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Objective: To investigate the self-reported effects of mask usage on vocal fatigue and number of vocal complaints of high school and college educators., Method: Forty teachers at high schools and universities who reported using masks to teach in person during the Spring 2020 to Fall 2020 semesters completed an anonymous survey regarding self-report of teaching history, vocal use, vocal complaints, and vocal health. Responses were analyzed using descriptive statistics and t tests., Results: Survey participants reported an increase in all forms of vocal complaints investigated despite an increase in amplification use. Participants also reported a decrease in daily water consumption between eight and 16 ounces of water when wearing a mask in the classroom compared to teaching prior to coronavirus disease 2019. Participants also reported a significant increase in vocal effort while teaching in a mask (P < 0.001)., Conclusion: Educators reported a significant effect of increased vocal complaints and decreased water intake while wearing masks. The decrease in water consumption and increase in vocal effort may lead to more frequent vocal complaints in teachers at the high school and college level., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate whether vocal function exercises (VFE) could be an adjunct treatment for patients with unilateral vocal fold paralysis (UVFP) who were not satisfied with their postoperative voices after reinnervation surgeries., Study Design: Retrospective., Methods: Medical records of the patients with UVFP who underwent laryngeal reinnervation between October 2011 and October 2014 were reviewed. Patients were classified into two groups: one received VFE according to patients' desire (VFE group) and the other did not have voice therapy (control group). Effects of VFE were assessed by vocal fold vibration (regularity, amplitude and glottal gap), aerodynamic measurements (maximum phonation time (MPT) and mean airflow rate (MFR)), GRBAS scale, acoustic parameters (pitch range, pitch perturbation and amplitude perturbation quotients (PPQ, APQ), and noise-to-harmonics ratio (NHR)) and subjective evaluation by patients (Voice Handicap Index-10 (VHI-10)). Phonatory function was also compared between the two groups at three time points: before reinnervation surgery, before VFE, and after VFE., Results: Thirty patients were enrolled (11 men, 19 women). The VFE group included eight patients, and 22 patients served as controls. In the VFE group, several parameters (amplitude, MPT, MFR, pitch range, APQ, and NHR) did not improve significantly after surgery, while all parameters examined improved significantly in the control group. After VFE, amplitude, glottal gap, MFR, B score, pitch range, and PPQ showed significant improvement, while the control group did not show a significant improvement except in VHI-10, during the corresponding period. Significant differences in G and B scores and VHI-10 between the two groups were observed at the third time point., Conclusions: VFE may be used as an adjunct treatment for patients with UVFP who are not satisfied with their voices after reinnervation surgery. However, phonatory function after VFE may not reach the same level as for those who are satisfied with their voices after reinnervation surgery., Competing Interests: CONFLICT OF INTEREST There is no conflict of interest to disclose., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: To describe voice and airway outcomes and complications experienced by patients with laryngotracheal stenosis following Montgomery T-tube placement., Methods: Retrospective chart review of all patients with laryngotracheal stenosis and Montgomery T-tube placement treated at a tertiary referral center from 2012 to 2021., Results: Eighteen patients met criteria with laryngotracheal stenosis, seven including the level of the glottis and 11 without glottal involvement. Eleven were completely aphonic before T-tube placement and the remainder had severe dysphonia. There was improvement of Voice Handicap Index-10, Reflux Symptom Index, and GRBAS grade following T-tube placement in patients compared to their preoperative values. Improvement of grade was greater in patients without glottal involvement. Complications of chronic indwelling T-tube included granulation in 14 patients (78%), tracheitis in two patients (11%), and mucus plugging in three patients (17%) with one T-tube related mortality. Five patients were eventually decannulated, six returned to tracheostomy tube, and seven retained the T-tube at last follow-up (average: 30 months, range: 4-80 months)., Conclusions: Montgomery T-tube placement improves voice in patients with severe dysphonia secondary to laryngotracheal stenosis with and without glottal involvement though the degree of improvement is greater in patients without glottal involvement. T-tube can help reestablish long-term laryngotracheal continuity in patients with no other surgical options. The potential benefits in phonation should be weighed against the possibility of rare but serious adverse events., Competing Interests: Competing interests None to report., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction: The upper esophageal sphincter (UES) has been reported to show activity during phonation. As it is still unknown whether the phonation-induced UES contraction represents a reflex or a simultaneous activation phenomenon, i.e. co-innervation, this study aims to investigate and characterize the phonation-induced contraction of the UES in healthy individuals by analyzing the influence of various phonation tasks on pressure parameters of the UES., Methods: Twenty-five healthy volunteers produced the German neutral vowel [ə] in five different phonation tasks (modal voice, whispering, voiceless speech, creaky voice, and whispery voice). Simultaneously, they underwent high resolution manometry and electroglottography for measurement of pressure parameters in the region of the UES and latencies between larynx and UES activation., Results: During all types of phonation, the maximum pressures of the UES increased significantly (maximum pressure increases of 72%-132%). With regard to mean pressures this was valid for modal voice and whispering (mean pressure increases of 20%-25%). Differences concerning total pressure changes reached statistical significance when comparing whispering and voiceless speech as well as whispery voice. However, differences concerning the total pressure change between modal voices on the one hand and voiceless speech and whispery voice on the other hand turned out to be small. The averaged time delay between larynx and UES activation ranged from approximately -15 ms (whispery voice) to +15 ms (whispering)., Conclusion: A phonation induced pressure increase of the UES was confirmed in this study and did exist for different types of phonation. The extent of total pressure changes in the UES increases in relation with laryngeal muscle activity necessary for the phonation type. Next to varying effects of different types of phonation on UES activation, very short latencies indicate that a phonation induced contraction of the UES exists most likely due to co-innervation of UES and laryngeal muscles by the vagus nerve., Competing Interests: Declaration of interest None, (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives/hypothesis: This exploratory pilot study aimed to probe the relationship between past experiences of trauma in people who self-identify as "laryngoresponders" compared to those who do not. It also explored the communicative context of past traumatic events in laryngoresponders versus non-laryngoresponders., Study Design: Prospective, within-subjects experimental design., Methods: 29 vocally healthy cisgender women (ages 19 to 56) completed a battery of validated self-report measures relating to their past traumatic experiences. Participants also completed two original self-report measures designed to provide insight about (1) where stress tends to manifest in their body and (2) communicative settings of participants' past trauma., Results: Six participants (21%) self-identified a predictable laryngeal and/or vocal response to acute stress and thus comprise the laryngoresponders group. Laryngoresponders exhibited worse scores on 75% of all trauma-related variables compared to non-laryngoresponders, and Emotional Neglect was disproportionately represented in laryngoresponders. Participants with a reported history of childhood Emotional Neglect (83% of laryngoresponders, 35% of nonlaryngoresponders) reported quantitatively "less ideal" communication experiences in the context of past traumatic experiences., Conclusions: Other investigators identify the larynx as a "vulnerable body pathway" for some women. This pilot study of adult women without voice complaints revealed several commonalities amongst self-reported laryngoresponders, and compels further exploration of the voice-trauma relationship., Competing Interests: DECLARATION OF COMPETING INTEREST None., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: Within the scope of semi-occluded vocal tract exercises (SOVTEs), we aimed to examine the effects of four exercise combinations, which involved various fluid densities and tube submersion depths, on acoustic and electroglottographic (EGG) parameters., Methods: Four procedures (P) were applied consecutively to 30 female participants with normal voices using different tube submersion depths and fluid densities, including P1 (2 cm, water), P2 (2 cm, nectar), P3 (10 cm, water), and P4 (10 cm, nectar). Nasometric (Nasometer II model 6450) and EGG (Electroglottograph model 6103) measurements were taken before the procedures were initiated (pre-test) and at the end of each procedure. In addition, EGG measurements were taken for each procedure during the application., Results: For all three velar positions (oral passage, oro-nasal passage, nasal passage), the only procedure that caused a significant change compared to the pre-test stage in regard to nasalance score was P2 (2 cm nectar) in common. All other procedures except P1 (2 cm water) significantly increased velar closure compared to pre-test levels. However, when the differences between the exercises were examined, the least velar closure, compared to the other procedures, was obtained after P4 (10 cm nectar). While there was no significant difference between the procedures in the EGG measurements during the exercise, a significantly higher tendency to contact was observed after the procedures with a denser consistency, and an increase in the fundamental frequency (f o ) values occurred in the pairwise comparisons of the procedures in the measurements after the exercises., Conclusion: In SOVTEs in which water phonation is performed with a tube, the use of a fluid with a consistency denser than water can be considered a particularly promising approach. In addition, exercises performed with increasing consistencies in 2 cm depth can provide more vocal cord and velopharyngeal port closure by increasing EGG-CQ and nasalance score values. However, more care should be taken while increasing the consistency at a submersion depth of 10 cm., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate results of telerehabilitation (TR) during the coronavirus disease 2019 pandemic for the treatment of dysphonia caused by permanent post-thyroidectomy unilateral vocal fold paralysis (UVFP)., Methods: Forty subjects with post-thyroidectomy UVFP (onset <1 month) underwent