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Summary Objectives A whole body vibration platform using vertical oscillation has been shown to be efficacious in reducing vocal fatigue in adults. This study aimed to investigate whether this platform-generated whole body vibration was unique in reducing vocal fatigue by comparing it with self-generated whole body vibration. Methods Twenty-four female adults (mean age = 23.96 years) were randomly assigned to one of the following three groups: a machine-generated whole body vibration group (N = 8), a self-generated whole body vibration group (N = 8), and a placebo vocal resting group (N = 8). All participants performed a karaoke singing task for at least 95 minutes. Each participant received 10 minutes of platform-generated vibration, self-vibration, or sham localised vibration (placebo group with basically voice rest only), according to their group allocation. Vocal function ability, measured by the highest fundamental frequency produced, and a self-reported vocal fatigue score were evaluated at three time points: baseline (prefatigue), after the singing task (post-fatigue) and post-vibration. Results The study revealed that machine-generated whole body vibration was significantly better at improving vocal fatigue than self-generated whole body vibration or voice rest. Conclusion The findings support previous research that machine-generated whole body vibration is effective in reducing vocal fatigue. The non-significant results of self-generated whole body vibration in terms of relieving vocal fatigue suggest that inadequate vibration frequency or amplitude together with leg muscle fatigue may have been the main factor of ineffectiveness.

Purpose The study of air pressure in the vocal tract is essential to understanding vocal function. Changes in vocal tract shape during different phonatory gestures are hypothesized to produce nonuniform air pressure across lower vocal tract locations. Current methods of air pressure measurement, however, are limited to a single location in the anterior oral cavity. The purposes of this study were (a) to assess the feasibility of a novel method of simultaneously measuring phonatory air pressure at multiple locations across the lower vocal tract using high-resolution pharyngeal manometry (HRM) and (b) to compare pressure across locations and among phonatory tasks. Method Two subjects underwent HRM while performing phonatory tasks. A catheter was passed transnasally and air pressure was measured simultaneously at five locations between the velopharyngeal port and the upper esophageal sphincter. Descriptive statistics were calculated for each location by task, and for each task averaged across locations. Results HRM was well tolerated, and air pressures from multiple locations in the lower vocal tract were able to be obtained simultaneously. During vocal tract semi-occlusion tasks, air pressures differed by location. Pressures averaged across locations demonstrated a pattern of increasing pressure with increasing semi-occlusion. Conclusions HRM is feasible for measuring air pressure simultaneously at multiple locations in the lower vocal tract during phonation with high spatial and temporal resolution, providing rich data to augment understanding of vocal function. The high spatial and temporal resolution yielded by this new method, paired with preliminary evidence that pressures change by location as a function of phonatory task, may be useful in future assays exploring differences in lower vocal tract air pressures between normal and disordered populations.

BACKGROUND We assessed the safety and efficacy of supracricoid partial laryngectomy with cricohyoidoepiglottopexy (SCL-CHEP) in patients with laryngeal cicatricial stenosis. METHODS Sixteen patients receiving SCL-CHEP for severe laryngeal cicatricial stenosis between 2017 and 2018 were reviewed. Decannulation rate and tracheostomy closure time were used to evaluate efficacy. The Voice Handicap Index-10 (VHI-10), Voice-related Quality of Life (V-RQOL) scale and Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale were used to assess vocal function. Fiberoptic endoscopic evaluation of swallowing (FEES) was performed and the Penetration-Aspiration Scale (PAS), Eating Assessment Tool-10 (EAT-10), and Swallow Quality of Life Questionnaire (SWAL-QOL) were used to assess swallowing function. RESULTS Thirteen patients (81.25%) were decannulated successfully. The average tracheostomy closure time was 45.15 days. There was no observed postoperative complications or recurrence of stenosis. VHI-10 and V-RQOL scores showed significantly improved V-RQOL (p

Currently accepted standard of surgical treatment of patients with locally advanced stage III and IV laryngeal and laryngopharyngeal cancer is laryngectomy which leads to loss of vocal function. Therefore, vocal rehabilitation is one of the most important tasks of the doctor. It allows to increase quality of life of patients after treatment. Currently used techniques of vocal rehabilitation have their advantages and disadvantages. The article considers various techniques of vocal rehabilitation, primarily, subtotal laryngectomy with laryngotracheal shunt as a promising method of surgical rehabilitation of patients with locally advanced caner of the larynx and laryngopharynx.

Summary Background Vibration is commonly used to relax tension in the limb and truck muscle. Vibration used directly on the muscle concerned and vertical vibration used on the whole-body through a foot platform have been reported in the literature to be useful to release muscle tension. Aim The present study investigated the effect of indirect whole-body vibration (WBV) and direct localized perilaryngeal vibration (LPV) on the phonatory functions of nondysphonic individuals with vocal fatigue. Methods Forty-four subjects (mean age = 21.67 years) with normal voice, were randomly assigned to either the WBV group, the LPV group, or the Control (sham hand-held vibratory device) group. They performed karaoke singing for at least 95 minutes. They then received either WBV through a Turbosonic vibratory machine, LPV with a Novofan vibrator, or a sham vibrator for 10 minutes. The highest pitch produced, and self-reported vocal fatigue score were taken before singing, after singing, and after the intervention. Data were analyzed separately for the gender subgroups. Results All subject groups showed significant reduction of vocal function (highest pitch production, and vocal fatigue score) after singing. Following the vibrational interventions, both the WBV and LPV groups showed significantly recovery in the highest pitch production and the perception of vocal fatigue (P Conclusion Vibrational therapy, whether it is localized vibration on the peri-laryngeal muscles, or whole-body vibration, is more effective than voice rest per se in relieving vocal fatigue. Vibrational methods are recommended for treating vocal fatigue.

Background. Endolaryngeal suture lateralisation is an ideal operation for bilateral vocal fold paralysis. However, restenosis owing to breakage and slippage of suture can sometimes occur. In such a case, methods that are more effective in expanding the glottis, including arytenoidectomy, must be selected. Case Report. Herein, we report two female patients aged 86 and 54 years who presented with bilateral vocal cord paralysis and who had restenosis after suture lateralisation. Endoscopic partial arytenoidectomy was performed, and satisfactory outcomes were obtained. This method maintains the height of the arytenoid and preserves its sensation by leaving a part of the cartilage and mucous membrane. Conclusion. Endoscopic partial arytenoidectomy is effective for securing the airway while preserving vocal function and preventing aspiration. This technique is suitable for patients with restenosis after they have undergone endolaryngeal suture lateralisation.

