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Background and objective: Following thyroid surgery, vocal changes are a common complication and well-known morbidity that may be linked to neuronal and non-neuronal voice breakdown. Nevertheless, their effects on different voice characteristics are not fully understood, and their bases are still poorly characterized. In order to determine the diagnostic indicators that address the nature of such post-thyroidectomy voice alternations, this study was designed to provide a multidimensional assessment of vocal function after thyroid surgery. Methods: This research was a 1-year prospective cohort study conducted on 100 adult patients aged 40.19 (± 12.82) years who were recruited from the outpatient clinic of Phoniatric Unit, Assiut University Hospital, and scheduled to undergo thyroid surgery during the period from November 2020 to November 2021. All subjects underwent vocal assessment preoperatively and 15 days, 1 month, and 2 months postoperatively by filled in subjective evaluation of voice complaints via voice handicap index (VHI-30), auditory perceptual assessment (APA) of the voice, and videolaryngoscopy in addition to acoustic analysis using computerized speech lab (CSL). Statistical analysis was performed to compare multi-parameter voice assessment tools across different assessment time points. Results: The voice changes were significantly decreased from 51.0% after 15 days postoperatively to 33.0% after 2 months of follow-up. Among these cases, 35.0% cases developed vocal fold paralysis and complained of a breathy voice (27% developed unilateral vocal fold paralysis, and 8% developed bilateral focal fold lesions), and the remaining 16.0% cases had no paralytic manifestations. Also, only one case developed gross lesion "bilateral vocal fold nodules." The subjective evaluation of voice outcome after thyroidectomy showed significant improvement in VHI subscales and total score from 15 days postoperatively to 2 months of follow-up (P < 0.001). All of the acoustic parameters except HNR showed a significant difference across the different assessment settings (P < 0.001). Conclusion: Thyroidectomy can result in significant vocal alterations, even in cases where the laryngeal nerve is unharmed. These changes should be taken into consideration in patient having thyroid surgery, especially a total thyroidectomy because of malignant lesions. More efforts are needed in order to determine the extent and pathophysiological reasons for the vocal alterations following thyroid surgery in order to reduce the morbidity associated with one of the most popular surgical procedures performed globally. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the effects of caffeine on the vocal health of university teachers. METHODS: This cross-sectional study employed a non-probability convenience sampling technique to recruit 362 university teachers from Riphah International University, University of Education, University of Management and Technology, and University of Punjab, Pakistan between January 1, 2022, and June 31, 2022. The sample included both male and female participants aged 25 to 60 years. A Basic Demographic Sheet and the Voice Handicap Index (VHI) were used for data collection. Data were analyzed using SPSS version-22. RESULTS: Out of 362 university teachers, 239 (66%) were females and majority (n=92/362, 25.4%) were within the 30-35 years’ age group. The majority of university teachers (n=290; 80.11%) in the study were caffeine users. Among them, 196 (54.1%) had severe voice handicaps, with 72 (19.9%) being non-caffeine users. Importantly, all teachers with mild and moderate handicaps were caffeine users (p=0.000). VHI scale, including functional, physical, and emotional subscale scores, as well as total mean scores, were significantly higher among non-caffeine users (p

Abstract Background and objective Following thyroid surgery, vocal changes are a common complication and well-known morbidity that may be linked to neuronal and non-neuronal voice breakdown. Nevertheless, their effects on different voice characteristics are not fully understood, and their bases are still poorly characterized. In order to determine the diagnostic indicators that address the nature of such post-thyroidectomy voice alternations, this study was designed to provide a multidimensional assessment of vocal function after thyroid surgery. Methods This research was a 1-year prospective cohort study conducted on 100 adult patients aged 40.19 (± 12.82) years who were recruited from the outpatient clinic of Phoniatric Unit, Assiut University Hospital, and scheduled to undergo thyroid surgery during the period from November 2020 to November 2021. All subjects underwent vocal assessment preoperatively and 15 days, 1 month, and 2 months postoperatively by filled in subjective evaluation of voice complaints via voice handicap index (VHI-30), auditory perceptual assessment (APA) of the voice, and videolaryngoscopy in addition to acoustic analysis using computerized speech lab (CSL). Statistical analysis was performed to compare multi-parameter voice assessment tools across different assessment time points. Results The voice changes were significantly decreased from 51.0% after 15 days postoperatively to 33.0% after 2 months of follow-up. Among these cases, 35.0% cases developed vocal fold paralysis and complained of a breathy voice (27% developed unilateral vocal fold paralysis, and 8% developed bilateral focal fold lesions), and the remaining 16.0% cases had no paralytic manifestations. Also, only one case developed gross lesion “bilateral vocal fold nodules.” The subjective evaluation of voice outcome after thyroidectomy showed significant improvement in VHI subscales and total score from 15 days postoperatively to 2 months of follow-up (P

This study examines the effectiveness of a voice training program designed for Islamic religious officials, who are occupational voice users with a significant vocal load. The participants included 34 healthy religious officials whose acoustic measures were within normal voice ranges for healthy adults (jitter < 1%; shimmer < 3%) and reported no voice complaints. Participants were randomly divided into two groups (experimental, n = 17; control, n = 17). The two-stage voice training program consisted of 32 sessions over 8 weeks with informative and voice exercise stages. Objective and subjective voice measurements were performed at the beginning and end of the research. Objective measurements included fundamental frequency, percentage of vocal pitch perturbation (jitter), percentage of vocal intensity perturbation (shimmer), and harmonics-to-noise ratio. Subjective voice measurements included the Singing Voice Handicap Index, Vocal Fatigue Index (VFI), and Voice-Related Quality of Life (V-RQoL) scores. All initial measurements other than VFI scores were within acceptable limits for both groups. There were no significant differences between the groups initially (p > 0.05) and no significant changes in the control group in the second evaluation (p > 0.05). However, there was significant improvement in the experimental group after the training program in all measures, including VFI scores (p < 0.05). This study shows the positive results of a voice training program. Voice training should be integrated into the formal education of occupational voice users or in-service training programs of relevant institutions. [ABSTRACT FROM AUTHOR]

This study aimed to examine the impact of the timing of voice therapy on vocal outcomes in patients post-surgery for benign vocal fold lesions.The study prospectively assessed 20 patients undergoing phonomicrosurgery for benign vocal fold lesions. Participants were categorized into early voice therapy (within 7 days), late voice therapy (after 7 days), and no voice therapy groups. Vocal outcomes were assessed using the Voice Handicap Index (VHI) and the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V).Early voice therapy led to significant improvements in post-operative VHI scores (p = 0.001) and CAPE-V scores (p = 0.014199), whereas delayed or no therapy showed less pronounced improvements. No significant differences were observed in preoperative VHI and CAPE-V scores among the groups.Early initiation of voice therapy post-surgery significantly improves vocal outcomes in patients with benign vocal fold lesions. These findings advocate for the integration of early voice therapy into post-operative care protocols. [ABSTRACT FROM AUTHOR]

To investigate the prevalence of obesity in patients with dysphonia and the association between Body Mass Index (BMI) and the Voice Handicap Index-10 (VHI-10). This is a retrospective study that included 304 patients who visited the senior author's Otolaryngology practice between the years 2018 and 2020. Patients were divided into two groups, those presenting for dysphonia and those presenting for other otolaryngologic complaints (Controls). Patients were also stratified as Normal weight (BMI < 25 kg/m2) vs. Overweight (BMI between 25-30 kg/m2), vs. Obese (BMI ≥ 25 kg/m2). The VHI-10 was used as a subjective outcome measure reported by patients with dysphonia. A total of 304 patients included in this study, 203 presenting with dysphonia and 101 with other otolaryngologic complaint. Within the dysphonia group, a significantly higher percentage of patients had a BMI ≥ 25 (70.4%) as compared to the control group (57.4%). The odds ratio were 1.76, meaning that obese patients were 1.76 times more likely to present with dysphonia. There was a weak negative correlation between overweight, obesity, and VHI-10 scores (r=-0.007 and r=-0.039, respectively). There was a significantly higher prevalence of overweight and obesity in patients with dysphonia vs. patients with no dysphonia. Although there was a weak correlation between BMI and VHI, our results demonstrate that overweight and obese patients are more likely to have dysphonia. [ABSTRACT FROM AUTHOR]

Unilateral vocal cord paralysis is frequently observed in patients who undergo thyroid surgery. This study explored the correlation between acoustic voice analysis (objective measure) and Voice Handicap Index (VHI, a self-assessment tool). One hundred and forty patients who had thyroid surgery with or without postoperative unilateral vocal cord paralysis (PVCP and NPVCP) were included. The patients were evaluated by the VHI and Dysphonia Severity Index (DSI) tools. VHI scores were significantly higher in PVCP patients than in NPVCP patients. Jitter (%) and shimmer (%) were significantly increased, whereas DSI was significantly decreased in PVCP patients. Receiver operating characteristics curve revealed that VHI scores were associated with the diagnosis of PVCP, of which VHI total score yielded an area under the curve (AUC) of 0.81. Among acoustic parameters, DSI was highly associated to PVCP (AUC=0.82, 95%CI=0.75 to 0.89). Moreover, we found a correlation between VHI scores and voice acoustic parameters. Among them, DSI had a moderate correlation with functional and VHI scores, as suggested by an R value of 0.41 and 0.49, respectively. VHI scores and acoustic parameters were associated with the diagnosis of PVCP.

