Search

Purpose: The purpose of this study was to investigate the changes in voice nasality after septoplasty and turbinate hypertrophy reduction and to evaluate the effect of these changes on patients' voice-related quality of life. Methods: Sixty patients with nasal obstruction symptoms caused by septal deviation and inferior turbinate hypertrophy who underwent septoplasty and inferior turbinate hypertrophy reduction and 25 healthy controls were included. Active anterior rhinomanometry and acoustic rhinometry were utilized for the evaluation of nasal patency and nasometry was used for quantitative assessment of nasalance. All participants completed validated questionnaires for assessing nasal obstruction symptom severity, psychological status and the impact of voice performance on their quality of life preoperatively and 6 months after septoplasty. Results: Patients presented preoperatively statistically significantly lower nasalance scores and higher VHI scores than controls (p < 0.05). Septoplasty and inferior turbinate hypertrophy reduction led to improvement of nasalance for the nasal text and the physical subscale of the VHI scores. Postoperatively, there were no statistically significant differences in nasalance and VHI scores between patients and controls. Significant correlations were found only for the baseline and the postoperative nasalance scores for the nasal text and the total nasal cavity volume (p < 0.05). Postoperatively, patients who presented significant improvement of nasal obstruction symptoms and resolution of stress levels were more likely to positively evaluate the impact of their voice quality on their daily life (OR: 2.32, 95% CI 1.08–5.15, p = 0.041 and OR: 3.06, 95% CI 1.15–7.04, p = 0.038, respectively). Conclusion: Septoplasty and inferior turbinate hypertrophy reduction may increase the nasal resonance, but in the long term, this change appears not to be significant enough. The severity of nasal obstruction symptoms and psychological status mainly affect the patients' perceptual assessment regarding the effect of voice performance on their quality of life. [ABSTRACT FROM AUTHOR]

Background/Aim: Laryngopharyngeal reflux (LFR) occurs due to the backward traveling of gastric contents through the esophagus, resulting in their contact with the upper respiratory tract and laryngopharynx. It has been determined that more than 50% of patients presenting with voice hoarseness may have a pathology associated with such reflux. Symptoms including hoarseness, difficulty in making high-pitched sounds, and a tired and cracked voice may occur due to changes in the vocal cord mucosa induced by the reflux. The present study investigated the relationship between the Reflux Symptom Index (RSI) and Voice Handicap Index-10 (VHI-10) evaluations of patients with significant findings for LFR. Methods: Patients with an RSI score of 13 and above and RFS of 7 and above, considered significant for LFR, and patients aged between 18 and 65 years, who met the mandatory requirements, were included in the study. The patients included in the study were divided into three groups, mildly impaired (MII), moderately impaired (MOI), and severely impaired (SEI) based on their response to the question, "How do you feel about your voice?'' VHI-10 was also applied to the patients included in the study. The RSI and VHI-10 scores of the patients were separately recorded and compared using various parameters. Results: Of the 38 patients included in the study, 18 (47.4%) were female and 20 (52.6%) were male. It was observed that RSI and VHI-10 scores increased significantly as the patients' level of voice disorder increased (P<0.001, P<0.001). A statistically significant positive correlation was found between the RSI and VHI-10 scores of the patients (r=0.749, P<0.001). Conclusion: The high level of significant positive correlation between VHI-10 and RSI scores suggested that VHI-10 could serve as a valuable supportive tool in the evaluation of dysphonia in patients with LFR. RSI and VHI-10 can further play an important role in the initiation of appropriate treatment on diagnosis of LFR. [ABSTRACT FROM AUTHOR]

Abstract Background Glottal insufficiency results in glottal gap between the two vocal folds, which in turn might cause dysphonia, dysphagia, and breathing problems. Vocal fold injection is considered a safe, reliable, and highly effective method of treatment. The purpose of the present study was to assess voice outcomes and complication rates in patients with glottal insufficiency undergoing injection laryngoplasty (IL) under local versus general anesthesia before, 1 week then 1 month after IL. Results Examined patients were 13 males and 12 females, suffering from dysphonia due to glottal insufficiency with mean age 43.68 ± SD 14.55. Unilateral vocal fold paralysis (UVFP) was diagnosed in seventeen cases, vocal fold scarring in six cases, presbylarynx in one case, and sulcus vocalis in one case. IL was performed in 18 cases under local anesthesia, and 7 under general anesthesia. Hyaluronic acid was injection material in 23 cases and calcium hydroxylapatite in two cases. IL by either local or general anesthesia has improved the patients’ auditory perceptual analysis of voice quality as assessed by “GRBAS” scale and Voice Handicap Index (VHI). There were four (16% of all injections) minor and self-limited complications (12% under local and 4% under general anesthesia). Conclusion Injection laryngoplasty performed under local and general anesthesia offers similar voice outcomes, but with slightly higher self-limited complications in IL under local anesthesia.

The aim of this non-randomized clinical trial was to evaluate tumor outcomes and subjective quality of voice following radiotherapy and partial laryngectomy in early-stage glottic laryngeal cancers. Non-Randomized Clinical Trial. Otolaryngology and radiation oncology clinics of Imam Khomeini (an affiliated hospital of Tehran University of Medical Sciences) and Amir Aalam Hospitals. Fifteen patients with earlystage glottic laryngeal carcinoma were admitted to the otolaryngology clinic, divided into two treatment groups: radiotherapy and partial laryngectomy. Of the total 50 patients, 25 had a partial laryngectomy and 25 radiotherapies. The comparison of the average of the Voice Handicap Index (VHI) showed significant improvement of vocal quality after treatment for both partial laryngectomy and radiotherapy (P<0.0001 for both). But there was no significant difference in VHI mean scores between the two treatment groups (patients treated by partial laryngectomy and radiotherapy). Short- and long-term complication was higher in patients undergoing surgery than radiotherapy group (P<0.0001). With regard to oncological outcome after one and eight-year after treatment, no differences were observed in the two treatment groups; there was a significant relationship between smoking cessation and recurrence of disease in the partial laryngectomy treatment group (P=0.012). There was no significant difference in voice quality and life expectancy of patients operated on using open surgery and patients treated with radiotherapy in this series. Open surgery may have more noticeable complications than radiotherapy. [ABSTRACT FROM AUTHOR]

Background: Laryngeal disorders are common in our environment, and a number of studies have been carried out. However, there is a paucity of literature with regard to the evaluation of voice-related handicap, and Voice Handicap Index (VHI) score for specific laryngeal disorders. Aim: The aim of this study was to apply the VHI score and flexible laryngoscopy in the evaluation of patients with laryngeal disorders and to determine the mean VHI score for specific laryngeal disorders in our environment. Methodology: A cross-sectional study was conducted among patients with the clinical diagnosis of laryngeal disorder who presented at the otolaryngology clinic of our institution. Patients who had previous laryngeal surgery or tracheostomy were excluded. Data was collected on sociodemographic variables, clinical history, and flexible laryngoscopic findings. The VHI score, which comprised of functional, physical, and emotional subscales was also collected and analyzed. Results: A total of 90 patients completed the study; 56.7% of them were males, whereas 43.3% were females. The mean VHI was highest in patients with laryngeal tumor (68.8 ± 14.8) followed by patients with vocal cord palsy (58.2 ± 5.7), but it was lowest in patients with acute laryngitis (27.1 ± 5.3). There was a statistically significant difference in mean VHI for each laryngeal disorder (P = 0.000). Conclusion: The patients with laryngeal tumor and those with vocal cord palsy had the highest VHI score, which affected their functional and emotional well-being. Therefore, applying VHI score and flexible laryngoscopy is important in the holistic evaluation of patients with laryngeal disorders. [ABSTRACT FROM AUTHOR]

