Phonomicrosurgery in Vocal Fold Nodules: Quantification of Outcomes in Professional and Non-Professional Voice Users

There are few data demonstrating the specific extent to which surgical intervention for vocal fold nodules (VFN) improves vocal function in professional (PVU) and non-professional voice users (NVU). The objective of this study was to compare and quantify results after phonomicrosurgery for VFN in these patient groups. METHODS: In a prospective clinical study, surgery was performed via microlaryngoscopy in 37 female patients with chronic VFN manifestations (38±12 yrs, mean±SD). Pre- and postoperative evaluations of treatment efficacy comprised videolaryngostroboscopy, auditory-perceptual voice assessment, voice range profile (VRP), acoustic-aerodynamic analysis, and voice handicap index (VHI-9i). The dysphonia severity index (DSI) was compared with the vocal extent measure (VEM). RESULTS: PVU (n=24) and NVU (n=13) showed comparable laryngeal findings and levels of suffering (VHI-9i 16±7 vs 17±8), but PVU had a better pretherapeutic vocal range (26.8±7.4 vs 17.7±5.1 semitones, p<0.001) and vocal capacity (VEM 106±18 vs 74±29, p<0.01). Three months postoperatively, all patients had straight vocal fold edges, complete glottal closure, and recovered mucosal wave propagation. The mean VHI-9i score decreased by 8±6 points. DSI increased from 4.0±2.4 to 5.5±2.4, and VEM from 95±27 to 108±23 (p<0.001). Both parameters correlated significantly (rs=0.82). The average vocal range increased by 4.1±5.3 semitones, and the mean speaking pitch lowered by 0.5±1.4 semitones. CONCLUSIONS: These results confirm that phonomicrosurgery for VFN is a safe therapy for voice improvement in both PVU and NVU who do not respond to voice therapy alone. Top-level artistic capabilities in PVU were restored, but numeric changes of most vocal parameters were considerably larger in NVU.

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The comparative assessment of the vocal function in the professional voice users and non-occupational voice users in the late adulthood

Vestnik otorinolaringologii ◽

10.17116/otorino201782338-41 ◽

2017 ◽

Vol 82 (3) ◽

pp. 38

Author(s):

O. G. Pavlikhin ◽

S. G. Romanenko ◽

D. I. Krasnikova ◽

E. V. Lesogorova ◽

V. S. Yakovlev

Keyword(s):

Comparative Assessment ◽

Late Adulthood ◽

Vocal Function ◽

Professional Voice Users ◽

Professional Voice

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Vocal Fold Steroid Injection for Benign Vocal Lesions in Professional Voice Users

Journal of Voice ◽

10.1016/j.jvoice.2021.02.002 ◽

2021 ◽

Author(s):

Chien-Hao Wu ◽

Wu-Chia Lo ◽

Li-Jen Liao ◽

Yi-Chia Kao ◽

Chi-Te Wang

Keyword(s):

Vocal Fold ◽

Steroid Injection ◽

Professional Voice Users ◽

Professional Voice

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Normative Voice Range Profiles of Male and Female Professional Voice Users

Journal of Voice ◽

10.1016/s0892-1997(02)00065-6 ◽

2002 ◽

Vol 16 (1) ◽

pp. 1-7 ◽

Cited By ~ 32

Author(s):

L Heylen ◽

F.L Wuyts ◽

F Mertens ◽

M De Bodt ◽

P.H Van de Heyning

Keyword(s):

Male And Female ◽

Professional Voice Users ◽

Voice Range ◽

Professional Voice

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Prevalence of Benign Vocal Fold Lesions in Ear, Nose, and Throat Outpatient Unit of Dr. Soetomo General Hospital, Surabaya, Indonesia

Biomolecular and Health Science Journal ◽

10.20473/bhsj.v3i1.19103 ◽

2020 ◽

Vol 3 (1) ◽

pp. 37

Author(s):

Lucia Miranti Hardianingwati ◽

Diar Mia Ardani

Keyword(s):