Background: Hoarseness affects a significant portion of the population, impacting communication and quality of life. While systemic hydration and dietary modifications have been suggested as management strategies, empirical evidence supporting their efficacy remains sparse. Methods: This prospective study at the District Hospital in Sheopur involved 100 participants with hoarseness, assessing the impact of hydration and dietary interventions over six months. Voice quality was measured using the Voice Handicap Index (VHI) and acoustic parameters pre- and post-intervention. Adherence to interventions was monitored and correlated with outcomes. Results: Postintervention, significant improvements were observed in VHI scores (from 30 ± 10 to 20 ± 8, p < 0.001) and acoustic measures. A strong correlation was found between high adherence to the prescribed interventions and improvement in voice quality (Spearman's rho for VHI improvement = 0.70, p < 0.001). Despite overall positive outcomes, 10% of participants experienced worsened symptoms, indicating variability in individual responses. Conclusion: The study provides empirical support for the efficacy of hydration and dietary modifications in improving voice quality among individuals with hoarseness. High adherence to the intervention was a key factor in achieving significant voice improvement, emphasizing the importance of patient engagement and tailored support in treatment plans. [ABSTRACT FROM AUTHOR]

This study investigates self-perceptions of voice-related handicap as a function of facemask use in the general working population during the COVID19 outbreak, using the Voice Handicap Index (VHI). Each VHI item was answered twice in a row; the first answer referred to the condition of not wearing a facemask (henceforth, the Without condition) and the second to the condition of using a facemask (henceforth, the With condition). VHI scores were collected via Google Forms (Google, Mountain View, California), targeting 2 groups of speakers of different nationalities, Portuguese (n = 261) and Spanish (n = 297). A Wilcoxon test was carried out to compare VHI scores between With and Without conditions for each group of speakers; a Mann-Whitney U test was used to compare groups within each condition. Results suggested that VHI overall scores and scores for all dimensions were higher for the With condition, for both Portuguese and Spanish speakers. When comparing groups of speakers, Spanish speakers presented higher scores for functional and emotional dimensions, for both With and Without conditions. In addition, the overall score for the Without condition was higher for Spanish speakers. No differences between groups were found for the total VHI score for the With condition. When comparing overall VHI diff between speakers, that is, the difference in the VHI total score between With and Without conditions, no significant differences could be found. Thus, a multiple regression analysis was carried out between the VHI diff and the independent variables of interest: age, sex, smoking habits, professional occupation, nationality, facemask type and its hours of use. The resulting model providing the highest association suggested that 2.5% of the variation in overall VHI diff total score could be associated with sex, smoking habits, and professional level. Female smokers who use their voices during prolonged hours at work (e.g., teachers, lawyers, sales people) presented a higher VHI total score when wearing a mask. Future voice-related health interventions should address preventive strategies towards speaking behaviors leading to vocal fatigue and vocal effort as a consequence of compulsory facemask use, especially with respect to female professional voice users who smoke. [ABSTRACT FROM AUTHOR]

Objective: Voice disorders have an adverse effect on the psychological, social, and physical lives of patients, and they diminish their quality of life. A subjective self-assessment tool, the voice handicap index (VHI-10) and an objective diagnostic tool, the multi-dimensional voice program (MDVP), are frequently used in the evaluation of voice disorders. The aim of this study is to determine how these tools correlate with each other and whether they can be used independently. Methods: A total of 27 patients were enrolled in this study. VHI-10 and MDVP were prepared to perform voice analysis. The strength of the linear relationship was measured using Pearson's and Spearman's correlation. Results: The study included 14 (51.8%) males and 13 (49.2%) females with a mean age of 46.07±14.78 years. The total score of the VHI-10 was 23.4±9.9. According to the MDVP scores, the mean fundamental frequency (mF0) was 188.064±53.6 Hz (88.946-260.153), jitter (percentage jitter) was 1.85 (1.115-7.27), shimmer (absolute shimmer) was 0.475 (0.394-0.829), and noise harmonic ratio (NHR) was 1.715±4.7. There was no correlation between VHI scores and MDVP parameters, including mean fundamental frequency, jitter, shimmer, and NHR (r=0.086; -0.018; 0.002; and 0.083) (p>0.05). Conclusion: VHI-10 scores and parameters of the MDVP were not significantly related to each other, and these tools cannot be used interchangeably. [ABSTRACT FROM AUTHOR]

Objectives: Injection of botulinum toxin type A (BTX) into intrinsic laryngeal muscles is the current gold standard therapy for adductor spasmodic dysphonia (AdSD). However, a surgical procedure could potentially offer more stable and long‐lasting voice quality to AdSD patients. Here, we report the long‐term results of type 2 thyroplasty (TP2) with TITANBRIDGE® (Nobelpharma, Tokyo, Japan) compared with those of BTX injections. Methods: In total, 73 AdSD patients visited our hospital between August 2018 and February 2022. Patients were provided the option of BTX injections or TP2. They were assessed via the Voice Handicap Index (VHI)‐10 before treatments and at scheduled clinical follow‐ups at 2, 4, 8, and 12 weeks for BTX and at 4, 12, 26, and 52 weeks for TP2. Results: Overall, 52 patients selected the BTX injection and had a pre‐injection mean VHI‐10 score of 27.3 ± 8.8. Following injections, the scores significantly improved to 21.0 ± 11.1, 18.6 ± 11.5, and 19.4 ± 11.7 at 2, 4, and 8 weeks, respectively. There were no significant differences between the pre‐injection scores and the 12‐week scores (21.5 ± 10.7). Alternately, 32 patients opted to be treated with TP2 and had a pre‐treatment mean VHI‐10 score of 27.7. All patients reported an improvement in their symptoms. Additionally, the mean VHI‐10 score significantly improved to 9.9 ± 7.4 at 52 weeks following treatment. There was a significant difference between the two treatment groups at 12 weeks. Some patients received both treatments. Conclusion: These preliminary results provide important insights into the value of TP2 as a potential permanent treatment for AdSD patients. Level of Evidence: 3 Laryngoscope, 133:3443–3448, 2023 [ABSTRACT FROM AUTHOR]

Objective One of the most voice-related complaints in teachers is vocal tract discomfort (VTD) which can increase the voice handicap index (VHI) to different degrees. In teachers Muscle Tension Dysphonia (MTD), increases voice complaints and decreases the voice-related quality of life. The aims of this study were to evaluate and compare the frequency and severity subscales of the VTD score and total score of VHI and determine the relation between them in primary school teachers with and without MTD. Materials & Methods This study was cross-sectional and was performed on 80 primary female teachers with and without MTD. The participants in both groups were randomly selected after checking the inclusion criteria. Voice history, auditory-perceptual assessment of voice, palpation, and laryngeal video-stroboscopy were assessed on the teachers in two groups. Then, asked the participants to complete the Persian versions of the VTD and VHI scales. After determining the normal distribution of the data using the Kolmogorov-Smirnov test, the results of VTD, VHI, and their subscales were compared between two groups with an independent t-test. Also, the relationship between them was assessed with the Pearson correlation coefficient analysis. Results The mean score of the frequency subscale of VTD in teachers with MTD was more than in teachers without MTD (30.17±5.11, 8.22±2.26), respectively. The score of severity subscales of VTD in teachers with MTD was 39.12±4.94 and in teachers without MTD was 7.89±2.13. Also, the total score of the VHI questionnaire in teachers with MTD was significantly higher than teachers without MTD (P