The aim of this non-randomized clinical trial was to evaluate tumor outcomes and subjective quality of voice following radiotherapy and partial laryngectomy in early-stage glottic laryngeal cancers. Non-Randomized Clinical Trial. Otolaryngology and radiation oncology clinics of Imam Khomeini (an affiliated hospital of Tehran University of Medical Sciences) and Amir Aalam Hospitals. Fifteen patients with early-stage glottic laryngeal carcinoma were admitted to the otolaryngology clinic, divided into two treatment groups: radiotherapy and partial laryngectomy. Of the total 50 patients, 25 had a partial laryngectomy and 25 radiotherapies. The comparison of the average of the Voice Handicap Index (VHI) showed significant improvement of vocal quality after treatment for both partial laryngectomy and radiotherapy (P

Objective: The effects of voice disorders vary from person to person. Occupation, work environment, life, and family reaction are variables that affect one’s perception of his/her own as an impaired voice. Voice Handicap Index (VHI) has not yet been used to compare the degree of voice disorders. Assuming that the quality of life may be different under a variety of voice disorders and that different physical, emotional and functional aspects maybe affected differently and that each disorder has a different treatment, This stud was conducted to prioritize and propose the appropriate treatments (voice health, manual therapy of larynx, voice therapy, and referral to relevant specialists) based on VHI score. Materials & Methods: This is a descriptive/analytic study with cross-sectional design. Firstly, voice disorder of 166 patients aged 18-60 years referred to private clinics in Tabriz city was confirmed based on the diagnosis of a otolaryngologist and laryngeal stroboscopic images. VHI test was performed and a questionnaire was used to survey them in the presence of examiner to answer their potential questions. The VHI test consists of 30 items and 3 subscales of physical (10 items), emotional (10 items) and functional (10 items) rated on a 5-point Likert scale (0=Never, 1=Almost Never, 2=Sometimes, 3=Almost Always, and 4=Always). The patient's stroboscopic samples was examined by 3 speech-language pathologists and based on their consensus, patients were assigned into functional and structural voice disorders. In the next step, values obtained from the VHI test were compared between the two groups based on three subscales. Finally, the data were analyzed in SPSS v.19 software using statistical methods such as mean, standard deviation and Multivariate Analysis Of Variance (MANOVA). Results: The rate of voice impairment was significantly higher in patients with structural voice disorder than in patients with functional disorder in overall and based on functional, physical and emotional components (p

Introduction: This study explores the quality of life among patients with recurrent respiratory papillomatosis (RRP) after vocal fold surgery as measured by the outcome scores of the Voice Handicap Index (VHI) and the Distress Thermometer and Problem List in Patients with Recurrent Respiratory Papillomatosis (DT&PL). Differences in quality of life were explored within the independent variables age, surgical frequency, weeks since last vocal fold operation, gender, HPV type, surgical location, vaccination with Gardasil©, and a patient's request to speak with a speech-language pathologist., Methods: A single-center, observational cohort study was conducted using VHI and DT&PL scores and demographic and clinical data obtained from patient files. Inclusion criteria were a confirmed HPV type, age 18 years or older, the ability to fill in both questionnaires in Dutch, and having undergone at least one surgical procedure to remove laryngeal papilloma. Relationships of the independent variables with VHI and Distress Thermometer (DT) scores were explored using univariable and multivariable regressions and linear regression models., Results: Of 271 RRP patients, 100 met the inclusion criteria and responded to requests to fill in both questionnaires with a minimum of 12 weeks after their last operation. Our study showed a statistically significant negative relationship between age and VHI scores (p = 0.02) in the univariable, and multiple linear regressions (p = 0.01), indicating that patients experienced fewer self-perceived functional voice disabilities with each increase in age. A parallel negative relationship is seen between the variables age (p = 0.03) and DT scores. Our results showed a statistically significant positive relationship between the number of vocal fold surgeries and DT scores (p = 0.03)., Conclusion: The results of this study show a significant relationship between age, surgical frequency, and quality of life in patients with RRP. Older patients have lower Voice Handicap Index (VHI) and Distress Thermometer (DT) scores, indicating fewer self-perceived voice and disease-related quality of life problems. Conversely, a rise in surgical frequency is significantly associated with higher DT scores, reflecting greater disease-related distress., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Objective: To analyze the reliability, measurement error, and responsiveness of the Voice Handicap Index (VHI) for measuring voice handicap in individuals with voice disorders., Methods: This systematic review followed the recommendations of the COnsensus-based Standards for the Selection of Health Measurement INstruments. Studies that validated the VHI, analyzed the measurement properties of reliability, measurement error, or responsiveness, and had dysphonic individuals as the study population were included. The following electronic databases were searched: Cochrane Library, EMBASE, LILACS, PubMed, Scopus, and Web of Science. The manual search was carried out on gray literature in the Biblioteca Digital Brasileira de Teses e Dissertações and ProQuest Dissertation & Theses, in addition to mapping citations and consulting an expert in the field. Evidence selection, data extraction, risk of bias analysis, certainty of evidence, and good psychometric measurements were performed by two blinded and independent reviewers. A meta-analysis was performed using Fisher's transformed r-to-z correlation coefficient and standardized mean difference. Heterogeneity was calculated using Tau² and I² statistical tests in JAMOVI 2.3.2 software., Results: Eighty studies were included in the meta-analysis. When assessing the risk of bias, most studies were classified as inadequate during the reliability and measurement error stages. In the responsiveness stage, they were classified as doubtful in the sensitivity and specificity sub-boxes and good in the comparison sub-box with a gold standard instrument. For psychometric properties, most studies were classified as indeterminate in terms of both reliability and responsiveness. In test-retest reliability and responsiveness, the average outcome differed significantly from zero, indicating agreement between the test and retest moments and a significant reduction in the VHI score after intervention. Considering certainty of the evidence, the level of evidence was very low in both the reliability and responsiveness stages. The analyzed studies did not evaluate observational errors, and hence, they were not considered in this review., Conclusion: The VHI proved to be reliable and responsive in measuring voice handicap. However, it should be used with caution, as there is heterogeneity, a risk of bias, and no adherence to the analysis of observational error., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to examine a number of pause-and-speech-measurements in patients with unilateral vocal fold paralysis, before and after injection laryngoplasty. The non-invasive measurements were selected to investigate and explain the treatment effect on connected speech in these patients., Study Design: Retrospective study with repeated measurements design., Method: Voice recordings of 24 patients with unilateral vocal fold paralysis from before and after injection laryngoplasty in local anesthesia were analyzed retrospectively with the computer program Praat. Measurements examined were number of pauses, average pause duration, pause ratio (expressing the amount of pausing during a reading-aloud task), number of breath groups, average duration of breath groups, articulation rate, speaking rate, maximum phonation time, and Voice Handicap Index., Results: Injection laryngoplasty had a significant improving effect on the number of pauses, pause ratio, number of breath groups, average duration of breath groups, articulation rate, speaking rate, maximum phonation time, and Voice Handicap Index. Maximum phonation time before treatment correlated with several pause and speech measurements., Conclusion: The results showed that treatment with injection laryngoplasty had a clear effect on several pause and speech measurements and that these measurements correlated with maximum phonation time, but not with Voice Handicap Index., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: There is no available data on the prevalence of voice disorders in Croatia. The objective of this research was to determine the prevalence of perceived voice disorders (PVD) in teachers and general population in Croatia using the Croatian Voice Handicap Index (VHI-HR) questionnaire., Methods: This research was divided into two phases. In phase I, the potential of the VHI-HR questionnaire to distinguish individuals with and without voice disorders was assessed. A total of 113 participants completed the VHI-HR. Receiver operating characteristic analysis was performed. In phase II, a cross-sectional study was conducted. A total of 1898 participants, including 1088 teachers from 434 Croatian schools, and 810 nonteachers were included in the study. The questionnaire on sociodemographic factors, potential risk factors associated with voice disorders, and the VHI-HR was administered. The differences in the PVD prevalence in teachers and nonteacher adults and adverse effects of PVD were investigated. The multiple logistic regression model was used to examine the factors associated with PVD occurrence., Results: In phase I, the cut-off point of 18.32 with 93.44% sensitivity and 98.08% specificity for VHI-HR was determined. In phase II, higher lifetime PVD prevalence was found among teachers. The point prevalence of PVD was 45.68% for teachers, and 21.11% for nonteachers. This study demonstrated that being a teacher, a woman, having a family history of voice disorders, reflux, working in environment with elevated noise levels, and having more than 30years of employment are associated with PVD occurrence., Conclusions: VHI-HR score of 19 and higher proves effective in distinguishing individuals with voice disorders from those without. The odds of having PVD for teachers are 2.83 times higher than for nonteachers. Risk factors for voice disorders, among others, include occupational use of voice and working in environments with elevated noise levels., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Voice change after thyroid surgery is common despite preservation of laryngeal nerves. In this study, we sought to find if the change in voice after total thyroidectomy is related to the weight and volume of the removed thyroid gland. This is a prospective cohort study of 50 patients of papillary carcinoma of the thyroid treated with total thyroidectomy from December 2016 through May 2018. Both objective and subjective voice parameters were analyzed preoperatively and at 1 and 3 months following surgery. A cohort of 29 patients, with a median age of 31 years (18–64 years), comprising 22 women were eligible for final analysis. Speaking fundamental frequency showed a mean change of 17.21 Hz (SD 34.49) while the mean intensity change was 5.54 dB (SD 18.21). The mean weight and volume of thyroid gland was 18.99 g (SD 8.93) and 15.67 ml (SD 8.70), respectively. On multivariate analysis, both weight and volume affected the range of frequency (P = 0.002 and 0.035, respectively) and range of intensity (P = 0.014 and 0.008, respectively). Larger thyroid tumors are more likely to be associated with transient change in voice quality following their surgical removal despite physical preservation of external and recurrent laryngeal nerves, which may persist up to 3 months. This study affirms that perturbations in voice after thyroidectomy can still exist in spite of clinical demonstration of integrity of neuromuscular function. [ABSTRACT FROM AUTHOR]

