Does neuromonitoring affect voice quality in patients subjected to a complete thyroidectomy ?

2021 ◽  
Vol 75 (5) ◽  
pp. 1-8
Author(s):  
Piotr Bryk ◽  
Stanislaw Głuszek
Keyword(s):  
Vocal Fold ◽  
Vocal Tract ◽  
Voice Quality ◽  
Recurrent Laryngeal Nerve Injury ◽  
Control Group ◽  
Study Group ◽  
Laryngeal Nerves ◽  
Vocal Fold Palsy ◽  
Recurrent Laryngeal Nerves ◽  
The Voice

Voice dysfunction is the most common complication of thyroid surgery. The use of intraoperative neuromonitoring (IONM) is to protect the recurrent laryngeal nerves, the damage of which causes voice dysfunction. The aim of the study was to evaluate voice quality in patients who underwent complete thyroidectomy operated on with the application of IONM as well as a group of patients operated on with only macroscopic nerve visualization. In the analysis, clinical voice assessment was performed with particular focus on voice efficiency using the Voice Handicap Index (VHI), Vocal Tract Discomfort (VTD) and GRBAS scale. The study group consisted of 205 patients operated on with IONM. The control group consisted of 162 patients subjected to surgery only with macroscopic visualization of recurrent laryngeal nerves, without IONM. During the follow-up period from 2 to 10 years after surgery, checkups were performed. Each patient who came for a checkup was subjected to perceptual voice evaluation with the use of the GRBAS scale, indirect laryngoscopy procedure and voice selfevaluation with two questionnaires (VHI and VTD). The frequency of vocal fold palsy did not differ significantly statistically in the study group and the control group. Both in the study group and in the control group, patients with vocal fold paralysis had statistically significantly higher results in the VHI and VTD questionnaires as well as in the GRBAS study. Patients with recurrent laryngeal nerve injury show significant differences in the scope of voice handicap, both in the voice quality assessment with the use of the GRBAS scale, and self-evaluation questionnaires: VHI and VTD. All voice disorders evaluated with self-assessment are medium voice disability.

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

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.

scholarly journals The Effect of Intraoperative Neuromonitoring on Damage to the Laryngeal Nerves in Patients Undergoing Total Thyroidectomy.

2021 ◽  
Author(s):  
Piotr Bryk ◽  
Stanisław Głuszek
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Nodular Goiter ◽  
Intraoperative Neuromonitoring ◽  
Laryngeal Nerve ◽  
Control Group ◽  
Study Group ◽  
Laryngeal Nerves ◽  
Recurrent Laryngeal Nerves

Abstract Background: Assessment of intraoperative neuromonitoring in the prevention of damage to the recurrent laryngeal nerve during total thyroidectomy.Material and methods: A group of 367 patients qualified for the study, including 312 women (85.01%) and 55 (14.99%) men, aged 18-79, having undergone total thyroidectomy due to a neutral nodular goiter. The patients were operated on by one surgeon. The study group consisted of 205 patients, including 173 (84.39%) women and 32 (15.61%) men, aged 19-79, who were operated on with the use of intraoperative neuromonitoring. The control group consisted of 162 patients, including 139 (85.80%) women and 23 (14.20%) men, aged 18-77 years, who had undergone surgery only with macroscopic visualization of the recurrent laryngeal nerve without the application of intraoperative neuromonitoring. Then, in the period from 2 to 10 years after the surgery, follow-up examinations were performed, which included 153 patients from the control group (74.6% [153/205]) and 122 patients from the study group (75.3% [122 / 162] Results: The frequency of vocal fold palsy did not differ significantly statistically in the study group and the control group (study group: 4.9% [10/205], control group: 4.9% [8/162]; p = 0.979). In the follow-up study, the incidence of laryngeal fold palsy did not show statistically significant differences between the study and control groups. Most of the damage to the recurrent laryngeal nerves was persistent.Conclusions: Neuromonitoring did not reduce the number of recurrent laryngeal nerve injuries in relation to the nerve visualization alone in noncapsular total thyroidectomy for benign nodular goiter, performed by the same experienced surgeon.