TR. Videostrobolaryngoscopy, acoustic and perceptual voice analysis and patient self-assessment were carried out in person before, at the end of TR and 6 months later., Results: Twenty-five subjects spontaneously recovered full vocal fold motility at some time during follow-up, whereas 15 had a permanent UVFP at the end of the follow-up period. These subjects constituted our study group. At the early posttherapy control 10/15 subjects (66.6%) showed a complete glottal closure, while in 5/15 (33.3%) a glottal gap remained (P = 0.03). These results did not change 6 months after TR. At the late posttherapy control the maximum phonation time improved significantly (P = 0.02). Both post-therapy Voice Handicap Index scores were significantly lower than the pre-therapy ones (P = 0.04). Grade, Breathiness, and Asthenia parameters of the Grade-Roughness-Breathiness-Asthenia-Strain scale improved 6 months after TR (P < 0.05). The number of voice signals suitable for acoustic analysis increased significantly after therapy. Finally, 87% of patients were satisfied with TR., Conclusions: With careful patient selection, TR may be considered as a promising method for voice therapy in postthyroidectomy UVFP., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives/hypothesis: Voice therapy is a mainstay treatment modality in the management of phonotrauma in singers. However, the typical duration of therapy an injured singer undergoes is unknown. The primary aims of the study were to determine (1) the number of therapy sessions preceding a decision for surgery and (2) the number of sessions and length of time to achieve improvement in singers who did not undergo surgery. Whether specific singer factors were associated with the length of therapy was also investigated., Study Design: Retrospective., Methods: Records of singers with phonotraumatic vocal fold lesions seen over a 9-year period at a tertiary care voice center were reviewed., Results: Sixty singers who underwent surgery and 183 singers who did not undergo surgery were included in the final analysis. In nearly ¾ of the surgical patients, five or fewer voice therapy sessions were completed prior to the decision for surgery. Singers who did not undergo surgery required on average 3-4 sessions before noting improvement. Over 60% of the non-surgical singers improved within 3 months and 84% were judged to be improved by 6 months. Lesion type, professional/amateur status, formal voice training, and having a current voice teacher/coach were not associated with the length of voice therapy., Conclusions: The length of voice therapy prior to decision for surgery was limited, and so was the length of therapy leading to initial improvement in singers who did not require surgery. These findings provide a framework for voice therapy expectations and could be reassuring for this unique population., Competing Interests: DECLARATION OF COMPETING INTEREST None., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: To verify the relationship between obesity, voice and behavior in childhood and adolescence, through an integrative review., Methods: The researchers surveyed the articles indexed in the following databases: Embase, Web of Science, Scopus and Pubmed, using uniterms found in the Medical Subject Headings, related to the subject of the study, combined by the Boolean operators "and" and "or", published until January 2022. In the end, three reviewers selected the articles., Results: When searching for studies related to voice, obesity and behavior, 62 articles were found that did not meet the selection criteria and were excluded. Given this result, new searches were carried out with the following crossing strategies: voice and obesity and; Voice, Behavior and Child Behavior Checklist (CBCL). After the evaluation of the reviewers, two articles were selected referring to the intersection "voice and obesity in children and adolescents" and, two studies, in the intersection between "voice, behavior and CBCL". The first study on voice and obesity showed that the greater the abdominal circumference, the greater the maximum expiratory force and sound pressure found. The second study showed high Jitter and NHR values in obese children. Furthermore, studies on voice, behavior and CBCL showed that children with vocal nodules were more sociable than children without vocal nodules, and had behaviors described as "screams a lot" and "teases a lot". On the other hand, another study found potential risks of behavioral changes in the face of vocal complaints., Conclusions: Although this literature review did not find studies associating obesity with vocal and behavioral disorders, the literature found showed the presence of vocal alteration in some acoustic parameters in obese children. Regarding voice, behavior and CBCL, two studies were found reporting the presence of behavioral changes in children with voice-related complaints, according to the opinion of their parents., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: Voice-related quality of life (Qol) questionnaires provide the clinician with information regarding the impact of voice disorders on the patient's well-being. The available voice-related QoL tools for Dutch-speaking children are parent-proxy in nature. However, the use of proxy measurements has been debated in the literature. The Children's Voice Handicap Index-10 (CVHI-10) is a self-reported QoL tool for dysphonic children. Therefore, the aim of this study is to develop and validate a Dutch version of the CVHI-10., Study Design: Observational, prospective, cross-sectional study., Methods: The original version of the CVHI-10 was translated and adapted to Dutch according to the recommendations of the Quality of Life Special Interest Group - Translation and Cultural Adaptation group. Subsequently, the questionnaire was individually completed by 77 children (dysphonic group: n = 30, control group: n = 47) between eight and 14 years. In order to investigate test-retest reliability, 50% of the participants were asked to complete the questionnaire twice with an interval of 2 weeks. Internal consistency, test-retest reliability and construct validity were calculated. A receiver operating characteristic (ROC) analysis was conducted to check the sensitivity and specificity levels of the instrument., Results: Internal consistency measured with Cronbach's alpha coefficient was 0.745. Test-retest reliability measured with intraclass correlation coefficients was 0.718. Mean total CVHI-10 score was 6.17 ± 2.7 in the dysphonic group and 2.68 ± 2.6 in the control group. The difference in total score between the groups was statistically significant (P < 0.001), suggesting that the tool has good construct validity. ROC analysis demonstrated moderate diagnostic accuracy (area under the curve = 0.869) and suggested a cut-off score of 3.5., Conclusions: The Dutch CVHI-10 is the first self-reported voice-related QoL tool for dysphonic Dutch-speaking children. It is a valid, reliable and sensitive tool to assess the impact of a voice disorder on the child's well-being., Competing Interests: DECLARATIONS OF INTEREST None., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: COVID-19 has transformed face to face teaching in classrooms to online and hybrid modes. Increased vocal intensity/ pitch to call attention of students and transact in the online class, inappropriate posture (head, neck & upper trunk) while using the laptop and other online tools cause vocal loading leading to voice related concerns in teachers. Tele voice assessment is a feasible alternative means to seek professional help in the current situation and possibly in the future too. Client-led asynchronous and clinician-led synchronous voice recordings for clinical vocal measures among school teachers were compared in this study., Method: Twenty-five school teachers (21 females & four males) from Chennai consented to the study. Information of voice use, its impact on the day-to-day situations, self-perception of vocal fatigue, and their recorded voice sample (phonation & speaking) were obtained online (asynchronous mode). Within a period of ten days, the clinician-led synchronous session was planned on a mutually convenient time for obtaining voice samples through zoom call. The voice samples obtained were compared for clinical measures and perceptual voice evaluation., Results: Participants reported of vocal symptoms and increased vocal fatigue scores. The maximum phonation time values obtained through synchronous mode were lesser when compared to asynchronous mode. Also, variability was noted in the perceptual vocal measures of voice samples obtained through synchronous mode. During synchronous voice recording & evaluation, the background noise, internet stability, audio enhancement feature, and microphone placement & quality could be monitored, and immediate feedback was provided. Additionally, the asynchronous recording can be supplemented for synchronous recording, with clear instructions & demonstration., Conclusion: This study explored the feasibility of using synchronous and asynchronous voice recording for voice analysis in school teachers. The findings could serve as a base to understand the advantages and challenges of using client-led asynchronous and clinician-led synchronous methods for estimating vocal measures., Competing Interests: CONFLICT OF INTEREST The authors declare that they have no conflict of interest., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: The study investigated effects of laryngeal manual therapy on different types of primary muscle tension dysphonia (MTD-1)., Study Design: Interventional pre-test post-test design., Methods: Thirty-two traditional Iranian singers (mean age of 36.75 ± 9.34 years.) diagnosed with MTD-1, 8 female and 24 male, and recruited by convenience sampling completed the study. MTD-1 was classified as Morrison and Rammage's types 1-5, based on standardized criteria (1993). Pre-post-treatment measures were based on visual ratings of the larynx, acoustic analyses, auditory-perceptual assessments of voice (Auditory-Perceptual Rating Instrument for Operatic Singing Voice: EAI Scale Form), and the Persian Singing Voice Handicap Index (P-SVHI), reported before and after 10 sessions of laryngeal manual therapy (LMT)., Results: The most notable finding was that the number of cases with MTD-1 types 1 and 2 actually increased after treatment, while the number of cases with MTD-1 types 3, 4 and 5 decreased. The data suggested that MTD-1 types 3, 4, and 5 tended to convert to types 1 and 2 with LMT. Acoustic analyses showed a significant decrease in F0 (males only; P = 0.011), a sharp decrease in HNR from 23.26 dB to 14.74 dB (P = 0.000), and an increase in shimmer from 4.18% to 6.90 % while no appreciable change was found in jitter (P = 0.57). Mean P-SVHI score decreased significantly from 52.03 to 41.16 (P = 0.002) and EAI score increased from 4.41 to 6.31 (P = 0.000) after treatment., Conclusions: The primary finding was that the distribution of MTD-1 type changed after treatment in many cases, converting from one to another type. Acoustic as well as glottal closure measures for several participants revealed closure insufficiency after treatment, unveiled as hyperfunction was unloaded with LMT. For those participants, complementary treatments aimed at reinforcement of laryngeal closure functions would be appropriate., Competing Interests: Conflict of Interest The authors declare no conflict of interest associated with the present work., (Copyright © 2022. Published by Elsevier Inc.)