The aim of this study is to compare the relatively new CO 2 laser microlaryngeal surgery and conventional cold dissection method in treatment of minimal associated pathological lesions of vocal folds. Eighty patients aged 20-70 years old were randomly divided into two groups, group A (40 patients) was treated by the conventional method and group B (40 patients) was treated with CO 2 laser microlaryngeal surgery. Assessment procedures included GRBAS scale, stroboscopic examination, and Arabic version of voice handicap index. Results stated that improvement of quality of voice after surgery in both techniques had no significant difference. The significant difference was in operative time and bleeding because laser had less time and bleeding. Both techniques had no recurrence within 3-months follow-up. [ABSTRACT FROM AUTHOR]

Objective  The present study aimed to investigate the effects of dopaminergic medication on voice, speech motor functions, and motor impairment in patients with Parkinson's disease (PD). Materials and Methods  Twenty-five individuals (16 males and 9 females) with PD underwent comprehensive assessment of voice, speech, and motor functions in levodopa medication ON and medication OFF conditions. Age- and gender-matched healthy controls were recruited to compare speech and acoustic parameters. Multi-Dimensional Voice Program (MDVP) from Computerized Speech Laboratory (Model: 4500) was utilized for acoustic analysis of voice and the Voice Handicap Index (VHI) for the self-assessment of vocal function. Frenchay Dysarthria Assessment (FDA-2) and Unified Parkinson's Disease Rating Scale-III (UPDRS III) were used to evaluate speech motor and motor functions, respectively. Statistical Analysis  The mean and standard deviation were used as descriptive statistics measures. Raw scores were obtained for FDA-2, DRS, VHI, MDVP parameters, and UPDRS-III in either medication condition. The Wilcoxon signed-rank test was performed to determine the statistical significance of the above measures in both genders across the medication conditions. Spearman's rank correlation coefficient was used to determine the relationship between motor speech function and motor impairment and between VHI and MDVP parameters across both medication conditions. The interrater reliability rating was established using Cohen's kappa. Results  An improvement in lip and laryngeal functioning was found in the medication ON over medication OFF state in both males and females with PD. A few frequency and amplitude-related measures improved in the medication-ON state over the medication-OFF state. UPDRS-III scores reduced from the OFF state to the ON state, and no change in dysarthria severity or VHI was found in either gender or medication condition. No correlation was found between speech motor function and motor function or between VHI and acoustic parameters of voice in either medication condition. Conclusions  Improvement in motor symptoms with levodopa was predominantly observed when compared with the minor improvements in a few aspects of speech motor function and vocal parameters. The results of this study suggest the need for speech therapy as a nonpharmacological treatment method for speech impairments in PD. [ABSTRACT FROM AUTHOR]

Objective: Botulinum toxin (BT) therapy is a first‐line treatment for spasmodic dysphonia (SD). However, a detailed chronological course and clinical factors that affect the therapeutic effect have been vague. In this study, we analyzed the data from our placebo‐controlled, randomized, double‐blinded parallel‐group comparison/open‐label clinical trial of BT (Botox) to clarify these. Methods: A total of 22 patients with abductor SD (ADSD) were enrolled. The female‐to‐male ratio was 20:2 with a mean age of 40.0 ± 10.3 years and a median duration of symptoms of 7.5 years. The therapeutic effect was evaluated based on the change in the number of aberrant morae (phonemes), GRBAS scale, Voice Handicap Index (VHI), and Visual Analogue Scale (VAS). Results: The change in the number of aberrant morae peaked at 2 weeks and lasted for 12 weeks in the BT group with significance (P <.01) compared to the placebo group. Objective improvement (number of aberrant morae and [S] element in GRBAS) preceded subjective improvement (VHI and VAS). The change in number of aberrant morae and VHI showed a significant correlation (P <.01). The changes in the number of aberrant morae, VHI, and VAS in younger subjects were greater than in older subjects. Patients who presented with post‐treatment breathy hoarseness or dysphagia showed better therapeutic effects. Conclusions: BT therapy was effective for ADSD based on both objective and subjective assessments. Improvements in subjective parameters were delayed compared to objective measures due to post‐treatment breathy hoarseness. However, this adverse event was believed to reflect the treatment effect. Level of Evidence: 1b. [ABSTRACT FROM AUTHOR]

