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BackgroundVoice disorders mainly result from chronic overuse or abuse, particularly in occupational voice users such as teachers. Previous studies proposed a contact microphone attached to the anterior neck for ambulatory voice monitoring; however, the inconvenience associated with taping and wiring, along with the lack of real-time processing, has limited its clinical application. ObjectiveThis study aims to (1) propose an automatic speech detection system using wireless microphones for real-time ambulatory voice monitoring, (2) examine the detection accuracy under controlled environment and noisy conditions, and (3) report the results of the phonation ratio in practical scenarios. MethodsWe designed an adaptive threshold function to detect the presence of speech based on the energy envelope. We invited 10 teachers to participate in this study and tested the performance of the proposed automatic speech detection system regarding detection accuracy and phonation ratio. Moreover, we investigated whether the unsupervised noise reduction algorithm (ie, log minimum mean square error) can overcome the influence of environmental noise in the proposed system. ResultsThe proposed system exhibited an average accuracy of speech detection of 89.9%, ranging from 81.0% (67,357/83,157 frames) to 95.0% (199,201/209,685 frames). Subsequent analyses revealed a phonation ratio between 44.0% (33,019/75,044 frames) and 78.0% (68,785/88,186 frames) during teaching sessions of 40-60 minutes; the durations of most of the phonation segments were less than 10 seconds. The presence of background noise reduced the accuracy of the automatic speech detection system, and an adjuvant noise reduction function could effectively improve the accuracy, especially under stable noise conditions. ConclusionsThis study demonstrated an average detection accuracy of 89.9% in the proposed automatic speech detection system with wireless microphones. The preliminary results for the phonation ratio were comparable to those of previous studies. Although the wireless microphones are susceptible to background noise, an additional noise reduction function can alleviate this limitation. These results indicate that the proposed system can be applied for ambulatory voice monitoring in occupational voice users.

Purpose: This study attempted to develop and to preliminarily validate the Mandarin Chinese version of the Vocal Fatigue Index (VFI) as a standardized self-assessment questionnaire tool for potential clinical applications. Method: The experimental procedure involved (a) cross-cultural adaptation of the VFI into the Mandarin Chinese version (CVFI), (b) evaluation by an expert panel, (c) back translation, (d) pilot testing, and (e) validation of the questionnaire by three participant groups: 50 with voice disorders, 50 occupational voice users (at-risk group), and 50 with normal voice (control group). Internal consistency, test--retest reliability, content validity, and convergent validity of the CVFI were examined, and discriminatory ability (diagnostic accuracy) for distinguishing between the groups was evaluated. Results: Results showed high internal consistency (Cronbach's alpha [greater than or equal to] 0.8817 for the total CVFI scores for all groups), high test-retest reliability (intraclass correlation coefficients [greater than or equal to] 0.9072, p < 0.001 for the total CVFI scores for all groups), high content validity (total content validity index = 0.9368), and high convergent validity (Pearson r [greater than or equal to] 0.8155, p < 0.001 between the total CVFI scores and Factors 1 and 2 scores). Significant differences between the three groups were found in all scores. Receiver operating characteristic analysis revealed a high diagnostic accuracy for distinguishing between the disorders group and the normal group (area under the curve [greater than or equal to] 0.927, p < 0.001 for the total CVFI scores and Factors 1 and 2 scores), with cutoff scores of [greater than or equal to] 36 (total CVFI score), [greater than or equal to] 23.5 (Factor 1 score), [greater than or equal to] 7.5 (Factor 2 score), and [greater than or equal to] 6.5 (Factor 3 score). Conclusions: These findings suggested that the CVFI could be a reliable and valid self-assessment tool for the clinical evaluation of vocal fatigue in Mandarin Chinese-speaking populations. A full-scale validation study of the CVFI is recommended to verify these results.

Objective: This study investigated whether artificial intelligence (AI) models combining voice signals, demographics, and structured medical records can detect glottic neoplasm from benign voice disorders. Methods: We used a primary dataset containing 2–3 s of vowel "ah", demographics, and 26 items of structured medical records (e.g., symptoms, comorbidity, smoking and alcohol consumption, vocal demand) from 60 patients with pathology‐proved glottic neoplasm (i.e., squamous cell carcinoma, carcinoma in situ, and dysplasia) and 1940 patients with benign voice disorders. The validation dataset comprised data from 23 patients with glottic neoplasm and 1331 patients with benign disorders. The AI model combined convolutional neural networks, gated recurrent units, and attention layers. We used 10‐fold cross‐validation (training–validation–testing: 8–1–1) and preserved the percentage between neoplasm and benign disorders in each fold. Results: Results from the AI model using voice signals reached an area under the ROC curve (AUC) value of 0.631, and additional demographics increased this to 0.807. The highest AUC of 0.878 was achieved when combining voice, demographics, and medical records (sensitivity: 0.783, specificity: 0.816, accuracy: 0.815). External validation yielded an AUC value of 0.785 (voice plus demographics; sensitivity: 0.739, specificity: 0.745, accuracy: 0.745). Subanalysis showed that AI had higher sensitivity but lower specificity than human assessment (p < 0.01). The accuracy of AI detection with additional medical records was comparable with human assessment (82% vs. 83%, p = 0.78). Conclusions: Voice signal alone was insufficient for AI differentiation between glottic neoplasm and benign voice disorders, but additional demographics and medical records notably improved AI performance and approximated the prediction accuracy of humans. Level of Evidence: NA Laryngoscope, 134:4585–4592, 2024 [ABSTRACT FROM AUTHOR]