Purpose The purpose of this preliminary study was to identify a vocal task that could be used as a clinical indicator of the vocal aptitude or vocal fitness required for vocally demanding occupations in a manner similar to that of the anaerobic power tests commonly used in exercise science. Performance outcomes for vocal tasks that require rapid acceleration and high force production may be useful as an indirect indicator of muscle fiber complement and bioenergetic fitness of the larynx, an organ that is difficult to study directly. Method Sixteen women (age range: 19–24 years, M age = 22 years) were consented for participation and completed the following performance measures: forced vital capacity, three adapted vocal function tasks, and the horizontal sprint test. Results Using a within-participant correlational analyses, results indicated a positive relationship between the rate of the last second of a laryngeal diadochokinesis task that was produced at a high fundamental frequency/high sound level and anaerobic power. Forced vital capacity was not correlated with any of the vocal function tasks. Conclusions These preliminary results indicate that aspects of the laryngeal diadochokinesis task produced at a high fundamental frequency and high sound level may be useful as an ecologically valid measure of vocal power ability. Quantification of vocal power ability may be useful as a vocal fitness assessment or as an outcome measure for voice rehabilitation and habilitation for patients with vocally demanding jobs.

The platysma skin flap was used for laryngeal reconstruction after vertical partial laryngectomy to improve the postoperative voice quality of patients with T2 and T3 glottic laryngeal carcinoma. Sixty-nine patients with unilateral T2 and T3 glottic laryngeal carcinoma were included. Forty-six patients received vertical partial laryngectomy, and a platysma skin flap was used for laryngeal reconstruction. The other 23 patients underwent transoral laser microsurgery. Subjective and objective examinations were performed to evaluate laryngeal morphology after the surgery. Acceptable voice quality was achieved for 46 patients who underwent vertical partial laryngectomy. Flap vibrational waves occurred in 19 cases (41.3%). The platysma skin flap is an ideal tissue for the reconstruction of articulation structure in open surgery of T2 and T3 unilateral glottic laryngeal carcinoma.

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

Tradicionalmente, se ha planteado que el reposo es la herramienta ideal para permitir la recuperación natural de los tejidos inducidos a sobrecarga. Sin embargo, los tiempos necesarios para que esto se produzca son muy largos. Se ha estimado que la electroterapia es útil al momento de recuperar algunos tejidos sobreutilizados, no obstante, se desconocen estos beneficios en la función vocal. Este estudio tuvo como objetivo describir los efectos de la electroterapia sobre los tejidos laríngeos y cordales que previamente fueron sometidos a sobrecarga vocal. En esta investigación participaron 21 mujeres sin patología o entrenamiento vocal, cuya edad fue de 24 ± 1,28 años. Las participantes fueron sometidas a sobrecarga vocal por 40 minutos y posteriormente, a 15 minutos de estimulación eléctrica transcutánea (TENS) de tipo acupuntura. A través de laringoscopía con luz continua, análisis acústico-perceptual y estudio sintomatológico, se examinaron los cambios provocados por la electroterapia. Los principales resultados incluyen a la relajación perilaríngea y de los músculos intrínsecos sobreutilizados, y eliminación de los síntomas sufridos. De esta forma, se concluye que la TENS de tipo acupuntura es una herramienta útil en la aceleración de la recuperación de los tejidos sometidos a sobrecarga vocal., Traditionally, it has been suggested that rest is the ideal tool to allow natural recovery of tissues induced by overload. However, the times necessary for this to occur are very long.It has been estimated that electrotherapy is useful when it comes to recover some overused tissues, however, these benefits in vocal function are unknown. The purpose of this study was to describe the effects of acupuncture-like transcutaneous electrical nerve stimulation on the laryngeal and cordal tissues that were previously subjected to vocal overload. In this research, 21 women without pathology or vocal training participated, whose age was 24 ± 1.28 years. The participants were subjected to vocal overload for 40 minutes and subsequently to 15 minutes of acupuncture-like transcutaneous electrical nerve stimulation. Through continuous laryngoscopy, acoustic-perceptual analysis and symptomatic study, the changes caused by electrotherapy were examined. The main results include perilaryngeal and intrinsic laryngeal muscles relaxation, and elimination of the symptoms suffered. This way it is concluded that electrostimulation is a useful tool in the acceleration of tissue recovery subjected to vocal overload.

Background: Various voice assessment tools, such as questionnaires and aerodynamic voice characteristics, can be used to assess vocal function of individuals. However, not much is known about the best combinations of these parameters in identification of functional dysphonia in clinical settings. Methods: This study investigated six scores from clinically commonly used questionnaires and seven acoustic parameters. 514 females and 277 males were analyzed. The subjects were divided into three groups: one healthy group (N01) (49 females, 50 males) and two disordered groups with perceptually hoarse (FD23) (220 females, 96 males) and perceptually not hoarse (FD01) (245 females, 131 males) sounding voices. A tree stumps Adaboost approach was applied to find the subset of parameters that best separates the groups. Subsequently, it was determined if this parameter subset reflects treatment outcome for 120 female and 51 male patients by pairwise pre- and post-treatment comparisons of parameters. Results: The questionnaire “Voice-related-quality-of-Life” and three objective parameters (“maximum fundamental frequency”, “maximum Intensity” and “Jitter Percent”) were sufficient to separate the groups (accuracy ranging from 0.690 (FD01 vs. FD23, females) to 0.961 (N01 vs. FD23, females)). Our study suggests that a reduced parameter subset (4 out of 13) is sufficient to separate these three groups. All parameters reflected treatment outcome for patients with hoarse voices, Voice-related-quality-of-Life showed improvement for the not hoarse group (FD01). Conclusion: Results show that single parameters are insufficient to separate voice disorders but a set of several well-chosen parameters is. These findings will help to optimize and reduce clinical assessment time., In this study, we show that only a small set of four parameters is sufficient to differentiate between healthy subjects and patients with diagnosis of functional dysphonia. These four parameters also reflect treatment outcome for functional dysphonia and perceivable hoarse voices (success or failure). Thus, in future a functioning set of objective tools could be created that improves and accelerates assessment and therapy of voice disorders.

