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Purpose: Auditory-perceptual evaluation is essential for the assessment of voice quality. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) provides a standardized protocol and assessment form for clinicians to analyze the voice quality and has been adapted into several different languages. The aims of this study were to develop the Japanese version of the CAPE-V and to investigate its reliability and validity. Method: The Japanese CAPE-V consisted of the same three speech contexts (vowels, sentences, and conversation) as developed in the original English version. The sentences were designed according to the concepts of the original version and reviewed by Japanese phoneticians. To validate the usefulness of the Japanese CAPE-V, voices of 173 Japanese-speaking subjects (76 subjects with dysphonia and 97 without voice complaints) were evaluated by five experienced judges, according to the Japanese CAPE-V as well as the GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) scale. Results: The Japanese CAPE-V provided a high interrater reliability (intraclass correlation coefficients [ICCs] > 0.85 for all the parameters) as well as a high intrarater reliability (ICCs > 0.85 for all the parameters). In addition, overall severity, roughness, and breathiness in the Japanese CAPE-V were highly correlated with the corresponding dimensions in the GRBAS scale, having Spearman correlation coefficients greater than 0.8. Conclusion: This study demonstrated the reliability and validity of the newly developed Japanese CAPE-V as an auditory-perceptual evaluation instrument.

Purpose: Auditory-perceptual evaluation is essential for the assessment of voice quality. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) provides a standardized protocol and assessment form for clinicians to analyze the voice quality and has been adapted into several different languages. The aims of this study were to develop the Japanese version of the CAPE-V and to investigate its reliability and validity. Method: The Japanese CAPE-V consisted of the same three speech contexts (vowels, sentences, and conversation) as developed in the original English version. The sentences were designed according to the concepts of the original version and reviewed by Japanese phoneticians. To validate the usefulness of the Japanese CAPE-V, voices of 173 Japanese-speaking subjects (76 subjects with dysphonia and 97 without voice complaints) were evaluated by five experienced judges, according to the Japanese CAPE-V as well as the GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) scale. Results: The Japanese CAPE-V provided a high interrater reliability (intraclass correlation coefficients [ICCs] > .85 for all the parameters) as well as a high intrarater reliability (ICCs > .85 for all the parameters). In addition, overall severity, roughness, and breathiness in the Japanese CAPE-V were highly correlated with the corresponding dimensions in the GRBAS scale, having Spearman correlation coefficients greater than .8. Conclusion: This study demonstrated the reliability and validity of the newly developed Japanese CAPE-V as an auditory-perceptual evaluation instrument., To evaluate the quality of one's voice, it is necessary to conduct multidimensional assessments, including auditory-perceptual evaluation, subjective assessment, acoustic analysis, and aerodynamic analysis. Because voice is fundamentally perceptual, auditory-perceptual [...]

Introduction: Radiation-induced carotid artery stenosis (RI-CS) is known as one of long-term side effects of radiotherapy for head and neck cancer (HNC). However, the clinical time course after irradiation has been poorly understood. We aimed to investigate the natural history of radiation-induced carotid atherosclerosis, comparing the patients who received radiotherapy for HNC with the patients who were treated without radiotherapy. Methods: The patients who received treatment of HNC at Department of Otolaryngology, Head and Neck Surgery of Kyoto University Hospital, from November 2012 to July 2015 were enrolled. The patients were assigned into the RT group and the control group, depending on whether radiotherapy was planned or not. Annual carotid ultrasound was performed from the enrollment to 5 years. The increase of mean intima-media thickness (IMT) at common carotid artery from the enrollment (Δmean IMT) was evaluated. Results: Fifty-six patients in the RT group and 25 patients in the control group were enrolled. From 5-year follow-up data, the significant higher increase of Δmean IMT was consistently observed in the RT group than in the control group after 2 years. The RT group presented a 7.8-fold increase of mean IMT compared to the control group (0.060 mm per year in the RT group and 0.008 mm per year in the control group). Cumulative incidence curves obtained from the analysis of all vessels revealed that the RT group presented higher incidence of Δmean IMT ≥0.25 mm than the control group (p < 0.01). In the RT group, the patients with mean IMT ≥1.0 mm at enrollment exhibited significantly higher incidence of Δmean IMT ≥0.25 mm than the patients with mean IMT <1.0 mm (p < 0.01). Discussion: Radiotherapy for HNC induces continuous carotid mean IMT progression. The irradiated carotid arteries with mean IMT ≥1.0 mm before radiotherapy presented earlier IMT progression than those with mean IMT <1.0 mm. [ABSTRACT FROM AUTHOR]

