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BackgroundVocal fold nodules are a common cause of pediatric dysphonia. The aim of the study was to assess the acoustic structure of the voice in children with vocal fold nodules and investigate the relationship between objective and subjective measures.Material and methodsThe study group consisted of 223 children, aged 7 to 12 years with normal hearing. The control group included 213 children. All children underwent ENT and phoniatric examination including laryngovideostroboscopy (LVS), assessment of voice on the GRBAS perceptual scale, and acoustic analysis (spectrographic analysis using the Multi-Dimensional Voice Profile).ResultsIn children with vocal fold nodules the average perceptual score for their voice was G1R1B0A0S2. No statistically significant effect of the child’s sex or age on the values of the MDVP parameters was found. The acoustic structure of the voice of children with childhood dysphonia and vocal fold nodules differed significantly from the acoustic structure of those in the control group. A relationship between GRBAS features and MDVP analysis was found.ConclusionsVoice acoustic analysis is a valuable tool for assessing voice quality in children. The analysis can identify deviations from normal values that the human ear is unable to pick up.

Purpose Laryngeal sensory neuropathy (LSN) is caused by a disorder of the superior laryngeal nerve or the recurrent laryngeal nerve. A diagnosis of LSN should include laryngeal electromyography (LEMG) and laryngovideostroboscopy (LVS). The aim of this study was to characterize the physical and subjective symptoms of neuropathy in patients diagnosed with LSN following COVID-19. Material and methods Since the beginning of the COVID-19 pandemic, 6 patients who had recovered from the disease presented to us with LSN symptoms. All patients underwent laryngological and phoniatric examination, objective and subjective voice assessment, and LEMG. Results The most common LSN symptom reported by patients was periodic hoarseness of varying severity. Other common symptoms were the sensation of a foreign body in the throat and voice fatigue. Endoscopy often showed functional abnormalities. The LSN patients could be characterized by LEMG recordings, and all showed abnormal activity of the cricothyroid (CT) muscle. The degree of EMG changes in the CT correlated moderately with the severity of dysphonia. Conclusions Sensory neuropathy of the larynx may be a long-lasting complication of SARS-COV-2 infection. The severity of EMG neuropathic changes in the CT muscle broadly corresponds to the severity of dysphonia.

The relation between the autonomic nervous system (ANS) and muscles of the vocal tract is of particular importance when considering the pathomechanism of a functional voice disorder.The aim of this study was to record electrophysiological indicators from the ANS as well as the tone of the external laryngeal muscle and test whether together they could point to an enhanced risk of primary functional voice disorder.The study material consisted of 81 people, 27 of whom were professional opera singers. None reported any voice complaints. The research comprised ENT and phoniatric examination, superficial electromyography (SEMG), and recording of physiological indicators (pulse rate, skin resistance).All subjects had a clear voice with no sign of vocal disability. Endoscopy revealed laryngeal hyperfunction in 26 people. SEMG revealed that the 26 had increased external laryngeal muscle tone during phonation, and this finding correlated with a change in certain electrophysiological indicators HRV, BVP, EDA.We conclude that anomalies in electrophysiological parameters in individuals with subclinical symptoms of functional voice disorder may be at risk of developing fully symptomatic hyperfunctional dysphonia in the future. Vocal training, which differentiates singers and non-singers, is known to have an effect on subclinical hyperfunctional dysphonia.By measuring indicators of hyperfunctional dysphonia, it may be possible to take remedial action before symptomatic dysphonia develops.