We investigate the connection between the autonomic nervous system and the voice in patients with vocal hyperfunction and healthy-control groups. We present a methodology and preliminary results of two multi-modal measurement streams that capture this relationship. Subjects were instrumented for daily, ambulatory collection of their voice and wrist-based electrodermal activity. Measures of vocal function (e.g., fundamental frequency) were computed, as well as measures of autonomic function (e.g., skin conductance response). Spearman correlation coefficients were calculated to measure the relationship between vocal and autonomic function over sliding windows throughout each observation day. We found preliminary evidence that patients with a subtype of vocal hyperfunction (non-phonotraumatic vocal hyperfunction) exhibit a coupling between the autonomic nervous system and the vocal system. Understanding how the autonomic nervous system interacts with the voice may provide new insights into the etiology/pathophysiology of vocal hyperfunction and improve prevention, diagnosis and treatment of these disorders.

Acoustic analysis is widely used for assessing and monitoring vocal function. Dermatoglyphics is a method that analyzes genetic fingerprint markers, and uses that information for predicting physical skills related to anaerobic (explosive strength and speed) and aerobic (motor coordination and resistance) mechanisms. Therefore, it can be used as an indicator for individualized vocal training.To characterize the dermatoglyphic profiles and their relation to acoustic measures in voice professionals.A cross-sectional study involving 79 voice professionals. Acoustic analysis was performed using the PRAAT software. Mean intensity, fundamental frequency (F0), and cepstral peak prominence (CPP) value were extracted from the sustained vowel /a/. Fingerprints were collected using a Watson mini-integrated biometric scanner, and were quantified by design predominance, delta index (D10), total ridge count (TRC), and dermatoglyphic profile. The acoustic measures were analyzed descriptively and compared, considering the subjects' dermatoglyphic profiles. The confidence levels ranged from 90% to 95%.Most subjects exhibited anaerobic dermatoglyphic profiles (P = 0.004) and low TRC (p0.001). Higher F0 (P = 0.061), intensity (P = 0.065), and CPP (P = 0.073) were found for anaerobics (P0.001). There was a weak and negative correlation between TRC and intensity (P = 0.026), as well as between F0 (P = 0.017) and CPP (P = 0.069).Anaerobic profiles were predominant. The values of F0, intensity, and CPP increased for the anaerobics. There was a weak negative correlation between the TRC and intensity, F0, and CPP measures. Dermatoglyphics could have been seen as an interesting tool in the voice assessment and training direction for voice professionals.

Objective The present study proposes a direct surface hydration system based on nasal breathing through a damp gauze. The goal is to observe whether such direct hydration procedure positively modifies vocal fold functionality by improving voice quality and enhancing the mobility and pliability of the vocal fold mucosa. Methods Sixty-one young adults without voice problems were enrolled and were randomly divided into three double-blinded treatment groups. In the first group (the gauze group), participants breathed through the nose wrapped in a damp gauze for 10 minutes while doing vocal warm-up exercises to facilitate water penetration into the mucosal layers of the vocal folds. The second group (the exercise group) performed the same warm-up exercises as the gauze group for 10 minutes without hydration procedures. The third group (the control group) talked using their normal speaking voice for 10 minutes. The participants were evaluated before and after the treatment tasks with three tests: a laryngostroboscopic examination (ie, the glottic closure, the amplitude of the mucosal wave, and the maximum opening of the glottic space); voice acoustic analysis (multidimensional voice program); and a perceptual voice evaluation (GRBAS scale). Results Results showed that after the use of a damp gauze, glottic closure, the amplitude of the mucosal wave, the maximum opening of the glottic space, the shimmer, and the B of GRBAS all improved. Conclusion Findings showed significantly better vocal results for the participants of the gauze group, suggesting the damp gauze procedure to be an effective, fast, and economical procedure to improve and optimize vocal fold functionality. It can be hypothesized that the obtained results are related to an improvement in vocal folds surface hydration and viscoelasticity.

The aim of the present study was a systematic literature review on selected evidence-based voice therapy programs for the treatment of various types of dysphonia. The results showed that nine of seventeen voice therapy programs complied the selection criteria. All nine voice therapy programs revealed significant improvements in various aspects of laryngeal evaluation, voice quality, vocal function, and/or self-evaluation. These improvements might be expected between one day to ten weeks. Mostly, the voice therapy programs based on physiological voice therapy.

Objective. To estimate the possibility of performance of selective reinnervation of larynx in its abductionaal unilateral paralysis in thyroidal surgery. Маterials and methods. There were analyzed the results of selective laryngeal reinnervation in 2 patients, suffering thyroidal cancer. Visual inspection of the larynx was conducted (fibrolaryngoscopy with archiving of the data) in preoperative and postoperative periods, аs well as in 2, 4, 6, 12, 18 and 24 mo postoperatively, spectral vocal analysis, estimation of vocal quality in accordance to the VHI-30 sсale reporting, using questionnaires ЕАТ-10 for determination of the dysphagia degree. Results. Selective reinnervation was performed in 2 patients with extralaryngeal branching of nervus recurrence: in one - the postponed selective reinnervation of larynx (аutoplasty of the adduction branch of nervus recurrence) for correction of its postoperative abductional paralysis, and in the second - primary selective laryngeal reinnervation (аnastomosis of the adductional branch of nervus recurrence in the “end-to-end” style). In the first patient the tone and stretching of the paralyzed vocal cord free edge was registered in 15 mo after reinnervation, the coordinated move signs - in 2 yrs. In a second patient the restoration of tone and mobility of a vocal cord was registered in 4 mo after reinnervation. In both patients the main indices of the voice spectral analysis and of the self-estimation in accordance to the VHI-30 and ЕАТ-10 scales were restored up to normal values. Conclusion. Selective reinnervation of larynx may be applied not for correction of respiratory disorders due to its bilateral paralysis only, but for restoration of a vocal function and elimination of aspiration symptoms in a case of unilateral paralysis of larynx as well.