Purpose: Laryngeal framework surgery, including medialization laryngoplasty and arytenoid adduction (AA), is expected to have a lasting or permanent effect in patients with unilateral vocal fold paralysis (UVFP); however, there are few reports about the long-term outcomes of AA. This study aimed to evaluate the long-term postoperative effects of AA surgery and examine its stability and reliability. Methods: This study collected the voice handicap index (VHI) questionnaire from patients with UVFP who underwent AA more than 2 years previously. The VHI values preoperatively and 3 months postoperatively (early postoperative evaluation) were retrospectively calculated, and VHI values more than 2 years after surgery (late postoperative evaluation) were collected by mailing a sheet to the patients and asking to fill and return it. Possible influenced subscales such as age, sex, causes of UVFP, affected side, and surgeons were also analyzed. Results: A total of 77 patients with UVFP who underwent AA had significantly lower early and late postoperative evaluations than preoperative evaluations. In 38 patients with no missing values, there were no significant differences between early and late postoperative evaluations, measured at a median of approximately 5 years. There were also no significant differences between early and late postoperative evaluations in any of the subscale groups. Conclusion: Patients with UVFP who underwent AA surgery achieved stable voice improvement in the long term after surgery. [ABSTRACT FROM AUTHOR]

Background & Objectives: VH (Vocal health) is the need of the hour. VH of parents of children with hearing assistive devices (HAD) reveals a literature gap, during the habilitation process of their children. To explore the vocal health of parents of children with hearing assistive devices. Methods: This cross-sectional study was conducted at Riphah International University from September to December 2021. Study recruited N=384 parents of Hearing Impaired children (HIC) using HAD for at least two years, of both genders and aged 2-9 years using convenience sampling. Voice-related quality of life (V-RQOL), and vocal health Index (VHI) -10 were used for data collection. Data was analyzed on SPSS Version 25. Descriptive statistics, Anova and t-test were utilized to see difference between means of groups. P<0.05 shows significant-results. Results: Parents of children using hearing assistive devices had excellent V-RQOL score in 350(91.14%) parents. There was no significant difference in V=RQOL as regards type of hearing assistive device use (p=0.102), laterality of device use (p=0.918) and degree of hearing loss (p=0.143). However, type of hearing loss revealed significant difference (p=0.021). Also VHI score revealed significantly (p=0.008) lower means in parents of children with cochlear implants. Conclusion: Current study concludes that the parents raising hearing impaired children with hearing assistive devices, possess good vocal health as determined by VHI and V-RQOL scores with only a very small number of parents reporting vocal symptoms. [ABSTRACT FROM AUTHOR]

Voice abnormalities were reported in patients during the course of COVID-19 infection. This study aims to evaluate the effect of COVID 19 infection on the self-perception of voice handicap in positive COVID 19 patients in addition to investigating the factors that might correlate with voice handicap if present. Voice handicap index-10 was filled in by 200 patients that were confirmed to be COVID 19 positive based on the RT-qPCR and symptomatology of the disease. The result showed that about 65.5% had mild degree of COVID 19 and 27.5% had moderate degree. Dysphonia was reported by 19% of the patients when questioned about voice symptoms. Dysphonia was detected in 35% of them by auditory perceptual assessment. Symptoms of Dyspnea, dysphonia, headache were significantly correlated with total and subtotal scores of Voice handicap index. COVID 19 infection has a negative impact on some of the patients? self- perception of voice handicap on the functional, physical and emotional domains. Age and degree of COVID 19 severity were correlating with the patients? self -perception of voice handicap. [ABSTRACT FROM AUTHOR]

Objective Today transoral laser microsurgery is considered as one of the first options to control early laryngeal cancer, and voice disorder is one of the inevitable complications of this therapeutic component. This study aimed to compare the vocal function in patients with early-stage laryngeal cancer following laser surgery with healthy individuals with normal voice quality using acoustic analysis and the voice handicap index and to examine the correlation between the results of these two evaluations in each group. Materials & Methods The current research is a descriptive-correlational and comparative study that was cross-sectioned using convenience sampling into two groups consisting of 60 men (Mean±SD of age 59.18±5.170 years) with early laryngeal cancer undergoing laser surgery as a patient group and 60 men (Mean±SD of age 56.68±5.491 years) with normal voice quality, and without any history of voice disorder as a control. The vocal function of participants was assessed using acoustic parameters (including jitter, shimmer, harmonic to noise ratio, fundamental frequency, smoothed cepstral peak prominence) and a 30-item Persian version of the voice handicap index questionnaire (including overall score and scores of physical, emotional and functional subscale). Then, data were analyzed using SPSS software, version 20, descriptive statistics, Kolmogorov-Smirnov, independent t-test, and Pearson correlation coefficient at the P

Abstract Background In-office vocal fold injections (VFI) are an effective treatment for glottic insufficiency. The primary objective of this study was to assess if patients reported decisional regret after VFI. Secondary objectives included determining if variables were associated with lower decisional regret. Methods Case–control study of patients who underwent in-office VFIs for glottic insufficiency from August 2017 to December 2019 at a tertiary laryngology clinic. Participants completed the validated Decision Regret Scale (DRS). Demographic data, clinician’s perceptual analysis with GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain), and patient’s self-reported Voice Handicap Index-10 (VHI-10) were analyzed. Nonparametric tests as well as univariate and multiple logistics regression were performed. Results Of patients eligible, 75% (136/182) completed the DRS (mean age 65.4 years (SD 13.9), 58.1% male). Eighty-three (61.0%) reported no decisional regret, thirty-three (24.3%) reported mild decisional regret, and twenty (14.7%) reported moderate to strong decisional regret. Improvement in most recent VHI-10 (Kendall correlation coefficient tau = 0.156, p = 0.029), Grade of voice (tau = 0.236, p value = 0.002) and Breathiness of voice (tau = 0.150, p = 0.044) were associated with lower DRS. Multivariate logistics regression results showed that the change in Grade of voice (OR 9.9, p

Aim: This study aimed to compare voice changes after Carotid endarterectomy (CEA) and Glomus body tumor resection with objective instrumental and acoustic assessments. Material and Methods: A total of 14 patients underwent CEA or glomus carotid tumor resection at our institution between 2009 and 2013. Among the 14 patients, two patients were excluded due to vocal cord paralysis. This study was applied to 12 patients. Patients were called retrospectively, and objective and subjective voice parameters were measured and compared. Voice handicap index was used to measure subjective voice parameters. Objective voice analysis was performed for patients by using Multi-dimensional voice programming (MDVP), a computer-aided program. Results: A total of 12 patients were included in the study. Five patients underwent carotid endarterectomy. Glomus tumor resection was performed on seven patients. Of the patients who underwent carotid endarterectomy, four were male and one was female. Three of the patients who underwent glomus tumor resection were male and four were female. Voice handicap index (VHI) showed that two patients who underwent glomus tumor resection experienced moderate problems and the patients who underwent CEA had no obvious problems. Patients who underwent glomus carotid tumor resection obtained higher values in all MDVP parameters than those who underwent CEA. Conclusion: Despite the small number of patients, it can be said that glomus tumor resection in neck surgery, that is, tumor surgery, causes more voice changes than carotid endarterectomy operations. The elevated objective sound parameters found in this study necessitate that patients should be informed regarding the potential of developing postoperative dysphonia, especially those who rely on their voice as their profession (e.g. sound artists, teachers, politicians). 12 patients were included in the study. 5 patients underwent carotid endarterectomy. Glomus tumor resection was performed on 7 patients. Of the patients who underwent carotid endarterectomy, 4 were male and 1 was female. Three of the patients who underwent glomus tumor resection were male and 4 were female. Voice handicap index (VHI) showed that two patients who underwent glomus tumor resection experienced moderate problems and patients who underwent CEA had no obvious problems. Patients who underwent glomus carotid tumor resection obtained higher values in all MDVP parameters than those who underwent CEA . CONCLUSIONS Despite the small number of patients, it can be said that glomus tumor resection in neck surgery, that is, tumor surgery, causes more voice changes than carotid endarterectomy operations. The elevated objective sound parameters found in this study necessitate that patients should be informed regarding the potential of developing postoperative dysphonia, especially those who rely on their voice as their profession (e.g. sound artists, teachers, politicians). [Turk J Vasc Surg 2023; 32(2.000): 78-82]

Objective. The aim of this study was to identify if cochlear implant (CI) users are perceiving a decrease in life quality due to voice problems. This study evaluated 43 CI user’s perception of their voice and how it affects their quality of life through a survey. Approach. Forty-three CI users responded to a survey regarding their demographics, details about their CI, the Hearing Health Quick Test (HHQT), the Voice Related Quality of Life (V-RQOL), and the Voice Handicap Index-10 (VHI-10). The survey responses were analyzed using univariate linear regression analysis. Results. Few of the CI users scored below the cut off for normal voice related quality of life. CI users averaged 93.4 out of 100 on the V-RQOL and only four scored abnormally for the VHI-10. Lower scores on the V-RQOL were correlated with the participants having an associate degree and with participants visiting friends, family, and neighbors less often due to hearing loss. The VHI-10 scores were correlated with gender, education levels, difficulty in social situations due to hearing loss, noise exposure, and tinnitus. Limitations of the study. The small n was the primary limitation of this study. Originality. This study was one of the first to examine the voice-related quality of life in CI users. Conclusions. Overall, respondents did not perceive much voice-related difficulty. However, they were more likely to perceive voice-related difficulty if they experienced difficulty hearing in noise and avoided social situations due to hearing loss.

