Comparison of Maximum Phonation Time Associated with the Changes in Vocal Intensity in Patients with Unilateral Vocal Fold Palsy and Sulcus Vocalis

Abstract Purpose Endoscopic arytenoid abduction lateropexy (EAAL) is a reliable surgical solution for the minimally invasive treatment of bilateral vocal fold palsy (BVFP), providing a stable airway by the lateralization of the arytenoid cartilages with a simple suture. The nondestructive manner of the intervention theoretically leads to higher regeneration potential, thus better voice quality. The study aimed to investigate the respiratory and phonatory outcomes of this treatment concept. Methods 61 BVFP patients with significant dyspnea associated with thyroid/parathyroid surgery were treated by unilateral EAAL. Jitter, Shimmer, Harmonics to Noise Ratio, Maximum Phonation Time, Fundamental frequency, Voice Handicap Index, Dysphonia Severity Index, Friedrich’s Dysphonia Index, Global-Roughness-Breathiness scale, Quality of Life, and Peak Inspiratory Flow were evaluated 18 months after EAAL. Results All patients had a stable and adequate airway during the follow-up. Ten patients (16.4%) experienced complete bilateral motion recovery with objective acoustic parameters in the physiological ranges. Most functional results of the 13 patients (21.3%) with unilateral recovery also reached the normal values. Fifteen patients (24.6%) had unilateral adduction recovery only, with slightly impaired voice quality. Eleven patients (18.0%) had false vocal fold phonation with socially acceptable voice. In 12 patients (19.7%) no significant motion recovery was detected on the glottic level. Conclusion EAAL does not interfere with the potential regeneration process and meets the most important phoniatric requirements while guaranteeing the reversibility of the procedure—therefore serving patients with transient palsy. Further, a socially acceptable voice quality and an adequate airway are ensured even in cases of permanent bilateral vocal fold paralysis.

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Impact of speech therapy on the improvement of voice quality in patients with unilateral vocal fold paralysis

Polski Przegląd Otorynolaryngologiczny ◽

10.5604/01.3001.0012.7783 ◽

2018 ◽

Vol 7 (4) ◽

pp. 1-7

Author(s):

Anna Kuligowska ◽

Barbara Jamróz ◽

Joanna Chmielewska ◽

Katarzyna Jędra ◽

Tomasz Czernicki ◽

...

Keyword(s):

Vocal Fold ◽

Speech Therapy ◽

Acoustic Analysis ◽

Vocal Tract ◽

Voice Quality ◽

Maximum Phonation Time ◽

Before And After ◽

Vocal Fold Palsy ◽

The Voice

Aim of study: Evaluation of the speech therapy on voice quality in patients with unilateral vocal fold palsy. Material and methods: The study group included 11 patients, 8 women and 3 men, in age between 16 to 72 years, with unilateral vocal fold palsy, diagnosed in ENT Department of Warsaw Medical University between 2017-2018. Each person completed questionnaires: the voice disability self-assessment scale (VHI), the voice-based quality of life (VRQoL) scale, the vocal tract discomfort scale (VTD). All questionnaires were completed twice, before and after the voice therapy. In addition, the acoustic analysis of the voice, the assessment of the maximum phonation time and the breathing tract were performed twice in each patient. Each of the patients had a voice rehabilitation consisting of a series of 10 meetings. Results: Statistical analysis of the results of maximum phonation time, the self-assessment of voice disability, the quality of life depending on the voice, discomfort of the vocal tract voice acoustic analysis showed statistically significant differences in the results before and after rehabilitation (p <0.005). In addition, the improvement of the respiratory tract was observed in the majority of patients. Conclusions: Speech therapy significantly affects the voice quality of patients with unilateral laryngeal nerve palsy.

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The Reliability of Vocal Intensity and Pitch Range in Unilateral Vocal Fold Palsy Patients

Acta Scientific Otolaryngology ◽

10.31080/asol.2021.03.0229 ◽

2021 ◽

Vol 3 (5) ◽

pp. 94-100

Author(s):

Siti Nurfarhana Mohd Arif ◽

Mawaddah Azman ◽

Sharifa Ezat Wan Puteh ◽

Nur Shahrina Mohd Zawawi ◽

Abdullah Sani ◽

...