The change of vocal function after vocal fold dehydration due to dryness was discussed along with the treatment effect of different atomizing agents. Forty-eight staffs from The Central Hospital of Wuhan were recruited. All volunteers breathed dry air for vocal fold dehydration. After dry air inhalation, the subjects were randomly divided into four groups, with 12 cases each. Three groups were treatment groups, receiving 0.9% normal saline (IS), 5% hypertonic saline (HS) and double-distilled water (SW) atomizing inhalation therapy, respectively, and the last group was the control group without treatment. Voice data were collected for all subjects before and immediately after dry air inhalation using the Multi-Dimensional Voice Program (MDVP) system. Atomizing inhalation therapy was given 10 min after dry air inhalation, and voice data were collected using MDVP system at the following time points after atomizing inhalation treatment: 5 min, 20 min, 35 min, 50 min, 65 min, 80 min, 95 min, 110 min. In the control group, voice data were collected at the same time points and compared with those of treatment groups. The vocal function parameters collected before and after dry air inhalation as well as after treatment were subjected to test using SPSS 16.0 software. In the four groups, jitter (fundamental frequency perturbation), shimmer (amplitude perturbation), and amplitude perturbation quotient (APQ) were significantly increased after dry air inhalation (P

Objectives: The aim of this study was to assess the feasibility of the submucosal infusion combined with microflap dissection via laser CO2 as both a diagnostic and therapeutic procedure for superficial glottic lesions. To define a safe surgical procedure in terms of local control, a morphometric study of surgical margins was performed. Methods: From January 2011 to January 2016, we treated 122 patients with early glottic lesions with phonomicrosurgery. Patients with effective hydrodissection underwent a microflap and type I-II diagnostic cordectomy. In the others, a biopsy was carried out, and in the case of a malignant lesion, a type III to VI cordectomy was performed. Disease-free survival (DFS) for all the lesions was also determined according to comparative assessments of surgical margins. The Voice Handicap Index was used to evaluate functional outcomes. Results: In 27 cases (32%), hydrodissection was effective; specifically, 24 (88.8%) were premalignant lesions, and 3 (11.2%) had a carcinoma. In 56 patients (68%), hydrodissection was not adequate, and a biopsy was performed: 9 (16%) were premalignant and 47 (84%) malignant lesions. The DFS analysis suggests that margins >0.7 mm resulted in a cutoff that can guarantee a safe procedure in the case of effective hydrodissection ( P < .05). Conclusion: Phonomicrosurgery may be both a diagnostic and therapeutic option with oncological efficacy for superficial glottic lesions of undetermined nature when surgical margins exceed 0.7 mm. In case of inadequate hydrodissection, the hypothesis of an infiltrative carcinoma warrants a wider cordectomy.

Simple Summary Recurrent laryngeal nerve (RLN) is the second most common structure invaded by primary or metastatic thyroid cancer. However, little is known about the optimal procedure for maintaining vocal function in patients with unilateral RLN involvement in thyroid cancer. This study aimed to evaluate various parameters of vocal function to establish the optimal management of thyroid cancer patients with unilateral RLN involvement. Based on our findings, we propose that for optimal management of unilateral RLN involvement in thyroid cancer, first, sharp dissection should be performed, and if this is impossible, a simultaneous RLN reconstruction procedure should be adopted whenever possible. These findings may help improve management of RLN involvement in patients with thyroid cancer and ensure vocal function preservation. Abstract We aimed to determine the optimal management of recurrent laryngeal nerve (RLN) involvement in thyroid cancer. We enrolled 80 patients with unilateral RLN involvement in thyroid cancer between 2000 and 2016. Eleven patients with preoperatively functional vocal folds (VFs) underwent sharp tumor resection to preserve the RLN (shaving group). Thirty-three patients underwent RLN reconstruction with RLN resection (reconstruction group). We divided the reconstruction group into two subgroups based on preoperative VF mobility (normal-reconstruction and paralyzed-reconstruction subgroups). In the cases where RLN reconstruction was difficult, phonosurgeries including arytenoid adduction (AA), with or without thyroplasty type I, or nerve muscle pedicle implantation with AA were performed later (phonosurgery group). We evaluated and compared vocal function among the evaluated periods and different groups. Postoperative vocal function in the shaving and normal-reconstruction subgroups was favorable. There were no significant differences between the two groups. In the paralyzed-reconstruction and phonosurgery groups, postoperative vocal function was significantly improved, and vocal function in the paralyzed-reconstruction subgroup was significantly better than that in the phonosurgery group. For optimal management of unilateral RLN involvement in thyroid cancer, first, sharp dissection should be performed, and if this is impossible, a simultaneous RLN reconstruction procedure should be adopted whenever possible.

The article is devoted to the problem of voice rehabilitation of patients after laryngectomy. Modern possibilities of repairing laryngeal vocal function, methods for extending the lifetime of voice prostheses are considered. The author’s method of prevention of infection of vocal prostheses using the antimicrobial photodynamic therapy (PDT) with chlorin-type photosensitizer Radagel is presented. Performing antimicrobial PDT of vocal prostheses increased the average operating time to 11.9 months compared to the control group (6.8 months), where a monthly dose of 150 mg of fluconazole was used for prevention. The method developed by the authors makes it possible to significantly extend the lifetime of vocal prostheses, is devoid of adverse events, is well tolerated by patients.

Purpose Society has become increasingly dependent on telecommunication, which has been shown to negatively impact vocal function. This study explores the use of sidetone regulation during audio-visual communication as one potential technique to alleviate the effects of telecommunication on the voice. Method The speech acoustics of 18 participants with typical voices were measured during conversational tasks during three conditions of sidetone amplification: baseline (no sidetone amplification), low sidetone amplification, and high sidetone amplification. Vocal intensity, vocal quality (estimated using acoustic measures of the low-high ratio and the smoothed cepstral peak prominence), and self-perceived vocal effort were used to measure the impacts of sidetone amplification on vocal function. Results Compared to baseline, there were statistically significant decreases in vocal intensity and increases in low-high ratio in the high level of sidetone amplification condition. Changes in these measures were not significantly correlated. When asked to rank conditions based on their perceived vocal effort, participants most often ranked the high level of sidetone amplification as least effortful; however, the visual-analog ratings of vocal effort were not significantly different between conditions. The smoothed cepstral peak prominence did not change with varying levels of sidetone amplification. Conclusions Vocal intensity decreased with high levels of sidetone amplification. High levels of sidetone amplification also resulted in increases in the low-high ratio, which were shown to be more than just a byproduct of decreased vocal intensity. The impact of sidetone amplification on vocal effort was less clear, but results suggested that participants generally decreased their vocal effort with increased levels of sidetone amplification. This was a preliminary study and future work is warranted in a population of participants with voice complaints and in a more noisy, realistic environments.