Vocal Cord ◽

Vocal Fold ◽

Sound Production ◽

Age Group ◽

Group Iii ◽

Outpatient Unit ◽

Benign Vocal Fold Lesions ◽

Professional Voice Users ◽

Professional Voice ◽

Nose And Throat

Introduction: Benign vocal fold lesions reduce the efficiency of sound production. Reports of dysphonia cases caused by vocal principles in Indonesia are still very limited. This study aimed to determine incidence and prevalence of benign vocal fold lesions, namely vocal cord nodules, cysts, and polyps.Methods: A descriptive retrospective study was conducted using patient’s medical record of Ear, Nose, and Throat (ENT) Outpatient Unit. Dysphonia patients with benign vocal cord abnormalities were identified. The data analyzed using descriptive analytic.Results: There were 20 patients with benign vocal fold lesions, consisting of 13 patients (65%) with nodules, 3 patients (15%) with polyps, and 4 patients (20%) with cysts. The ratio of male and female patients was 1: 1. Most patients belonged to age group of 20-59 years (12 patients; 60%). In term of occupation, most patients belonged to group III, which is a group of workers who are not professional voice users (12 patients; 60%). Most vocal fold lesions were found in the 1/3 of bilateral anterior (17 patients; 85%). Most therapy was non-operative in 13 patients (65%). Conclusion: Benign vocal fold lesions, including vocal cord nodules, polyps, and cysts, are found in all patients with dysphonic complaints. The prevalence of dysphonia symptoms is quite high every year, but only a small portion are diagnosed with benign vocal cord lesion.

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Estimation of Subglottal Pressure, Vocal Fold Collision Pressure, and Intrinsic Laryngeal Muscle Activation From Neck-Surface Vibration Using a Neural Network Framework and a Voice Production Model

Frontiers in Physiology ◽

10.3389/fphys.2021.732244 ◽

2021 ◽

Vol 12 ◽

Author(s):

Emiro J. Ibarra ◽

Jesús A. Parra ◽

Gabriel A. Alzamendi ◽

Juan P. Cortés ◽

Víctor M. Espinoza ◽

...

Keyword(s):

Vocal Fold ◽

Muscle Activation ◽

Production Model ◽

Vocal Function ◽

Voice Production ◽

Laryngeal Muscle ◽

Surface Vibration ◽

Subglottal Pressure ◽

The Mean ◽

Collision Pressure

The ambulatory assessment of vocal function can be significantly enhanced by having access to physiologically based features that describe underlying pathophysiological mechanisms in individuals with voice disorders. This type of enhancement can improve methods for the prevention, diagnosis, and treatment of behaviorally based voice disorders. Unfortunately, the direct measurement of important vocal features such as subglottal pressure, vocal fold collision pressure, and laryngeal muscle activation is impractical in laboratory and ambulatory settings. In this study, we introduce a method to estimate these features during phonation from a neck-surface vibration signal through a framework that integrates a physiologically relevant model of voice production and machine learning tools. The signal from a neck-surface accelerometer is first processed using subglottal impedance-based inverse filtering to yield an estimate of the unsteady glottal airflow. Seven aerodynamic and acoustic features are extracted from the neck surface accelerometer and an optional microphone signal. A neural network architecture is selected to provide a mapping between the seven input features and subglottal pressure, vocal fold collision pressure, and cricothyroid and thyroarytenoid muscle activation. This non-linear mapping is trained solely with 13,000 Monte Carlo simulations of a voice production model that utilizes a symmetric triangular body-cover model of the vocal folds. The performance of the method was compared against laboratory data from synchronous recordings of oral airflow, intraoral pressure, microphone, and neck-surface vibration in 79 vocally healthy female participants uttering consecutive /pæ/ syllable strings at comfortable, loud, and soft levels. The mean absolute error and root-mean-square error for estimating the mean subglottal pressure were 191 Pa (1.95 cm H2O) and 243 Pa (2.48 cm H2O), respectively, which are comparable with previous studies but with the key advantage of not requiring subject-specific training and yielding more output measures. The validation of vocal fold collision pressure and laryngeal muscle activation was performed with synthetic values as reference. These initial results provide valuable insight for further vocal fold model refinement and constitute a proof of concept that the proposed machine learning method is a feasible option for providing physiologically relevant measures for laboratory and ambulatory assessment of vocal function.