The objective of this study was to compare phonetic outcomes of TOETVA with those of conventional transcervical thyroidectomy(OPEN). Retrospective chart review of total 61 patients who received thyroidectomy through OPEN (n = 34) or TOETVA (n = 27) approach in single tertiary center were enrolled. There were significant differences in F0 between the two groups and there were significant changes from different time points within each group in jitter for vowel /i/. Aerodynamically, there were significant differences in mean sound pressure level for vowel /a/ and mean sound pressure level, mean air pressure, and aerodynamic resistance for syllable /pa/ between the two groups. In subjective VHI evaluations, there were no significant differences between the two groups. This study is significant in that it has investigated voices of patients with TOETVA. Results of this study are expected to be useful for voice evaluation, treatment, and prevention in the future. 3 [ABSTRACT FROM AUTHOR]

The purpose of this study is to compare patient-reported voice handicap and auditory-perceptual measures of voice between healthy individuals and COVID-19 patients, as well as to investigate the effect of clinical factors on voice quality. COVID-19 patients (n = 138) and 90 healthy controls were included in the study. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) was used to grade voice samples based on overall severity, roughness, breathiness, strain, pitch, and loudness. The Voice Handicap Index-10 was completed by all participants (VHI-10). Physical (pVHI), emotional (eVHI) and functional (fVHI) subscores were calculated. Clinical data were collected (disease stage, CT grade, neutrophil/lymphocyte ratio, CRP, and symptoms). A statistically significant difference between patient and control groups in VHI-10 and CAPE-V scores was detected (p < 0.001). Except eVHI, total score and all subscale scores were higher in patients with COVID-19 as the pVHI was the most affected (η2 = 0.324) subscale. All scores of CAPE-V were significantly worse in patients with COVID-19 as highest impact of COVID-19 was on breathiness (η2 = 0.518). Pre-existing pulmonary comorbidity, dyspnoea and N/L was significantly associated with the VHI-10 overall score (βpc = 4.27, βdyspnoea = 5.69 and βnl = 0.25). The overall severity of CAPE-V was significantly dependent on dyspnoea and pulmonary comorbidity (βdyspnoea = 11.25, βpc = 10.12). VHI ≥4 and CAPE-V overall severity ≥11 were good indicators of COVID-19 related dysphonia. COVID-19 causes patient-reported voice handicap and deteriorates auditory-perceptual measures of voice. COVID-19 related voice impairment was mainly associated with the decreased respiratory capacity. [ABSTRACT FROM AUTHOR]

Objective One of the most voice-related complaints in teachers is vocal tract discomfort (VTD) which can increase the voice handicap index (VHI) to different degrees. In teachers Muscle Tension Dysphonia (MTD), increases voice complaints and decreases the voice-related quality of life. The aims of this study were to evaluate and compare the frequency and severity subscales of the VTD score and total score of VHI and determine the relation between them in primary school teachers with and without MTD. Materials & Methods This study was cross-sectional and was performed on 80 primary female teachers with and without MTD. The participants in both groups were randomly selected after checking the inclusion criteria. Voice history, auditory-perceptual assessment of voice, palpation, and laryngeal videostroboscopy were assessed on the teachers in two groups. Then, asked the participants to complete the Persian versions of the VTD and VHI scales. After determining the normal distribution of the data using the Kolmogorov-Smirnov test, the results of VTD, VHI, and their subscales were compared between two groups with an independent t-test. Also, the relationship between them was assessed with the Pearson correlation coefficient analysis. Results The mean score of the frequency subscale of VTD in teachers with MTD was more than in teachers without MTD (30.17±5.11, 8.22±2.26), respectively. The score of severity subscales of VTD in teachers with MTD was 39.12±4.94 and in teachers without MTD was 7.89±2.13. Also, the total score of the VHI questionnaire in teachers with MTD was significantly higher than teachers without MTD (P<0.05). Moreover, there was a significant positive correlation between the frequency and severity subscales of VTD and the total score of VHI in the two groups (P<0.05). Conclusion This study showed the frequency and severity scores of the VTD and the degree of VHI experienced by MTD are remarkably higher than teachers without MTD. The authors emphasize on the use of VTD and VHI scales in screening teachers who are at risk of voice problems, and the researchers pointed out the importance of paying attention to the reduction of discomfort feelings in the vocal tract and voice handicap in the voice therapy sessions of teachers with MTD. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to compare voice changes after Carotid endarterectomy (CEA) and Glomus body tumor resection with objective instrumental and acoustic assessments. Material and Methods: A total of 14 patients underwent CEA or glomus carotid tumor resection at our institution between 2009 and 2013. Among the 14 patients, two patients were excluded due to vocal cord paralysis. This study was applied to 12 patients. Patients were called retrospectively, and objective and subjective voice parameters were measured and compared. Voice handicap index was used to measure subjective voice parameters. Objective voice analysis was performed for patients by using Multi-dimensional voice programming (MDVP), a computer-aided program. Results: A total of 12 patients were included in the study. Five patients underwent carotid endarterectomy. Glomus tumor resection was performed on seven patients. Of the patients who underwent carotid endarterectomy, four were male and one was female. Three of the patients who underwent glomus tumor resection were male and four were female. Voice handicap index (VHI) showed that two patients who underwent glomus tumor resection experienced moderate problems and the patients who underwent CEA had no obvious problems. Patients who underwent glomus carotid tumor resection obtained higher values in all MDVP parameters than those who underwent CEA. Conclusion: Despite the small number of patients, it can be said that glomus tumor resection in neck surgery, that is, tumor surgery, causes more voice changes than carotid endarterectomy operations. The elevated objective sound parameters found in this study necessitate that patients should be informed regarding the potential of developing postoperative dysphonia, especially those who rely on their voice as their profession (e.g. sound artists, teachers, politicians). [ABSTRACT FROM AUTHOR]

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Introduction: Voice production can be affected in early laryngeal cancer. The purpose of this study was to investigate the correlation between Voice Handicap Index (VHI) and Voice-Related Quality of Life (V-RQOL) among patients with early laryngeal cancer. Methods: Twenty-seven patients with early laryngeal cancer (T1, T2) and a mean age of 59.35 ± 7.77 years who were visited in Amir-Alam hospital, took part in this study. After a diagnosis of early laryngeal cancer by a laryngologist, the patients filled out the Persian versions of the VHI and V-RQOL questionnaires. Results: The results showed the mean total score of VHI and V-RQOL were 65.94 ± 14.21 and 48.64 ± 9.75% in patients with early laryngeal cancer, respectively. These results indicated the total and subscales' scores of VHI increased while the scores of VRQOL decreased. The Pearson correlation between total scores of the VHI and V-RQOL was − 90. Also, there was a negative significant correlation between total and subscales' scores of VH and VRQOL (r Pearson= -0.46 to -0.90, p ≤ 0.05). Conclusion: Our findings demonstrated decreased quality of life related to voice in patients with laryngeal cancer who were in the early stages of tumor growth (T1, T2). Regarding the high negative significant correlation between results of VHI and V-RQOL in patients with early laryngeal cancer, both questionnaires can be used instead of each other for saving time in voice clinics. [ABSTRACT FROM AUTHOR]

Introduction: The causal relation between STN-DBS and speech problems and the associated clinical features are in the incipient stages of being investigated. Methods: All the Parkinson's disease (PD) subjects with and without STN-DBS who applied to our movement disorders outpatient clinics between January 2022 and June 2022 and agreed to participate in the study were enrolled. The demographic data and clinical features were noted. Besides, the MDS-UPDRS was administered during the medication off-state in all subjects. All the participants completed the voice handicap index (VHI). Besides, the Freezing of Gait Questionnaire (FOGQ) and the quality of life (QoL) scales including the Parkinson's Disease Questionnaire (PDQ-39) and the Schwab and England Activities of Daily Living (ADL) scale were also administered to all the individuals. Results: We have included 66 patients with PD (F/M = 23/43). Thirty-five patients were those with DBS therapy whereas 31 patients were without. The results of the comparative analyses between the patients with and without DBS therapy revealed that the DBS group had a higher disease duration (P = 0.006) and FOGQ scores (P = 0.008). The VHI scores did not differ between groups (P = 0.577), and the correlation analyses did not reveal an association between the VHI scores and the duration of DBS therapy. However, the VHI scores correlated with the disease duration as well as the FOG scores. Conclusion: We did not find convincing evidence supporting the increased risk of speech disturbance with STN-DBS therapy. We suggest that the frequent existence of speech disturbance in this patient subgroup with STN-DBS is associated with the classical nature of PD.