Purpose The objective was to investigate whether a patient’s preoperative test results can predict the need for future reoperation in unilateral vocal fold paralysis (UVFP). Methods A single-centre retrospective study was performed. The study group consisted of 18 patients with UVFP who had been treated with injection laryngoplasty but who required further treatment and were augmentated again within 36 months. The control group consisted of 33 injected patients who had not required reintervention up to 36 months later. Results Only glottal gap was associated with a relative risk for reinjection. Glottal gap was found to be severe in 77.8% of the patients from the study group compared to 42.4% of the controls, and the difference was statistically significant. The kind of injected material (calcium hydroxylapatite or hyaluronic acid), age, and voice assessment (perceptual, objective, or subjective) did not seem to affect the likelihood of reoperation being needed. There were no between-group statistically significant differences in individual aspects of the GRBAS scale. The global score was slightly higher in the study group, but it did not reach statistical significance (U = 198.5; p = 0.09). A comparison of VHI scores did not yield statistically significant differences between the study and control groups. No significant differences in objective acoustic voice parameters were observed between the groups. Conclusion Only glottal gap occurred to be associated with a relative risk for reinjection. A kind of injected material (CaHA or HA), age, perceptual, objective and subjective voice assessment do not seem to impact the likelihood of reoperation in patients with UVFP.

This article presents an overview of information on the development of voice, based on a detailed analysis of the literature. The data demonstrate voice abnormalities in individuals with hearing impairment as compared to individuals with normal hearing. Many researchers believe that the main factor leading to voice abnormalities among hearing-impaired individuals is incorrect auditory feedback resulting from higher hearing thresholds. This lack of feedback leads to abnormal encoding of neuronal patterns in cortical regions of the brain, which results in a disrupted control of internal and external laryngeal muscles.

BackgroundAccording to the literature, the rate of laryngeal paralysis after thyroid surgery is as high as several percent. For oncolog-ical operations the rate can reach 20%. The return of laryngeal function depends on the degree of nerve damage. Surgical procedures are required to increase the likelihood of nerve function recovery. Three methods of phonosurgery are currently used. The first is based on injecting auto or alloplastic materials into the vocal fold. The second interferes with the skeleton of the laryngeal cartilages; according to the Isshiki clas-sification, it includes type I thyreoplasty (medialisation thyreoplasty), optionally with complementary arytenoid adduction. The third method reconstructs the laryngeal nerves. Combinations of the three methods are increasingly used. Conservative treatment including phoniatric voice rehabilitation should be started as early as possible.Case reportThe paper presents a case report of a patient after thyroid surgery due to papillary carcinoma, complicated by bilateral laryn-geal paralysis and aphonia.ConclusionsFunctional Voice Therapy started just after healing of the postoperative wound in the neck eliminated abnormal compensatory mechanisms of phonation. Reconstruction of the laryngeal nerves is an opportunity to quickly return laryngeal function and prevents unwanted secondary functional mechanisms within the vocal organ.

The surface EMG technique (sEMG) gives valuable assessment of vocal tract as well as diagnosis or outcome assessment in dysphonia. There are very few papers on the use of sEMG in vocal professionalists.The aim of this study was to evaluate the electromyographic characteristics of selected external laryngeal and neck muscles in professional opera singers.The study material consisted of 50 subjects. Twenty-six opera professional singers and 24 healthy non-singers.Each person underwent otolaryngologic and phoniatric examination, laryngeal videostroboscopy, hearing testing, multiparametric acoustic voice analysis (multidimensional voice program) and sEMG of submentalis, cricothyroid and sternocleidomastoid muscles.Statistical analysis of the values of the amplitudes of the submentalis and the cricothyroid muscles showed significant differences between the vocalists and the control group. Moreover, during vowel phonation and glissando, significantly greater differences in the asymmetry of sternocleidomastoid muscles amplitudes were observed in singers compared to the control group. In most subjects, the studied muscles did not show asymmetry during saliva swallowing.Laryngeal muscle function should be assessed during different phonation and non-phonation tasks. Singers have different SEMG characteristics than non-singers. Knowledge of the patient's history and endoscopic studies is needed to interpret EMG recordings.