With the emergence of the multidisciplinary approach to the management of patients with voice disorders, nonsurgical “conservative” voice management has gained popularity as a primary treatment option in sports occupational voice users (SOVU) and others with dysphonia. The most commonly adopted strategies are vocal hygiene therapy (VHT), vocal function exercises (VFE), and voice amplification (VA). Vocal hygiene therapy (VHT) stresses voice health education, nontraumatic phonatory behavior, and lifestyle behavioral modifications, whereas VFE includes supervised voice training to reduce laryngeal muscle tension and imbalance and improve the coordination between oscillation (vocal fold vibration), respiration, and resonance to optimize phonation. VA aims to decrease vocal dose by amplifying the voice, using either via a stationary or portable system. Although VA does not address the laryngeal behavior directly, it is still an alternative treatment strategy in SOVU with or without dysphonia, and it can be used in combination with VHT and VFE.

Summary Introduction Bamboo nodes are transverse creamy-yellow subepithelial nodes in the vocal folds (VF) midpoint, usually bilateral, resembling a bamboo stem. They appear almost exclusively in females, and are associated with underlying autoimmune diseases. Case summary Six female patients, 45.5 years median age, with underlying autoimmune diseases, consulted due to dysphonia. The laryngeal stroboscopy showed bilateral VF bamboo nodes in four patients, and unilateral in the remaining two. VF mobility was normal in all patients, while the mucosal wave was impaired in four of them. Treatment with speech therapy and proton pump inhibitors was indicated. All the patients were referred for rheumatologic evaluation and immunosuppressive treatment optimization. Follow-up in five patients showed vocal function self-perception and GRBAS scores improvement. Discussion VF bamboo nodes are an infrequent cause for dysphonia, associated with phonotrauma and autoimmune diseases. Speech therapy and a rheumatologic workup must be indicated, for immunosuppressive treatment enhancement.

Summary Objectives This prospective randomized study aimed to investigate whether patients with dysphagia after treatment for head and neck cancer improve their vocal function from doing head lift exercises (Shaker's exercise). Methods Patients were randomized into an intervention group (n = 24) or a control group (n = 26). Patients in the intervention group performed the head lift exercise three times a day for 8 weeks. At baseline and at follow-up after 8 weeks, participants’ voices were evaluated perceptually with the Grade-Roughness-Breathiness-Asthenia-Strain (GRBAS) scale. Vocal fry (VF) was also perceptually evaluated and patients filled in the Voice Handicap Index (VHI). Results Patients in the intervention group were perceptually evaluated as having less roughness and vocal fry in their voices at follow-up compared to the control group. There were no statistically significant changes between baseline and follow-up neither in the intervention nor the control group regarding GRBAS, VF, or VHI. Neither were there any statistically significant differences within the groups when results on the perceptual evaluations at baseline and follow-up were compared. Conclusions The voices of the participants in the intervention group were slightly better than the voices of the participants in the control group with less roughness and VF at follow-up. However, no improvement in the VHI or the remaining GRBAS variables was found. Therefore, this study can only give cautious support to the head lift exercise as a method for improving the voice of patients with dysphagia after treatment for head and neck cancer.

Introduction: The benefits of intraoperative neural monitoring (IONM) of recurrent laryngeal nerve (RLN) on post-thyroidectomy vocal cord palsy (VCP) rates are contentious. We wished to study impact of IONM on permanent VCP after thyroidectomy. Methods: Retrospective review of prospective series of 1011 (1539 nerves-at-risk) patients undergoing thyroidectomy without (418, group 1) and with (583, group 2) IONM. Results: There were three recognized nerve injuries in group 1, vs one in group 2 (P =.3). There were no differences in overall VCP rates. However, patients in group 2 with immediate postoperative VCP had higher likelihood of full recovery than patients in group 1 (55 of 56 vs 23 of 29 patients, P =.01), and lower incidence of total permanent VCP (2 of 917 vs 9 of 647 patients, P =.01). Conclusion: Among patients with immediate postoperative VCP after thyroidectomy, IONM is associated with a higher likelihood of regaining normal vocal function. This may be related to better identification of RLN branching in IONM cases.

Objective: To compare vocal function between females with benign vocal fold lesions, and females with normal voices by use of electroglottograph (EGG), also in addition to determining which EGG parameters were significantly correlated with the perceptual degree of dysphonia. Material and Methods: EGG data were obtained from 32 females with benign vocal fold lesions and 32 females with normal voices. The EGG parameter values were analyzed from their productions of four sustained vowels (/a:/, /u:/, /i:/, and /æ:/). Results: The two perturbation measures of EGG signals, EGG-jitter and EGG-shimmer of females with benign vocal fold lesions were significantly higher than those of normal females at a p-value

Summary The purpose of this investigation was to observe laryngeal tissue and vocal function changes over the course of 28 days in a single participant diagnosed by a laryngologist with bilateral nodules. Laryngeal imaging, acoustic variables and perceptual assessments of voice quality, and perceived vocal effort were obtained every morning for 28 consecutive days. A daily journal of occupational and recreational voice use as well as menstruation and alcohol consumption was maintained each day. It was hypothesized that the laryngeal pathology would appear more extensive and the vocal function measures obtained would be worse following extensive voice use. Laryngeal imaging, acoustic variables, and perceptual measures quantified provided evidence to support the study hypotheses. The size, extent, and asymmetry of the bilateral vocal pathologies observed were more extensive on days following occupational and recreational vocal loading. Acoustic and perceptual measures obtained correlated with the laryngeal tissue changes observed. Study findings support a more holistic approach to laryngeal pathology diagnosis that is based on a more thorough understanding of vocal loading considerations up to 48 hours prior to laryngeal endoscopy to better understand the pathophysiology of the observed lesion(s) for most accurate clinical diagnosis.

During surgery on the thyroid gland, injury to the recurrent nerve is possible with the development of a clinical picture due to impaired mobility of the vocal fold. A disturbance of the mobility of the opposite vocal fold in the form of a paradoxical spasm may join these manifestations if the parathyroid glands were affected during surgery, followed by a decrease in the level of ionized calcium in the blood. Management of such patients presents certain difficulties. A clinical case of examination and treatment of a patient with bilateral impairment of mobility of the vocal folds resulting from thyroid surgery is presented. The peculiarity of this observation is that because of our treatment, we managed to stop the spasm of one vocal fold, and then restore the mobility of the other vocal fold, due to which a complete restoration of the respiratory and vocal function was achieved.При проведении операций на щитовидной железе возможна травма возвратного нерва с развитием клинической картины, обусловленной нарушением подвижности голосовой складки. К данным проявлениям может присоединяться нарушение подвижности противоположной голосовой складки в виде парадоксального спазма, если во время операции были затронуты паращитовидные железы, с последующим снижением уровня ионизированного кальция в крови. Ведение подобных больных представляет определенные трудности. Представлен клинический случай обследования и лечения пациентки с двусторонним нарушением подвижности голосовых складок, возникшим вследствие операции на щитовидной железе. Особенность данного наблюдения заключается в том, что в результате проведенного нами лечения удалось добиться купирования спазма одной голосовой складки, а затем восстановить подвижность другой голосовой складки, благодаря чему было достигнуто полное восстановление дыхательной и голосовой функции.