Abstract Background The objective of the study is to compare the conventional microlaryngeal surgery and the CO2 laser in the treatment of cysts of vocal folds, regarding the postoperative quality of voice. This study was conducted on 53 cases with vocal fold cysts. The cases were randomly allocated into two groups: group 1 (27 cases) was operated by the conventional technique, and group 2 (26 cases) was operated with CO2 laser microlaryngeal operation. At 3-month postoperative, evaluation was done by stroboscopic evaluation of vocal folds, grade of hoarseness, roughness, breathiness, asthenia, and strain (GRBAS) scale and Arabic version of Voice Handicap Index (VHI). Results The stroboscope assessment revealed that glottic closure was complete, symmetrical motion, the reappearance of the mucosal wave, normal amplitude, and periodicity in all patients. There is insignificantly different between either group as regards the postoperative scores on VHI and GRBAS scale. Conclusion There is insignificantly different when comparing laser to conventional microlaryngeal surgery for excision of vocal fold cysts regarding the quality of voice.

Background: Vocal fold polyps (VFP) are a common cause of voice disorders and laryngeal discomfort. They are usually treated by behavioral voice therapy (VT) or phonosurgery, or a combination (CT) of both. However, the superiority of either of these treatments has not been clearly established. Methods: Three databases were searched from inception to October 2022 and a manual search was performed. All clinical trials of VFP treatment were included that reported at least auditory–perceptual judgment, aerodynamics, acoustics, and the patient-perceived handicap. Results: We identified 31 eligible studies (VT: n = 47–194; phonosurgery: n = 404–1039; CT: n = 237–350). All treatment approaches were highly effective, with large effect sizes (d > 0.8) and significant improvements in almost all voice parameters (p-values < 0.05). Phonosurgery reduced roughness and NHR, and the emotional and functional subscales of the VHI-30 were the most compared to behavioral voice therapy and combined treatment (p-values < 0.001). Combined treatment improved hoarseness, jitter, shimmer, MPT, and the physical subscale of the VHI-30 more than phonosurgery and behavioral voice therapy (p-values < 0.001). Conclusions: All three treatment approaches were effective in eliminating vocal fold polyps or their negative sequelae, with phonosurgery and combined treatment providing the greatest improvement. These results may inform future treatment decisions for patients with vocal fold polyps. [ABSTRACT FROM AUTHOR]

Background: In-office vocal fold injections (VFI) are an effective treatment for glottic insufficiency. The primary objective of this study was to assess if patients reported decisional regret after VFI. Secondary objectives included determining if variables were associated with lower decisional regret. Methods: Case–control study of patients who underwent in-office VFIs for glottic insufficiency from August 2017 to December 2019 at a tertiary laryngology clinic. Participants completed the validated Decision Regret Scale (DRS). Demographic data, clinician's perceptual analysis with GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain), and patient's self-reported Voice Handicap Index-10 (VHI-10) were analyzed. Nonparametric tests as well as univariate and multiple logistics regression were performed. Results: Of patients eligible, 75% (136/182) completed the DRS (mean age 65.4 years (SD 13.9), 58.1% male). Eighty-three (61.0%) reported no decisional regret, thirty-three (24.3%) reported mild decisional regret, and twenty (14.7%) reported moderate to strong decisional regret. Improvement in most recent VHI-10 (Kendall correlation coefficient tau = 0.156, p = 0.029), Grade of voice (tau = 0.236, p value = 0.002) and Breathiness of voice (tau = 0.150, p = 0.044) were associated with lower DRS. Multivariate logistics regression results showed that the change in Grade of voice (OR 9.9, p < 0.01), Roughness (OR 0.2, p < 0.01) and Breathiness (OR 0.2, p < 0.03) were significantly associated with DRS. Conclusion: The majority of patients had no or mild decisional regret after in-office VFI for glottic insufficiency. Both patients who reported less vocal handicap after VFI and clinician-noted improvements in perceptual evaluation of voice after VFI were associated with significantly lower decisional regret. [ABSTRACT FROM AUTHOR]

Objective Today transoral laser microsurgery is considered as one of the first options to control early laryngeal cancer, and voice disorder is one of the inevitable complications of this therapeutic component. This study aimed to compare the vocal function in patients with early-stage laryngeal cancer following laser surgery with healthy individuals with normal voice quality using acoustic analysis and the voice handicap index and to examine the correlation between the results of these two evaluations in each group. Materials & Methods The current research is a descriptive-correlational and comparative study that was cross-sectioned using convenience sampling into two groups consisting of 60 men (Mean±SD of age 59.18±5.170 years) with early laryngeal cancer undergoing laser surgery as a patient group and 60 men (Mean±SD of age 56.68±5.491 years) with normal voice quality, and without any history of voice disorder as a control. The vocal function of participants was assessed using acoustic parameters (including jitter, shimmer, harmonic to noise ratio, fundamental frequency, smoothed cepstral peak prominence) and a 30-item Persian version of the voice handicap index questionnaire (including overall score and scores of physical, emotional and functional subscale). Then, data were analyzed using SPSS software, version 20, descriptive statistics, Kolmogorov-Smirnov, independent t-test, and Pearson correlation coefficient at the P<0.05. Results The results show that the acoustic parameters and voice handicap index in the group undergoing laser surgery are significantly different from the control group (P<0.001). Also, a significant direct correlation between jitter and shimmer with total score and physical subscale of VHI, a significant inverse correlation between the harmonic-to-noise ratio and total score, functional and physical subscales of VHI, as well as between smoothed cepstral peak prominence with total score and all subscales of VHI (P<0.05). In addition, in the control group, there is no significant correlation between the acoustic parameters and the subscales of the voice handicap index (P<0.05). Conclusion The findings of the acoustic analysis and the voice handicap index show impairment in vocal function and a decrease in voice-related quality of life (QoL) in patients with early laryngeal cancer after laser surgery. Furthermore, a significant correlation between the scores of the voice handicap index and acoustic analysis parameters, especially cepstral analysis indicates the necessity to pay attention to frequency-based analysis. Therefore the results of the present study emphasize the need for a comprehensive assessment of vocal function, providing voice therapy programs, and attention to psychological problems in patients with early laryngeal cancer after laser surgery. [ABSTRACT FROM AUTHOR]

To determine cut-off points in auto-assessment questionnaires to predict the presence and extent of presbylarynx signs. This case control, prospective, observational, and cross-sectional study was carried out on consecutive subjects observed by Otorhinolaryngology, in a tertiary center, in 2020. Each subject underwent fiberoptic videolaryngoscopy with stroboscopy, and presbylarynx was considered when it was identified two or more of the following endoscopic findings: vocal fold bowing, prominence of vocal processes in abduction, and a spindle-shaped glottal gap. Each subject completed three questionnaires: the Voice Handicap Index (VHI), with 30 and 10 questions, and the "Screening for voice disorders in older adults questionnaire" (RAVI). The studied population included 174 Caucasian subjects (60 males; 114 females), with a mean age of 73.99 years (standard deviation = 6.37; range 65–95 years). Presbylarynx was identified in 71 patients (41%). Among patients with presbylarynx, a glottal gap was identified in 22 patients (31%). The mean score of VHI-30 between "no presbylarynx" and "presbylarynx" groups was statistically different (P < 0.001), with a higher score for subjects with signs of presbylarynx. The presence of glottal gap was associated to a higher mean score of VHI-30 (41.64 ± 11.87) (P < 0.001). The mean score of VHI-10 between "no presbylarynx" and "presbylarynx" groups was statistically different (P < 0.001), with a higher score for subjects with signs of presbylarynx. Among patients with presbylarynx, the presence of glottal gap was associated to higher mean score of VHI-10 (14.04 ± 3.91) (P < 0.001). There was a strong positive correlation between VHI-30 and VHI-10 (rs = 0.969; P < 0.001). The mean score of RAVI between "no presbylarynx" and "presbylarynx" groups was statistically different (P < 0.001), with a higher score for subjects with signs of presbylarynx. Among patients with presbylarynx, the presence of glottal gap was associated to a higher mean score of RAVI (11.68 ± 1.61) (P < 0.001). There was a strong positive correlation not only between RAVI and VHI-30 (rs = 0.922; P < 0.001), but also between RAVI and VHI-10 (rs = 0.906; P < 0.001). The optimal cut-off points to discriminate "no presbylarynx" from "presbylarynx", obtained by the Youden' index, were 3.5 for RAVI, 4.5 for VHI-30 and 1.5 for VHI-10. RAVI had the highest sensitivity and specificity. The optimal cut-off points to predict glottal gap, obtained by the Youden' index, were 9.5 for RAVI, 21 for VHI-30 and 7.5 for VHI-10. The optimal cut-off points do discriminate "no presbylarynx" from "presbylarynx" were 3.5 for RAVI, 4.5 for VHI-30 and 1.5 for VHI-10. RAVI had the highest sensitivity and specificity, probably because it was designed specifically for vocal complaints of the elderly. Among patients with presbylarynx, cut-off points of 9.5 for RAVI, 21 for VHI-30 and 7.5 for VHI-10 were determined to predict patients with and without glottal gap. It was found a strong positive correlation between RAVI, VHI-30 and VHI-10. Thus, VHI-10 can be preferred to VHI-30 to assess voice impairment in clinical practice, because for elderly patients it is easier to answer. However, to predict endoscopic signs of presbylarynx, RAVI should be preferred. [ABSTRACT FROM AUTHOR]

