scholarly journals Differences in Weeklong Ambulatory Vocal Behavior Between Female Patients With Phonotraumatic Lesions and Matched Controls

2020 ◽  
Vol 63 (2) ◽  
pp. 372-384 ◽  
Author(s):  
Jarrad H. Van Stan ◽  
Daryush D. Mehta ◽  
Andrew J. Ortiz ◽  
James A. Burns ◽  
Laura E. Toles ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Second Harmonic ◽  
Characteristic Curve ◽  
Vocal Behavior ◽  
Adult Women ◽  
Glottal Closure ◽  
Vocal Hyperfunction ◽  
The Difference ◽  
Voice Data ◽  
Voice Use

Purpose Previous work using ambulatory voice recordings has shown no differences in average vocal behavior between patients with phonotraumatic vocal hyperfunction and matched controls. This study used larger groups to replicate these results and expanded the analysis to include distributional characteristics of ambulatory voice use and measures indicative of glottal closure. Method Subjects included 180 adult women: 90 diagnosed with vocal fold nodules or polyps and 90 age-, sex-, and occupation-matched controls with no history of voice disorders. Weeklong summary statistics (average, variability, skewness, kurtosis) of voice use were computed from neck-surface acceleration recorded using an ambulatory voice monitor. Voice measures included estimates of sound pressure level (SPL), fundamental frequency ( f o ), cepstral peak prominence, and the difference between the first and second harmonic magnitudes (H1–H2). Results Statistical comparisons resulted in medium–large differences (Cohen's d ≥ 0.5) between groups for SPL skewness, f o variability, and H1–H2 variability. Two logistic regressions (theory-based and stepwise) found SPL skewness and H1–H2 variability to classify patients and controls based on their weekly voice data, with an area under the receiver operating characteristic curve of 0.85 and 0.82 on training and test sets, respectively. Conclusion Compared to controls, the weekly voice use of patients with phonotraumatic vocal hyperfunction reflected higher SPL tendencies (negatively skewed SPL) with more abrupt glottal closure (reduced H1–H2 variability, especially toward higher values). Further work could examine posttreatment data (e.g., after surgery and/or therapy) to determine the extent to which these differences are associated with the etiology and pathophysiology of phonotraumatic vocal fold lesions.

scholarly journals Changes in a Daily Phonotrauma Index After Laryngeal Surgery and Voice Therapy: Implications for the Role of Daily Voice Use in the Etiology and Pathophysiology of Phonotraumatic Vocal Hyperfunction

2020 ◽  
Vol 63 (12) ◽  
pp. 3934-3944
Author(s):  
Jarrad H. Van Stan ◽  
Daryush D. Mehta ◽  
Andrew J. Ortiz ◽  
James A. Burns ◽  
Katherine L. Marks ◽  
...  
Keyword(s):  
Patient Group ◽  
Vocal Fold ◽  
Second Harmonic ◽  
Voice Therapy ◽  
Laryngeal Surgery ◽  
Vocal Hyperfunction ◽  
The Difference ◽  
Two Parameters ◽  
Voice Use

Purpose This study attempts to gain insights into the role of daily voice use in the etiology and pathophysiology of phonotraumatic vocal hyperfunction (PVH) by applying a logistic regression-based daily phonotrauma index (DPI) to predict group-based improvements in patients with PVH after laryngeal surgery and/or postsurgical voice therapy. Method A custom-designed ambulatory voice monitor was used to collect 1 week of pre- and postsurgery data from 27 female patients with PVH; 13 of these patients were also monitored after postsurgical voice therapy. Normative weeklong data were obtained from 27 matched controls. Each week was represented by the DPI, standard deviation of the difference between the first and second harmonic amplitudes (H1–H2). Results Compared to pretreatment, the DPI significantly decreased in the patient group after surgery (Cohen's d effect size = −0.86) and voice therapy ( d = −1.06). The patient group DPI only normalized after voice therapy. Conclusions The DPI produced the expected pattern of improved ambulatory voice use across laryngeal surgery and postsurgical voice therapy in a group of patients with PVH. The results were interpreted as providing new objective information about the role of daily voice use in the etiology and pathophysiology of PVH. The DPI is viewed as an estimate of potential vocal fold trauma that relies on combining the long-term distributional characteristics of two parameters representing the magnitude of phonatory forces (neck-surface acceleration magnitude) and vocal fold closure dynamics (H1–H2). Further validation of the DPI is needed to better understand its potential clinical use.

scholarly journals Differences in Daily Voice Use Measures Between Female Patients With Nonphonotraumatic Vocal Hyperfunction and Matched Controls