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Acoustic Analysis of Voice in School Teachers

Journal of Nepal Medical Association ◽

10.31729/jnma.3626 ◽

2018 ◽

Vol 56 (211) ◽

pp. 658-661 ◽

Cited By ~ 2

Author(s):

Nain Bahadur Mahato ◽

Meera Bista ◽

Deepak Regmi ◽

Pema Sherpa

Keyword(s):

Fundamental Frequency ◽

Tissue Damage ◽

Vocal Fold ◽

Teaching Practice ◽

Acoustic Analysis ◽

School Teachers ◽

Maximum Phonation Time ◽

Professional Voice Users ◽

Professional Voice

Introduction: The term ‘voice' is the acoustic energy generated from the vocal tract that are characterized by their dependence on vocal fold vibratory pattern. Teachers as professional voice users are afflicted with dysphonia and are discouraged with their jobs and seek alternative employment. Loud speaking and voice straining may lead to vocal fatigue and vocal fold tissue damage. Methods: Sixty teachers from various schools, volunteered to participate in this study. Acoustic analysis Doctor Speech Tiger Electronics, USA was used to assess the voice quality of the school teachers before and after teaching practice. The data were collected and analyzed using Doctor Speech Tiger Electronics, USA. Analysis was performed in terms of perturbation (jitter and shimmer), fundamental frequency, harmonic to noise ratio and maximum phonation time. Results: We found statistically significant difference in all the four parameters except the Jitter value. The fundamental frequency and shimmer value has significantly increased (P<0.001) and (P=0.002) respectively after teaching practice. Unlikely, there was significant decrease in harmonic to noise ratio value (P<0.001) and maximum phonation time value (P<0.01) after teaching practice. Conclusions: Vocal abuse, overuse, or misuse in teaching practice over a long period of time can result in inadequate phonatory pattern due to vocal fold tissue damage, which ultimately results in vocal nodules or polyps. So voice evaluation is particularly important for professional voice users and for the people who are concerned about their quality of voice.

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The importance of the occupational vocal load for the occurence and treatment of organic voice disorders

Slovenian Journal of Public Health ◽

10.1515/sjph-2018-0003 ◽

2018 ◽

Vol 57 (1) ◽

Author(s):

Miha Zabret ◽

Irena Hočevar Boltežar ◽

Maja Šereg Bahar

Keyword(s):

Vocal Fold ◽

Voice Disorders ◽

Speaking Rate ◽

Work Related ◽

Tertiary Centre ◽

Benign Vocal Fold Lesions ◽

Professional Voice Users ◽

Clinical Records ◽

The Voice ◽

Professional Voice

AbstractIntroductionThe voice represents a basic working tool for carrying out certain occupations. Hoarseness, as a consequence of vocal fold lesions, presents an important cause of work-related absences for voice professionals.MethodsOur study was designed as a retrospective cohort one. Data on gender, workplace, vocal load and exposure to risk factors for voice disorders of the patients who had surgery in the 2014-2015 period at the tertiary centre due to benign vocal fold lesions were collected from their clinical records. We compared professional voice users (PVU) to subjects with no vocal load at work (NPVU). The SPSS programme, version 22.0, was used for statistical analysis.ResultsFrom 2014 to 2015, 103 PVU and 132 NPVU were surgically treated for benign vocal fold lesions. In comparison to the second group, loud speech use was reported significantly more often by PVU (40.8% vs. 14.4%), as was a fast speaking rate (22.3% vs. 9.8%) and additional vocal load outside of the workplace (23.3% vs. 12.9%). The time that had passed between the occurrence of the hoarseness and the surgical treatment did not differ between the groups. The majority of patients were satisfied with the outcome of the operation.ConclusionsNearly a half of the operated patients had a considerable vocal load at work. An ENT assessment prior to starting a job as well as priority phoniatric treatment of voice disorders for PVU would significantly reduce the costs of work absences and contribute to a speedier recovery and return to the workplace.