Abstract Objectives The aim of this study was to explore the prevalence and risk factors in public kindergarten and elementary school teachers in the Jimei district in Xiamen. We took particular interest in the relationship between work‐related factors and voice disorders. Study Design A cross‐sectional investigation; a General Investigation. Methods This study was conducted from September 14 to 18, 2020 at public kindergarten and elementary schools in Xiamen, China. A total of 3140 teachers were separated into a perceived voice disorder group (PVD) and no perceived voice disorder group (NPVD) according to the Voice Handicap Index. The chi‐square test was applied to explore the differences between the PVD and NPVD groups. The univariate logistic regression models were used to identify the risk factors in terms of unadjusted odds ratio and 95% confidence interval. Stepwise logistic regression was then used to ascertain independent determinants. Results We found that the prevalence of PVD was 47.52%. The results showed that risk factors of PVD included being female (OR = 1.574), middle‐rank technical title and higher (OR = 2.199), continuous lecturing for more than 3 classes (OR = 3.034), lectured more than 10 classes a week (OR = 1.436) and taught art or physical education (OR = 1.742). Conclusions Teachers' work‐related characteristics were associated with PVD. This proves that a preventive voice care program for teachers, administered by the school or education bureau, is urgent. This could include components such as the reasonable arrangement of timetables and recruitment of a sufficient number of kindergarten and elementary school teachers. Level of evidence: Case‐series

Objective To establish multi-parameter speech assessment by using the objective acoustic parameters, roughness breathiness hoarseness (RBH) perceptual evaluation system and the voice handicap index (VHI) self-assessment scale, and to explore the role of laryngopharyngeal reflux in the occurrence and development of vocal cord diseases. Methods One hundred and eighty patients with voice disorders and 25 normal voice recruiters were evaluated by computer voice acoustic analysis system, RBH perceptual evaluation system and VHI self-assessment scale. The features of laryngopharyngeal reflux were analyzed by reflux symptom index (RSI) and reflux finding score (RFS). Results The VHI and dyhphonia severity index (DSI) of the disease groups were all higher than those of the control group. The difference in shimmer of each disease group and malignant group had statistical significance (P<0.05). There was a trend of correlation between H and jitter, shimmer, DSI, maximum phonation time (MPT) and VHI (P<0.05), but a weak correlation between H and average fundamental frequency (F0). There was statistical difference in laryngopharyngeal reflux rate between the control group and patients with voice diseases, but there was no statistical difference between patients with different voice diseases. Conclusions Multi-parameter voice assessment should be established to comprehensively assess patients’ voice status and guide treatment decisions. The occurrence and development of voice disease may be related to laryngopharyngeal reflux disease, but the disease progression seems to have no close relationship with laryngopharyngeal reflux disease. [ABSTRACT FROM AUTHOR]

Introduction: SPEAK-OUT!® is a behavioral treatment for hypokinetic dysarthria in persons with Parkinson's disease (PD) that has become an alternative to the gold-standard Lee Silverman Voice Treatment (LSVT) in recent years. Acoustic evaluation of the efficacy of SPEAK-OUT!® therapy has focused on prosody. The purpose of this study was to investigate SPEAK-OUT!® efficacy in terms of vocal quality and its impact on quality of life. Vocal quality was measured acoustically using cepstral peak prominence (CPP) analysis and the Acoustic Voice Quality Index (AVQI) and perceptually using clinical ratings of speech performance. Impact on quality of life was measured with the Voice Handicap Index (VHI) and Voice-Related Quality of Life (V-RQOL). An additional goal of this study was to investigate whether dysarthria severity and disease duration were predictive of changes in voice quality due to SPEAK-OUT!®. Methods: Pre- and post-therapy data included PD participants' acoustic and perceptual ratings of audio recordings. Demographic data included age, sex, diagnosis, duration of PD, and severity of dysarthria. Results: Participants achieved significant improvement in the vowel and sentence CPP smoothed (CPPS) mean score as well as in their AVQI score post SPEAK-OUT!® treatment. Improvements in AVQI correlated negatively with disease duration and positively with dysarthria severity. Discussion/Conclusion: SPEAK-OUT!® is effective in improving voice quality in patients with hypokinetic dysarthria due to idiopathic PD. Patients with more severe dysarthria and with a shorter disease duration may benefit the most, supporting earlier intervention. As for the type of measurement, AVQI combines acoustics from both vowel and sentence contexts and may therefore be the measure of choice over CPPS (vowel) or CPPS (sentence). [ABSTRACT FROM AUTHOR]

Objectives: To compare the results of a voice handicap index (VHI) scale and acoustic parameters in patients who underwent microlaryngeal surgery followed by either short‐duration (voice rest for <7 days) or long‐duration (≥7 days) voice rest. Study Design: Systematic review and meta‐analysis. Methods: The PubMed, Embase, and Cochrane Library databases were systematically searched for articles published before March 1, 2021. Randomized controlled trials (RCTs) that measured the voice outcomes of patients after different durations and extents of postoperative voice restriction were included in the meta‐analysis. Results: Four RCTs comprising 112 patients were included in the quantitative meta‐analysis. Compared with the long‐duration voice rest group, the short‐duration group exhibited comparable VHI scores (mean difference [MD], −7.01; 95% CI, −16.12 to 2.09; p = 0.13), maximum phonation time (MD, −2.58; 95% CI, −5.42 to 0.26; p = 0.07), and acoustic variables of jitter (MD, −1.25; 95% CI, −3.43 to 0.94; p = 0.26) and shimmer (MD, −0.79; 95% CI, −2.08 to 0.51; p = 0.24). Subgroup analysis for benign pathology and cold instruments studies demonstrated significantly better VHI scores (MD, −14.45; 95% CI, −26.19 to −2.72; p = 0.02 and MD, −15.98; 95% CI, −28.52 to −3.44; p = 0.01, respectively) in the short‐duration group. Conclusions: The limited evidence does not demonstrate benefit in voice outcomes from long‐duration voice rest and suggests potential unfavorable effects on compliance and quality of life, providing a rationale for short‐duration voice rest after microlaryngeal surgery. More studies are required to determine the optimal duration and extent of postoperative voice rest. Level of Evidence: 1 Laryngoscope, 133:154–161, 2023 [ABSTRACT FROM AUTHOR]

Voice personifies an individual. Change in voice can be the only presentation for a benign malady like vocal nodule or acute laryngitis but can also indicate life threatening malignancy. Hence every voice change must be evaluated. The aim of this pioneering study was to assess patients with voice change due to non-malignant conditions, using Videolaryngostroboscopy (VLS) and Voice Handicap Index (VHI) pre and post1 month therapy. Diagnosis determined conservative therapy or Co2 laser phonosurgery according to accepted medical protocol. On VLS, glottic closure pattern and wave form was noted both before and after treatment. Patient completed VHI form before and after treatment. There is no previous study comparing pre and post treatment VHI and VLS in a extensive etiology of conservatively managed patients. In our study, 100 patients were enrolled in the age group between 10 years to the eighties, with majority in their thirties. The male to female ratio was 1.9:1. The majority of patients belonged to level IV occupation. A wide gamut of diagnosis was noted, majority being vocal nodules, followed by polyps, cysts, vocal cord palsy etc. A statistically significant improvement was seen pre and post treatment VLS in glottic closure pattern, waves presence along with improvement in VHI. Thus, Voice Handicap Index and Videostroboscopy can be used to prognosticate the vocal cord lesions and measure the effectiveness of treatment in both surgically and conservatively managed patients. [ABSTRACT FROM AUTHOR]