2021 ◽  
pp. 1-14
Author(s):  
Jarrad H. Van Stan ◽  
Andrew J. Ortiz ◽  
Juan P. Cortes ◽  
Katherine L. Marks ◽  
Laura E. Toles ◽  
...  
Keyword(s):  
Matched Control ◽  
Second Harmonic ◽  
Characteristic Curve ◽  
Classification Model ◽  
Control Group ◽  
Matched Control Group ◽  
Unseen Data ◽  
Vocal Hyperfunction ◽  
The Difference ◽  
Voice Use

Purpose The purpose of this study was to obtain a more comprehensive understanding of the pathophysiology and impact on daily voice use of nonphonotraumatic vocal hyperfunction (NPVH). Method An ambulatory voice monitor collected 1 week of data from 36 patients with NPVH and 36 vocally healthy matched controls. A subset of 11 patients with NPVH were monitored after voice therapy. Daily voice use measures included neck-skin acceleration magnitude, fundamental frequency ( f o ), cepstral peak prominence (CPP), and the difference between the first and second harmonic magnitudes (H1–H2). Additional comparisons included 118 patients with phonotraumatic vocal hyperfunction (PVH) and 89 additional vocally healthy controls. Results The NPVH group, compared to the matched control group, exhibited increased f o (Cohen's d = 0.6), reduced CPP ( d = −0.9), and less positive H1–H2 skewness ( d = −1.1). Classifiers used CPP mean and H1–H2 mode to maximally differentiate the NPVH and matched control groups (area under the receiver operating characteristic curve of 0.78). Classifiers performed well on unseen data: the logit decreased in patients with NPVH after therapy; ≥ 85% of the control and PVH groups were identified as “normal” or “not NPVH,” respectively. Conclusions The NPVH group's daily voice use is less periodic (CPP), is higher pitched ( f o ), and has less abrupt vocal fold closure (H1–H2 skew) compared to the matched control group. The combination of CPP mean and H1–H2 mode appears to reflect a pathophysiological continuum in NPVH patients of inefficient phonation with minimal potential for phonotrauma. Further validation of the classification model is needed to better understand potential clinical uses. Supplemental Material https://doi.org/10.23641/asha.14390771

scholarly journals Effectiveness of Body Roundness Index (BRI) and a Body Shape Index (ABSI) in Predicting Hypertension: A Systematic Review and Meta-Analysis of Observational Studies

2021 ◽  
Vol 18 (21) ◽  
pp. 11607
Author(s):  
Julián F. Calderón-García ◽  
Raúl Roncero-Martín ◽  
Sergio Rico-Martín ◽  
Jorge M. De Nicolás-Jiménez ◽  
Fidel López-Espuela ◽  
...  
Keyword(s):  
Body Shape ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Shape Index ◽  
Diagnostic Odds Ratio ◽  
The Body ◽  
Adult Women ◽  
Summary Receiver Operating Characteristic ◽  
The Difference ◽  
A Body Shape Index

Introduction: The body roundness index (BRI) and a body shape index (ABSI) are novel anthropometric indices established to determine both the amount visceral adipose tissue and body fat. Objective: to investigate whether BRI and ABSI are better predictors of hypertension than body mass index (BMI), waist circumference (WC) or waist-to-height ratio (WHtR). Methods: A systematic search was conducted in the Scopus, PubMed and Web of Science databases up until 31 December 2020. Results: The estimated pooled area under curve [AUC (95% CI)] for BRI [0.67 (0.65–0.70)] for the prediction of hypertension were superior to that of ABSI (0.58 (0.56–0.60)), similar to that of BMI [0.67 (0.64–0.69)], and lower than those WC [0.68 (0.66–0.70)] and WHtR [0.68 (0.66–0.71)]. Nevertheless, the difference of BRI compared to WC and WHtR in the context of predicting hypertension was non-significant. ABSI was significantly lower (p < 0.05) than BRI, BMI, WC and WHtR. Similar findings were observed with the summary receiver operating characteristic curve (AUC-SROC). There were no significant differences between subgroups according to type of population or diagnostic criteria of hypertension. The diagnostic odds ratio (dORs) proved that increased BRI and ABSI were related with an elevated hypertension risk. Conclusions: BRI and ABSI have discriminatory power for hypertension in adult women and men from different populations. Although, WHtR and WC provided the best performance when assessing hypertension, no significant differences were found for BRI. Finally, BRI was significantly better predictor of hypertension than ABSI.