scholarly journals Impact of Vocal Tract Resonance on the Perception of Voice Quality Changes Caused by Varying Vocal Fold Stiffness

2016 ◽  
Vol 102 (2) ◽  
pp. 209-213 ◽  
Author(s):  
Rosario Signorello ◽  
Zhaoyan Zhang ◽  
Bruce Gerratt ◽  
Jody Kreiman
Keyword(s):  
Vocal Fold ◽  
Vocal Tract ◽  
Voice Quality ◽  
Quality Changes ◽  
Vocal Tract Resonance

scholarly journals A Randomized Controlled Trial of Two Semi-Occluded Vocal Tract Voice Therapy Protocols

2015 ◽  
Vol 58 (3) ◽  
pp. 535-549 ◽  
Author(s):  
Mara R. Kapsner-Smith ◽  
Eric J. Hunter ◽  
Kimberly Kirkham ◽  
Karin Cox ◽  
Ingo R. Titze
Keyword(s):  
Quality Of Life ◽  
Vocal Tract ◽  
Controlled Trial ◽  
Voice Quality ◽  
Voice Handicap Index ◽  
Voice Therapy ◽  
Control Group ◽  
Perceptual Evaluation ◽  
Therapy Program

PurposeAlthough there is a long history of use of semi-occluded vocal tract gestures in voice therapy, including phonation through thin tubes or straws, the efficacy of phonation through tubes has not been established. This study compares results from a therapy program on the basis of phonation through a flow-resistant tube (FRT) with Vocal Function Exercises (VFE), an established set of exercises that utilize oral semi-occlusions.MethodTwenty subjects (16 women, 4 men) with dysphonia and/or vocal fatigue were randomly assigned to 1 of 4 treatment conditions: (a) immediate FRT therapy, (b) immediate VFE therapy, (c) delayed FRT therapy, or (d) delayed VFE therapy. Subjects receiving delayed therapy served as a no-treatment control group.ResultsVoice Handicap Index (Jacobson et al., 1997) scores showed significant improvement for both treatment groups relative to the no-treatment group. Comparison of the effect sizes suggests FRT therapy is noninferior to VFE in terms of reduction in Voice Handicap Index scores. Significant reductions in Roughness on the Consensus Auditory-Perceptual Evaluation of Voice (Kempster, Gerratt, Verdolini Abbott, Barkmeier-Kraemer, & Hillman, 2009) were found for the FRT subjects, with no other significant voice quality findings.ConclusionsVFE and FRT therapy may improve voice quality of life in some individuals with dysphonia. FRT therapy was noninferior to VFE in improving voice quality of life in this study.

scholarly journals Multidimensional acoustic analysis of pathological voice

2009 ◽  
Vol 137 (5-6) ◽  
pp. 234-238
Author(s):  
Mirjana Petrovic-Lazic ◽  
Snezana Babac ◽  
Zoran Ivankovic ◽  
Rade Kosanovic
Keyword(s):  
Vocal Fold ◽  
Acoustic Analysis ◽  
Control Group ◽  
Acoustic Parameters ◽  
Vocal Rehabilitation ◽  
Voice Treatment ◽  
Before And After ◽  
The Voice ◽  
Vocal Fold Nodules ◽  
Pathological Voice

Introduction. There are subjective and objective ways to examine the effects of vocal therapy in voice disorders. The most precise and objective check-up is the use of computer voice analysis. Objective. The aim of the research was to perform a detailed analysis of acoustic structure of the vowel A before and after voice treatment in patients with vocal fold nodules in order to obtain objective verification of the vocal rehabilitation success. Methods. We examined 30 female patients, aged 34.6?6.69 years, with vocal fold nodules. Acoustic parameters of voice were compared with the control group consisting of 21 subjects without voice pathology. In all persons the vowel A was recorded and analyzed before and after a month of vocal therapy. The success of the vocal therapy was tracked using computer analysis of vocal structure. Signal, noise and tremor parameters were processed. Results. Of the analyzed vowel A parameters: STD, PER, JITA, JITT, RAP, vFO, ShdB, SHIM, APQ, VTI, SPI, F0, NHR, FTRI, eleven improved (p<0.05 and p<0.01). Three parameters (F0, NHR, FTRI) changed showing improvement, but the obtained differences were not statistically significant (p>0.05). Conclusion. Based on the obtained results it was concluded that vocal therapy gave satisfactory results, but that it should be continually applied until full stabilization of the voice.