ntroduction: The publication describes the characteristics of the glottis in FDs objectified by OQ, measured with VSK and EGG. Aim: The aim of the study was to objectify glottal function in different types of FDs. The scope was to use open quotients gained from various mucosal wave imaging techniques for differential diagnosis of FDs. Material and Method: The study included 204 individuals. In the study, each patient underwent otolaryngological and phoniatric examination. LVS, EGG and VSK were conducted, their results were recorded and stored using an EndoSTROB-DX- -Xion GmbH (Berlin) device with DIVAS software. Results: All patients with FDs had abnormalities in LVS. A statistical analysis showed differences in LVS characteristics according to the type of FD. The mean value of OQVSK was 0.521 in the control group and 0.565 in the study group (P < 0.05). Significant differences were found between patients with hypofunctional – 0.584 and hyperfunctional dysphonia – 0.55. The QOQEGG mean value in patients with FDs was 0.581 and in the control group 0.549 (P < 0.01). There were statistically significant differences between groups of patients with hyper- and hypofunctional dysphonias. Medians amounted to 0.574 and 0.604, respectively. Authors observed different relations of OQ with the type of FD. They decided to introduce a new parameter, illustrating the proportion of QOQEGG/OQVSK. Conclusions: Videostrobokymographic and electroglottographic open quotients differentiate euphony from dysphony. The value of OQVSK and QOQEGG and their proportion varies depending on different types of functional dysphonias. The OQVSK and QOQEGG should be included in the diagnostic algorithm of voice.

Traditional voice evaluations, including imaging techniques, auditory-perceptual ratings, and acoustic and aerodynamic analyses, fail to assess the global handicap that a patient experiences as a result of a voice disorder. The Voice Handicap Index (VHI) is currently one of the most widely used and psychometrically robust instruments for measuring voice disability. The aim of the study is to translate and validate a Polish version of the VHI. The original English-language version of VHI-30 was translated into Polish. We enrolled 188 subjects—123 patients (91 women and 32 men) with voice disorders and 65 controls (53 women and 12 men) without voice disorders. Results obtained by the patients were significantly higher than those obtained by the controls on the Emotional subscale (U = 519.0; p < 0.001), Functional (U = 829.0; p < 0.001), Physical (U = 331.0; p < 0.001), and the global score (U = 390.0; p < 0.001). There were statistically significant negative correlations between maximum phonation time and global score (rho = −0.31; p < 0.01) as well as all three subscales. Shimmer and Smoothed Amplitude Perturbation Quotient were correlated positively with the global score (rho = 0.22; p < 0.05; rho = 0.25; p < 0.01, respectively) and with all three subscales. There were also statistically significant correlations between VHI scores and auditory perceptual evaluation. In the patient group, there was excellent internal consistency (α = 0.97) and strong test–retest reliability (intraclass correlation = 0.94). The cut-off value equal to 17 points was estimated. The Polish VHI showed excellent internal consistency, good test–retest reproducibility, and clinical validity. It is a useful tool for evaluating the voice disability perceived by a patient.

Background: The aim of this study was to present a rehabilitation program of occupational voice disorders for teachers, conducted in the form of health resort stays, and evaluate its effectiveness depending on job seniority. Methods: The study included 420 teachers who participated in a complex vocal prophylactic and rehabilitation program carried out during a 24-day stay at a health resort hospital. Employment time varied from 4 to 45 years (mean 28.3 years). The participants were divided into three groups: employment time &lt, 21 years (57 teachers), 21–30 years (182 teachers) and &gt, 30 years (181 teachers). All of the subjects underwent maximum phonation time assessment as well as jitter, shimmer and NHR (noise to harmonic ratio) parameters assessment before and after the program, they also underwent perceptual evaluation using the GRBAS scale and voice self-assessment using the VHI-30 scale. Results: The perceptual evaluation using the GRBAS scale and self-report measures of voice function assessed using the VHI scale revealed improvement (p &lt, 0.001). The parameters of jitter, shimmer and NHR improved significantly: jitter p &lt, 0.001, shimmer p &lt, 0.001 and NHR p &lt, 0.003. Maximum phonation time increased slightly but significantly (p &lt, 0.001). For all of the studied groups regardless of their employment time, maximum phonation time increased (p &lt, 0.001). Initially, the lowest values of maximum phonation time were observed in teachers with longer job seniority, which improved after the rehabilitation but remained &lt, 15 s. Conclusions: Voice care for teachers is crucial regardless of their job seniority. Early prophylaxis for voice disorders is effective, as the results of rehabilitation are better in teachers with a shorter employment time.