S190 – Voice Spectral Analysis After Surface Electrical Stimulation

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P139-P139 ◽  
Author(s):  
Edie Renee Hapner ◽  
Mary Gorham-Rowan ◽  
Richard J. Morris ◽  
Linda P Fowler
Keyword(s):  
Spectral Analysis ◽  
Electrical Stimulation ◽  
Direct Effect ◽  
Vocal Fold ◽  
Second Harmonic ◽  
The Third ◽  
Glottal Closure ◽  
Significant Difference ◽  
Study Participants ◽  
Spectral Tilt

Objectives The purpose of this study was to measure changes in vocal fold closure associated with surface electrical stimulation (VitalStim®). Methods 30 participants, 15 male and 15 female, ages 20–56 years, were included in the study. Participants underwent 1 hour of surface electrical stimulation, per guidelines reported in the VitalStim® manual. 3 trials of the vowel /ae/ were analyzed pre- and post-stimulation. Indirect estimates of glottal closure were obtained from the recorded vowels, as follows: 1) H1–H2: the amplitude of the first harmonic to the second harmonic (open quotient); 2) H1–A1: the ratio of the amplitude of the first harmonic to the amplitude of the first formant (glottal width); and 3) H1–A3: the ratio of the amplitude of the first harmonic to the amplitude of the third formant (spectral tilt). Results The direction and magnitude of change for all 3 parameters varied widely across participants. No significant difference occurred pre- vs. post-stimulation for any of the parameters. Conclusions VitalStim® did not systematically affect open quotient, glottal width, or spectral tilt. These results do not support the concept that VitalStim® has a direct effect upon vocal fold closure.

scholarly journals Changes in the Daily Phonotrauma Index Following the Use of Voice Therapy as the Sole Treatment for Phonotraumatic Vocal Hyperfunction in Females

2021 ◽  
Vol 64 (9) ◽  
pp. 3446-3455
Author(s):  
Jarrad H. Van Stan ◽  
Andrew J. Ortiz ◽  
Katherine L. Marks ◽  
Laura E. Toles ◽  
Daryush D. Mehta ◽  
...  
Keyword(s):  
Patient Group ◽  
Second Harmonic ◽  
Vocal Folds ◽  
Theoretical Framework ◽  
Voice Therapy ◽  
Control Group ◽  
Group Data ◽  
Vocal Hyperfunction ◽  
The Impact ◽  
Voice Use

Purpose The aim of this study was to use the Daily Phonotrauma Index (DPI) to quantify group-based changes in the daily voice use of patients with phonotraumatic vocal hyperfunction (PVH) after receiving voice therapy as the sole treatment. This is part of an ongoing effort to validate an updated theoretical framework for PVH. Method A custom-designed ambulatory voice monitor was used to collect 1 week of pre- and posttreatment data from 52 female patients with PVH. Normative weeklong data were also obtained from 52 matched controls. Each week was represented by the DPI, which is a combination of neck-surface acceleration magnitude skewness and the standard deviation of the difference between the first and second harmonic magnitudes. Results Compared to pretreatment, the DPI statistically decreased towards normal in the patient group after treatment (Cohen's d = −0.25). The posttreatment patient group's DPI was still significantly higher than the control group ( d = 0.68). Conclusions The DPI showed the pattern of improved ambulatory voice use in a group of patients with PVH following voice therapy that was predicted by the updated theoretical framework. Per the prediction, voice therapy was associated with a decreased potential for phonotrauma in daily voice use, but the posttreatment patient group data were still significantly different from the normative control group data. This posttreatment difference is interpreted as reflecting the impact on voice use of the persistence of phonotrauma-induced structural changes to the vocal folds. Further validation of the DPI is needed to better understand its potential clinical use.

scholarly journals Modeling the Pathophysiology of Phonotraumatic Vocal Hyperfunction With a Triangular Glottal Model of the Vocal Folds

2017 ◽  
Vol 60 (9) ◽  
pp. 2452-2471 ◽  
Author(s):  
Gabriel E. Galindo ◽  
Sean D. Peterson ◽  
Byron D. Erath ◽  
Christian Castro ◽  
Robert E. Hillman ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Muscle Activation ◽  
Maximum Flow ◽  
Vocal Folds ◽  
Element Model ◽  
Compensatory Mechanisms ◽  
Glottal Closure ◽  
Vocal Hyperfunction ◽  
Subglottal Pressure ◽  
Lumped Element Model