scholarly journals Functional results of endoscopic arytenoid abduction lateropexy for bilateral vocal fold palsy

2021 ◽  
Author(s):  
László Rovó ◽  
Vera Matievics ◽  
Balázs Sztanó ◽  
László Szakács ◽  
Dóra Pálinkó ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Voice Quality ◽  
Functional Results ◽  
Severity Index ◽  
Invasive Treatment ◽  
Maximum Phonation Time ◽  
Motion Recovery ◽  
Bilateral Vocal Fold Paralysis ◽  
Vocal Fold Palsy ◽  
False Vocal

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.

Phonetics of Singing in Western Classical Style

2018 ◽  
Author(s):  
Johan Sundberg
Keyword(s):  
Fundamental Frequency ◽  
Vocal Fold ◽  
Vocal Tract ◽  
Formant Frequency ◽  
Vowel Identification ◽  
Fundamental Frequencies ◽  
Vocal Fold Vibration ◽  
Syllable Duration ◽  
Classical Singing ◽  
The Voice

The function of the voice organ is basically the same in classical singing as in speech. However, loud orchestral accompaniment has necessitated the use of the voice in an economical way. As a consequence, the vowel sounds tend to deviate considerably from those in speech. Male voices cluster formant three, four, and five, so that a marked peak is produced in spectrum envelope near 3,000 Hz. This helps them to get heard through a loud orchestral accompaniment. They seem to achieve this effect by widening the lower pharynx, which makes the vowels more centralized than in speech. Singers often sing at fundamental frequencies higher than the normal first formant frequency of the vowel in the lyrics. In such cases they raise the first formant frequency so that it gets somewhat higher than the fundamental frequency. This is achieved by reducing the degree of vocal tract constriction or by widening the lip and jaw openings, constricting the vocal tract in the pharyngeal end and widening it in the mouth. These deviations from speech cause difficulties in vowel identification, particularly at high fundamental frequencies. Actually, vowel identification is almost impossible above 700 Hz (pitch F5). Another great difference between vocal sound produced in speech and the classical singing tradition concerns female voices, which need to reduce the timbral differences between voice registers. Females normally speak in modal or chest register, and the transition to falsetto tends to happen somewhere above 350 Hz. The great timbral differences between these registers are avoided by establishing control over the register function, that is, over the vocal fold vibration characteristics, so that seamless transitions are achieved. In many other respects, there are more or less close similarities between speech and singing. Thus, marking phrase structure, emphasizing important events, and emotional coloring are common principles, which may make vocal artists deviate considerably from the score’s nominal description of fundamental frequency and syllable duration.

Vocal fold paralysis: role of bilateral transverse cordotomy

2009 ◽  
Vol 123 (12) ◽  
pp. 1348-1351 ◽  
Author(s):  
Y Bajaj ◽  
N Sethi ◽  
A Shayah ◽  
A T Harris ◽  
P Henshaw ◽  
...  
Keyword(s):  
Treatment Option ◽  
Vocal Fold ◽  
Voice Quality ◽  
Vocal Fold Paralysis ◽  
Significant Loss ◽  
Tissue Loss ◽  
Swallowing Function ◽  
Simple Modification ◽  
Bilateral Vocal Fold Paralysis ◽  
Vocal Fold Palsy

AbstractObjective:Although modern endoscopic laser techniques aim to avoid a permanent tracheostomy by augmenting the glottic aperture in cases of bilateral vocal fold palsy, loss of tissue from the posterior glottis risks compromising voice quality and swallowing function. The objective of this study was to describe our experience with bilateral transverse posterior cordotomy.Methods:This was a retrospective analysis of functional outcomes in a series of consecutive patients undergoing a simple modification of the classical laser cordectomy procedure, which avoids tissue loss. The procedure was confined to the complete release of the vocal ligament from the arytenoid cartilage on both sides, while avoiding any significant loss of mucosa or cartilage.Results:Post-operative voice quality and quality of life were rated as good by most patients, which makes bilateral transverse cordotomy an attractive treatment option for bilateral vocal fold paralysis.Conclusion:Bilateral transverse cordotomy is a reliable treatment option for patients with bilateral vocal fold paralysis, and aims to avoid the morbidity associated with a permanent tracheostomy.