Objectives: Mutational falsetto (MF) is a functional voice disorder involving failure to transition from the high-pitched voice of childhood to the lower-pitched voice of adolescence and adulthood. The low mandible maneuver (LMM) is used by professional singers to relax the larynx and expand the resonance space. It relaxes suprahyoid muscles and pushes the larynx backwards, so it can be used as a therapy for MF. Material and Methods: The data of 20 MF patients treated by the LMM were analyzed in this study. All of the patients were asked to complete the Voice Handicap Index-10 (VHI-10) before the first session, and again 2 weeks after the second visit. The Grade-Roughness-Breathiness-Asthenia-Strain (GRBAS) scale scores and fundamental frequency (F0) were analyzed for each patient. Results: All except 1 patient reported that they completed the exercises without difficulty; the patient who did not perform the exercises cited reasons other than their difficulty. Only 2 patients failed to transition from MF to a lower-pitched voice. The GRBAS scale scores (all parameters) differed significantly between the first and second sessions. The VHI-10 score also changed, i.e., self-perceived voice quality was improved significantly, as was the F0. Conclusions: Our results showed that the LMM is an efficient and rapid technique for treating MF patients and shows high patient compliance. [ABSTRACT FROM AUTHOR]

Objective: To compare presenting symptoms, etiology, and treatment outcomes among dysphonic adults <65 and ≥65 years of age. Study Design: Retrospective cohort study. Setting: Tertiary care voice center between January 2011 and June 2016. Methods: A total of 755 patients presenting for dysphonia were included in the study: 513 adults <65 years of age and 242 adults ≥65. Data collected included demographics, referral information, prior diagnoses, prior treatments, clinical examination findings, diagnosis, coexisting symptoms, treatments, and pre- and postintervention Voice Handicap Index scores. Statistical analysis was performed with SPSS to determine significant relationships between variables of interest. Results: The most common etiologies of dysphonia were vocal cord atrophy (44.8%) in the ≥65 cohort and benign vocal cord lesions (17.8%) in the <65 cohort. When compared with adults <65 years old, patients ≥65 had a higher incidence of neurologic dysphonia (P =.006) and vocal cord atrophy (P <.001) but were less likely to have laryngopharyngeal reflux (P =.001), benign vocal cord lesions (P <.001), or muscle tension dysphonia (P <.001). Overall, 139 patients had surgery, 251 received medical therapy, and 156 underwent voice therapy. The ≥65 cohort demonstrated improvement in Voice Handicap Index scores after surgery (P =.001) and voice therapy (P =.034), as did the <65 cohort (surgery, P <.001; voice therapy, P =.015). Adult surgical patients <65 reported greater improvements than patients ≥65 (P =.021). Conclusions: There are notable differences in the pathophysiology of dysphonia between patients aged ≥65 and <65 years. Although adults <65 reported slightly better outcomes with surgery, patients ≥65 obtained significant benefit from surgery and voice therapy. [ABSTRACT FROM AUTHOR]

Abstract Background Amyotrophic lateral sclerosis (ALS) is a fatal degenerative disease of a rapid course. In 25% of ALS sufferers, speech disorders occur as prodromal symptoms of the disease. Impaired communication affects physical health and has a negative impact on mental and emotional condition. In this study, we assessed which domains of speech are particularly affected in ALS. Subsequently, we estimated possible correlations between the ALS patients’ subjective perception of their speech quality and an objective assessment of the speech organs carried out by an expert. Methods The study group consisted of 63 patients with sporadic ALS. The patients were examined for articulatory functions by means of Voice Handicap Index (VHI) and the Frenchay Dysarthria Assessment (FDA). Results On the basis of the VHI scores, the entire cohort was divided into 2 groups: group I (40 subjects) with mild speech impairment, and group II (23 subjects) displaying moderate and profound speech deficits. In an early phase of ALS, changes were typically reported in the tongue, lips and soft palate. The FDA and VHI-based measurements revealed a high, positive correlation between the objective and subjective evaluation of articulation quality. Conclusions Deterioration of the articulatory organs resulted in the reduction of social, physical and emotional functioning. The highly positive correlation between the VHI and FDA scales seems to indicate that the VHI questionnaire may be a reliable, self-contained tool for monitoring the course and progression of speech disorders in ALS. Trial registration NCT02193893.

Objective:The aim of this study is to evaluate smoothed cepstral peak point and laryngostrobosopic results in patients who underwent supraglottic laryngectomy.Method:Ten patients who underwent transcervical supraglottic laryngectomy with bilateral modified radical neck dissection, and who completed at least 12 months of follow-up, were included. All patients underwent laryngostroboscopic evaluation at study commencement; glottal closure and mucosal wave pattern were examined. Voice records were taken at fundamental frequency and smoothed cepstral peak point were analysed. Voice handicap index-10 was requested to be completed. Ten healthy individual constituted control group. Results were compared.Results:The mean smoothed cepstral peak points were 1.53-5.91 in the supraglottic laryngectomy group and 4.6-6.06 in controls, a significant difference. The fundamental frequency ranged from 174.49 to 197.25 Hz in the supraglottic laryngectomy group and from 118.57 to 197.61 Hz in the control group, also a significant difference. Laryngostroboscopic evaluation revealed no significant between-group differences in closure, but the mucosal waves differed significantly. Voice handicap index was significantly lower in supraglottic laryngectomy patients.Conclusion:Supraglottic laryngectomy reduces smoothed cepstral peak point and affects the mucosal wave, reducing voice quality.

Background and purpose: Botulinum toxin (BT) injection into the laryngeal muscles has been a standard treatment for spasmodic dysphonia (SD). However, few high‐quality clinical studies have appeared, and BT is used off‐label in most countries. Methods: We performed a multicenter, placebo‐controlled, randomized, double‐blinded, parallel‐group comparison/open‐label clinical trial to obtain approval for BT (Botox) therapy in Japan. Twenty‐four patients (22 with adductor SD and two with abductor SD) were enrolled. The primary end point was the change in the number of aberrant morae (phonemes) at 4 weeks after drug injection. The secondary end points included the change in the number of aberrant morae, GRBAS scale, Voice Handicap Index (VHI), and visual analog scale (VAS) over the entire study period. Results: In the adductor SD group, the number of aberrant morae at 4 weeks after injection was reduced by 7.0 ± 2.30 (mean ± SE) in the BT group and 0.2 ± 0.46 in the placebo group (p = 0.0148). The improvement persisted for 12 weeks following BT injections. The strain element in GRBAS scale significantly reduced at 2 weeks after BT treatment. The VHI and VAS scores as subjective parameters also improved. In the abductor SD group, one patient responded to treatment. Adverse events included breathy hoarseness (77.3%) and aspiration when drinking (40.9%) but were mild and resolved in 4 weeks. Conclusions: Botulinum toxin injection was safe and efficacious for the treatment of SD. Based on these results, BT injection therapy was approved as an SD treatment in Japan. [ABSTRACT FROM AUTHOR]