Purpose In cases of unilateral vocal fold paralysis (UVFP), voice disorders caused by glottic insufficiency can lead to a considerable reduction in the patient's quality of life. Voice therapy (VT) is an effective treatment that must be started early after the onset of vocal fold paralysis. This study examined the effect of early VT for patients with UVFP occurring after esophagectomy. Materials and methods Patients who had residual UVFP at 1 month postoperatively after esophagectomy for esophageal cancer between November 2014 and March 2017 were evaluated. Seventeen patients were divided into the VT group (n = 6) and non-VT group (n = 11). We compared these two groups and retrospectively examined the effect of early VT. The study endpoints included aerodynamic tests, laryngeal endoscopy, laryngeal stroboscopy, and glottal closure. All of these evaluations were performed at preoperatively and at 1 and 3 months postoperatively. Results Subglottal pressure reduced notably in the VT group, and both the mean flow rate and maximum phonation time tended to improve after VT. Conversely, there were no significant differences in MFR and MPT in the non-VT group. Furthermore, although UVFP remained after VT, we achieved glottal closure for all three patients. Conversely, only two of the six patients with glottic insufficiency in the non-VT group achieved glottal closure. Conclusion VT may be effective for improving impaired vocal function in patients with UVFP. It is reasonable to expect that VT can be initiated 1 month after the onset of vocal fold paralysis.

Summary Background Adenotonsillectomy is one of the most common pediatric surgical procedures. Postoperative voice changes are a very common concern among patient's parents. Therefore, the aim of this study is to analyze acoustic voice parameters after adenotonsillectomy, tonsillectomy, and adenoidectomy in pediatric patients in a tertiary referral academic center. Patients and Methods All pediatric patients undergoing an adenotonsillectomy, tonsillectomy or adenoidectomy in a single center from 2002 to 2018 were included in the study. Change of fundamental frequency, jitter, shimmer, and harmonic-noise ratio at first, seventh and 30th postoperative day compared to preoperative values were the primary outcome parameters. Statistical analysis was performed using repeated measures analysis of variance model. Results A total of 1258 patients were included in the study. The mean age of patients at the time of surgery was 8.3 years (range 3.0–18.0 years). Around 698 were male (55.5%) and 560 female (44.5%). The values of fundamental frequency increased significantly after the first and seventh postoperative day (P = 0.001 both) but normalized 1 month after surgery (P = 0.962). At the first postoperative month, values of jitter and shimmer decreased significantly (P = 0.005 and P = 0.002, respectively). Measurements of harmonic-noise ratio revealed a significant increase 30 days after surgery (P = 0.004). Conclusion Statistically significant differences in objective voice parameters within the first postoperative month after tonsillectomy, adenoidectomy, and adenotonsillectomy were observed. The fundamental frequency returned to normal 1 month after surgery. These findings can contribute in soothing the concerns of parents regarding postoperative voice changes.

Summary Introduction There exist a cohort of transmasculine patients who remain dissatisfied with vocal function following testosterone therapy and voice training. Aim The objective of this case report was to describe the use of injection laryngoplasty in this cohort as an alternative to laryngeal framework surgery. Method A case report and literature review was undertaken. Results Our case describes a 45-year-old transmasculine patient who remained unsatisfied with vocal pitch despite testosterone therapy and voice training. On initial presentation, the patient had fundamental frequency (fo) ranging from 70–344 Hz with a mean of approximately 135 Hz on reading, and 146 Hz in monologue. Injection augmentation of the vocal folds under local anesthesia with an injectable carboxymethylcellulose gel (prolaryn) was trialed. Following re-absorption of this, further injection was performed using autologous fat and subsequently a longer acting Calcium Hydroxyapatite injectable (Prolaryn Plus). This was followed by re-injection 1 year later. Patient satisfaction has been sustained throughout this period. Repeat acoustic evaluation in 2019 revealed a mean fo of 108 Hz on reading, 100 Hz in monologue, and a fo range of 85–134 Hz across these tasks. Conclusion This case report presents an alternative surgical intervention to supplement testosterone and voice training in transmasculine patients unsatisfied with vocal function.

Summary This study investigated the effects of therapeutic singing as an intervention for improving the vocal functions of the elderly. Data collection for this study took place at five senior community centers in Seoul, South Korea, from August 2018 to March 2019. A total of 54 elderly with healthy voices were assigned to a therapeutic singing group, a general singing group, or a control group, using convenience sampling. The therapeutic singing intervention involved using the Alexander technique, performing oral motor and respiratory exercises, and singing participant-written songs, across 12 sessions. The general singing group sang popular and folk songs of their choice. The control group received no treatment. Using peak expiratory flow rate (PEF) and Praat analysis, the participants’ vocal functions were measured before and immediately after the intervention. Vocal function was compared among the groups pre- and post-test; the therapeutic singing group showed statistically significant improvement in all vocal parameters: PEF, maximum phonation time, voice intensity (intensity), fundamental frequency (F0), jitter, shimmer, and noise-to harmonics ratio. The general singing group showed improvement only in F0, jitter, and noise-to harmonics ratio. The control group showed an overall reduction in all vocal functions, with a significant decrease in PEF and intensity, and a decrease in jitter and shimmer. Although singing is considered helpful for the voice health of the elderly, therapeutic singing, which involves posture correction and breathing exercises, is even more effective, thus proving to be a viable intervention for preventive voice care of the elderly.