Purpose: To develop and evaluate a rat excised larynx model for the measurement of acoustic, aerodynamic, and vocal fold vibratory changes resulting from vocal fold scar. Method: Twenty-four 4-month-old male Sprague-Dawley rats were assigned to 1 of 4 experimental groups: chronic vocal fold scar, chronic vocal fold scar treated with 100-ng basic fibroblast growth factor (bFGF), chronic vocal fold scar treated with saline (sham treatment), and unscarred untreated control. Following tissue harvest, histological and immunohistochemical data were collected to confirm extracellular matrix alteration in the chronic scar group; acoustic, aerodynamic, and high-speed digital imaging data were collected using an excised larynx setup in all groups. Phonation threshold pressure (P [subscript th]), glottal resistance (R[subscript g]), glottal efficiency (E[subscript g]), vibratory amplitude, and vibratory area were used as dependent variables. Results: Chronically scarred vocal folds were characterized by elevated collagen Types I and III and reduced hyaluronic acid abundance. Phonation was achieved, and data were collected from all control and bFGF-treated larynges; however, phonation was not achieved with 3 of 6 chronically scarred and 1 of 6 saline-treated larynges. Compared with control, the chronic scar group was characterized by elevated P[subscript th], reduced E[subscript g], and intralarynx vibratory amplitude and area asymmetry. The bFGF group was characterized by P[subscript th] below control-group levels, E[subscript g] comparable with control, and vocal fold vibratory amplitude and area symmetry comparable with control. The sham group was characterized by P[subscript th] comparable with control, E[subscript g] superior to control, and vocal fold vibratory amplitude and area symmetry comparable with control. Conclusions: The excised larynx model reported here demonstrated robust deterioration across phonatory indices under the scar condition and sensitivity to treatment-induced change under the bFGF condition. The improvement observed under the sham condition may reflect unanticipated therapeutic benefit or artifact. This model holds promise as a tool for the functional characterization of biomechanical tissue changes resulting from vocal fold scar and the evaluation of experimental therapies. (Contains 8 figures and 1 table.)

Purpose: To develop and evaluate a rat excised larynx model for the measurement of acoustic, aerodynamic, and vocal fold vibratory changes resulting from vocal fold scar. Method: Twenty-four 4-month-old male Sprague-Dawley rats were assigned to 1 of 4 experimental groups: chronic vocal fold scar, chronic vocal fold scar treated with 100-ng basic fibroblast growth factor (bFGF), chronic vocal fold scar treated with saline (sham treatment), and unscarred untreated control. Following tissue harvest, histological and immunohistochemical data were collected to confirm extracellular matrix alteration in the chronic scar group; acoustic, aerodynamic, and high-speed digital imaging data were collected using an excised larynx setup in all groups. Phonation threshold pressure ([P.sub.th]), glottal resistance ([R.sub.g]), glottal efficiency ([E.sub.g]), vibratory amplitude, and vibratory area were used as dependent variables. Results: Chronically scarred vocal folds were characterized by elevated collagen Types I and III and reduced hyaluronic acid abundance. Phonation was achieved, and data were collected from all control and bFGF-treated larynges; however, phonation was not achieved with 3 of 6 chronically scarred and 1 of 6 saline-treated larynges. Compared with control, the chronic scar group was characterized by elevated [P.sub.th], reduced [E.sub.g], and intralarynx vibratory amplitude and area asymmetry. The bFGF group was characterized by [P.sub.th] below control-group levels, [E.sub.g] comparable with control, and vocal fold vibratory amplitude and area symmetry comparable with control. The sham group was characterized by [P.sub.th] comparable with control, [E.sub.g] superior to control, and vocal fold vibratory amplitude and area symmetry comparable with control. Conclusions: The excised larynx model reported here demonstrated robust deterioration across phonatory indices under the scar condition and sensitivity to treatment-induced change under the bFGF condition. The improvement observed under the sham condition may reflect unanticipated therapeutic benefit or artifact. This model holds promise as a tool for the functional characterization of biomechanical tissue changes resulting from vocal fold scar and the evaluation of experimental therapies. KEY WORDS: rat excised larynx, vocal fold scar, basic fibroblast growth factor, subglottal pressure, glottal resistance, glottal efficiency, high-speed digital imaging, Vocal fold scar results from abberant extracellular matrix (ECM) remodeling following injury (Rousseau et al., 2003; Tateya, Tateya, Sohn, & Bless, 2005; Thibeault, Gray, Bless, Chan, & Ford, 2002) and [...]