Purpose Our goal was to test prevailing assumptions about the underlying biomechanical and aeroacoustic mechanisms associated with phonotraumatic lesions of the vocal folds using a numerical lumped-element model of voice production. Method A numerical model with a triangular glottis, posterior glottal opening, and arytenoid posturing is proposed. Normal voice is altered by introducing various prephonatory configurations. Potential compensatory mechanisms (increased subglottal pressure, muscle activation, and supraglottal constriction) are adjusted to restore an acoustic target output through a control loop that mimics a simplified version of auditory feedback. Results The degree of incomplete glottal closure in both the membranous and posterior portions of the folds consistently leads to a reduction in sound pressure level, fundamental frequency, harmonic richness, and harmonics-to-noise ratio. The compensatory mechanisms lead to significantly increased vocal-fold collision forces, maximum flow-declination rate, and amplitude of unsteady flow, without significantly altering the acoustic output. Conclusion Modeling provided potentially important insights into the pathophysiology of phonotraumatic vocal hyperfunction by demonstrating that compensatory mechanisms can counteract deterioration in the voice acoustic signal due to incomplete glottal closure, but this also leads to high vocal-fold collision forces (reflected in aerodynamic measures), which significantly increases the risk of developing phonotrauma.

Update: Behavioral Management of Unilateral Vocal Fold Paralysis and Paresis

2019 ◽  
Vol 4 (3) ◽  
pp. 474-482
Author(s):  
Sarah L. Schneider
Keyword(s):  
Vocal Fold ◽  
Treatment Plan ◽  
Traumatic Injury ◽  
Voice Therapy ◽  
Valuable Insight ◽  
Behavioral Management ◽  
Use Patterns ◽  
Vocal Quality ◽  
And Function ◽  
Voice Use

PurposeVocal fold motion impairment (VFMI) can be the result of iatrogenic or traumatic injury or may be idiopathic in nature. It can result in glottic incompetence leading to changes in vocal quality and ease. Associated voice complaints may include breathiness, roughness, diplophonia, reduced vocal intensity, feeling out of breath with talking, and vocal fatigue with voice use. A comprehensive interprofessional voice evaluation includes auditory-perceptual voice evaluation, laryngeal examination including videostroboscopy, acoustic and aerodynamic voice measures. These components provide valuable insight into laryngeal structure and function and individual voice use patterns and, in conjunction with stimulability testing, help identify candidacy for voice therapy and choice of therapeutic techniques.ConclusionA comprehensive, interprofessional evaluation of patients with VFMI is necessary to assess the role of voice therapy and develop a treatment plan. Although there is no efficacy data to support specific voice therapy techniques for treating VFMI, considerations for various techniques are provided.

Application of a Computer Vision Tool for Automated Glottic Tracking to Vocal Fold Paralysis Patients

2021 ◽  
pp. 019459982198960
Author(s):  
Tiffany V. Wang ◽  
Nat Adamian ◽  
Phillip C. Song ◽  
Ramon A. Franco ◽  
Molly N. Huston ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Assessment Tool ◽  
Medical Center ◽  
Characteristic Curve ◽  
Academic Medical Center ◽  
Vocal Fold Paralysis ◽  
Control Group ◽  
Large Patient ◽  
Patient Reported ◽  
Before And After

Objectives (1) Demonstrate true vocal fold (TVF) tracking software (AGATI [Automated Glottic Action Tracking by artificial Intelligence]) as a quantitative assessment of unilateral vocal fold paralysis (UVFP) in a large patient cohort. (2) Correlate patient-reported metrics with AGATI measurements of TVF anterior glottic angles, before and after procedural intervention. Study Design Retrospective cohort study. Setting Academic medical center. Methods AGATI was used to analyze videolaryngoscopy from healthy adults (n = 72) and patients with UVFP (n = 70). Minimum, 3rd percentile, 97th percentile, and maximum anterior glottic angles (AGAs) were computed for each patient. In patients with UVFP, patient-reported outcomes (Voice Handicap Index 10, Dyspnea Index, and Eating Assessment Tool 10) were assessed, before and after procedural intervention (injection or medialization laryngoplasty). A receiver operating characteristic curve for the logistic fit of paralysis vs control group was used to determine AGA cutoff values for defining UVFP. Results Mean (SD) 3rd percentile AGA (in degrees) was 2.67 (3.21) in control and 5.64 (5.42) in patients with UVFP ( P < .001); mean (SD) 97th percentile AGA was 57.08 (11.14) in control and 42.59 (12.37) in patients with UVFP ( P < .001). For patients with UVFP who underwent procedural intervention, the mean 97th percentile AGA decreased by 5 degrees from pre- to postprocedure ( P = .026). The difference between the 97th and 3rd percentile AGA predicted UVFP with 77% sensitivity and 92% specificity ( P < .0001). There was no correlation between AGA measurements and patient-reported outcome scores. Conclusions AGATI demonstrated a difference in AGA measurements between paralysis and control patients. AGATI can predict UVFP with 77% sensitivity and 92% specificity.