Summary Purpose Participation in sorority recruitment often results in acute vocal impairment. The purpose of this investigation was to characterize the extent to which voice function and laryngeal appearance may be altered by participation in this social phenomenon. Methods Using a within-participant repeated measures design, nine women participating as sorority recruiters completed the study protocol. The following data were collected at two time points, immediately before and after the completion of two weeks of sorority recruitment: stroboscopic laryngeal imaging, vocal acoustic measures, and perceptual measures of vocal effort and voice quality. Results Perceived phonatory effort and overall severity of voice quality were significantly impaired following sorority recruitment. All participants had evidence of mucosal changes in the form of one or more the following: observed edema, erythema, increased vascularity, glottic margin changes. No significant differences in acoustic measures were identified. Conclusions Increased perceived vocal effort, increased overall severity ratings of voice quality, and deleterious vocal fold tissue changes observed support the hypothesis that the acute vocal loading that is characteristic of the sorority recruitment process contributes to a decline in voice function in the short term. Acoustic measures taken either lacked the sensitivity for the perceived decline in voice function or the participants, who were otherwise healthy, managed to adapt the acoustic signal to the tissue changes observed. The extent to which these acute changes may be mitigated with vocal hygiene and voice training is an area for future study.

PURPOSE: To explore the short-term effect of work-related voice use on voice function, and noise exposure on hearing function among radio broadcasters. METHOD: A one-week follow-up study with the participation of two radio broadcasters was conducted. Participants were monitored at the beginning and at the end of the working week. Pre-monitoring assessment on Monday (baseline measure) and post-monitoring assessment on Friday (follow-up measure) were performed to identify short-term effects of work-related conditions on voice and hearing function among radio broadcasters. RESULT: Changes in fundamental frequency post-monitoring at the end of the work week may be an indication of work-related vocal fatigue. Changes in the distribution and standard deviation of SPL during the monitoring from Monday to Friday may indicate control of the vocal loudness as a strategy to reduce vocal effort during broadcasting. During a one-week follow-up, noise conditions during radio broadcasting were below occupational exposure limits and without noticeable consequences on hearing function. CONCLUSION: The work-related communicative profile of radio broadcasting, from this pilot study, suggests that although vocal demands in terms of vocal load may differ among broadcasters, the work-related conditions of broadcasting may play a role on vocal function among these occupational voice users. Concerning hearing function, our results indicate that occupational noise exposure be represented minimal risk for hearing problems but the consequences of long-term noise exposure on hearing mechanisms may yet occur. Future studies with bigger sample sizes are warranted to confirm our results.

The first aim, was to compare participant compliance with postoperative voice rest advice in two groups. The second aim was to compare vocal function and recovery in the short-term, seven days post-surgery and in the long-term, 3-6 months post-surgery.Preliminary randomized prospective blind clinical trial.Twenty patients scheduled for surgery for benign vocal fold lesions were randomized into seven days of absolute or relative voice rest. Compliance with voice rest advice was monitored with a voice accumulator for seven days following surgery. Vocal recovery was tracked through (a) self-perceived vocal function, (b) perceptual assessments of voice recordings and (c) visual assessment of high resolution and high speed digital imaging (d) vocal stamina and reaction to vocal loading, explored with a vocal loading task.The absolute voice rest group phonated significantly less than the relative voice rest group during seven days post-surgery, but they were not silent. The absolute voice rest group self-reported more difficulty with compliance than the relative voice rest group. The relative voice rest group coped with significantly more vocal loading at long-term check-up. In the short-term the absolute voice rest group improved morphological recovery to a significant degree, however relative voice rest renders superior long-term recovery.Absolute voice rest is difficult to comply with. Neither short-term, nor long-term vocal recovery differed significantly between groups. Within-group comparisons showed significant improvements in vocal stamina, immediate recovery from vocal loading and self-assessments of voice problems only for the group with recommended relative voice rest.

Summary Vocal fold polyp (VFP) is an exophytic gelatinous lesion with an atrophic epithelium. After behavioral and conservative management, phonomicrosurgery is the treatment of choice for VFPs with excellent outcomes in terms of lesion resolution and postoperative vocal function. Office-based potassium titanyl phosphate (KTP) laser ablation is a new treatment modality for VFPs but its efficacy for professional singers has yet to be validated. Reported is a consecutive series of six professional singers (with seven episodes of VFP) who, based on patient and provider preference, underwent in-office KTP laser ablation of VFP. Two polyps required two ablation procedures; otherwise, a single treatment was successful in resolution of VFP at a mean resolution time of 44 days. Singing voice handicap index 10 improved from a mean of 30.8 (range 4–40) to 6.0 (range 0–22). All patients resumed their professional singing careers without vocal limitations. Posttreatment videos were reviewed by three blinded fellowship trained laryngologists, who were not able to accurately predict the laterality of the polyp (52% correct, p = 0.99).

There are few data demonstrating the specific extent to which surgical intervention for vocal fold nodules (VFN) improves vocal function in professional (PVU) and non-professional voice users (NVU). The objective of this study was to compare and quantify results after phonomicrosurgery for VFN in these patient groups. METHODS: In a prospective clinical study, surgery was performed via microlaryngoscopy in 37 female patients with chronic VFN manifestations (38±12 yrs, mean±SD). Pre- and postoperative evaluations of treatment efficacy comprised videolaryngostroboscopy, auditory-perceptual voice assessment, voice range profile (VRP), acoustic-aerodynamic analysis, and voice handicap index (VHI-9i). The dysphonia severity index (DSI) was compared with the vocal extent measure (VEM). RESULTS: PVU (n=24) and NVU (n=13) showed comparable laryngeal findings and levels of suffering (VHI-9i 16±7 vs 17±8), but PVU had a better pretherapeutic vocal range (26.8±7.4 vs 17.7±5.1 semitones, p

Objective The goal of this study was to investigate the effects of a vocal loading challenge that combined prolonged speaking, in child-directed voice within a noisy environment, in older adults. An additional goal was to determine whether increased environmental humidity would attenuate the negative effects of this vocal loading challenge. Method Thirteen healthy subjects (five males and eight females; >65 years) completed a vocal loading challenge. The challenge involved 45 minutes of child-directed speech in the presence of 65 dB multitalker babble background noise. Subjects completed this challenge in both low humidity and moderate humidity in counterbalanced order. Vocal function was assessed before and after the challenge using phonation threshold pressure (PTP), cepstral peak prominence (CPP), low/high spectral ratio (LHR), perceived phonatory effort (PPE), and perceived vocal tiredness. Results Negative changes were observed in the aging larynx following the 45-minute vocal loading challenge. Measures of PTP, PPE, and perceived vocal tiredness demonstrated statistically significant loading effects. Increased ambient humidity significantly alleviated the negative changes observed in PPE and perceived vocal tiredness. Increased humidity significantly improved CPP measures both before and after the vocal loading challenge. Conclusions This study furthers our understanding of how older adults respond to a vocal loading challenge of prolonged nonhabitual speech in a noisy environment. Our data suggest that the aging voice is negatively affected by prolonged loud speaking and that humidification may be beneficial in reducing some of these negative effects.