Objectives/hypothesis: The validity of cepstral analysis (Cepstral Peak Prominence [CPP] and Cepstral Peak Prominence-Smoothed [CPPS]) as an indicator of perceptual dysphonia was investigated in the Persian language STUDY DESIGN: Cross-sectional study., Methods: A total of 223 participants (159 with and 64 without dysphonia) uttered vowels /a/ and /i/, six standard sentences, and non-standard connected speech. All vocal samples were perceptually evaluated by three raters on a visual analog scale and put into four groups (normal voice, mild, moderate, and severe perpetual dysphonia). CPP and CPPS of sustained vowel /a/, reading the second standard sentence, and a sentence extracted from non-standard connected speech were established using "Praat" software. Statistical analysis involved a one-way factorial analysis of variance (ANOVA), Kruskal-Wallis H, Kendall's Tau-b correlation, t test, and receiver operating characteristics (ROC) curve., Results: The results showed that CPP of sustained vowels and reading the standard sentence and CPPS of sustained vowel differed significantly (P < 0.05), except between the normal voice and mild perpetual dysphonia groups (P > 0.05). The CPP of non-standard connected speech, CPPS of reading the standard sentence, and non-standard connected speech differed significantly between all groups (P < 0.05). The mean of cepstral analysis of all tasks, "averaged CPP," and "averaged CPPS" were significantly different between two groups of the normal voice and perceptual dysphonia (P < 0.05). Correlation between the cepstral analysis and the perceptual ratings demonstrated that the correlation coefficients for CPP and CPPS were between 0.4 and 0.6 (P < 0.05). ROC curve analysis revealed that the area under the ROC curve for "averaged CPP" and "averaged CPPS" was greater than 0.8 (P < 0.05). The values of 22.11 and 12.29 were determined as cut-off scores of "averaged CPP" and "averaged CPPS," respectively., Conclusions: Cepstral analysis was known as useful clinical tool for diagnosis of perpetual dysphonia and determining its severity level in the Persian language., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: SPEAK OUT! has been shown to enhance various aspects of voice such as intensity, prosody, voice quality and perception of voice. However, their impacts on expiration and communication effectiveness have not yet been evaluated. This study aimed to evaluate the effectiveness of the Hybrid SPEAK OUT! method on aerodynamic measurements and patient-reported outcome measures (PROMs) in individuals with Parkinson's disease (PD)., Methods: This study included 157 participants with PD who underwent an intensive 8-week multidisciplinary treatment program. The Hybrid SPEAK OUT! method consisted of three sessions per week, including two group sessions and one individual treatment session. Voice-related aerodynamic measures included maximum phonation time (MPT), vocal cord function using the S/Z ratio, and expiratory flow measures including peak expiratory flow (PEF) and peak cough flow (PCF). Two PROMs were included: the Hebrew version of the voice handicap index-10 and communication effectiveness questionnaire., Results: The results of 111 participants were analysed. MPT duration increased, PEF and PCF increased, and better scores were found in PROMs., Conclusion: These findings would appear to support the effectiveness of the Hybrid SPEAK OUT! methods improving function, activity and participation in individuals with PD. However, further research is needed., What This Paper Adds: What is already known on the subject Prior research has demonstrated the effectiveness of behavioral therapies, including the SPEAK OUT! program, in managing speech symptoms in individuals with Parkinson's disease (PD). These therapies have shown improvements in voice intensity, fundamental frequency, voice quality, and voice perception. However, the impact on aerodynamic measures, expiratory flow, and patient-reported outcome measures has not been extensively studied. What this paper adds to existing knowledge This study adds to the existing knowledge by demonstrating that a Hybrid SPEAK OUT! approach, can lead to improvements in aerodynamic measures, including maximum phonation time (MPT), expiratory and cough peak flow. In terms of motor learning, we found that two non-speech exhalation-related tasks that were not directly trained improved following the intensive speech training protocol. Furthermore, it shows positive changes in patient-reported outcome measures, with reduced voice-related disability and improved communication efficiency. What are the potential or actual clinical implications of this work? The findings of this study have important clinical implications for the management of speech symptoms in individuals with PD. The Hybrid SPEAK OUT! program, which combines group and individual sessions, can effectively improve voice, aerodynamic measurements and patient-reported outcome measures (PROMs), ultimately enhancing the overall quality of life for patients. These findings support the effectiveness of the Hybrid SPEAK OUT! methods for improving function, activity, and participation in individuals with PD., (© 2024 Royal College of Speech and Language Therapists.)

Objective: To analyze oncological efficacy and voice outcomes of the 445-nm blue laser (BL) in the treatment of early glottic carcinoma and compare results with the 532-nm potassium-titanyl-phosphate (KTP) laser., Study Design: Single institution, retrospective chart review., Methods: All patients who underwent microlaryngoscopic KTP or BL laser excision of early glottic carcinoma from 2018 to the present day with at least 1-year follow-up were included. Primary and recurrent disease, including radiation and surgical failures, were included. Demographic data, voice outcomes and oncologic outcomes were compared between the two laser groups., Results: Forty-nine patients met the inclusion criteria for the BL group and 88 for the KTP group, with average follow-up of 635 and 1236 days, respectively. Oncologic outcomes were not significantly different, with disease-specific survival rates of 95.9% for BL and 100% for KTP (p = 0.13), organ preservation rates of 98.0% for BL and 95.6% for KTP (p = 0.39), and local control rates of 93.9% for BL and 92.1% for KTP (p = 0.81). Both BL and KTP groups showed significant improvement in CAPE-V (p = 0.04, 0.006 respectively) and VHI-10 scores (p = 0.003, <0.00001) following surgery., Conclusions: Photoangiolytic removal of early glottic carcinoma with BL appears to be equally safe and effective as with KTP laser at minimum one-year follow-up, and with excellent voice outcomes. Additional study will be warranted over time to assess long-term outcomes in BL patients., Level of Evidence: 3 Laryngoscope, 134:4656-4660, 2024., (© 2024 The Author(s). The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: The majority of individuals with Parkinson's disease (PD) experience voice and speech problems during the course of the disease. Despite the importance of voice quality in communication and the documented disordered voice quality in PD, few studies have explored the effects of speech treatment on this variable., Study Design/methods: A parallel arm, unblinded randomized controlled trial (RCT) was conducted with two active comparators, LSVT LOUD (n = 23) and LSVT ARTIC (n = 20), and an inactive comparator group of untreated individuals with PD (n = 22). A group of 20 healthy adults was also included for pre-treatment analysis. Voice recordings were obtained pre-treatment, immediately post-treatment and at 6-month follow-up. The acoustic voice quality index (AVQI) is reported here as a secondary outcome measure of the RCT. Linear mixed-effects regression analysis was performed with AVQI and sound pressure level (SPL) as dependent variables. Pearson correlation coefficient analysis was also conducted to explore the relationship between voice quality and SPL., Results: Statistically significant improvements in AVQI and SPL from pre-treatment to post-treatment and follow-up were only observed in the LSVT LOUD group. Voice quality significantly improved only from pre-treatment to follow-up in the LSVT ARTIC group, whilst significant improvements in SPL were observed during maximum phonation only immediately post-treatment. No significant changes were observed in the untreated group., Discussion: This study investigated the effects of intensive speech treatment targeting voice or targeting articulation on voice quality, as measured by the AVQI, in individuals with PD. Findings indicate that voice-focused treatment leads to greater improvements in voice quality in this population., Competing Interests: DISCLOSURES Dr. Gemma Moya-Galé is employed by Long Island University, and has no relevant financial or nonfinancial relationships to disclose. Jennifer Spielman has been a paid consultant for LSVT Global since 2012. She currently receives consulting fees for research and training projects. She has a preference for the LSVT LOUD treatment protocol in her clinical practice. Dr. Lorraine Ann Ramig is employed as Chief Scientific Officer and has ownership interest in the for-profit company LSVT Global, Inc. She is in full compliance with Federal Statute 42 C.F.R. Part 50, Subpart F (see https://grants.nih.gov/grants/policy/coi/index.htm). She has disclosed any conflict of interest and her conflict of interest management plan has been approved by the Office of Conflict of Interest and Commitment at the University of Colorado, Boulder and she is in full compliance. Dr. Lorraine Ann Ramig reports funding from the National Institutes of Health and National Institute of Deafness and other Communicative Disorders (NIH-NIDCD) R01 DC 01150 during the conduct of the study. Dr. Luca Campanelli is employed by the University of Alabama, and has no relevant financial or nonfinancial relationships to disclose. Dr. Youri Maryn is employed by the Department of Otorhinolaryngology & Head and Neck Surgery, Sint-Augustinus Hospital (Wilrijk, Belgium); serves as professor at University College Ghent, University of Ghent and Université Catholique Louvain, for which he receives salaries. He is executive board member of Vlaamse Vereniging voor Logopedisten (Flemish Association of Speech-Language Therapists) for which he also receives a salary. He owns Phonanium (Lokeren, Belgium) and receives royalty payments from the sale of voice analysis products. He is post-doctoral researcher at University of Antwerp and received no compensation for this project., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: The study aims to quantify the impact of sociodemographic, personal, and choir-related characteristics on perceived singing well-being and mental health changes due to singing., Study Design: 847 German adult choristers (233m, 614f, age 18-86 years) were interviewed in a cross-sectional online questionnaire study that included questions on singing well-being, vocal and choral characteristics, the adapted versions of the Bochum change questionnaire (BCQ2000), the Utrecht Work Engagement Scale (UWES-09), and the WHO-5 well-being index., Methods: Multiple regression models were calculated with singing related well-being or mental health changes as dependent variables and individual and choir-related characteristics as factors. Predictors of mental health benefits were analyzed in gender subgroups and in persons with a low or normal/high score on the WHO-5., Results: On average, participants rated the impact of singing on well-being and mental health changes positively. Subgroup analysis revealed smaller but significant positive mental health effects in men compared to women and in persons with a low WHO-5 score compared to those with a normal/high score. Education level and relationship status were not significantly related to subjects' perceptions of mental health benefits, whereas singing well-being increased with age in women and in participants with a low WHO-5 score. Larger improvements in mental health came along with longer choir membership, more singing hours per week, and a high engagement in choral activity. Significant positive associations of well-being with optimal singing behavior and vocal warm-ups were observed., Conclusion: Results suggest that singers of all ages, genders, and educational backgrounds perceive the choral experience as beneficial to their well-being and mental health. Positive effects are related to WHO-5 scores, engagement in choral activity, and optimal singing conditions. On average, women rate singing benefits higher than men and singers with preexisting vocal pathologies or low WHO-5 benefit slightly less., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: This study aims to investigate the role of one of these models in the field of voice pathology and compare its performance in distinguishing the perceived dysphonia level., Methods: Demographic information, voice