lt;bgt;Introduction:lt;/bgt; Patient-reported outcome measures have been used within the otorhinolaryngologic disorders' field for many years to compare patient's perception of the severity of symptoms and the effectiveness of a therapeutic approach. Questionnaires that evaluate dysphagia are relatively complex instruments aimed mostly at patients with neurological or malignant diseases. The ICD-10 classification specifies only one broad term - dysphagia (R13). Introduction of Muscle Tension Dysphagia (MTDg) in 2016 by Kang completed the spectrum of the nomenclature. This dysphagia type is defined as a type of laryngeal muscle tension disorder manifesting primarily as swallowing difficulty with or without any accompanying organic cause, laryngeal hyperresponsiveness and/or nonspecific laryngeal inflammation.lt;brgt;lt;bgt;Aim:lt;/bgt; Since there were no clear diagnostic and therapeutic perspectives on the group of patients with MTDg, the aim of this work was to analyse selected diagnostic tools used for the evaluation of swallowing disorders in the context of finding the most suitable tools for patients with Muscle Tension Dysphagia.lt;brgt;lt;bgt;Material and method:lt;/bgt; The material of the work included 61 patients. Each patient underwent otolaryngologic, phoniatric and speech therapist's examination, Functional Endoscopic Evaluation of Swallowing (FEES) and filled out questionnaires concerning dysphonia and dysphagia symptoms.lt;brgt;lt;bgt;Results:lt;/bgt; The results of the work showed that patients with MTDg were characterised by correct results of FEES examination, prolonged swallowing, features of inappropriate mucous and oropharyngeal muscle function.lt;brgt;lt;bgt;Conclusions:lt;/bgt; The Swallowing Disorder Scale (SDS), developed by the authors, correlated best with the cause of dysphagia. The questionnaire corresponded well with the degree of severity. In the diagnostic process of MTDg one of the key tasks is the differentiation with patients with non-normative swallowing patterns. Apart from specialistic consultations with otolaryngologist and speech therapist, while diagnosing MTDg we recommend using objective (FEES, videofluroscopy, SEMG) and subjective (SDS, DHI, EAT-10 surveys) assessment tools. In our opinion, the inclusion of questionnaires to detect reflux syndromes is also important in the causal treatment of ailments.