Unilateral vocal cord paralysis presents with dysphonia, shortness of breath and swallowing difficulty and occurs secondary to damage to the recurrent laryngeal nerve by causes such as viral infection, iatrogenic, trauma and idiopathic. The objective of this study was to study the efficacy of early voice therapy in the management of patients with unilateral vocal fold paralysis. Total 116 patients in previous two years were included in this retrospective study suffering from unilateral vocal fold paralysis. They were subjected to a protocol of voice evaluation including Voice handicap index, Maximum phonation time and S/Z ratio. Patients were also examined using Hopkins Examination. All patients included received voice therapy for 6-month duration in 24 sessions. Patients who had started voice therapy early during their symptoms within few days or 1 to 2 weeks had better outcomes regarding Voice handicap index, Maximum phonation time and S/Z ratio than patients who had started voice therapy at 1 to 1.5 month after symptom onset. Early onset voice therapy may enhance the reduction in glottal gap and improvement of voice quality by hindering the development of faulty hyper functional compensatory behaviors; early voice therapy may therefore enhance the patient's quality of life. [ABSTRACT FROM AUTHOR]

Voice Handicap Index (VHI) is the most commonly used tool to assess the quality of life in voice disordered patients. A validated Tamil language version of VHI is not developed yet. Hence, this study was undertaken to translate and validate the Voice Handicap Index in Tamil language, which can potentially benefit Tamil speaking patients with voice disorders. This was a translation and tool validation study done at a tertiary care teaching hospital using an analytical, follow up design according to WHO guidelines. Dysphonic (Group A) and Normal (Group B) respondents were purposively invited to fill a self administered VHI-Tamil questionnaire. The content validity, response process validity, internal consistency and clinical validity of the questionnaire was calculated using appropriate statistical analysis methods using SPSS version 24.0 software. Out of 117 respondents, 61 respondents were dysphonic (Group A) and 56 respondents were normal (Group B). Overall index for content validation was over 0.84, and response process validation was 1.00 in all domains. Overall internal consistency was excellent, with Cronbach's alpha of 0.993. Excellent test–retest reliability was identified using the Spearman rank correlation coefficient (r = 0.96; p-value < 0.001). For clinical validity, a statistically significant difference between the dysphonic and the normal groups, for the overall VHI-Tamil scores and each of the three domain scores was noted. VHI-Tamil was found to be reliable and valid for assessing the quality of life in patients with voice disorders. It can be recommended for future use among Tamil speaking population. [ABSTRACT FROM AUTHOR]

To perform a subjective and objective assessment of vocal complaints in patients of allergic rhinitis (AR) using voice handicap index and video-stroboscopy respectively and find the association of their parameters with severity of the disease. Cross-sectional-observational study design. Outpatient department of Otorhinolaryngology of a tertiary centre. Seventy-five adult patients diagnosed with AR and classified according to 'Allergic Rhinitis and its Impact on Asthma' guidelines were compared with same number of normal subjects as controls, with the same age and sex, to ensure uniformity. Both the groups were asked to fill a self-answered questionnaire called Voice Handicap Index (VHI) and underwent laryngeal examination with Video-Stroboscopy (VS). The mean VHI score of the AR group (29.45 ± 32.11) was significantly higher (p < 0.05) than that of controls (12.07 ± 16.62). VS parameters including amplitude, supraglottic activity, vocal edge and phase closure also showed significant difference between cases and controls (p < 0.05). VHI scores increased, but the VS findings did not change significantly with the severity of the disease. AR patients show subjective and objective derangements of voice quality. VHI scores show increase, while VS parameters do not change with the severity of AR. [ABSTRACT FROM AUTHOR]

Background: The Voice Handicap Index (VHI) and the Voice-Related Quality of Life Measure (V-RQOL) are seldom administered to alaryngeal patients who use pneumatic artificial larynx (PAL) and esophageal speech (ES). As such, the specificity of VHI and 10-item VHI (VHI-10) for assessing voice-related changes in such patients is unclear. Accordingly, this study investigated the correlation between scores on the VHI, its shortened version (VHI-10), and the V-RQOL for Mandarin-speaking laryngectomees using PAL and ES, with the aim of establishing which of these instruments is suited to such patients. Methods: The participants comprised 126 PAL and 26 ES patients from Taiwan who completed the Mandarin VHI and V-RQOL. Fifty-two of these alaryngeal participants then completed both those instruments a second time, between 8 and 64 days later. Results: One item appearing in both the Mandarin long-form VHI and the VHI-10 was excluded because more than half the participants left it unanswered. The correlation of scores on the remaining 29 items on the former with the nine on the latter was high (r = 0.968), while that between the former and V-RQOL scores was moderate (r = -0.569), as was the correlation between short-form VHI and Mandarin V-RQOL scores (r = -0.582). Structural equation modeling was then used as the basis for simplifying the Mandarin longform VHI into a new 10-item VHI specifically for alaryngeal Mandarin speakers (MA-VHI-10), to eliminate the scoring effect of the original VHI's and VHI-10's work-related item. MA-VHI-10 scores were highly correlated with those on the Mandarin long-form VHI (r = 0.983). Conclusion: The Mandarin versions of long-form VHI, short-form VHI, and MA-VHI-10 are interchangeable for a Mandarinspeaking alaryngeal population. However, neither of the former two instruments should be substituted for the V-RQOL. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the influence of voice therapy on maximum phonation time (MPT) and S:Z ratio in patients diagnosed with primary muscle tension dysphonia (pMTD). The goal was to investigate whether pMTD is associated with reduced S:Z ratio and prolonged MPT., Study Design: Prospective cohort study., Methods: A comparative analysis was conducted on a cohort of patients diagnosed with pMTD. Prevoice and postvoice therapy assessments of MPT and S:Z ratio were performed. Data from these measurements were analyzed to determine the impact of voice therapy on the studied parameters. A paired t test was used to evaluate MPT and S:Z ratio pretherapy and post therapy., Results: Fifty-two patients met the inclusion criteria for the study, having completed a laryngology evaluation with diagnosis of pMTD and agreeing to voice therapy between July 22, 2021, and April 4, 2023. Sixteen of these patients completed a full course of voice therapy. The Voice Handicap Index-10 (VHI-10), MPT, and S:Z ratio were measured during initial evaluation as part of a complete laryngeal function study. A statistically significant reduction in VHI-10 scores was observed, with values decreasing from 17.81 (±2.81) pretherapy to 8.81 (±1.8) post therapy (P < 0.001). However, no significant differences were detected in MPT or the S:Z ratio following the intervention., Conclusions: There is a lack of correlation between subjective evaluations of voice (VHI-10) and objective assessments (MPT and S:Z ratio), indicating that these objective parameters may not accurately reflect changes in voice quality following therapy in the pMTD population., Lay Summary: MPT and S:Z ratio do not appear to be uniformly impacted in patients with pMTD. Moreover, these measures do not consistently improve following voice therapy for pMTD., Competing Interests: Declaration of Competing Interest This manuscript is original research, and we believe that it represents innovative and illustrative work. This manuscript has never been published, nor is it being considered for publication elsewhere. All authors have approved the manuscript and agree with its submission. All authors are listed, have agreed to be listed and have contributed significantly to the intellectual content, concept and design of this work, the analysis and interpretation of the data, and writing of the manuscript. All authors take public responsibility for this work. This research received no specific grant from any funding agency, commercial or not-for-profit sectors. Competing interests: The authors declare none. We give the rights to the corresponding author, Stacey Menton, to make necessary changes as per the request of the journal and continue with the rest of the correspondence., (Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Context: There is a considerable diagnostic delay in acromegaly contributing to increased morbidity. Voice changes due to orofacial and laryngeal changes are common in acromegaly., Objective: Our aim was to explore the use of digital voice analysis as a biomarker for acromegaly using broad acoustic analysis and machine learning., Methods: Voice recordings from patients with acromegaly and matched controls were collected using a mobile phone at Swedish university hospitals. Anthropometric and clinical data and the Voice Handicap Index (VHI) were assessed. Digital voice analysis of a sustained and stable vowel [a] resulted in 3274 parameters, which were used for training of machine learning models classifying the speaker as "acromegaly" or "control". The machine learning model was trained with 76% of the data and the remaining 24% was used to assess its performance. For comparison, voice recordings of 50 pairs of participants were assessed by 12 experienced endocrinologists., Results: We included 151 Swedish patients with acromegaly (13% biochemically active and 10% newly diagnosed) and 139 matched controls. The machine learning model identified patients with acromegaly more accurately [area under the receiver operating curve (ROC AUC) 0.84] than experienced endocrinologists (ROC AUC 0.69). Self-reported voice problems were more pronounced in patients with acromegaly than matched controls (median VHI 6 vs 2, P < .01) with higher prevalence of clinically significant voice handicap (VHI ≥20: 22.5% vs 3.6%)., Conclusion: Digital voice analysis can identify patients with acromegaly from short voice recordings with high accuracy. Patients with acromegaly experience more voice disorders than matched controls., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)