self-assessments, and acoustic measurements related to a sample of 50 adult dysphonic outpatients were presented to ChatGPT and Perplexity AI chatbots, which were interrogated for the perceived dysphonia level., Results: The agreement between the auditory-perceptual assessment by experts and ChatGPT and Perplexity AI chatbots, as determined by Cohen's Kappa, was not statistically significant (p = 0.429). There was also a low positive correlation (r s = 0.30, p = 0.03) between the diagnosis made by ChatGPT and Perplexity AI chatbots (r s = 0.30, p = 0.03)., Conclusion: It seems that AI could not play a vital role in helping the voice care teams determine the perceptual level of dysphonia., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Ansa cervicalis-to-recurrent laryngeal nerve anastomosis (ARA) is an established technique for the treatment of recurrent laryngeal nerve (RLN) injury after head and neck surgery. However, the optimal timing of ARA remains unclear, and the evidence bases for ARA performed at each timepoint after RLN injury have not previously been clearly distinguished. We conducted a systematic review of the literature to evaluate the efficacy of ARA performed at different timepoints on postoperative voice outcomes., Methods: A review of English-language journal articles published in the last 20 years was undertaken on three electronic databases: Ovid MEDLINE, PubMed and Embase. Studies with a focus on paediatric RLN injury, bilateral RLN injury, ansa cervicalis anatomy and non-ARA techniques alone were excluded., Results: Twenty eight articles were included in the review. ARA was performed as a delayed surgery in 16/28 studies (57%), while immediate ARA was utilized in 14/28 studies (50%). On qualitative synthesis, delayed ARA was shown to be effective in improving patient-reported, subjective observer-reported and objective observer-reported voice outcomes. Likewise, a substantial body of evidence was identified demonstrating postoperative voice improvement with immediate ARA. On direct comparison of timepoints, some benefit was shown for early delayed ARA relative to late delayed operations, while no comparative data for immediate versus delayed repair were available in the literature., Conclusions: ARA at both delayed and immediate timepoints is effective in the treatment of patients with RLN injury after head and neck surgery. The timing of ARA may have some influence on its efficacy, with early delayed repair potentially associated with superior outcomes to late delayed operations, and immediate ARA offering several practical advantages relative to delayed repair. Further comparative studies are required to better characterize the optimal timing of ARA after RLN injury., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: Voice disorders are common in children and have a negative impact on their quality of life. However, presently, voice assessment and therapy are inaccessible in most pediatric departments of Mainland China. Thus, referring pediatric patients with voice disorders to otolaryngology is warranted for prompt and appropriate treatment. The purpose of this study is to investigate referral patterns and their influencing factors for pediatricians' managing children with dysphonia in Southwestern Mainland China., Study Design: Observational study., Methods: A 28-item questionnaire was designed by multidisciplinary experts, and an anonymous survey was performed online via Wenjuanxing between September 8, 2021 and October 8, 2021. The statistical analyses were performed using the independent sample median test, the linear/logistic regression model, the Kruskal-Wallis test, and Spearman's correlation test to determine any statistically significant relationships between the variables of interest., Results: Predominantly recruited from institutions in Southwestern China, 368 pediatricians were surveyed. (1) The majority of the pediatricians reported that ≤10% of children sought medical help for voice disorders; (2) only 22.1% of the pediatricians' hospitals had equipment for evaluating voice disorders; (3) 74.6% of the pediatricians would refer children with dysphonia to otolaryngology, and the older pediatricians were more likely to refer their patients than were the younger pediatricians (P = 0.022); (4) in the group that would make a referral (n = 250), the pediatricians who had worked longer (P = 0.037) and practised in the Grade-A tertiary hospitals (P = 0.044) were more likely to trust their experience as a reason for making a referral. For each year worked the probability of referring children with dysphonia depending on the pediatrician's experience increased by 3.4%., Conclusion: Although the pediatricians encountered some barriers to diagnosing voice disorders, their attitude towards making referrals was positive. The age and work duration of the pediatricians and the hospital grade were the influencing factors in the referral patterns. Further publicity of vocal hygiene, ongoing education among Chinese pediatricians and the improvement of referral systems may be most useful for better managing children with dysphonia., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: Although vowels are of interest for acoustic analysis in clinics, there is no consensus regarding the effect of vowel selection on acoustic perturbation parameters. This study aimed to reveal the effects of Mandarin vowels on acoustic measurements., Study Design: A prospective observational study., Methods: This prospective observational study enrolled normal phonation Mandarin speakers at the Otolaryngology Department of the Eye & ENT Hospital affiliated with Fudan University from December 2020 to August 2021. This study recruited 107 normal-voiced Mandarin speakers (59 women and 49 men) with a median age of 26 (22, 33) years old. The objective measures included traditional acoustic parameters (fundamental frequency, harmonic-to-noise ratio, percent jitter, and percent shimmer) and cepstral analysis (smoothed cepstral peak prominence) of six Mandarin vowels (ɑ /a/, o /o/, e /ɤ/, i /i/, u /u/, ü /y/)., Results: The acoustic analysis revealed no significant differences in the fundamental frequency among vowels. The low vowel /a/ had the highest values for percent jitter and percent shimmer and the lowest harmonic-to-noise ratio value. The back vowel /u/ had the lowest cepstral measures (P < 0.05)., Conclusions: The acoustic analysis significantly varied across the different Mandarin vowels, and these differences must be considered for the effective clinical application of objective evaluations., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: To observe the cases of superior laryngeal nerve injury along with summarizing and analyzing its clinical characteristics., Methods: A total of 14 patients with unilateral superior laryngeal nerve injury (SLN) diagnosed by laryngeal electromyography (LEMG) in our department from 2018 to 2020 were collected as SLN injury group. A total of 14 healthy subjects with normal laryngeal electromyography were recruited as normal group matched by age and sex. The etiology and LEMG of the SLN injury group were analyzed, and the video stroboscopic manifestations of SLN injury group and normal group were compared to see the characteristic video stroboscopic manifestations of SLN injury., Results: The most common causes of SLN injury were surgery and idiopathic etiology. Compared with normal group, the most frequent video stroboscopic manifestations of SLN injury group were vocal fold dyskinesia. Abnormal video stroboscopic manifestations occurred in normal group except larynx deviation, epiglottic petiole deviation, and dyskinesia. There was a significant difference between the two groups in various abnormal video stroboscopic manifestations (P < 0.05). Time limit widening was the most common manifestation of LEMG., Conclusions: Vocal fold dyskinesia was a prominent finding in SLN injury, laryngeal deviation and epiglottic petiole deviation were relative specific signs of SLN injury. Vocal fold bowing combined with shortening will contribute to the diagnosis of SLN injury. There were no specific diagnostic signs for SLN injury, clinicians need further LEMG for a firm diagnosis., Competing Interests: DECLARATION OF COMPETING INTEREST The authors had no conflict of interest to declare., (Copyright © 2022. Published by Elsevier Inc.)

Background: Case history assessments are ubiquitously performed across various health professions for diagnostic purposes. Questionnaires are considered a valuable tool within this process. There is currently no standardized tool available to collect such information in the assessment of voice disorders. Conflicting advice from peak bodies and research evidence makes the process heterogenous, haphazard and difficult to compare findings., Objective: To systematically identify existing case history questionnaires available for general clinical practice and provide synthesis and analysis of the questions within., Methods: A scoping review was conducted across published and unpublished literature using the PRISMA Extension for Scoping Reviews framework. The broad search included research papers within six electronic databases, textbooks, online publishing sites, voice clinic websites and peak body websites. Search criteria were uniformly applied. Descriptive analysis and content analysis was conducted. At each stage, transparency and replicability was achieved through an independent review process., Results: Identified voice case history questionnaires were few (n = 23) with 80% from unpublished sources. A total of 581 unique questions were identified. No single question was common across all 23 questionnaires. The most frequently asked questions, excluding demographics, included medicines taken (n = 21), smoking (n = 20) and alcohol (n = 19). These questions were not reflected in the highest frequency categories: Health Status/Medical Conditions/Reports (n = 200), Vocal Symptoms (n = 88), Voice Use (n = 51) despite these categories representing 58% of all questions asked. Within the highest frequency category, the subcategory of Systemic Diseases was the highest, representing 19% of all questions within the category., Conclusions: This study illuminates the similarities yet many differences that exist across identified voice case history questionnaires in terms of number of questions, number of categories, preference for question-type and structure. It demonstrates the need for standardization of a voice case history questionnaire which would potentially enable more accurate diagnosis and data comparison between voice clinics to aid future research., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Rough vocal effects, extreme, or extended vocal techniques to sound intentionally hoarse or rough are an integral part of many genres and styles, and research has recently demonstrated the involvement of supraglottic narrowing and vibrations to produce such sounds. The vocal health of singing with rough vocal effects is poorly documented, especially in a longitudinal manner, while much vocal pedagogy continuously treats the sounds as harming to or dangerous for the vocal mechanism., Objective: To longitudinally investigate the vocal health of professional singers who perform the five rough-sounding vocal effects Distortion, Growl, Grunt, Rattle, and Creaking as part of their singing and teaching., Methods: Twenty singers underwent nasoendoscopic examination, filled in SVHI questionnaires, and were assessed by GRBAS with a 14-year interval in a retrospective longitudinal study (from 2007 to 2021). Endoscopic materials were assessed by Reflux Finding Score and a hybrid version of the Stroboscopy Rating Scale., Results: Singers presented at initiation of study with an average SVHI of 9.2 (±9), which decreased at time of follow up 14 years later to an average of 5.12 (±6). Laryngeal assessments (RFS and SRS) revealed low averages at initiation of study as well as at conclusion of the study with only small fluctuations in averages, with findings mainly relating to arytenoid asymmetry., Conclusion: The participating singers perform and teach rough vocal effects continually and present with healthy laryngeal mechanisms and within-normal SVHI and GRBAS scores. The findings suggest that controlled supraglottic narrowing and techniques to allow for supraglottic structures to engage in vibration as an additional noise source can be performed sustainable and in a healthy manner if performed with correct vocal technique., Competing Interests: Declarations One author (MA) is employed in a PostDoc granted by the Danish Innovation Foundation (ref. no. 8054-00039B) which is in part given to Nottingham University Hospital of which one author (JM) is employed as an ENT laryngologist and in part to Complete Vocal Institute of which one author (CS) is employed., (Copyright © 2022 The Voice Foundation. All rights reserved.)