Objectives: Vocal process granuloma (VPG) is a chronic condition resulting from a mucoperichondrial injury of vocal process. Initial conservative treatment typically involves vocal hygiene education and antireflux medication. Treatment challenges arise with refractory cases. Outcomes of second‐line treatments such as surgical excision and botulinum toxin injections remain inconsistent. Thus, we propose this study to investigate the effectiveness of intralesional steroid injections for refractory VPG. Methods: We conducted a retrospective review of 23 patients with VPG who showed no improvement after 3 months of proton pump inhibitors. These patients underwent one to three courses of monthly in‐office intralesional steroid injections as a second‐line therapy. Treatment outcomes were evaluated by measuring the size of the VPG relative to the length of the vocal folds before and after the final injection procedure. Results: Results showed a significant reduction in VPG size from baseline of 27.74 ± 15.06 to 5.48 ± 8.95 (p <.001). 15 out of 23 patients were responsive (size reduction ≥ 75%) to intralesional steroid injection. Alcohol consumption and longer symptom duration were associated with a poor response (size reduction <75%), whereas prior intubation was associated with better response. Conclusions: For refractory VPG not responding to conservative treatment, intralesional steroid injection appears to be a promising alternative option without significant adverse effects. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies have reported that voice therapy via telepractice is useful for patients with nodules and muscle tension dysphonia. Nevertheless, telepractice for elderly patients with voice disorders has not yet been investigated. We conducted this study to examine the hypothesis that voice therapy via telepractice is not inferior to conventional voice therapy. Method: Eighty patients with dysphonia aged more than 55 years participated in this study from September 2016 to June 2018. After screening the inclusion and the exclusion criteria, 69 patients were randomized into telepractice (33 patients) and conventional (36 patients) groups. The outcome measurements included Voice Handicap Index-10, videolaryngostroboscopy, maximum phonation time, auditory-perceptual evaluation, and acoustic analysis. Paired "t" test, Wilcoxon signed-ranks test, and repeated measures analysis of variance were used to examine treatment outcomes. Results: The diagnoses of voice disorders included atrophy (n = 33), unilateral vocal paralysis (n = 13), muscle tension dysphonia (n = 7), nodules (n = 6), and polyps (n = 10). No significant differences were observed in age, sex, and baseline measurements between the two groups. Twenty-five patients in the telepractice group and 24 patients in the control group completed at least four weekly sessions. Significant improvements were observed for all the outcome measures (p < 0.05) in both groups. Improvements in Voice Handicap Index-10 in the telepractice group (24.84 ± 5.49 to 16.80 ± 8.94) were comparable to those in the conventional group (22.17 ± 7.29 to 13.46 ± 9.95, p = 0.764). Other parameters also showed comparable improvements between the two groups without statistically significant differences. Conclusions: This is the first randomized controlled trial comparing telepractice and conventional voice therapy in elderly patients with voice disorders. The results showed that the effectiveness of voice therapy via telepractice was not inferior to that of conventional voice therapy, indicating that telepractice can be used as an alternative to provide voice care for elderly patients with vocal disorders.

Objective: Fat injection laryngoplasty (FIL) is a common procedure used to correct glottic insufficiency. Nevertheless, few studies have discussed potential treatments for cases with poor voice recovery after FIL. Methods: Eighteen patients with unfavorable vocal outcomes from FIL were analyzed. Each of these patients presented persistent dysphonia for more than 2 months following FIL, together with bulging vocal folds and poor mucosal wave. We applied microsurgery as the standard treatment to remove excessive fat. Vocal fold steroid injection (VFSI) was administered to patients that were hesitant or declined to undergo microsurgery. Voice outcomes were evaluated using the Voice Handicap Index-10 (VHI-10), grade-roughness-breathiness (GRB) scores, and smoothed cepstral peak prominence (CPPs). Results: Six patients underwent microsurgery directly, 6 patients received only VFSIs as a salvage treatment, and the remaining 6 patients received 1 to 3 courses of VFSIs before the decision to undergo microsurgery. Pathology reports were available for 10 patients, and contained 5 instances of adipose tissues, 3 of fat necrosis, 1 of chronic inflammation, and 1 of fibrosis. Seventeen patients reported satisfactory or improved outcomes. We found remarkable improvements in VHI-10, GRB, and CPPs (all P <.05) after salvage treatments for FIL. Subgroup analyses showed comparable voice outcomes for patients undergoing direct microsurgery, VFSI alone, and VFSI followed by microsurgery (P >.05). Conclusions: This study demonstrated that fat overinjection and/or fibrotic change in the injected vocal folds may cause poor voice outcomes after FIL. Both microsurgery and VFSI could be applied as salvage treatments with good voice recovery profiles. Level of evidence: Level 4. [ABSTRACT FROM AUTHOR]