scholarly journals Fundamental frequency, phonation maximum time and vocal complaints in morbidly obese women

2014 ◽  
Vol 27 (1) ◽  
pp. 43-46 ◽  
Author(s):  
Lourdes Bernadete Rocha de SOUZA ◽  
Rayane Medeiros PEREIRA ◽  
Marquiony Marques dos SANTOS ◽  
Cynthia Meida de Almeida GODOY
Keyword(s):  
Fundamental Frequency ◽  
Vocal Tract ◽  
Control Group ◽  
Morbidly Obese ◽  
Obese Women ◽  
Obese People ◽  
Maximum Phonation Time ◽  
Significant Difference ◽  
The Voice ◽  
Voice Recording

Background : Obese people have abnormal deposition of fat in the vocal tract that can interfere with the acoustic voice. Aim : To relate the fundamental frequency, the maximum phonation time and voice complaints from a group of morbidly obese women. Methods : Observational, cross-sectional and descriptive study that included 44 morbidly obese women, mean age of 42.45 (±10.31) years old, observational group and 30 women without obesity, control group, with 33.79 (±4.51)years old. The voice recording was done in a quiet environment, on a laptop using the program ANAGRAF acoustic analysis of speech sounds. To extract the values of fundamental frequency the subjects were asked to produce vowel [a] at usual intensity for a period in average of three seconds. After the voice recording, participants were prompted to produce sustained vowel [ a] , [ i] and [ u] at usual intensity and height, using a stopwatch to measure the time that each participant could hold each vowel. Results : The majority, 31(70.5%), had vocal complaints, with a higher percentage for complaints of vocal fatigue 20(64.51%) and voice failures 19(61.29%) followed by dryness of the throat in 15 (48.38%) and effort to speak 13(41.93%). There was no statistically significant difference regarding the mean fundamental frequency of the voice in both groups, but there was significance between the two groups regarding maximum phonation. Conclusion : Increased adipose tissue in the vocal tract interfered in the vocal parameters.

scholarly journals Effects on Vocal Fold Collision and Phonation Threshold Pressure of Resonance Tube Phonation With Tube End in Water

2013 ◽  
Vol 56 (5) ◽  
pp. 1530-1538 ◽  
Author(s):  
Laura Enflo ◽  
Johan Sundberg ◽  
Camilla Romedahl ◽  
Anita McAllister
Keyword(s):  
Vocal Fold ◽  
Voice Quality ◽  
Glass Tube ◽  
Audio Signals ◽  
Resonance Tube ◽  
Phonation Threshold Pressure ◽  
Before And After ◽  
Subglottal Pressure ◽  
Voice Pathologies ◽  
The Voice

Purpose Resonance tube phonation in water (RTPW) or in air is a voice therapy method successfully used for treatment of several voice pathologies. Its effect on the voice has not been thoroughly studied. This investigation analyzes the effects of RTPW on collision and phonation threshold pressures (CTP and PTP), the lowest subglottal pressure needed for vocal fold collision and phonation, respectively. Method Twelve mezzo-sopranos phonated into a glass tube, the end of which was placed under the water surface in a jar. Subglottal pressure, electroglottography, and audio signals were recorded before and after exercise. Also, the perceptual effects were assessed in a listening test with an expert panel, who also rated the subjects' singing experience. Results Resonance tube phonation significantly increased CTP and also tended to improve perceived voice quality. The latter effect was mostly greater in singers who did not practice singing daily. In addition, a more pronounced perceptual effect was found in singers rated as being less experienced. Conclusion Resonance tube phonation significantly raised CTP and tended to improve perceptual ratings of voice quality. The effect on PTP did not reach significance.

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