Objective: Reinke's edema is a benign laryngeal disease characterized by inflammation and swelling of the superficial layer of the lamina propria of the vocal fold, known as Reinke's space. The aim of this study was to evaluate the quality of voice by quantitative acoustic measurements in patients affected by RE according to new classification proposed by de Vincentiis., Study Design: Prospective case-control., Methods: We enrolled 76 consecutive patients with RE: eight type 1, 36 type 2, four type 3. and 28 type 4. A population of 30 healthy subjects was enrolled too. A voice recording for each subject was performed and the analysis were performed using the Multi-Dimensional Voice Program. The parameters considered were: fundamental frequency (F0), Jitter% (Jitt%), Shimmer% (Shim%), and Noise Harmonics to Ratio (NHR). Statistical analyses were performed using GraphPad Prism 8 software. A level of significance of P < 0.05 was used., Results: The mean values and standard deviation for each parameter for the male group of patients affected by RE are: F0 101.06 (± 9.56) Hz, Jitt% 2.254 (±0.93), Shim% 9,037 (±2.21) and NHR 0.235 (±0.099). About the female group, the mean values are: F0 147,58 (±13.68) Hz, Jitt% 3,733 (±1.12), Shim% 11.172 (±3.54) and NHR 0.278 (±0.12). The difference between the types of RE and reference sample people in male and female groups are statistically significative (P < 0.05) for each parameter. In the female group all outcomes are statistically different except the F0 and NHR between healthy people and type III RE patients., Conclusions: RE is one of the most common diseases of true vocal folds and the classification proposed by de Vincentiis is a synthesis of endoscopic findings. In this paper we underline the change in vocal quality before surgery according a new type of RE classification., Competing Interests: CONFLICT OF INTEREST None., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Auditory-perceptual rating of voice is one component of voice evaluation, and the CAPE-V is one of the tools for this purpose. Because of its advantages, the CAPE-V has been adapted into several languages. Accordingly, the adaptation of the CAPE-V into Malay is essential for its utility among the Malaysian population, which this study aimed to accomplish. This study involved translating the CAPE-V into Malay, termed the Malay CAPE-V, followed by establishing its validity. The translation processes (ie, forward translation and backward translation) involved four different translators ie, three speech-language therapists (SLTs), and one linguist with at least 14 years of experience. Most items were similarly translated, except for a few, which were subsequently accepted as similar, following consensus among the translators. In the examination of content validity, two raters (ie, SLTs) with at least 12 years of clinical experience reviewed and scored the tested items. Given that the scale-level content validity index average value (S-CVI/Ave) was above the acceptable level, all items were retained. The examination of construct validity and concurrent validity involved ratings of voice samples recorded from 38 participants, comprising 19 individuals with normal and disordered voices, respectively. The ratings were performed by three raters (ie, SLTs) with at least 12 years of clinical experience. For the construct validity, the Mann-Whitney U test indicated significantly higher scores of the vocal parameters of the Malay CAPE-V for the disordered voice group than for the normal voice group. Meanwhile, for the concurrent validity, the Spearman correlation indicated that all relationships between the scores of the vocal parameters of the Malay CAPE-V and GRBAS Scale were significant, with most of them achieving a very strong positive correlation. The results demonstrated that the Malay CAPE-V is a valid tool for an auditory-perceptual rating of voice among the Malaysian population., Competing Interests: DECLARATION OF COMPETING INTEREST None., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: The goal of this study is to determine how online education affects the vocal health of schoolteachers in Saudi Arabia's Eastern Province. Teachers' phono trauma is well-known as a serious occupational hazard, and online education was the primary mode of delivering instruction to students during COVID-19., Methods: This is a descriptive cross-sectional study conducted among teachers in the Eastern Province area of Saudi Arabia. Teachers completed a self-administered questionnaire via an online platform, which included socio-demographic data, academic status, and the Voice Handicap Index-10 questionnaire, which assessed their vocal difficulties., Results: A total of 335 teachers responded to the survey (78.2% females vs. 21.8% males). Nearly half (48.7%) were primary school teachers. 45.7% were currently teaching distance learning. Earphones and microphones (49.3%) were the most commonly used distance learning accessories. Noise in the classroom was a very much disturbing factor in teaching implied by 44.8% of the teachers. During the COVID-19 pandemic, the vocal handicap index-10 was significantly higher among females (P = 0.007), primary school teachers (P < 0.001), moreover those currently teaching distance learning (P = 0.001) and those who perceived that there is more work in distance teaching (P < 0.001)., Conclusion: Compared to in-person teaching, online teaching may have a positive impact on vocal health among Saudi teachers. Of all the teachers, phono trauma tends to be more among females who were primary school teachers, currently teaching distance learning, and those who perceived distance learning to be laborious., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To compare two surgical techniques, the Wendler glottoplasty (GP) and its modification, the vocal fold shortening, and retrodisplacement of the anterior commissure (VFSRAC) associated with laser assisted voice adjustment (LAVA) cordotomy, used to feminize the voice of transgender women by increasing the fundamental frequency (F 0 )., Methods: A retrospective study of 22 trans-women (20-62 years-old) was carried out. 12 of them were treated with GP and 10 with the VFSRAC+LAVA technique. They were evaluated before surgery and 6 months after surgery and the postoperative speech therapy. Laryngostroboscopy examination, F 0 measurements, Transgender Woman Voice Questionnaire (TWVQ) assessment and the perceptual assessment using a visual analog scale (PA-VAS) were obtained from all patients., Results: Laryngostroboscopic findings showed normal vocal folds before surgery and a shortening of the vocal folds, due to the anterior glottic synechia, after surgery. Significant increases of F 0 were found in both groups but they were higher in the VFSRAC+LAVA group (47.75Hz in GP group vs 69.70Hz in VFSRAC+LAVA group). TWVQ scores showed a significant decrease in both groups although the difference was greater in the VFSRAC+LAVA group. Similarly, PA-VAS scores lowered significantly in both groups but VFSRAC+LAVA group presented the biggest decreases., Conclusion: Both surgical techniques produce the shortening of the vocal folds through an endoscopic approach and result in voices with higher vocal pitch. Of the two techniques presented, the VFSRAC+LAVA produces better results although when compared with previous studies it seems that the LAVA technique may not significantly contribute to the postoperative results. So, the VFSRAC technique followed by postoperative speech therapy could be recommended for trans-women who wish to feminize their voice., Competing Interests: DECLARATIONS OF INTEREST None., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To identify the prevalence of vocal fold abnormalities in patients with a primary complaint of globus sensation. Secondly, to determine the relationship between globus, vocal fold abnormality, and patient-reported quality of life questionnaire score., Study Design: Retrospective chart review., Methods: A retrospective chart review was performed to identify all new patients evaluated at a tertiary academic care laryngology practice between January 2018 and December 2018 presenting with a chief complaint of globus. Variables of interest include age, gender, laryngeal symptoms, self-reported quality-of-life questionnaire results, and laryngostroboscopy findings. Questionnaires selected for this investigation include the reflux symptom index (RSI), eating assessment tool-10 (EAT-10), and voice handicap index-10 (VHI-10)., Results: Two hundred twenty-eight subjects with an average age of 54 ±17 years, were categorized based on one of three laryngostroboscopic findings: absence of vocal fold abnormality, vocal fold paresis/paralysis (motion abnormality), or a vocal fold mass lesion. Fifty percent of patients reporting globus had a normal laryngeal exam, and 50% had a mass lesion or motion abnormality. Twenty five percent had vocal fold motion abnormality (paresis, paralysis, or supraglottic squeeze); 19% had a mass lesion; and 3% had both a lesion and motion abnormality. The average self-reported survey scores were compared among the three groups. Patients with dysphonia had a significantly higher VHI-10 (P = 0.00), and a significantly higher RSI (P = 0.00) than those without dysphonia. Those patients with dysphagia had significantly higher EAT-10 (P = 0.00) and RSI (P = 0.02) scores than those who did not have dysphagia. Patients with vocal fold motion abnormality had significantly higher VHI-10 than those with normal vocal fold mobility (P = 0.02) CONCLUSIONS: Identifying the etiology of globus presents a significant challenge to laryngologists. Data presented here suggest that vocal fold abnormalities may contribute to the sensation of globus and should therefore be considered in the differential when managing these patients., Competing Interests: CONFLICTS OF INTEREST None for either author., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate whether there is a relationship between voice-related quality of life, pulmonary function, risk of dysphagia, symptoms of dyspnea, and the different degrees of Chronic Obstructive Pulmonary Disease, and to verify which factors may be associated to voice-related quality of life., Methods: Complete records of 37 individuals diagnosed with Chronic Obstructive Pulmonary Disease, of both sexes, aged between 35 and 89, assessed using the Voice-Related Quality of Life Questionnaire, Questionnaire for Dysphagia Screening, Modified Medical Research Council, Index of Body Mass, Peak Expiratory Flow, COPD Assessment Test and Global Initiative for Chronic Obstructive Lung Disease classification., Results: There was a significant, moderate, and negative correlation between the total scores and the physical domain scores of the Voice-Related Quality of Life as a COPD Assessment Test. In the multivariate linear regression analysis, the coefficient of determination explained 51.1% of the relationship between the total Voice-Related Quality of Life score and the independent variables: Peak Expiratory Flow and Questionnaire for Dysphagia Screening., Conclusion: In the analyzed group, voice-related quality of life was negatively influenced by Chronic Obstructive Pulmonary Disease, risk of dysphagia, and changes in Peak Expiratory Flow., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction: Outcome measures describing acoustic voice quality and self-perceived vocal handicap are commonly used in clinical voice practice. Previous reports of the relationship between acoustic and self-perceived measures have found only limited associations, but it is unclear if acoustic measures associated with voice quality and self-perceived voice handicap change in a similar manner over the course of voice treatment. The current study, therefore, considered the relationship between the degree of change in Acoustic Voice Quality Index (AVQI) and Voice Handicap Index (VHI-30 and VHI-10) in dysphonic patients receiving treatment in a private practice voice clinic., Methods: Data were collected retrospectively from patient records of a private practice voice clinic over 80 consecutive months. For each patient, their voice disorder diagnosis, age, and biological sex were collected as well as pre-and post-treatment measures of the AVQI and VHI-30 or VHI-10 depending on which version was used. Correlations were calculated between the AVQI and VHI-30 and the AVQI and VHI-10 before and after treatment as well as for the percentage change of AVQI and VHI-30/VHI-10. Friedman and Kruskal-Wallis tests were used to determine the pre-and post-treatment effect and group differences respectively., Results: Seventy-eight patients were included in the analyses. The scores of the AVQI (χ²[1] = 24.01, P < 0.001), VHI-30 (χ²[1] = 18.00, P < 0.001), and VHI-10 (χ²[1] = 38.35, P < 0.001) all improved significantly after treatment. However, correlations between the AVQI and VHI-30, and the AVQI and VHI-10 were all non-significant, except for a moderate correlation between the AVQI and VHI-10 before treatment (r[43] = 0.31, P = 0.04). The percentage change of the AVQI and the VHI-30/VHI-10 did not correlate significantly., Conclusions: Voice therapy significantly improved acoustic and