Objectives/Hypothesis To clarify the time course of recovery in patients with idiopathic vocal fold paralysis. Study Design Retrospective chart review. Methods Medical records for all patients with idiopathic vocal fold paralysis over a 10-year period were reviewed to obtain demographic and clinical information, including onset of disease and recovery of vocal function. Stroboscopic exams of patients who recovered voice were reviewed blindly to assess return of vocal fold motion. Results Thirty-eight of 55 patients (69%) recovered vocal function. Time course of recovery could be assessed in 34 patients who did not undergo injection augmentation. The mean time to recovery was 152.8 ± 109.3 days (left, 179.8 ± 111.3 days; right, 105.3 ± 93.7 days; P = .088). Two-thirds of patients recovered within 6 months. Probability of recovery declined over time. Five of 22 patients who recovered voice had return of vocal fold motion; 17 did not. The mean time to recovery did not differ between these groups (return of motion, 127.4 ± 132.3 days; no return of motion, 160.1 ± 105.1 days; P = .290). Conclusions Sixty-nine percent of patients with idiopathic vocal fold paralysis recovered vocal function, two-thirds doing so within 6 months of onset. Age, gender, laterality, use of injection augmentation did not influence recovery rate. Declining probability of recovery over time leads us to consider framework surgery after 6 months in patients with idiopathic paralysis. Level of Evidence 4. Laryngoscope, 128:148–152, 2018

Background Paracoccidioidomycosis (PCM) is a systemic mycosis of acute and chronic evolution, caused by species belonging to the genus Paracoccidioides. It is considered the most prevalent systemic endemic mycosis in Latin America, with cases in the tropical and subtropical regions. Residual PCM refers to the fibrotic scar sequelae resulting from the disease treatment which, when associated with collagen accumulation, leads to functional and anatomic alterations in the organs. Aims The aim of this study was to evaluate the vocal function of patients with residual PCM in upper airways and digestive tract. Methods We performed a cross-sectional study in 2010 in a cohort of 21 patients with residual PCM in upper airways and digestive tract. Results The average age was 49.48 ± 9.1 years, and only two (9.5%) patients were female. The study was performed in the 1–113 month-period (median 27) after the end of drug treatment. Five (23.8%) patients had alterations in the larynx as a sequela of the disease. However, all patients had vocal changes in vocal auditory perceptual analysis by GRBASI scale. The computerized acoustic analysis using the software Vox Metria, showed that 11 patients (52.4%) presented alterations in jitter, 15 (71.4%) in shimmer, 8 (38.1%) in F0, 4 (19%) in glottal to noise excitation (GNE), 7 (33.3%) in the presence of noise and 12 (57.1%) in the presence of vibratory irregularity. Conclusions The great frequency of alterations in residual PCM suggests that the patients in such phase could benefit from a multidisciplinary treatment, offering them integral monitoring of the disease, including speech rehabilitation after the PCM is healed.

Background Endoscopic laryngopharyngeal surgery (ELPS) was developed for superficial pharyngeal cancers in Japan. In this study, we present our results of ELPS for superficial pharyngeal cancers. Methods From November 2009 to December 2015, 258 patients with superficial pharyngeal cancers underwent ELPS. Results, including survival rates, postoperative complications, and vocal function, are reviewed. Results The median follow-up period of 258 patients was 31 months. The overall and cause-specific survival rates over 3 years were 85.7% and 100%, respectively. Only 3 patients incurred local recurrences and were successfully salvaged by re-ELPS. Regarding postoperative complications, 4 patients required reoperation because of postoperative bleeding. As for the postoperative quality of life, no patients developed vocal fold paralysis. Every patient was able to consume meals at preoperative levels. Conclusion ELPS is a feasible and minimally invasive treatment for superficial pharyngeal cancers with impressive quality of life results.

Purpose The purpose of this study was to determine the vocal fold structural and vibratory symmetries that are important to vocal function and voice quality in a simulated paramedian vocal fold paralysis. Method A computational kinematic speech production model was used to simulate an exemplar “voice” on the basis of asymmetric settings of parameters controlling glottal configuration. These parameters were then altered individually to determine their effect on maximum flow declination rate, spectral slope, cepstral peak prominence, harmonics-to-noise ratio, and perceived voice quality. Results Asymmetry of each of the 5 vocal fold parameters influenced vocal function and voice quality; measured change was greatest for adduction and bulging. Increasing the symmetry of all parameters improved voice, and the best voice occurred with overcorrection of adduction, followed by bulging, nodal point ratio, starting phase, and amplitude of vibration. Conclusions Although vocal process adduction and edge bulging asymmetries are most influential in voice quality for simulated vocal fold motion impairment, amplitude of vibration and starting phase asymmetries are also perceptually important. These findings are consistent with the current surgical approach to vocal fold motion impairment, where goals include medializing the vocal process and straightening concave edges. The results also explain many of the residual postoperative voice limitations.

The resection of the medial and lateral pyriform sinus was associated with post-operative voice impairment after TOVS. Scar contracture around the cricoarytenoid joint lead to arytenoid fixation toward lateral position, and this wound healing process caused insufficient glottis closure. Although oncological and functional outcomes of TOVS was satisfactory, surgeons should mention the risk of post-operative voice impairment in pre-operative counseling.Transoral surgery is a minimally invasive treatment option for hypopharyngeal and supraglottic cancer. Post-operative vocal function was satisfactory in most cases, but in some cases vocal cord was fixed and occasionally voice impairment persists.Vocal function of 55 patients who underwent transoral videolaryngoscopic surgery (TOVS) for hypopharyngeal and supraglottic cancers was evaluated by the GRBAS perceptive scale, aerodynamic tests and acoustic analyses, and the Voice Handicap Index questionnaire. The risk factors for voice impairment were identified.Voice impairment (G score ≧2) was found in 16 cases (29.1%). Univariate analysis revealed that the resection of medial and lateral pyriform sinus (p = .0018) and neck dissection (p = .0421) were associated with post-operative voice impairment. Multivariate analysis revealed that the resection of medial and lateral pyriform sinus (p = .0021) was associated with post-operative voice impairment.