmed they would take the same medicine again due to the same problem. Conclusion. The results of this "proof-of-concept" study indicated that lysozyme-based antiseptic could be effective and safe in the treatment of non-infectious sore throat in teachers and should be further evaluated as treatment option in this condition. [ABSTRACT FROM AUTHOR]

Practitioners in the field of voice are often faced with patients who are 'dysphonic', but who do not have identifiable abnormalities of the vocal tract structures or any neural or hormonal alteration affecting the phonatory function. For lack of better nomenclature describing the origin of the disorder, this group of patients has been labeled as having 'non-organic' or 'functional' dysphonia. 'Non-organic' only states what the dysphonia is not, and 'functional' does not have any etiological implication. Hence 'functional disorder' as a determination of the origin is at best vague, imprecise and often misleading. In truth, the terms "functional" and 'non-organic' are by now so muddled and confused in everyday clinical usage and parlance that it is unclear what they mean in any given clinical setting or for any particular clinical case. Thus, the UEP Voice Committee (VC) has come to the conclusion that it is best to adopt a new term that is clearly defined, universally agreed to, and indicative of a different and more useful perspective. We have reviewed the literature relating to terminology of these phonatory disorders. We now propose replacement of the phrase 'functional dysphonia' with 'malregulative dysphonia', since the indication of faulty regulation represents an etiological connotation. We also propose a restructuring of the etiological terminology of phonation disorders. We believe this to be a biologically clearer framework for the labeling of 'non-organic' phonatory disorders, and hope that its routine use will allow for more clarity of presentation and discussion in the future. [ABSTRACT FROM AUTHOR]

Functional dysphonia (FD) refers to an abnormality in voice quality in the absence of an identifiable lesion. In this paper, we propose an approach based on the tunable Q wavelet transform (TQWT) to automatically classify two types of FD (hyperfunctional dysphonia and hypofunctional dysphonia) from a healthy voice using the acoustic voice signal. Using TQWT, voice signals were decomposed into sub-bands and the entropy values extracted from the sub-bands were utilized as features for the studied 3-class classification problem. In addition, the Mel-frequency cepstral coefficient (MFCC) and glottal features were extracted from the acoustic voice signal and the estimated glottal source signal, respectively. A convolutional neural network (CNN) classifier was trained separately for the TQWT, MFCC and glottal features. Experiments were conducted using voice signals of 57 healthy speakers and 113 FD patients (72 with hyperfunctional dysphonia and 41 with hypofunctional dysphonia) taken from the VOICED database. These experiments revealed that the TQWT features yielded an absolute improvement of 5.5% and 4.5% compared to the baseline MFCC features and glottal features, respectively. Furthermore, the highest classification accuracy (67.91%) was obtained using the combination of the TQWT and glottal features, which indicates the complementary nature of these features. • Multi-class classification of functional dysphonia using Tunable Q wavelet transform (TQWT)- based features is studied. • The Synthetic Minority Over-Sampling Technique (SMOTE) is used to balance the training data. • TQWT-based features are combined with glottal features to enhance the performance. • The results show that the combination of TQWT-based and glottal features provided best performance in the classification of functional dysphonia. [ABSTRACT FROM AUTHOR]

To explore the characteristics of functional dysphonia (FD) using multimodal methods. A total of 47 FD patients and a group of 22 normal controls were enrolled. Subjective auditory-perceptual assessment of the voice, Voice Handicap Index (VHI) 30, acoustic analysis, psychological scales assessment, surface electromyography (sEMG), nasal airflow and thoracoabdominal studies were performed. FD was mostly triggered by mood changes. Patient self-evaluation was more serious than auditory-perceptual evaluation and objective acoustic analysis. There was no obvious organic disorder observed under laryngoscope in patients with FD, but there were cases of glottic insufficiency and supraglottic compensation. With regards to sEMG, nasal airflow, chest, and abdomen examination results: (1) sEMG in the normal control group was symmetrical and stable on both sides during rest and phonation, and nasal airflow as well as the chest and abdomen were symmetrical and regular; (2) sEMG in the FD group showed increased recruitment of the sternocleidomastoid muscles, the infra- and suprahyoid muscles, and the cricothyroid muscle, accompanied by prephonation recruitment and postphonation persistence, mainly involving the infra- and suprahyoid muscles; (3) In the FD group, there was shortened inspiratory time, increased chest breathing amplitude, and reduced abdominal breathing, with predominantly chest breathing, and a "breath-holding" phenomenon was observed in some patients, with a significant increase in the number of breaths during the short text task. FD occurs mainly in middle-aged women, and there are many triggers. The Hamilton Anxiety/Depression Rating Scale scores were higher, and subjective symptoms were more serious than objective evaluation. No obvious organic changes were seen under laryngoscope, and features such as supraglottic compensation and glottic insufficiency were observed; muscle tension was significantly higher than that of the normal control group, and prephonation recruitment and postphonatory persistence were seen in some patients; the breathing pattern was mainly chest breathing, and the times of breaths during the short text task significantly increased. With identification of the characteristics of FD, the therapy could be focused them. [ABSTRACT FROM AUTHOR]