scholarly journals Relationship between Serum Alkaline Phosphatase and Low Muscle Mass Index Among Korean Adults: A Nationwide Population-Based Study

Biomolecules ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 842
Author(s):  
Jun-Hyuk Lee ◽  
A-Ra Cho ◽  
Yong-Jae Lee
Keyword(s):  
Skeletal Muscle ◽  
Alkaline Phosphatase ◽  
Muscle Mass ◽  
Skeletal Muscle Mass ◽  
Serum Alkaline Phosphatase ◽  
Inflammatory Marker ◽  
Characteristic Curve ◽  
Population Based ◽  
Nutrition Survey ◽  
The Difference

Sarcopenia has attracted interest due to its impact on various health problems. Chronic inflammation is an important contributor to sarcopenia. Thus, we aimed to investigate the association between serum alkaline phosphatase (ALP), which is a novel inflammatory marker, and muscle mass. This study included 15,579 adults from the 2008–2011 Korea National Health and Nutrition Survey. Low skeletal muscle mass index (LSMI) was defined as body mass index-adjusted appendicular skeletal muscle mass less than 0.789 for men and 0.512 for women. Multiple logistic regression revealed that the highest ALP tertile was significantly associated with LSMI compared with the lowest ALP tertile in both men [Odds ratio (OR): 1.41; 95% confidence interval (CI): 1.04–1.91] and women (OR: 1.45; 95% CI: 1.00–2.10) after adjusting for other confounders. On the receiver operating characteristic curve analysis, the predictive power was significantly higher for ALP levels than for white blood cell count in women (p < 0.001), whereas the difference was not significant in men (p = 0.515). Our findings suggest the potential use of serum ALP as an inflammatory marker and a predictor of sarcopenia.

scholarly journals 0588 Ring Pulse Oximeter for Screening of Moderate to Severe OSA: A Pilot Study

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A225-A225
Author(s):  
J Xue ◽  
R Zhao ◽  
J Li ◽  
L Zhao ◽  
B Zhou ◽  
...  
Keyword(s):  
Pilot Study ◽  
Pulse Oximeter ◽  
Characteristic Curve ◽  
Diagnostic Value ◽  
Receiver Operator Characteristic Curve ◽  
Oxygen Desaturation ◽  
Significant Difference ◽  
Acceptance Range ◽  
The Difference ◽  
Two Parameters

Abstract Introduction To evaluate the utility of the ring pulse oximeter for screening of OSA in adults. Methods 87 adults were monitored by a ring pulse oximeter and PSG simultaneously during a nocturnal in-lab sleep testing. 3% oxygen desaturation index (ODI3); Mean oxygen saturation(MSpO2), Saturation impair time below 90% (SIT90) derived from an automated algorithm of the ring pulse oximeter. Meanwhile, the parameters of PSG were scored manually according to the AASM Manual. Correlation and receiver operator characteristic curve analysis were used to measure the accuracy of ring pulse oximeter and its diagnostic value for moderate to severe OSA (AHI≥15). Results Among the 87 participants, 18 cases were AHI&lt;5, 17 cases were diagnosed with mild OSA (AHI:5-14.9), 25 cases were diagnosed with moderate OSA (AHI:15-29.9) and 27 cases were diagnosed with severe OSA (AHI≥30). There was no significant difference between PSG and ring pulse oximeter in regard to ODI3 (23.4±23.5 vs 24.7 ± 21.7), and SIT90 (1.54%, range 0.14%-8.99% vs. 3.20%, range 0.60%, 12.30%) (P&gt;0.05], Further analysis indicated that two parameters from the oximeter correlated well with that derived from PSG (r=0.889, 0.567, respectively, both p&lt;0.05). Although MSpO2 correlated significantly (r=0.448, P&lt;0.05), the difference was remarkable [95.9%, range 94.0% to 97.0% vs. 94.5%, range 93.3% to 95.7%, p&lt;0.05]. Bland-Altman plots showed that the agreement of these three parameters was within the clinical acceptance range. The ROC curve showed that the sensitivity and specificity of the ring pulse oximeter when the oximeter derived ODI3 ≥12.5 in the diagnosis of moderate to severe OSA were 82.7% and 74.3%, respectively. Conclusion The pilot study indicated that ring pulse oximeter can detect oxygen desaturation events accurately, therefore to be used as a screening tool for moderate to severe OSA. Support The study was supported by the National Natural Science Foundation of China (No. 81420108002 and NO. 81570083).

Sign in / Sign up

Export Citation Format

Share Document