Laryngeal carcinomas are the most common upper respiratory tract cancers and most commonly involve the glottic region. The aim of this study is to evaluate the voice quality after radiotherapy (RT) and microsurgical cordectomy (MC) treatments using Voice Handicap Index (VHI) and Grade, Roughness, Breathiness, Astenicity, and Strain (GRBAS) perceptual evaluation scale in patients with early-stage glottic carcinoma. A total of 37 patients with early-stage glottic carcinomas, 19 patients had RT and 18 patients with MC, were included in our study. The patients were evaluated in terms of their sound quality by using VHI-10 and GRBAS perceptual assessment scale 3 months after the treatment was completed. Although the findings were better in favor of RT according to GRBAS perceptual assessment scale of patients who received RT (n = 19) and MC (n = 18), no statistically significant difference was found between the 2 groups (P =.613). Patients in both groups were evaluated with VHI-10, emotional (P =.036) and physiological (P =.038) scores were significantly higher in MC group and no significant difference was found in functional scores (P =.192). However, there was no statistically significant difference between the 2 groups in terms of voice quality (P =.185). In early-stage (Tis, T1a, T1b) glottic carcinoma, there was no significant difference between RT and MC in terms of voice quality. Therefore, the choice of treatment modality in patients with early-stage glottic carcinoma should be taken into account in terms of the patient's occupation, comorbid diseases, cost of treatment, hospital stay, and, most importantly, patient preference. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate 5-year voice outcomes of vocal fold augmentation (VFA) using autologous fat (AF) injection via direct microlaryngoscopy versus office-based calcium hydroxylapatite (CaHA) injection. Methods: Retrospective study of patients who underwent VFA between 2012 and 2015, with a 5-year follow-up. Patients with a glottic gap of ≤ 3 mm caused by unilateral vocal fold paralysis or vocal fold atrophy were included in the study. VFA was performed using AF injection via direct microlaryngoscopy in 17 patients, and using office-based CaHA injection in 19 patients. Subjective satisfaction with voice, voice handicap index (VHI), and maximal phonation time (MPT) were analyzed pre-injection, and at 12 and 60 months post-VFA. Results: Altogether 36 patients underwent VFA between 2012 and 2015, of whom 5 were excluded within 1 year post-VFA, and 2 were excluded between 1 and 5 years post-VFA. Of the remaining 29 patients, 3 (10.3%) underwent re-intervention at between 1 and 3 years post-VFA. Thus, the 5-year follow-up included 26 patients (72.2%; 11 males and 15 females). At 5 years after surgery, 73.1% of the patients were satisfied with their voice, with no significant between-group difference (P = 0.307). The mean improvement of VHI was 28.8 ± 17.82 in the autologous fat group versus 33 ± 26.24 in the CaHA group (P = 0.458). MPT improvement was also similar between the two groups: 6.2 ± 4.26 for the autologous fat group versus 6.3 ± 4.34 for the CaHA group (P = 0.667). Conclusions: Both AF injection via direct microlaryngoscopy and office-based CaHA injection yielded good and comparable 5-year results. [ABSTRACT FROM AUTHOR]

Background: The use of a creaky voice in speech has become more common. Laryngeal findings relate creaky voice with strong adductive tension in the glottis, and thus it may be expected to be related to an increased risk of vocal fatigue. Methods: The present study investigated the relation of creaky voice use and vocal symptoms in 104 Finnish female university students (mean age 24.3 years, SD 6.3 years). They had no known pathology of voice or hearing. The participants were recorded while reading aloud a text of approximately 40 s in duration. They also filled in a questionnaire consisting of the Voice Handicap Index (VHI, translation in Finnish), and half of them also answered questions about the frequency and severity of symptoms of vocal fatigue. The samples were perceptually analysed for the amount of creakiness and strain by a speech therapist and a voice trainer. Results: The interrater reliability of the listeners was acceptable (Pearson's χ2 = 100.159, p = 0.000 for creak; χ2 = 69.199, p = 0.000 for strain). Neither creakiness nor strain correlated with vocal symptoms. Participants with a low and a high amount of creakiness or strain did not differ from each other in terms of vocal symptoms or VHI scores. Symptoms' total score correlated with VHI total score and total scores of VHI's physical subscale. Creakiness and strain correlated positively with each other (r = 0.40, p = 0.000). Conclusion: No significant relations were found between creakiness or strain and vocal symptoms in this sample of university students. [ABSTRACT FROM AUTHOR]

Objective: Dysphagia is multifactorial in unilateral vocal fold immobility (UVFI). Severe dysphagia could indicate greater functional deficits in UVFI. The purpose of this study is to evaluate the association of dysphagia with the need for surgical voice restoration in patients with UVFI., Study Design: Retrospective chart review., Setting: Single-institution, tertiary referral center., Methods: Records of UVFI patients from 2008 to 2018 were examined. Dysphagia severity was extracted from patient history. Etiology of UVFI and other relevant variables were analyzed to determine their association with dysphagia. Dysphagia severity and other clinical variables were then analyzed for their association with surgical voice restoration., Results: Eighty patients met selection criteria out of 478 patients with UVFI. There was significant concordance between dysphagia severity extracted from patient history and patient-reported EAT-10 scores (R = 0.59, p = 0.000035). Patients' EAT-10 scores were correlated with VHI-10 scores (R = 0.45, p = 0.011). Severe dysphagia (p = 0.037), high VHI-10 score on presentation (p = 0.0009), and longer duration of hoarseness before presentation (p = 0.008) were associated with surgical voice restoration in UVFI patients., Conclusion: In this pilot study, severe dysphagia and increased voice handicap on presentation were associated with the need for surgical voice restoration in UVFI patients. Presenting dysphagia may be an additional variable for clinicians to consider for management of UVFI., Competing Interests: Declaration of competing interest No conflicts of interest to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction Voice is a crucial tool for communication, and voice problems are more likely to occur in professionals who frequently use their voice for work. Teachers, whose profession requires sustained vocal use, are particularly susceptible to occupation-related voice disorders. This study aimed to quantify the prevalence of voice disorders among teachers in Saudi Arabia, with the general population serving as a control group, and to identify associated risk factors. Methods A cross-sectional study was conducted utilizing an online self-administered questionnaire, which was completed by both teachers and the general population in Saudi Arabia. The latter group acted as a control. The questionnaire included sections on sociodemographic data, teaching patterns, symptoms of voice issues, and the Voice Handicap Index-10 (VHI-10) for assessing voice disorders among participants. Results The study included 640 participants, with 438 (68.4%) being teachers, the majority of whom were females (N = 406; 63.4%). The most common voice-related symptoms reported by teachers were hoarseness (N = 210; 37.9%) and dry throat (N = 147; 26.9%). Voice disorders, as determined by the VHI, affected 355 (55.5%) of the teachers. A high VHI score was associated with a diagnosis of voice disorders and GERD. There was no significant difference in the VHI scores between teachers and the general population (p > 0.05). Conclusion Teachers in Saudi Arabia exhibited a higher prevalence of voice disorders compared to the general population. Risk factors, such as smoking, longer teaching experience, and more teaching hours per week, were more common among teachers with voice disorders. Further investigative studies are warranted to elucidate the causal relationships between these variables and voice disorders., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Alharbi et al.)

Background and Objective: Vocal changes are one of the most common consequences of thyroid surgery. These changes can be due to neurological or other factors. With respect to vocal changes after surgery, and the need for determination of details of the vocal problems and related consequences in the patients’ life after thyroidectomy, the aim of this study was determination of some acoustic parameters of their voice after thyroidectomy and the status of subscales of Voice Handicap Index (VHI). Methods: This study is a cross-sectional descriptive analytic and non-interventional. One voice of 32 thyroidectomized patients (23 women and 9 men) with 20-60 years of age analyzed acoustically and they completed VHI questionnaire. Results: Statistical comparison of mean scores of VHI in two groups of patients with and without vocal problem showed that mean score and standard deviation of total scores of VHI, and the scores of functional, emotional, and physical subscales in patients with voice problems are more than the other group, and the differences were significant (P=0.000). Comparison of acoustic parameters in the two groups of patients showed that F0, jitter, shimmer, and HNR were different, but the differences were not significant. According to our results, amplitude perturbations and harmonic to noise ratio was high in both groups of thyroidectomized patients. Conclusion: According to the findings of this research, we can conclude that F0, jitter, shimmer, and HNR of voice may be not enough for determination of voice problems, but other acoustic measures, self-perceptual, or self-reported evaluation tools such as VHI maybe more efficient in determination of thyroidectomized patients’ voice problems.