Objectives: The Nyquist plot provides a graphical representation of the glottal cycles as elliptical trajectories in a 2D plane. This study proposes a methodology to parameterize the Nyquist plot with application to support the quantitative analysis of voice disorders., Methods: We considered high-speed videoendoscopy recordings of 33 functional dysphonia (FD) patients and 33 normophonic controls (NC). Quantitative analysis was performed by computing four shape-based parameters from the Nyquist plot: Variability, Size (Perimeter and Area), and Consistency. Additionally, we performed automatic classification using a linear support vector machine and feature importance analysis by combining the proposed features with state-of-the-art glottal area waveform (GAW) parameters., Results: We found that the inter-cycle variability was significantly higher in FD patients compared to NC. We achieved a classification accuracy of 83% when the top 30 most important features were used. Furthermore, the proposed Nyquist plot features were ranked in the top 12 most important features., Conclusions: The Nyquist plot provides complementary information for subjective and objective assessment of voice disorders. On the one hand, with visual inspection it is possible to observe intra- and inter-glottal cycle irregularities during sustained phonation. On the other hand, shaped-based parameters allow quantifying such irregularities and provide complementary information to state-of-the-art GAW parameters., (Copyright © 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

In order to evaluate the effectiveness of the treatment in patients with functional dysphonia, the Cepstral Peak Prominence (CPP) test was used. Twenty dysphonic women aged from 18 to 47 years were under observation. The control group consisted of 20 healthy women of close age. Patients underwent 5-7 sessions electrostimulation of laryngeal muscles and phonopedic treatment, after which a complete restoration of the voice was noted. The Praat clinical program was used, installed on a Hewlett-Packard 630 laptop (Pentium B960, 2.2 GHz). A SHURE SM94 condenser microphone was used as well. In the control group, the results were as follows: M =7.49 ( SD =1.26) dB. In the main group before treatment: M =5.00 ( SD =1.07) dB, after treatment: M =7.95 ( SD =1.34) dB. Differences in KT values in the main group before and after treatment (5.00 dB and 7.95 dB, respectively) were significant at p <0.0001. Differences in KT values in the main group before treatment (5.00 dB) and in the control group (7.49 dB) were significant at p <0.0001. Differences in KT values in the main group after treatment (7.95 dB) and in the control group (7.49 dB) were not significant at p >0.05. The study showed high sensitivity of the method. The CPP data after treatment were higher than those before treatment and did not differ from the control ones. It is concluded that CPP is a highly sensitive method for evaluating the degree of periodicity of an acoustic signal and can be used to evaluate the effectiveness of treatment in patients with functional dysphonia.

Clinical experience shows that children with functional dysphonia often present disorders that are associated with abnormal auditory and emotional development. These children also struggle with voice therapy, perhaps because of difficulties with auditory control during speech. It has been hypothesized that difficulties in auditory processing in children may be an important factor in the pathogenesis of childhood dysphonia. The study aimed to assess selected auditory functions in children with hyperfunctional dysphonia. The study group consisted of 331 children aged from 7 to 12 years suffering from hyperfunctional dysphonia. The control group consisted of 213 children aged 7–12 years. All patients underwent ENT and phoniatric examination. All children underwent two standardized psychoacoustic tests: the Frequency Pattern Test (FPT) and the Duration Pattern Test (DPT). In the examined material, 223 children had edematous vocal fold nodules. The largest statistically significant differences were seen in the acoustic parameters describing relative frequency changes. FPT and DPT showed statistically significant differences in children with hyperfunctional dysphonia compared to the control group. At all ages the percentage of correctly identified tone sequences was significantly lower in children with dysphonia. Children with hyperfunctional dysphonia have difficulties in judging the pitch and duration of auditory stimuli. Difficulties in auditory processing appear to be important in the pathomechanism of functional voice disorders. Impaired hearing processes in children with hyperfunctional dysphonia can make it difficult to obtain positive and lasting effects from voice therapy. [ABSTRACT FROM AUTHOR]