Introduction The modern standard of voice diagnostics in both the adult and pediatric populations is based on perceptual, acoustic and videolaryngoscopic assessment, as well as self-assessment of voice quality. Currently, only two tools for assessing the voice in the pediatric population were translated into Polish: pVHI and its abbreviated version - cVHI (Children Voice Handicap Index). Thanks to the use of pVHI, the therapist and the patient, as well as his family and relatives, become aware of what functional zones are disturbed as a result of voice problems. Aim The aim of the study was to analyze various methods of assessing children's voice, including the pVHI voice disability questionnaire in children with various voice disorders. In addition, the authors wanted to develop a classification of the degree of disability of children's voice expressed by the sum of points obtained in pVHI. Material and method The study included a group of 89 children aged 5-12. Each child underwent a standard otolaryngological and phoniatric examination procedure with hearing assessment and fiberoscopic laryngeal evaluation. The voice of the dysphonic children was assessed with a spectrogram and the GRBAS scale. The children's guardians completed the Pediatric Voice Handicap Index (pVHI). Results Polish children without voice disorders obtained an average of 1.9 points as a total result of the pVHI questionnaire. The results of the questionnaire obtained from children with voice disorders were on average 24.7 (SD 13.9). Total and individual domain scores were significantly higher in children with dysphonia than in asymptomatic children. Children with voice disorders were rated an average of 1.95 (SD 0.6) degree of hoarseness in Yanagihara's scale, and obtained an average overall score of 4.8 on the GRBAS scale (SD 2). A common upward trend in all types of evaluation is evident, along with an increase in the handicap expressed in pVHI score. Statistical analysis showed significant dependence between the overall pVHI score and other voice rating indicators. The result correlated to a moderate degree with the sum of points obtained from GRBAS and the severity of hoarseness assessed subjectively (G) and objectively according to Yanagihara's scale. In addition, weak correlations of the functional part of the questionnaire with the presence of learning problems, and the emotional part with the presence of problems with socialization were noticed. Analyzing the results of the questionnaire depending on the GRBAS results and the Yanagihara scale, a better fit of the exponential trend line than the linear one was observed. The point of inflection of the exponential curve, and thus a significant deterioration in voice assessment indicators, was observed in children who obtained over 32 points, which is 33% of the maximum value that can be obtained from the questionnaire. Conclusions A new voice assessment tool for the pediatric population has been developed that complements the diagnostic facilities of the otolaryngologist, phoniatrician and speech therapist. Adaptation of the Polish version of the Voice Handicap Index (pVHI) allows the introduction of a new diagnostic indicator into medical and speech therapy practice. The pVHI questionnaire result differentiates children with voice and speech disorders from healthy children. The analysis of children's voice using various methods allows the clinician to further characterize the disturbance of voice quality. It is possible to assess the scale of the severity and type of problem, as well as the spheres of life it concerns most. There is a correlation between the severity of voice disorders and the severity of voice disability expressed in the pVHI question.

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.

Introduction Electroglottography (EGG) is the most commonly used method of indirect visual examination of vocal fold vibration. Aim The study was conducted with an aim of assessing EGG quasi open quotient (QOQEGG) in different functional dysphonias to develop a differential diagnosis. The second aim was to check the influence of articulation on QOQEGG values. Material and methods There were 20 people without voice problems, 20 patients with hypofunctional dysphonia and 20 patients with hyperfunctional dysphonia included in the study. Electroglottography was recorded during comfortable sustained phonation of [a], [e], [i], [o], [u]. Results There were no statistically significant differences in QOQEGG observed during phonation of different vowels in the control group and patients with hyperfunctional dysphonia. In patients with hypofunctional dysphonia, significantly higher values of QOQEGG were observed during [a] and [e]. Both in the control and in studied groups vowel [i] was vocalized significantly quieter. Conclusions To conclude, EGG can be useful in differential diagnosis of functional dysphonia. QOQEGG is a parameter differentiating hypofunctional dysphonia from hyperfunctional dysphonia. Dissimilarities in articulation of different vowels in patients with various types of dysphonia influence values of QOQEGG. EGG study protocol in cases of functional dysphonia should include a comparison of [a], [e], [i] vowels.

BackgroundThis study presents the case of a 32-year old woman who presented with severe dysphonia. She had experienced voice problems since childhood.Material and MethodsThe patient underwent otolaryngological and phoniatric examination including videolaryngostroboscopy (VLS), perceptual evaluation (GRBAS scale), and acoustic analysis of voice (MDVP software). Microsurgery was performed using a CO2 Acupulse laser (Lumenis) with AcuBlade micromanipulator.ResultsVLS revealed glottal incompetence, an intracordal mass on the right vocal fold, and capillary ectasia on the superior surface of the right vocal fold. Atrophy was seen along the free edge of the left vocal fold. GRBAS and MDVP revealed significant voice disturbances. The patient was referred for direct microlaryngoscopy. Initial inspection of the vocal folds showed bilateral intracordal mass and sulcus vergeture. Using a microflap technique the fibrous mass was removed. For the sulcus vergeture a surgical technique based on a concept by Cornut and Bouchayer and modified by Remacle was used. Complementary hyaluronic acid (Surgiderm 24XP) was injected to correct the left vocal fold volume. Stroboscopic evaluation performed 3 months postoperatively showed significant improvement of glottis closure and vibratory parameters. Perceptual and objective voice assessment revealed improvement in the acoustic structure of the voice after surgeryConclusionsCoexistence of bilateral sulcus vergeture and bilateral fibrous mass is a very rare occurrence. The preoperative diagnosis is often not obvious. Severe voice disturbances make surgery the first treatment option in such cases.