Introduction: Use of patient-based voice assessment scales is an appropriate method that is frequently used to demonstrate effectiveness of voice therapy. This study was aimed at determining the effectiveness ofvoice therapy among patients with secondary muscle tension dysphonia (MTD) and vocal mass lesions. Materials and Methods: The study design was prospective, with within-participant repeated measures. Thirty-three patients with secondary MTD and vocal mass lesions participated in the study, selected on the basis of voice history, laryngeal palpation, and videostroboscopy examination. An experienced otolaryngologist and one experienced speech language pathologist undertook the diagnostic process. Voice therapy included both direct and indirect techniques and lasted approximately 2 months for all included patients. The voice handicap index (VHI) was used to evaluate the effectiveness ofvoice therapy among included patients. Paired t-test, size of the standardized effect (ESI),and mean standardized response (ESII) were used to analyze effectiveness of the target voice therapy. Results: The findings of this study indicate astatistically significant improvement after the voice therapy protocol (P1.96). Results of ESI and ESII demonstrate that the VHI scale is sufficiently responsive to detect voice therapy change (ES>0.8). Conclusion: This study recommends a combination of direct and indirect voice therapy in the vocal rehabilitation of patients with secondary MTD and vocal mass lesions. Furthormore, we recommend use of the VHI scale to show voice therapy changes for both clinical and research purposes.

Chronic tonsillitis creates conditions for the functional disorders of the voice and deterioration of its acoustic characteristics. The study of larynx functional state (video laryngostroboscopy, acoustic analysis of the voice using the LingWaves Voice Program program, and the Voice Handicap Index) in 40 patients with vocal-speech professions with simple and toxico-allergic 1 forms of chronic tonsillitis. After the course of palatine tonsils lacunaes sanation, the positive dynamics of the average values of the vibratory insufficiency index from 18 to 14 points and the DSI index from 29 to 385 points were noted. Chronic tonsillitis should be considered as one of the reasons for the development of functional dysphonia. Sanitation of lacunae of palatine tonsils improves the functional state of the vocal apparatus, which is confirmed by the results of acoustic analysis of the voice, by video laryngostroscope and VHI questionnaire.

Background: Treatment approaches for voice therapy are diverse, yet their differential effects are not well understood. Evaluations of treatment effects across approaches are important for clinical guidance and evidence‐based practice. Objective of review: To quantify the evidence of treatment effectiveness on the outcome measure Voice Handicap Index with the 30‐items (VHI‐30) from existing randomised controlled/clinical trials (RCT) of voice therapy using the statistical approach of a network meta‐analysis (NMA) with a random effects model. Type of review: Meta‐analysis. Search strategy: We searched in MEDLINE (PubMed, 1950 to 2019), Embase (1974 to 2019) and Science Citation Index (1994 to 2019) using five key terms. The inclusion criteria were reports of randomised controlled/clinical trials (RCTs) published in English or German which evaluated the effectiveness of a specific voice therapy treatment using VHI‐30 as an outcome measure in adult participants with non‐organic or organic voice disorders. Studies were excluded if participants had been diagnosed with neurological motor speech disorders or who were vocally healthy. Furthermore, no medical, pharmacological or instrumental (eg voice amplification) treatments were considered. Evaluation method: The primary outcome variable was VHI‐30 with a score from 0 to 120. The pre‐post treatment change in VHI‐30 scores was an average score of 13 points related to various VHI‐30 test‐retest results. Results: We retrieved 464 publications (ie with duplicates) and included 13 RCTs, which evaluated nine interventions, in the final analysis. The most effective intervention with a significant and clinically relevant effect was Stretch‐and‐Flow Phonation (SFP) (mean pre‐post difference −28.37, 95% confidence interval [CI], −43.05 to‐13.68). Resonant Voice (RV), the Comprehensive Voice Rehabilitation Program (CVRP) and Vocal Function Exercises (VFE) also demonstrated significant improvements. Conclusions: Of the nine voice interventions identified with the present NMA, SFP, RVT, CVRP, and VFE effectively improved VHI‐30 scores from pre‐ to post‐treatment. SFP proved to be the most significant and clinically relevant treatment. Further contributions of high‐quality intervention studies are needed to support evidence‐based practice in vocology. [ABSTRACT FROM AUTHOR]

Purpose: To compare the prevalence and severity of depression and anxiety among patients with vocal fold (VF) nodules, polyps and edema. At the same time the aim was to analyse association between severity of distress and the level of vocal handicap as well as to identify other factors related to severity of depression and anxiety in these patients. Methods: To all participants were given five questionnaires: (1) questionnaire on socio-demographic and some other characteristics of patient; (2) Beck's Depression Inventory (BDI); (3) State–Trait Anxiety Inventory (STAI) 1 (State Anxiety); (4) STAI 2 (Trait Anxiety); and (5) Voice Handicap Index (VHI)-10. Results: A total of 205 patients were included in this study. Mild-to-severe depression, according to BDI was present in 79 (38.6%) patients. Mild-to-severe state anxiety and trait anxiety were present in 199 (97.1%) and 200 (97.6%) patients, respectively. Only 10 patients had VHI-10 score ≤ 11. Multivariate analyses showed that there were no significant differences in the level of depression and anxiety between patients with VF nodules, polyps and edema. The VHI-10 score was significantly higher in patients with VF edema in comparison with VF nodule patients (p = 0.001), as well as in comparison with VF polyp patients (p = 0.001). Conclusion: The present study identified a high prevalence of psychological and vocal distress among patients with vocal disorders. Severity of depression and anxiety did not differ between patients with VF nodules, polyps and edema, and it was not related to the level of vocal handicap. [ABSTRACT FROM AUTHOR]

Prior studies have evaluated various populations at increased risk of voice impairment. However, minimal data is available for military Drill Instructors, a population known to have significant vocal demands. The purpose of this study was to determine the prevalence of subjective, perceptual, and objective dysphonia in this population and to evaluate contributing factors and impact on job performance. Cross-sectional analysis. United States Marine Corps base (Marine Corps Recruit Depot, San Diego, California). Active US Marine Corps Drill Instructors. A survey was administered investigating subjective measures of dysphonia and its impact on occupational function. Standardized voice samples were recorded for objective and perceptual voice analysis. Prevalence of subjective (Voice Handicap Index-10 and Glottal Function Index scores), perceptual (CAPE-V score), and acoustic (Cepstral-spectral index of dysphonia) measures of dysphonia. Subjective dysphonia was present in 47.7% by the Voice Handicap Index-10 and 70.2% by the Glottal Function Index. 51% of subjects reported periods of aphonia, while 47% reported voice problems limiting job function in the month prior to being surveyed. The Cepstral-Spectral Index of Dysphonia Mean was abnormal in 95.3% and CAPE-V overall severity score was abnormal in 94%. There was significant improvement in subjective, perceptual, and acoustic voice outcomes as the amount of time since last training cycle (ie, relative voice rest) and as experience as a Drill Instructor increased, however the VHI-10 was the only measure that normalized. There is a very high prevalence of self-reported dysphonia in Drill Instructors, with near-universal prevalence of some degree of objectively and perceptually-rated dysphonia. Nearly half of those surveyed reported that dysphonia limited their job performance. Relative voice rest and experience seem to mitigate severity, but normal ratings were rare. While objective and perceptually-rated dysphonia are persistent and highly prevalent, it does not necessarily translate into a perceived impairment in this population. For these reasons and considering the importance of extraordinary vocal function in this occupation, Drill Instructors appear to be in dire need of proper voice care to both maximize job performance and mitigate long-term voice-related problems. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to evaluate smoothed cepstral peak point and laryngostrobosopic results in patients who underwent frontolateral laryngectomy (FLL). Methods: Eight patients who underwent FLL with bilateral modified radical neck dissection, and who completed at least 12 months of followup, were included. All patients underwent laryngostroboscopic evaluation at study commencement; glottal closure was examined. Voice records were taken at fundamental frequency (Fo) and smoothed cepstral peak point were analysed. Voice handicap index-10 was requested to be completed. Ten healthy individual constituted control group. Results were compared. Results: The smoothed cepstral peak points were between 1.81-2.42 in the FLL group and 4.6-6.06 in controls, a significant difference. The Fo ranged from 61 to 192.63 Hz in the FLL group and from 118.57 to 197.61 Hz in the control group, also a significant difference. Laryngostroboscopy revealed significant differences between-group in their closure. Seven patients had incomplete closure in FLL group and the entire control group had complete closure except one female patient who had posterior glottal gap (p=0.01). Voice handicap index-10 results were between 31-40 in FLL group and 8-14 in control group and also revealed a significant difference. Conclusion: FLL reduces smoothed cepstral peak point and affects the mucosal wave, reducing voice quality. [ABSTRACT FROM AUTHOR]