self-perceived vocal outcome measures. However, there was no significant relationship between these measures before or after treatment, nor was there a relationship in their degree of change. Results support the notion that VHI and AVQI measure unique constructs and that voice therapy can have a positive impact on both., Competing Interests: DECLARATION OF INTEREST Kristie Knickerbocker is the Chief Executive Officer and operator of a tempo Voice Center., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: The acoustic assessment of phonation after total laryngectomy is challenged by signal aperiodicity which makes frequency-based acoustic measures less reliable. This is important for patients who use esophageal voice since voice samples mostly include type III (highly aperiodic) and 4 (chaotic) signals. As such, using non-linear measures, which are better suited for aperiodic phonation, may be useful to investigate the relationship between acoustic signal characteristics and perception of esophageal voice quality., Objectives: This study aimed to investigate whether nonlinear dynamic acoustic methods, nonlinear energy difference Ratio (NEDR) and spectrum convergence ratio (SCR), were correlated with perceptual measures in subjects who used esophageal phonation., Methods: Thirty-one subjects who had undergone total laryngectomy and use esophageal voice as a rehabilitation method were included in this study. Expert and non-expert raters listened to the esophageal voice samples from the subjects and rated vowels and connected speech samples on a scale from 1 to 7 on dysphonia severity and intelligibility. In addition, non-linear acoustic analysis was performed to calculate NEDR and SCR. Analysis from the raters was compared to the non-linear acoustic analysis to find the correlation between the variables., Results: There were no significant correlations between any of the non-linear acoustic measures NEDR and SCR and the perceptual ratings at the significance level of 0.05. Correlations were calculated for each acoustic measure among the expert raters and among the non-expert raters in both connected speech samples and sustained vowel fragments., Conclusions: In conclusion, the nonlinear dynamic acoustic analyses of spectrum convergence ratio and nonlinear energy difference ratio do not have a significant correlation with perceptual measures of esophageal voice., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: Voice disorders are frequently seen among teachers. Intense and inappropriate use of the voice is the most frequent reason. In the literature, studies supporting the positive effect of voice hygiene behaviors to the voice in teachers exist. In the v pandemic era that we pass through, it's being observed that teaching via videoconference is becoming widespread all around the world. The primary aim of this study is to evaluate the risk factors for self-assessed "not normal" voice in teachers, in the light of their demographic and vocational information and voice hygiene behaviors. Our second aim in this study is to evaluate the effect of voice hygiene training via videoconference on teachers' voice. We believe this will contribute in shaping today's therapy modalities in vocal training., Materials and Methods: One hundred nine teachers, working as primary, secondary or high school teacher actively in different cities in Turkey, between 25 and 55 years of age participated and self-assessed their voice by filling the survey including demographic, occupational, medical history and voice symptoms and vocal behaviors data as well as Voice Handicap Index (VHI)-10 ve voice self rating scale (VSRS). The teachers with VHI-10 score below 5 and VSRS score "normal" were assumed to have "Normal Voice." The teachers with VHI-10 score 5 or above and VSRS "Not Normal" (mild, moderate or severe) (N = 52) were assigned to "Voice Hygiene Group" and were invited to videoconference for a voice hygiene session. Four weeks after this session, the survey, VHI-10 and VSRS were repeated and the results were compared., Results: In the first phase of the study, risk factors for not being in "Normal Voice" group for the teachers have been assessed. "Having chronic disease" and "having experienced voice problem before" have been found to be risk factors. In the second phase of the study, 52 teachers have been invited to online "Voice Hygiene" videoconference session; only 18 teachers have attended in total of three attempts of sessions. When vocal behaviors before and after the videoconference were compared, positive changes have been observed in five vocal behaviors including "avoiding smoking," "drinking enough water daily," "eating healthy food," "avoiding excessive meals," "avoiding frequent throat clearing," however VHI-10 and VSRS scores have not showed a meaningful change. Only one teacher has progressed to "normal voice" from "Voice Hygiene Group.", Conclusion: We believe further controlled studies with more participants adherent to videoconference sessions will be needed in order to shape today's therapy modalities., Competing Interests: CONFLICTS OF INTEREST The authors declare that they have no conflict of interest. This article does not contain any studies with animals performed by any of the authors, (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: The COVID-19 pandemic has affected the voice assessment protocols for dysphonic patients. In this study, we compared the changes in acoustic measures of the healthy population as well as dysphonic patients due to glottic insufficiency between the pandemic period requiring face masks and the prepandemic period when the masks were not essential. The clinical reliability of the acoustic measures with and without face masks was explored., Methods: A total of 120 patients (age = 42.3 ± 11.9 yrs) with glottic insufficiencies such as UVFP and sulcus vocalis and 40 healthy population (age = 40.5 ± 11.2 yrs) cohorts were enrolled during the pandemic period. Age- and gender-matched 120 patients and 40 healthy population cohorts who underwent voice assessment without face masks before the pandemic were enrolled as prepandemic controls. Acoustic measures and overall severity estimates of vowel and speech samples were compared, which included cepstral peak prominence (CPP), L/H spectral ratio (SR), their standard deviations, F0, jitter percent (Jitt), shimmer percent (Shim), noise-to-harmonic ratio (NHR), Cepstral Spectral Index of Dysphonia (CSID), and Acoustic Psychometric Severity Index of Dysphonia., Results: Both patients and healthy cohorts showed higher SRv and SRs but lower CSIDv during the pandemic compared to the prepandemic period. F0 of the healthy male controls during the pandemic was higher than during the prepandemic periods, while the CSIDs was lower for the pandemic period. The pandemic patient cohort showed lower σSRs compared to the prepandemic patient cohort. When the acoustic measures of patients were compared to the healthy population cohort, the patient cohort showed lower CPP and σCPPs, while higher σCPPv, Jitt, Shim, and NHR during both pandemic and prepandemic period. Overall, the area under the curve of the acoustic measures and overall severity estimates was similar between the mask and non-mask groups, although the AUC of the SR measures was poor., Conclusions: Wearing face masks during the pandemic did not compromise the overall reliability of the acoustic analysis in patients with glottic insufficiency, suggesting the current protocol of acoustic analysis can be carried out reliably while wearing a mask to ensure safety in the pandemic era., Competing Interests: Declaration of Competing Interest There are no potential conflicts of interest to disclose., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To verify whether there are differences in the performance and reliability of speech-language-hearing students between the moments of auditory-perceptual judgment (APJ) of voice before and after temporal auditory skills training and conventional auditory-perceptual training (APT)., Methods: Both trainings were applied to 30 speech-language pathology students, with the following stages: 1-Initial APJ of the general grade (GG), breathiness (GB), and roughness (GR) with 30 samples of the sustained vowel [Ɛ], plus 20% of repetitions (six samples), analyzed with a visual analog scale; 2-Temporal auditory skills training on the online platform Afinando o Cérebro, with a total duration of 4 hours; 3-APJ of GG, GR, and GB after training in Afinando o Cérebro; 4-APT in the classroom with a total duration of 6 hours; 5-APJ of GG, GR, and GB after APT., Results: There was a significant difference in the students' performance in the APJ of GG after the training. The agreement in identifying voices as dysphonic or nondysphonic increased after each training., Conclusion: Temporal auditory skills training associated with APT has the potential to improve the performance of speech-language-hearing students in APJ of voice, especially in GG., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships that may be considered as potential competing interests: Karoline Evangelista reports equipment, drugs, or supplies were provided by ProBrain. Ingrid Gielow reports a relationship with ProBrain that includes equity or stocks. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: To compare vocal symptoms, stress, overall fatigue, and self-reported vocal quality in teachers between pre pandemic, emergency remote teaching (ERT), and hybrid teaching (simultaneous in-person and online teaching), evaluate their voices during hybrid teaching, and correlate it with self-reported vocal quality., Study Design: Hybrid cross-sectional study with longitudinal cohort characteristics., Method: The sample comprised 70 teachers of both sexes, aged 24 to 68years (mean of 42.5years). Everyone filled out a recall questionnaire on pre-pandemic and ERT and another one on hybrid teaching. The voices were recorded and then submitted to judges for auditory-perceptual evaluation. The statistical analysis compared the three moments, verifying a correlation between the variables., Results: The auditory-perceptual evaluation carried out during hybrid teaching revealed that 74.3% of teachers in the sample had mild vocal deviations according to the overall severity in the CAPE-V. Changes in self-reported vocal quality were associated with hoarseness, dry throat, vocal fatigue, voice failures, loud speaking, stress, and overall fatigue. Also, 61.4% of participants reported that during ERT, their voices were better than before the pandemic and during hybrid teaching. Voice roughness and strain observed in the auditory-perceptual evaluation were associated with vocal symptoms., Conclusion: Remote teaching has transformed teachers' communication in class, highlighting the need for monitoring by them. Teachers reported improved vocal quality during ERT compared with before the pandemic, but it worsened slightly in hybrid teaching. Public school teachers perceived greater vocal improvement than those in private schools. The most common symptoms were hoarseness, dry throat, sore throat, and overall fatigue, regardless of the time of analysis. During hybrid teaching, most of the sample had mildly deviant voices, especially due to roughness and strain, which are related to the most frequent symptoms., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: Floating ball voice therapy (FBVT) is a voice-controlled virtual environment based on a common treatment component across multiple evidence-based therapies: improved vocal efficiency (target) via practicing voicing with modified resonance and airflow (ingredient). This study preliminarily tested FBVT's effects on outcomes and the potential for its novel variability metrics to predict individual patient generalization., Method: Ten patients with nonphonotraumatic vocal hyperfunction (NPVH) practiced FBVT for 10 days. Outcomes were assessed by a vocal efficiency ratio, a validated NPVH index, the patient-reported Voice-Related Quality of Life (V-RQOL), and forced-choice auditory judgments of overall severity. Exploration in early practice (Day 1) was estimated by how the patient's two-dimensional variability (mean airflow and intensity) related to error (difference between the patient-produced and normative vocal efficiency ratio). Generalization from the game to spontaneous speech was evaluated using the validated NPVH index., Results: Ten days of FBVT were associated with improved vocal efficiency (Cohen's d = 1.3), NPVH index ( d = -1.1), V-RQOL total score ( d = 0.9), and overall severity (odds ratio = 2.5). Patients who generalized on Day 10 exhibited airflow/intensity exploration that was more aligned with the error gradient on Day 1 ( d = 0.6-1.2)., Conclusions: A relatively small dosage of FBVT (i.e., 10 practice sessions) was associated with multiple improved voice therapy outcomes. The FBVT variability metrics on Practice Day 1 demonstrated strong potential to predict which patients generalized to connected speech. Future work can more thoroughly evaluate effects on outcomes and characterizing the quality of vocal exploration with a larger patient population., Supplemental Material: https://doi.org/10.23641/asha.27040873.