Abstract 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

Objectives: The aim of this study was to explore the prevalence and risk factors in public kindergarten and elementary school teachers in the Jimei district in Xiamen. We took particular interest in the relationship between work‐related factors and voice disorders. Study Design: A cross‐sectional investigation; a General Investigation. Methods: This study was conducted from September 14 to 18, 2020 at public kindergarten and elementary schools in Xiamen, China. A total of 3140 teachers were separated into a perceived voice disorder group (PVD) and no perceived voice disorder group (NPVD) according to the Voice Handicap Index. The chi‐square test was applied to explore the differences between the PVD and NPVD groups. The univariate logistic regression models were used to identify the risk factors in terms of unadjusted odds ratio and 95% confidence interval. Stepwise logistic regression was then used to ascertain independent determinants. Results: We found that the prevalence of PVD was 47.52%. The results showed that risk factors of PVD included being female (OR = 1.574), middle‐rank technical title and higher (OR = 2.199), continuous lecturing for more than 3 classes (OR = 3.034), lectured more than 10 classes a week (OR = 1.436) and taught art or physical education (OR = 1.742). Conclusions: Teachers' work‐related characteristics were associated with PVD. This proves that a preventive voice care program for teachers, administered by the school or education bureau, is urgent. This could include components such as the reasonable arrangement of timetables and recruitment of a sufficient number of kindergarten and elementary school teachers. Level of evidence: Case‐series We researched 3140 public kindergarten and elementary schools teachers through general investigation, and performed stepwise logistic regression model to identify uniquely increase risk factors for developing perceived voice disorder. Our investigation is the first study that showed teachers who continuous lecturing 3 or 4 classes had a 3.034‐fold higher risk of PVD than those who have no continuous lecturing (OR = 3.034) in Mainland China. This proves that a preventive voice care program for teachers, administered by the school or education bureau, is urgent. [ABSTRACT FROM AUTHOR]

Objective The study was aimed to assess changes in voice outcomes after radiotherapy in laryngeal cancer patients. Materials and Methods The study included 60 laryngeal cancer patients treated with definitive radiotherapy or chemoradiotherapy between 2005 and 2012. The primary endpoint of this study was to assess abnormalities of the patients’ voices after the treatment. The Thai version of the Voice Handicap Index (VHI) and xerostomia questionnaire were conducted by telephone. Videostroboscopic examination was done to objectively assess voice outcomes. Results The median age of patients was 63 years. Most patients had glottic cancer (84.1%) and T1–2 disease (84.1%). The median time from treatment to the study was 46 months. In terms of the total VHI score, most patients were in the normal and slight handicap groups (22% and 71.4%, respectively). Only 4.8% and 1.6% of the patients were in moderate and severe handicap group, respectively. Twenty-eight patients had significant xerostomia. Videostroboscopy examination was done in 23 patients and most common findings were telangiectasia (95.7%), abnormal mucosal wave (47.8%), and abnormal glottic closure configuration (34.8%). Regarding total VHI score, lower radiation dose, conventional radiation dose per fraction, longer period after treatment, and significant xerostomia status were significantly correlated with worse voice outcomes. There were no statistically significant correlations between the videostroboscopic findings and VHI scores. Conclusion Voice outcomes in most of laryngeal cancer patients treated with radiotherapy had a normal or mild handicap at more than 1 year of follow-up. Only 4.8% and 1.6% of the patients had moderate and severe voice outcome handicap, respectively.

Introduction: The Voice Handicap Index 10 (VHI-10) has been translated to many languages. There are substantial differences between the translation methods. Translated questionnaires without appropriate linguistic validation may not capture cultural differences or be understood by the participants in the manner intended by the original developers. This also holds true between dialects within a language. There are two versions of the VHI-10 in Spanish, both translated in Spain. Considering the cultural and dialectical differences amongst Spanish speakers, it is hypothesized that these translations may not be applicable globally. The purpose of this study was to determine the linguistic relevance and applicability of the currently available versions of the VHI-10 in Spanish amongst Spanish speakers outside of Spain. Methods: This study used mixed methods qualitative and quantitative procedures consisting of semi-structured interviews and quantitative analysis of data. Sixty-nine participants met the inclusion criteria. Participants with and without a diagnosis of dysphonia were included. Demographic data collected included age, gender, cultural/dialectical background, level of education, and number of years residing in Southern California. Participants were provided the currently available translated versions of the VHI-10 in Spanish (V1 and V2). After reading both questionnaires, a semi-structured interview was conducted by a bilingual SLP. Semi-structured interview responses were coded to determine patterns of words marked as problematic/not understood or non-representative of the Spanish dialect spoken by the participants. Results: The majority of participants marked at least one word in both versions as problematic/not understood or non-representative of the Spanish dialect spoken (60/69, 87.0% for V1 and 63/69, 92.3%, for V2). The two words most frequently marked as problematic/not understood or non-representative of the Spanish dialect spoken were "hándicap" (marked by 51/69 participants, 73.9%) and "minusvalía" (marked by 52/69 participants, 75.4%). Conclusions: Data analysis demonstrates that the majority of participants marked words as not understood/non-representative of their dialect on either V1 or V2. One question not understood or not answered could have an impact on how we interpret this patient-reported outcome measure in clinical practice. Use of currently available Spanish translations of the VHI-10 may yield unreliable results when used amongst Spanish speakers outside Spain due to dialectal and cultural differences. Future work will include validation of a voice patient-reported outcome measure that is culturally and linguistically appropriate for Spanish speakers outside Spain. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Cricotracheal resection (CTR) is an effective treatment for refractory idiopathic subglottic stenosis (iSGS) but is associated with persistent dysphonia. Outcomes were measured longitudinally to characterize how patients' voices and self‐perceived voice handicaps changed after CTR. Study Design: Retrospective case‐series. Methods: We conducted a retrospective cohort study of patients with refractory iSGS treated by CTR from 2006 to 2017. Voice Handicap Index (VHI), Consensus Auditory‐Perceptual Evaluation of Voice (CAPE‐V), and acoustic analysis were prospectively collected preoperatively and postoperatively at 1, 3, 6, 12, and 24‐month intervals. A linear mixed model was used to evaluate temporal change. Results: Thirty‐three patients (97% female) were included. VHI scores increased significantly from baseline preoperative score (27.2 ± 22.7) to a mean value of 44.3 ± 25.6 (P <.001) 1‐month postoperatively but decreased below preoperative scores after 2 years (18.8 ± 11.9, P =.795). Mean fundamental frequency (F0) values in speech decreased significantly from 192.0 ± 24.9 Hz preoperatively to 167.1 ± 19.8 Hz at a 2‐year follow‐up (P =.002), with a nadir value at 1‐month postoperatively (148.4 ± 20.5, P <.001). CAPE‐V scores increased significantly from preoperative to 1‐month postoperative (3.0 ± 2.3 vs. 21.9 ± 17.3, P <.001) but returned toward baseline values at 24 months after CTR (6.9 ± 4.8, P =.027). CAPE‐V measurements postoperatively were correlated with VHI and F0 (Pearson coefficient = 0.54 (VHI), −0.46 (F0), P <.001). Conclusions: Following CTR, mean F0 values were significantly and consistently lower but did increase over time, correlating with patients' improving VHI and CAPE‐V scores. VHI values indicate that patient's perception of their voice is not significantly impacted in long term. These results provide a framework to counsel patients about long term voice expectations. Level of Evidence: 4 Laryngoscope, 132:1054–1060, 2022 [ABSTRACT FROM AUTHOR]

Objective: To evaluate the short- and long-term voice outcomes after unilateral medialization thyroplasty (MT) and unilateral medialization thyroplasty with arytenoid adduction (MT + AA) in patients with unilateral vocal fold paralysis. Methods: Voice outcomes were assessed preoperatively, and postoperatively at 3 and 12 months according to a standardized protocol. Voice assessment was performed using Voice Handicap Index (VHI), GRBAS Grade, Maximum Phonation Time (MPT), s/z-ratio and subjective numeric rating scales on voice quality, effort, performance and influence on life. Results: Sixty-one patients were included (34 MT and 27 MT + AA). Significant pre- to postoperative improvements were seen in all voice outcome parameters. No significant differences in post-operative values were identified between the groups. Conclusion: Based on our findings, we conclude that patients with unilateral vocal fold paralysis who undergo MT and MT + AA achieve comparable and significant long time voice improvement, although voices do not completely normalize. We also conclude that this does not mean that AA is a superfluous procedure, but can indicate the accurate identification of patients in need of the additional AA procedure based on clinical parameters. [ABSTRACT FROM AUTHOR]