Keyword(s):

Vocal Fold ◽

Pitch Range ◽

Vocal Fold Palsy ◽

Vocal Intensity

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Outcome Analysis in Patients with Benign Vocal Fold Lesions

International Journal of Phonosurgery & Laryngology ◽

10.5005/jp-journals-10023-1111 ◽

2016 ◽

Vol 6 (1) ◽

pp. 8-13 ◽

Cited By ~ 2

Author(s):

Arpit Sharma ◽

Jyoti Dabholkar ◽

Nitish Virmani

Keyword(s):

Vocal Cord ◽

Vocal Fold ◽

Treatment Modalities ◽

Outcome Analysis ◽

Accurate Analysis ◽

Maximum Phonation Time ◽

Multidimensional Assessment ◽

Benign Vocal Fold Lesions ◽

Sulcus Vocalis ◽

Vocal Nodules

ABSTRACT Introduction Benign vocal cord lesions cause significant dysphonia by disrupting the normal vibratory function of the vocal fold mucosa. Multidimensional assessment of voice characteristics allows for an accurate analysis of voice impairment and can be used to assess the outcome of different treatment modalities. Aims To evaluate the outcome in patients treated for benign vocal fold lesions using multidimensional voice assessment Materials and methods Thirty adult patients with benign vocal fold lesions were treated according to standard protocols and followed up for 6 months. Voice was evaluated by visual analog scale (VAS), GRBAS (grade, roughness, breathiness, asthenia, strain) scale, maximum phonation time (MPT), S/Z ratio, and acoustic parameters using PRAAT. Pre- and posttreatment voice was compared. Results Benign lesions observed were vocal polyps (16), vocal nodules (7), vocal fold cysts (5), vocal cord papilloma (1), and sulcus vocalis (1). Mean VAS rating improved from 7.5 to 2 at 3 months and 1.6 at 6 months. Mean GRBAS score improved from 7.5 to 2.96 at 3 months and 2.3 at 6 months. Maximum phonation time increased from 9.43 seconds to 14.16 seconds at 3 months and 14.46 seconds at 6 months. S/Z ratio reduced from 1.37 to 1.16 at 3 months and 1.15 at 6 months. Jitter reduced from 1.81 to 1% at 3 months and 0.97% at 6 months; shimmer decreased from 6.07 to 2.19% at 3 months and to 2.03% at 6 months. Harmonic-to-noise ratio values improved from 8.01 to 10.78 dB at 3 months and 10.96 dB at 6 months; mean F0 increased from 207.27 to 217.89 Hz at 3 months and 219.65 Hz at 6 months. Conclusion A single measurement of voice cannot be used as a reliable outcome measure. Perceptual, aerodynamic, acoustic, and self-analysis together allow a multidimensional assessment of voice characteristics. How to cite this article Virmani N, Sharma A, Dabholkar J. Outcome Analysis in Patients with Benign Vocal Fold Lesions. Int J Phonosurg Laryngol 2016;6(1):8-13.

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Sleep-Related Breathing Disorders in Patients With Multiple System Atrophy and Vocal Fold Palsy

SLEEP ◽

10.1093/sleep/19.6.479 ◽

1996 ◽

Vol 19 (6) ◽

pp. 479-484 ◽

Cited By ~ 37

Author(s):

Tatsuya Sadaoka ◽

Noriya Kakitsuba ◽

Yuki Fujiwara ◽

Ryuichi Kanai ◽

Hiroaki Takahashi

Keyword(s):

Multiple System Atrophy ◽

Vocal Fold ◽

Sleep Related Breathing Disorders ◽

Breathing Disorders ◽

Vocal Fold Palsy

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Comments on the Myoelastic - Aerodynamic Theory of Phonation

Journal of Speech Language and Hearing Research ◽

10.1044/jshr.2303.495 ◽

1980 ◽

Vol 23 (3) ◽

pp. 495-510 ◽

Cited By ~ 60

Author(s):

Ingo R. Titze

Keyword(s):

Vocal Fold ◽

Vocal Tract ◽

Driving Forces ◽

Vibrational Amplitude ◽

Subglottal Pressure ◽

Vertical Displacements ◽

Vocal Intensity ◽

Tissue Deformations ◽

Chest Voice ◽

Phase Differences

The myoelastic-aerodynamic theory of phonation has been quantified and tested with mathematical models. The models suggest that vocal fold oscillation is produced as a result of asymmetric forcing functions over closing and opening portions of the glottal cycle. For nearly uniform tissue displacements, as in falsetto voice, the asymmetry in the driving forces can result from the inertia of the air moving through the glottis. This inertia can in turn be enhanced or suppressed by supraglottal or subglottal vocal tract coupling. More obvious and pronounced asymmetries in the driving forces are associated with non-uniform vocal fold tissue displacements. These are combinations of normal tissue modes, and can result in vertical and horizontal phase differences along the surfaces, as observed in chest voice. The ranges of oscillation increase among various models as more freedom in the simulated tissue movement is incorporated. Of particular significance in initiating and maintaining oscillation are the vertical motions that facilitate coupling of aerodynamic energy into the tissues and allow tissue deformations under conditions of incompressibility. Vertical displacements also can have a significant effect on vocal tract excitation. Control of fundamental frequency of oscillation (FO) is basically myoelastic, partially as a result of deliberate or reflex adjustments of laryngeal muscles, and partially as a result of nonlinear tissue strain over the vibrational cycle. This places limits on the control of FO by subglottal pressure, and forces such control to be inseparably connected with vibrational amplitude, or less directly, with vocal intensity.

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