Background: The Voice Handicap Index-10 (VHI-10) is used in clinics because of its validity and ease of use by patients. Objectives: The aim of this paper was to evaluate the internal consistency, reliability, and clinical validity of the Serbian version of the VHI-10. Method: In this cross-sectional study, we translated the original English version of the VHI-10 into Serbian, after which it was back-translated into English. The Serbian version of the VHI-10 was completed by 161 patients with voice disorders, divided into 4 groups according disease etiology (structural, neurological, functional, and inflammatory) and 73 healthy control subjects. Results: The VHI-10 internal consistency was 0.88. Spearman's rank correlation coefficient for VHI-10 test-retest reliability was ρ = 0.991 (p< 0.001). Patients with voice disorders had higher median total VHI-10 scores compared with controls (p< 0.001). The patients' Grade, Instability, Roughness, Breathiness, Asthenia, and Strain (GIRBAS) scale scores were significantly correlated with the VHI-10 test scores (ρ = 0,682, p < 0.001) and VHI-10 retest scores (ρ = 0.716, p < 0.001). Conclusion: The Serbian version of the VHI-10 had good validity and reliability and can be used by Serbian patients with voice disorders. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the vocal changes in the Iranian pregnant women according to trimesters both objectively and subjectively. There were 93 pregnant women and 31 non-pregnant women participants in the study. Thirty-three of the 93 pregnant women were in their first trimester, 31 in their second trimester, and 29 in their third trimester of their pregnancies. Clinical data were collected from the acoustic measurements, aerodynamic assessment, video laryngoscopy examination, and the self-assessment of quality of life related to voice using the Persian Voice Handicap Index (VHI P). The analysis of variance (ANOVA) test and Kruskal–Wallis test were used for between-group comparisons of the data. Decreased maximum phonation time (MPT), increased S/Z ratio, increased VHI P -30 scores, and evidence of vocal fold edema were the parameters that differed significantly only in the third trimester. Acoustic analysis revealed that F0, jitter, shimmer, and noise-to-harmonics ratio (NHR) were not significant across the four groups. Results showed that decreased MPT, increased S/Z ratio, mild to moderate edema, and a deterioration of the VHI P -30 score noticeably occurred during the third trimester. The results suggest significant vocal changes toward less stable phonation during the third trimester of pregnancy. [ABSTRACT FROM AUTHOR]

Objective: Office-based steroid injection has shown promise for idiopathic subglottic stenosis (iSGS). It is important to understand safety and patient-lived experience. We report patient experience related to airway restriction, voice, and side effects. Methods: Sixteen patients (51 ± 14 years) with mild-moderate (20-50%) stenosis undergoing office-based transnasal steroid injections were included; fourteen had prior operations. Patients typically underwent three injections, 1 month apart, followed by transnasal tracheoscopy 1 month later to evaluate outcome; number of injections can vary based on disease severity and response. Outcomes were Dyspnea Index (DI), Modified Medical Research Council (MMRC) dyspnea scale, voice handicap index-10 (VHI-10), and degree of stenosis (estimated from procedural video). At each visit, patients were queried about post-injection airway restriction and side effects. Paired t -tests compared values at baseline versus follow-up tracheoscopy. Results: DI decreased (t = 3.938, P = 0.0013), as did MMRC (t = 2.179, P = 0.0457). There was no change in VHI-10 (t = 1.354; P = 0.1957) scores. Airway stenosis decreased (t = 4.331; P = 0.0006); this was not correlated with change in DI (r = 0.267, P = 0.318). Side effects included airway restriction lasting <48 hours (n = 5), cough (n = 3), and nasal pain (n = 2). Conclusion: Steroid injections improved upper airway symptoms. Side effects were mild and transient. Improvement in DI did not correlate with percent stenosis. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to analyse the associations between the spirometry parameter changes in relation to laryngeal finding changes and self-reported voice and throat symptom changes among patients undergoing a histamine challenge test. Patients and Methods: Thirty adult patients with a chronic cough underwent a histamine challenge test. Videolaryngostroboscopy and voice and throat symptoms were assessed using a visual analogue scale immediately before and after the challenge test. Correlations between the relative changes in spirometry values in relation to the change in vocal fold oedema and redness and self-reported voice and throat symptom changes during the challenge test were assessed. Results: A correlation between the relative change in inspiratory and expiratory air flow values and the change in voice and throat symptoms during the histamine challenge test was found. The vocal fold oedema, visible on videolaryngostroboscopy, caused by the histamine challenge did not significantly affect the spirometry air flow values. Conclusion: The relative changes in inspiratory and expiratory air flow and voice and throat symptoms during the histamine challenge test correlated. The vocal fold oedema caused by the histamine challenge, visible on videolaryngostroboscopy, did not significantly affect the spirometry air flow values. [ABSTRACT FROM AUTHOR]

Objectives: Functional endoscopic sinus surgery (FESS) is a standard treatment modality for patients with chronic rhinosinusitis (CRS) who have failed appropriate medical therapy. However, FESS entails modification of the upper airway tract that may alter phonatory resonance and produce voice changes. The effects of FESS on postoperative voice characteristics in patients with CRS have yet to be quantitatively assessed. Methods: Patients with severe CRS who underwent FESS at a tertiary care referral center between May and October 2017 were prospectively enrolled. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and the Voice Handicap Index (VHI) were used to quantitatively evaluate voice characteristics and quality of life, respectively. Preoperative and postoperative CAPE-V and VHI scores were compared with postoperative scores for each patient. Sino-Nasal Outcome Test (SNOT-22) scores were also obtained to assess changes in patient symptoms. Results: 18 CRS patients undergoing FESS were enrolled. The average preoperative Lund-Mackay score was 14, indicating baseline severe CRS. Postoperative assessments demonstrated a statistically significant decrease in CAPE-V (45-27, p =.005) and VHI (10-4.7, p <.001) scores. These correlated with a statistically significant decrease in SNOT-22 scores (42-13, p <.001). Conclusions: Patients with CRS experience a significant improvement in voice characteristics and vocal quality of life following FESS. Furthermore, this appears to correlate with a significant decrease in self-reported disease severity. These findings may augment the discussion of potential benefits of FESS to a new potential domain for voice quality. [ABSTRACT FROM AUTHOR]