Purpose This is a retrospective study to evaluate the results of surgical treatment of patients with pathological sulcus vocalis. Methods Thirty-six patients with pathological sulcus underwent surgery and in 33 cases were performed additional injection laryngoplasty. The pre- and postoperative evaluation of patients included the GRBAS scale, stroboscopic, and objective acoustic voice assessment. The Voice Handicap Index questionnaire (VHI-30) was also used and the scores were obtained from 33 patients. Results The stroboscopic evaluation showed significant improvement of amplitude, mucosal wave, and glottal closure after treatment (p

BackgroundPartial deafness (PD) is a condition in which normal hearing is preserved in the low frequency range, while severe to profound hearing loss is observed in the middle and high frequency ranges. The aim of this study was to assess the acoustic structure of the voice in children considered for partial deafness treatment (PDT).Material and MethodsThe material included 127 children aged from 5 to 12 years old. The study group included children with partial deafness (PD). Depending on age, patients in the study group were divided into 2 groups. The first included 40 children aged 5–6 years, and the second consisted of 44 school-age children aged 7–12 years. The control group included 20 healthy normally hearing children aged 5–6 years and 23 healthy, normally hearing children with clear voices, aged 7–12 years. Children’s voices were assessed subjectively by the physician and objectively with the use of a digital CSL KAY Multidimensional Voice Profile analyser (MDVP). The sustained vowel “a” was used for analysis.ResultsAcoustic features of PD vs. normally hearing children were different. Statistically significant parameters differentiating voices in the group of younger children were fundamental frequency (Fo); shimmer, a parameter describing changes in amplitude (ShdB); and noise-to-harmonic-ratio (NHR). In the group of older children more acoustic parameters characterizing voices of PD children were defined. They included fundamental frequency (Fo); fundamental frequency variation (vFo); amplitude change (vAm, sAPQ); noise-to-harmonic-ratio (NHR); and voice tremor (FTRI).ConclusionsThe acoustic structure of the voice in children with partial deafness is different from that in children with normal hearing.

Aim: The main goal of the present study was to assess the feasibility of using evoked stapedius reflex (eSR) and evoked compound action potential (eCAP) thresholds to create speech processor programs for children using Med-El Maestro software. The secondary goals were (1) to compare the eSR and eCAP thresholds recorded using charge units in experienced adults fitted with Med-El Pulsar CI100 cochlear implants with most comfortable loudness levels (MCLs) obtained for the apical, medial and basal electrodes, and (2) to compare eSR and eCAP thresholds for the apical, medial and basal electrodes between adults and children. Methods: Fourteen children and 16 adults participated in the study. eSR and eCAP thresholds were measured in both groups using the auditory nerve response telemetry algorithm, with MCL being behaviourally measured only in the adult group. Results: In the adult population, the correlation between eSR threshold and MCL was better for apical, medial and basal electrodes than that between eCAP threshold and MCL. There was no significant difference in the means obtained for eCAP and eSR thresholds in children and adults for any of the electrodes tested. This finding suggests that in children, the correlations between eCAP thresholds and MCL values, and those between eSR thresholds and MCL values are not lower than those generally found in adults. Conclusions: Although the eSR threshold is a better predictor of MCL values, both eSR and eCAP thresholds can be useful tools for assisting with map creation for children.