Objective: To analyze the efficacy of unilateral arytenoid chondroplasty combined with minimally invasive mucosal flap plasty in the management bilateral vocal cord paralysis. Methods: A total of 66 patients with bilateral vocal cord paralysis hospitalized in the First Hospital of Sun Yat-sen University from January 2018 to December 2023 were retrospectively analyzed, among whom there were 8 males and 58 females, with ages ranging from 35 to 86 years old(mean age (57.8±11.6) years). All patients underwent suspension laryngoscopic CO 2 laser unilateral arytenoid chondroplasty and mucosal flap under general anesthesia. Postoperative follow-up period extended from 6 months to 6 years, with a median duration of 28 months. The study compared the degree of dyspnea and voice quality (subjective and objective evaluation) of the patients pre- and post-operatively, and analyzed the clinical differences between patients with and without preoperative or intraoperative tracheotomy, the extubation rate of tracheotomized patients, the recurrence rate, and the complication rate. Continuous variables conforming to normal distribution were tested by t-test and categorical variables by χ² test,the Wilcoxon rank-sum test was used to analyze the improvement in dyspnea before and after surgery. Results: Compared with the preoperative period, 59 patients showed improvement in postoperative dyspnea ( U =161.5, P <0.01); there was no significant difference in voice disorder index 10, subjective auditory-perceptual assessment, and maximal vocalization time ( P >0.05), all of which remained within the relative normal range. Tracheotomy was performed in 32 out of 66 patients, with predominantly degree Ⅲ- dyspnea (46.9%, 15/32), including 26 patients with preoperative tracheotomy and 6 patients with intraoperative tracheotomy. Among the 34 patients who did not undergo tracheotomy, the majority presented with degree Ⅱ-dyspnea (82.4%, 28/34). All patients achieved successful extubation following surgery, with a mean median time to extubation of 1 month. Conclusions: The combination of unilateral arytenoid chondroplasty and minimally invasive mucosal flap plasty represents a refined and effective therapeutic approach for bilateral vocal cord paralysis. This minimally invasive technique has the potential to reduce the rate of tracheotomy.

Purpose: Health content has been presented and accessed freely on social networks and can generate misinformation; hence, this study aimed to analyze the voice guidance in videos available on YouTube., Method: This observational cross-sectional research selected the 45 most-viewed videos on YouTube in 2022, produced by professional voice users with guidance on vocal hygiene and well-being. The content was described and compared with the scientific literature on the topic, analyzing which category of professional voice users produced the most scientifically based content., Results: Altogether, 38 topics were found in the videos, distributed in nine blocks, identified from A to I. Block A (foods with a positive effect on the voice) was the only one that had no citations in scientific articles, whereas block D (negative habits for the voice) had the highest mean number of articles in relation to the others. The most publicized guidelines were mainly related to actions and/or behaviors and resources considered positive for the voice. Eight professional categories were found who produced these videos. Singing teachers who also worked as singers produced the most scientifically based content., Conclusion: The study showed that not all the information in the videos was scientifically based, which means that people with voice problems have easy access to information that could even harm them if used in their professions., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Vowels vary in their acoustic similarity across regional dialects of American English, such that some vowels are more similar to one another in some dialects than others. Acoustic vowel distance measures typically evaluate vowel similarity at a discrete time point, resulting in distance estimates that may not fully capture vowel similarity in formant trajectory dynamics. In the current study, language and accent distance measures, which evaluate acoustic distances between talkers over time, were applied to the evaluation of vowel category similarity within talkers. These vowel category distances were then compared across dialects, and their utility in capturing predicted patterns of regional dialect variation in American English was examined. Dynamic time warping of mel-frequency cepstral coefficients was used to assess acoustic distance across the frequency spectrum and captured predicted Southern American English vowel similarity. Root-mean-square distance and generalized additive mixed models were used to assess acoustic distance for selected formant trajectories and captured predicted Southern, New England, and Northern American English vowel similarity. Generalized additive mixed models captured the most predicted variation, but, unlike the other measures, do not return a single acoustic distance value. All three measures are potentially useful for understanding variation in vowel category similarity across dialects., (© 2024 Acoustical Society of America.)

This study examined the acoustic correlates of the alignment between lexical stress and narrow focus prosody in English and investigated how this alignment is learned by second language learners whose native language is prosodically distinct from English. A production experiment was conducted where native English speakers and Korean learners of English were asked to read aloud sentences with a narrow focus on trisyllabic words with various stress patterns (e.g., ánimal, Novémber, submaríne). In the native English productions, the stressed syllables were characterized by either a rising F0 contour (for word-initial stress) or increased periodic energy (for word-medial and -final stress). The Korean speakers (KSs) produced stressed syllables with a rising F0 contour regardless of stress position, differing from the native speakers, and they exhibited greater periodic energy for word-medial and -final stressed syllables, similar to the native speakers. In addition, the KSs with higher English proficiency showed more native-like patterns by exhibiting a post-focus F0 drop immediately after word-initial stressed syllables. These findings are discussed in the context of existing literature and potential factors contributing to the challenges observed in L2 prosody learning., (© 2024 Acoustical Society of America.)

Objective: To conduct a systematic description and meta-analysis of the treatment of unilateral vocal cord paralysis（UVCP） with recurrent laryngeal nerve reinnervation through literature search, and to analyze the therapeutic effect of recurrent laryngeal nerve reinnervation on improving vocal function in UVCP. Methods: Electronic databases Pubmed, Web of Science, EMBASE, Cochrane Library, CNKI, and Wanfang databases were searched using relevant keywords and screened in strict accordance with the inclusion and exclusion criteria, and quality evaluations were conducted. Reported treatment outcomes were measured by relevant data extracted from literature, such as auditory perception assessment（GRBAS）, voice handicap index（VHI）, maximal phonation time（MPT）, jitter, shimmer, and noise harmonic ratio（NHR）, etc. Meta-analysis was performed by Revman5.3 and heterogeneity was analyzed using fixed effects or random effects models. Results: Eight articles were included in this study, all of which showed that the postoperative maximum phonation time of patients was significantly prolonged compared to preoperative, while the postoperative GRBAS score, Jitter, Shimmer, and NHR decreased compared to preoperative with statistical significance. Conclusion: The innervation of the internal laryngeal muscle was obtained through the reinnervation of the recurrent laryngeal nerve, which effectively improved the patient's vocal function and had a good long-term therapeutic effect. Although there was no difference in the efficacy of surgical methods for reconstructing the recurrent laryngeal nerve, the anastomosis between ansa cervicalis nerve and the recurrent laryngeal nerve is more ideal. Further randomized controlled studies with longer follow-up periods and larger samples will increase the credibility of their effectiveness., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To analyze the efficacy of endoscopic CO₂ laser arytenoidectomy in treating bilateral vocal cord paralysis. Methods: Ninety-five patients who underwent endoscopic CO₂ laser arytenoidectomy for bilateral vocal cord paralysis at the First Affiliated Hospital of Naval Medical University（Changhai Hospital） of Shanghai from January 2009 to December 2022 were included in this study. Among them, 59 patients underwent endoscopic CO₂ laser arytenoidectomy as their first glottic enlargement surgery（Group A）, while 36 patients, who had previously undergone two unsuccessful CO₂ laser-assisted posterior cordotomies, underwent endoscopic CO₂ laser arytenoidectomy as a subsequent surgery（Group B）. Swallowing function, electronic laryngoscopy, perceptual voice evaluation, and objective voice analysis indicators were statistically analyzed before and after surgery to evaluate clinical efficacy. Results: The extubation rate after the first surgery was 84.75% in Group A and 86.11% in Group B, with total extubation rates of 94.92% and 94.44%, respectively. There were no significant differences between the two groups in preoperative and postoperative swallowing function, glottic size, or various voice evaluation indicators（ P >0.05）. Within-group comparisons showed that postoperative swallowing function, glottic closure during phonation, perceptual evaluations of G（grade of hoarseness）, A（asthenia）, and B（breathiness） significantly worsened, with increased grades. The maximum transverse diameter of the posterior glottis during inspiration significantly increased, and the VHI-10 score was significantly higher postoperatively. Jitter, shimmer, and the harmonics-to-noise ratio significantly deteriorated, and maximum phonation time significantly shortened（ P <0.05）. No significant differences were observed in postoperative R（roughness） and S（strain） compared to preoperative values（ P >0.05）. Conclusion: Endoscopic CO₂ laser arytenoidectomy can impair voice quality to some extent but effectively alleviates breathing difficulties in patients with bilateral vocal cord paralysis. For patients who did not achieve successful extubation with CO₂ laser-assisted posterior cordotomy, endoscopic CO₂laser arytenoidectomy is an effective reoperative method, ensuring a high extubation rate while preserving certain voice functions., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: The aim of this study is to investigate the efficacy of posterior cordotomy with partial arytenoidectomy in bilateral vocal fold paralysis（BVFP）. Methods: Medical records of 37 patients with BVFP were retrospectively collected, and they were all admitted to the Department of Otolaryngology-Head and Neck Surgery, West China Hospital of Sichuan University, from Jan. 2019 to Dec. 2023. Preoperative and postoperative evaluations