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Profile of Laryngeal Microsurgeries in Patients Over 60 Years Old

International Archives of Otorhinolaryngology ◽

10.1055/s-0039-1698780 ◽

2020 ◽

Vol 24 (01) ◽

pp. e53-e61

Author(s):

Caroline Fernandes Rimoli ◽

Evaldo Dacheux Macedo Filho ◽

Maria Theresa Costa Ramos Oliveira Patrial ◽

Cynthia Fontoura Klas ◽

Giovana Aryane Nascimento

Keyword(s):

Private Hospital ◽

The Elderly ◽

Cross Sectional ◽

Associated Lesions ◽

Professional Voice Users ◽

Male Patients ◽

The Mean ◽

Cross Sectional Design ◽

Reinke Edema ◽

Professional Voice

Abstract Introduction The increase in life expectancy is an incentive to the development of researches with the elderly population aiming at actions that may ensure healthy and active aging. Objective To analyze the profile of laryngeal microsurgery performed in patients > 60 years old. Methods A retrospective observational study, with a cross-sectional design. A retrospective analysis of the medical records of elderly patients submitted to laryngeal microsurgery was performed at a private hospital in Curitiba, state of Paraná, Brazil, between January 2004 and December 2016. Were included all of the patients > 60 years old that underwent laryngeal microsurgery during this period. Results During the studied period, 213 laryngeal microsurgeries were performed in 181 patients > 60 years old. There was a preponderance of male patients. The mean age was 67.6 years old. Squamous cell carcinoma (SCC) was the most prevalent disorder (26%), followed by Reinke edema (20%), papillomatosis (14%), polyps (11%), leukoplakia (8%), minor structural alterations (8%), associated lesions (9%), and others (4%). Men presented a higher probability of SCC diagnosis, regardless of the age group, while Reinke edema was more frequently observed in women. A directly proportional relation between the frequency of laryngeal cancer and age increase was also observed. No significant differences were observed in professional voice users. Conclusion Further researches are required to properly comprehend the factors associated with laryngeal lesions and determine prevention and treatment approaches.

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Treatment of Hemorrhagic Vocal Polyps by Pulsed Dye Laser-Assisted Laryngomicrosurgery

BioMed Research International ◽

10.1155/2015/820654 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 10

Author(s):

Hyung Kwon Byeon ◽

Ji Hyuk Han ◽

Byeong Il Choi ◽

Hye Jin Hwang ◽

Ji-Hoon Kim ◽

...

Keyword(s):

Surgical Technique ◽

Vocal Fold ◽

Surgical Techniques ◽

Dye Laser ◽

Pulsed Dye Laser ◽

Vocal Polyp ◽

Promising Treatment ◽

Surgical Field ◽

Professional Voice Users ◽

Professional Voice

Objective. Conventional surgical techniques of laryngomicrosurgery (LMS) on hemorrhagic vocal polyps are often difficult due to obscuration of the surgical field by inadvertent bleeding from the lesion, and there are often significant amounts of mucosal epithelium loss. Here, we introduce our surgical technique using pulsed dye laser (PDL), which can effectively resect the polyp with vocal fold mucosa preservation.Methods. Patients who were diagnosed with hemorrhagic vocal polyp and who were surgically managed using PDL from March 2013 to October 2014 were retrospectively reviewed. Preoperative and postoperative clinical outcomes and surgical findings were evaluated.Results. A total of 39 patients were treated with PDL-assisted enucleation LMS. The average age was 43.7 years (range 20–73), and there were 20 males and 19 females (17 professional voice users). In all cases, the hemorrhagic polyp was successfully enucleated after application of PDL, thereby preserving the overlying epithelium. Postoperative voice outcomes were favorable with clear preservation of the vocal fold mucosal wave.Conclusion. PDL-assisted enucleation LMS for the treatment of hemorrhagic vocal polyps can be a safe and effective surgical technique. It can be considered a promising treatment option for hemorrhagic vocal polyps.

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