Voice and swallowing alterations are frequently reported after thyroidectomy, even in absence of nerve injury. The symptoms impair the quality of life. Aim of the study was to evaluate prospectively vocal function and swallowing symptom changes after total thyroidectomy in the early and late postoperative period. Prospective observational study. All consecutive patients scheduled for total thyroidectomy were included. Subjective voice evaluation using the Greek version of Voice Handicap Index (VHI) was performed preoperatively and at 2nd postoperative day, 1 month, 12 months postoperatively to assess the functional outcome. Laryngoscopy was performed at the same timing. Subjective swallowing evaluation using the Swallowing Impairment score (SIS) evaluated the swallowing symptoms. The study population included 125 patients. Total VHI score differed significantly between preoperative values and at 48 h and 1 year postoperatively (p = 0.000). Significant changes were observed for the functional and emotional domain of VHI between preoperative and 48 h postoperatively (p = 0.001, 0.003, respectively). There were statistically significant changes for physical domain of VHI between preoperative values and values at 48 h and 1 year (p = 0.000, 0.001, respectively). Regarding the swallowing symptoms, the mean postoperative score at 1 month did not differ significantly from the mean preoperative score (p = 0.103). Swallowing alterations showed a tendency to increase 48 h postoperatively and decreased thereafter. Swallowing score at 1 year postoperatively was statistical significant lower compared to preoperative values. Even with intact laryngeal nerves, transient voice and swallowing alterations may occur after total thyroidectomy. Patients should be informed about these mild changes to lower anxiety following the operation. [ABSTRACT FROM AUTHOR]

Background: Disorders of voice can limit an individual's participation and impair social interaction, thus affecting overall quality of life. Perceptual and objective evaluations can provide the clinician with detailed information regarding voice disorders. Methods: This study comprised 40 subjects aged 34–46 years, 20 of whom (10 male, 10 female) had unilateral vocal fold palsy. Data were obtained for all participants from: the Voice Handicap Index, the grade, roughness, breathiness, asthenia and strain ('GRBAS') scale, acoustic voice analysis, electroglottography, and voice range profiles. Results: The voice evaluations revealed statistically significant (p < 0.05) differences between the controls and study group, both in males and females, pre- and post-therapy. Conclusion: Despite the normalisation of vocal parameters, acoustic, perceptual and self-rated assessments revealed statistically significant differences after therapy. Hence, acoustic measures, namely electroglottographic perturbation, and voice frequency and intensity range, are recommended prior to termination of therapy. [ABSTRACT FROM AUTHOR]

Objective The effects of voice disorders vary from person to person. Occupation, work environment, life, and family reaction are variables that affect one's perception of his/her own as an impaired voice. Voice Handicap Index (VHI) has not yet been used to compare the degree of voice disorders. Assuming that the quality of life may be different under a variety of voice disorders and that different physical, emotional and functional aspects maybe affected differently and that each disorder has a different treatment, This stud was conducted to prioritize and propose the appropriate treatments (voice health, manual therapy of larynx, voice therapy, and referral to relevant specialists) based on VHI score. Materials & Methods This is a descriptive/analytic study with cross-sectional design. Firstly, voice disorder of 166 patients aged 18-60 years referred to private clinics in Tabriz city was confirmed based on the diagnosis of a otolaryngologist and laryngeal stroboscopic images. VHI test was performed and a questionnaire was used to survey them in the presence of examiner to answer their potential questions. The VHI test consists of 30 items and 3 subscales of physical (10 items), emotional (10 items) and functional (10 items) rated on a 5-point Likert scale (0=Never, 1=Almost Never, 2=Sometimes, 3=Almost Always, and 4=Always). The patient's stroboscopic samples was examined by 3 speech-language pathologists and based on their consensus, patients were assigned into functional and structural voice disorders. In the next step, values obtained from the VHI test were compared between the two groups based on three subscales. Finally, the data were analyzed in SPSS v.19 software using statistical methods such as mean, standard deviation and Multivariate Analysis Of Variance (MANOVA). Results The rate of voice impairment was significantly higher in patients with structural voice disorder than in patients with functional disorder in overall and based on functional, physical and emotional components (P<0.05). Based on Kolmogorov-Smirnov test results, the variables had normal distribution. According to the Box test results, the studied groups were homogeneous in terms of study variables. Based on Bartlett's test of sphericity results, the assumption of correlation between the variables was established, since the mean value of patients in the structural group was significantly higher than in the functional group (P<0.05). the mean scores of individuals with structural voice disorders in physical (18.7) and emotional (15.2) dimensions were significantly higher than in those with functional voice disorders (P<0.05). Conclusion Voice impairment in the structural group was lower than in the functional group. A comprehensive treatment should be considered for patients with structural voice disorder with an emphasis on improving the psychological aspects of voice disorders. [ABSTRACT FROM AUTHOR]

Voice disorders are common in the general population, affecting daily communication for nearly one-third. Prevalence of voice disorders has been studied extensively in certain professions, such as teachers, as well as students. The impact on voice characteristics of different risk factors has been studied and also correlated to cigarette smoking. This study was designed to examine the relationship between Voice Handicap Index and acoustic parameters of voice university student smokers in Greece. One hundred and ten female non-dysphonic students (aged 18 to 34) that smoked were recruited. Participants answered the Voice Handicap Index and their voice was recorded. Acoustic analysis of voice characteristics was performed with Dr. Speech software system. Results indicated that some measures were predictive of overall, functional and emotional Voice Handicap Index scores. Other voice parameters had no cohesive or predictable pattern on Voice Handicap Index scores. Significant relationships between Voice Handicap Index individual statements and smokers’ voice characteristics were also observed. Lack of correlation and subsequent clinical implications are discussed, as well as the direction for future research.

Background Voice disorders (VD) pose significant challenges for teachers as they impact their professional and personal lives. Teaching requires extensive use of the voice, making teachers particularly susceptible to vocal health issues. VD can hinder the quality of education. Objectives This study aimed to comprehensively explore the prevalence, associated factors, and impact of VD among teachers and their health-seeking behavior regarding VD. Methodology A cross-sectional observational study was conducted in Taif City, Kingdom of Saudi Arabia (KSA), between November and December 2023. The data were collected through a questionnaire covering demographic variables, occupational factors, voice-related symptoms, associated health conditions, and the impact of VD. The statistical analysis was performed using SPSS Statistics version 26 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.), and chi-squared tests were used to assess associations. Results The study involved 568 teachers, 61.8% of whom had VD. The study identified significant associations between VD and demographic characteristics, habits, and teaching-related variables. Age, gender, teaching subject, class size, and weekly teaching load were associated with the prevalence of VD. Hoarseness, throat pain, and throat dryness were prevalent symptoms among teachers with VD. The impact of VD on teachers was evident, with a considerable proportion reporting work absenteeism (28.7%) and even contemplating retirement due to voice problems (6.3%). Conclusion This study offers a nuanced understanding of VD among teachers in the Taif region, emphasizing the complex interplay of demographic, symptomatic, and behavioral factors. The findings underscore the need for targeted interventions, including awareness campaigns, preventive strategies, and streamlined healthcare access, to address the unique challenges that different subgroups of teachers face. Future research should further explore longitudinal trajectories and objective measures to enhance our understanding of VD in educational settings., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Fageeh et al.)