Purpose: The present study was a methodological study designed to reveal the dynamic mechanisms of phonation instability pressure (PIP) using bifurcation analysis. Phonation pressure range (PPR) was also proposed for assessing the pressure range of normal vocal fold vibrations. Method: The authors first introduced the concept of bifurcation on the basis of a symmetric vocal fold model and then applied the bifurcation analysis to data from excised larynges. By recording acoustic signals from 10 excised larynges, the authors measured phonation threshold pressure (PTP), PIP, and PPR at the bifurcation pressure points from the spectrograms as subglottal pressure was progressively increased. Furthermore, to investigate the effects of vocal fold elongation on PTP, PIP, and PPR, the authors manipulated the elongation of the vocal folds at 0%, 5%, 10%, and 15% of the resting vocal fold length. Results: The authors found that PTP, PIP, and PPR were effectively determined using the bifurcation analysis. When vocal fold elongation was increased from 0% to 15%, PTP was significantly increased (p < .001), PIP was not significantly changed (p = .54), and PPR was significantly decreased (p = .003). Conclusion: PIP and PPR represent important parameters to assess phonation instability. Bifurcation analysis represents a valuable procedure for revealing the mechanisms behind PTP, PIP, and PPR and for investigating the effects of vocal fold biomechanical parameters on these 3 pressure parameters. KEY WORDS: excised larynx, bifurcation analysis, phonation threshold pressure, phonation instability pressure, phonation pressure range, vocal fold elongation, Excised larynx experiments facilitate direct observation and measurement of vocal fold vibrations and have been shown to be advantageous in the study of voice physiology. In recent years, the excised [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jvoice.2005.06.002 Byline: Bernard Rousseau (a), Ichiro Tateya (a ), XinHong Lim (a ), Alejandro Munoz-del-Rio (a ), Diane M. Bless (a ) Abstract: Phytochemical constituents of medicinal plants demonstrate inhibition of tissue and bacterial hyaluronidase. Echinacoside is a caffeoyl conjugate of Echinacea with known anti-hyaluronidase properties. The purpose of this study was to investigate the wound healing effects of Echinacea on vocal fold wound healing and functional voice outcomes. Pig animal model. Methods: Vocal fold injury was induced in 18 pigs by unilateral vocal fold stripping. The uninjured vocal fold served as control. Three groups of six pigs randomly received a topical application of 300, 600, or 1200 mg of standardized Echinacea on the injured side. Animals were euthanized after 3, 10, and 15 days of wound healing. Phonation threshold pressure and vocal economy measurements were obtained from excised larynges. Treatment outcomes were examined by comparing the animals receiving treatment with a set of 19 untreated and 5 historical controls. Treatment effects on wound healing were evaluated by histologic staining for hyaluronan and collagen. Treated larynges revealed improved vocal economy and phonation threshold pressure compared with untreated larynges. Histologically, treated vocal folds revealed stable hyaluronan content and no significant accumulation of collagen compared with control. Findings provide a favorable outcome of anti-hyaluronidase treatment on acute vocal fold wound healing and functional measures of voice. Author Affiliation: (a) From the Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee (a ) Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin Article History: Accepted 17 May 2005 Article Note: (footnote) Presented at the Voice Foundation's 33rd Annual Symposium: Care of the Professional Voice, June 2-6, 2004, Philadelphia, Pennsylvania. Performed in accordance with the PHS Policy on Humane Care and Use of Laboratory Animals, the NIH Guide for the Care and Use of Laboratory Animals, and the Animal Welfare Act (7 U.S.C. et seq.); the animal use protocol was approved by the Institutional Animal Care and Use Committee (IACUC) of the University of Wisconsin-Madison. Supported by NIH Grants R01 DC 4428 & F31 DC 006314 from the National Institute on Deafness and other Communication Disorders (NIDCD).

Objective: Some patients with cleft palate (CP) need secondary surgery to improve functionality. Although 4-dimensional assessment of velopharyngeal closure function (VPF) in patients with CP using computed tomography (CT) has been existed, the knowledge about quantitative evaluation and radiation exposure dose is limited. We performed a qualitative and quantitative assessment of VPF using CT and estimated the exposure doses. Design: Cross-sectional. Setting: Computed tomography images from 5 preoperative patients with submucous CP (SMCP) and 10 postoperative patients with a history of CP (8 boys and 7 girls, aged 4-7 years) were evaluated. Patients: Five patients had undergone primary surgery for SMCP; 10 received secondary surgery for hypernasality. Main Outcome Measures: The presence of velopharyngeal insufficiency (VPI), patterns of velopharyngeal closure (VPC), and cross-sectional area (CSA) of VPI was evaluated via CT findings. Organ-absorbed radiation doses were estimated in 5 of 15 patients. The differences between cleft type and VPI, VPC patterns, and CSA of VPI were evaluated. Results: All patients had VPI. The VPC patterns (SMCP/CP) were evaluated as coronal (1/4), sagittal (0/1), circular (1/2), and circular with Passavant's ridge (2/2); 2 patients (1/1) were unevaluable because of poor VPF. The CSA of VPI was statistically larger in the SMCP group (P =.0027). The organ-absorbed radiation doses were relatively lower than those previously reported. Conclusions: Four-dimensional CT can provide the detailed findings of VPF that are not possible with conventional CT, and the exposure dose was considered medically acceptable. [ABSTRACT FROM AUTHOR]