of respiratory function, voice quality, and swallowing function were conducted. Results: Postoperatively, 32 out of 37 patients achieved significant relief in breathing difficulties. Out of 29 patients with tracheostomy, 26（89.7%） were successfully decannulated. One month postoperative follow-up revealed a decline in voice quality for 33 patients（89.2%）, and 5 cases（13.5%） reported a decrease in swallowing function. However, by three months postoperatively, both voice quality and swallowing function showed significant improvement. Conclusion: Posterior cordotomy with partial arytenoidectomy is an effective surgical method for BVFP, and significantly improve respiratory difficulty despite its impact on voice quality, with no significant impairment to swallowing function, shows significant clinical value., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: Investigates the application and clinical efficacy of ansa cervicalis anterior root-recurrent laryngeal nerve（RLN） anastomosis in the treatment of unilateral vocal fold paralysis（UVFP）. Methods: A prospective study was conducted with 92 UVFP patients admitted to our department from January 2018 to January 2022 who received ansa cervicalis anterior root-RLN anastomosis. The course of nerve injury ranged from 6 to 24 months. Videostroboscopy, voice subjective auditory perceptual assessment（GRBAS）, Voice Handicap Index（VHI-10）, voice objective acoustic analysis and laryngeal electromyography（EMG） were used to evaluate the efficacy of the operation. Results: Videostroboscopy showed that although the movement of vocal cords did not return to normal 12 months after operation, their volume and muscle tension were significantly improved and their positions were adducted to the median or near-median. Also the glottic closure, vocal cord position, vocal cord edge, symmetry and regularity of vocal cord vibration were significantly improved than pre-operation（ P <0.01）. The five indexes of GRBAS（Grade, Roughness, Breathiness, Asthenia, Strain） and VHI-10, as well as voice acoustic parameters（Jitter, Shimmer, NHR） post-operation were significantly reduced, while the maximum phonation time（MPT） was significantly longer（ P <0.01）. The results of laryngeal EMG indicated that the maximum voluntary motor unit recruitment（VMUR） post-operation was significantly recovered（ P <0.01）, which confirmed that the affected laryngeal muscle obtained effective nerve reinnervation. Conclusion: Ansa cervicalis anterior root-RLN anastomosis can effectively improve the voice function of patients which is safe and satisfactory. It is an ideal method for the treatment of unilateral RLN injury., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To explore the differences in clinical presentation and therapeutic outcomes between vocal fold fibrocystic degeneration and other common benign lesions, such as vocal fold polyp and cyst. Methods: Vocal function was assessed before and after surgery in 10 cases of vocal fold fibrocystoids, 30 cases of vocal fold polyps and 10 cases of vocal fold cysts at Department of Voice Medicine, Xiamen University Zhongshan Hospital. The voice Assessments included GRBAS（G-scale）, VHI-10 scale, Reflux Symptom Index（RSI） scale, stroboscope, acoustic objective analysis, and aerodynamics measurements. The acoustice analysis parameters included fundamental frequency（F0）, fundamental frequency perturbation（Jitter）, amplitude perturbation（Shimmer） and voice disturbance severity index（DSI）, while the maximum phonation time（MPT） was assessed for aerodynamics. Stroboscopic parameters included vocal fold straightness, vocal fold color, glottic closure and mucosal wave. All three groups underwent phonomicrosurgery and a follow-up review was conducted one month later. Pre-and post-operative function assessment parameters were compared across the three groups. Results: Significant differences were founded in the G grade, Jitter, Shimmer, DSI, glottic closure and mucosal wave between the vocal fold fibrocystic degeneration group and the vocal fold polyp and vocal fold cyst group（ P <0.05）. Most voice function parameters in all three groups showed significant improvement after surgery（ P <0.05）. The improvement of VHI（10）, RSI and mucosal wave scores in the vocal fold fibrocystic lesion group was significantly different from that of the vocal fold polyp group（ P <0.05）. Conclusion: Vocal fold fibrocystic degeneration is a more severe than that of vocal fold polyps and cysts, which are two common benign vocal fold lesions. Phonomicrosurgery is an effective treatment for vocal fold fibrocystic degeneration, but its curative effect are less favorable compared to those for vocal fold polyps and vocal fold cysts. Therefore, a detailed preoperative evaluation is essential for predicting surgical outcomes., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

This paper deals with study of formant and harmonic contours by processing the group delay (GD) spectrograms of speech signals. The GD spectrum is the negative derivative of the phase spectrum with respect to frequency. Recent study shows that the GD spectrogram can be obtained without phase wrapping. Formant frequency contours can be observed in the display of the peaks of the instantaneous wideband equivalent GD spectrogram, derived using the modified single frequency filtering (SFF) analysis of speech signals. Harmonic frequency contours can be observed in the display of the peaks of the instantaneous narrowband equivalent GD spectrogram, derived using the modified SFF analysis of speech signals. For synthetic speech signals, the observed formant contours match the ground truth formant contours from which the signal is derived. For natural speech signals, the observed formant contours match approximately with the given ground truth formant contours mostly in the voiced regions. The results are illustrated for several randomly selected utterances from the TIMIT database. While this study helps to observe the contours of formants in the display, automatic extraction of the formant frequencies needs further processing, requiring logic for eliminating the spurious points, without forcing the number of formants., (© 2024 Acoustical Society of America.)

Objective: Retrospective analysis of the efficacy and it's influencing factors of non-surgical treatment mainly focus on voice therapy for patients with unilateral vocal fold paralysis. Methods: The retrospective study includes 57 patients who were diagnosed with unilateral vocal fold paralysis and presented with hoarseness as their main complaint at the Department of Voice Medicine, Zhongshan Hospital of Xiamen University from August, 2021 to August, 2023. Judging the efficacy of non-surgical treatment mainly focus on voice therapy through changes in acoustic, aerodynamic, and laryngoscopic parameters; Analyze the relationship between patients' age, gender, duration of disease, cause of nerve injury, type of nerve injury, side of nerve injury and efficacy of non-surgical treatment. Results: After non-surgical treatment mainly focused on voice therapy, there were statistically significant differences（ P <0.01） in the changes of vocal fold bow, glottal gap, glottal compression, loudness, Jitter, Shimmer, IC, and NC parameters. There is a statistically significant correlation between the duration of the disease and changes in glottal gap, Shimmer, and IC（ P <0.05）, the side of nerve injury can affect changes of glottal gap and NC（ P <0.05）. Conclusion: Non-surgical treatment mainly focused on voice therapy has a good efficacy on patients with unilateral vocal fold paralysis. The duration of the disease and the side of nerve injury may affect the efficacy., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Purpose: There are few options for treatment of dysphonia secondary to vocal pathology related to lamina propria scar, atrophy, sulcus, or inflammatory disorders. Platelet rich plasma (PRP) may provide anti-inflammatory and regenerative properties seen with other tissue engineering therapies without the risks associated with these treatments. We evaluated vocal fold (VF) injection of PRP for feasibility, phonatory effects, patient satisfaction and durability., Methods: Patients with dysphonia secondary to vocal fold scar, atrophy, sulcus and inflammatory lesions were included. PRP injections were administered in office, to bilateral vocal folds. Patients were followed up at 1 week, 1 month, 3 months and 6 months to assess outcomes (GRBAS scale, maximum phonation time, vocal fatigue index (VFI), voice handicap index (VHI-10) and stroboscopy)., Results: 75 intracordal PRP injections were administered to 48 patients. All injections were completed, and no adverse reactions were experienced. Improvements in VHI-10 scores at 1,3,6 months were seen (mean VHI 21.73 at baseline, 15.62 at six months, p < 0.001). 72.3% rated improvement at 7 or above on Likert scale. 95.7% of patients would consider a future PRP injection. Secondary outcomes VFI, MPT, and GRBAS also demonstrated significant improvements over time. Patients receiving a single PRP injection (n = 26) still demonstrated significant VHI-10 improvements at 1,3 and 6 months., Conclusions: VF office PRP injections are feasible and safe and can provide phonatory benefit and reduce vocal effort in benign VF disorders. A single PRP injection is sufficient to provide sustained benefit in some cases., Level of Evidence: Level III: prospective cohort study., (© 2024. The Author(s).)

Introduction: Type 4 posterior glottic stenosis and bilateral vocal fold paralysis are clinically challenging causes of bilateral vocal fold immobility (BVFI) that result in glottic airway obstruction. Established procedures for BVFI typically worsen dysphonia. We hypothesize the use of thyroarytenoid myomectomy (TAM) in the setting of BVFI will improve dyspnea with decreased detriment to voice., Methods: Eleven unilateral TAM procedures were performed between April 2021 and June 2023 at a single institution. Pre- and postoperative patient reported outcomes were compared. Representative images of maximal glottic opening were analyzed in ImageJ to calculate ipsilateral bowing index (BI), total BI, maximum glottic surface area (MGSA), and maximum opening angle (MOA). Statistical comparisons were performed with paired t-tests when normality was confirmed with Shapiro-Wilk test and otherwise with Wilcoxon signed-rank tests, with threshold for significance of α = 0.05. Interrater reliability for objective glottal measures was compared with intraclass correlation coefficient (ICC)., Results: Dyspnea Index improved from mean (standard error) of 24.1 (3.8) to 9.1 (3.3), p = 0.004. Voice Handicap Index-10 improved from 20.0 (4) to 10.3 (3.8), p = 0.011. Glottal Function Index improved from 9.6 (1.4) to 6.3 (1.3), p = 0.017. There was no significant difference in ipsilateral BI, total BI, MOA, and median MGSA. There was good to excellent ICCs for all comparisons (0.83-0.95)., Conclusions: TAM demonstrated significant improvement in symptoms from BVFI while not significantly altering glottal structure. These data suggest TAM improves dyspnea in patients with BVFI without significantly impairing voice., Level of Evidence: 4 Laryngoscope, 134:4307-4312, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)