Potential Risk Factors and Prevalence of Voice Symptoms in Students Starting Their Teacher Education,
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Journal of Voice
Accepted: August 9, 2019; Published online: September 09, 2019
Publication stage: In Press Corrected Proof
ABSTRACT
The aim of the present study was to determine prevalence of voice problems and potential risk factors in teacher students at the start of their education. A total of 1494 students from seven teacher education schools participated in the study. The students answered a questionnaire about 11 risk factors, and one with six questions about voice symptoms, Screen6, and 30 statements in the Voice Handicap Index (VHI). Students reporting at least 2 weekly voice symptoms in Screen6 were assigned to the group with voice problems. Significance level was P < 0.05. Results: prevalence of risk factors was about the same in the seven groups of teacher students except the group with highest proportion of women that also showed the highest proportion of voice problems, 38%. Prevalence of voice problems in the total group was 17%. Comparison of students with or without voice problems showed that all factors except one were more prevalent among students with voice problems and women were overrepresented. Mean total VHI score was 22 in students with voice problems and eight in students without voice problems. Multiple regression analyses showed that frequent throat infections, hearing problems, previous speech therapy, or voice training were the potential risk factors that had the strongest association with voice symptoms as well as with total score in VHI. Conclusions: results from this study show that it is common that teacher students experience voice problems already at the start of their education and potential risk factors associated with voice problems are identified. Knowing that teaching is a high-risk profession for developing voice disorders, it is crucial that teacher students should receive compulsory preprofessional voice education including voice ergonomics and voice training.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in Press
Laryngeal Solitary Fibrous Tumor: A Case Report and Systematic Review
Journal of Voice
Accepted: August 9, 2019; Published online: September 06, 2019
Publication stage: In Press Corrected Proof
Abstract
Objectives/Hypothesis
Solitary fibrous tumors are spindle cell neoplasms of mesenchymal origin that rarely occur in the larynx and may be mistaken for other pathologies. This case presentation and systematic review investigates presentation, treatment modalities, and outcomes of this unusual tumor.
Study Design
Systematic review of PubMed, CINAHL, Web of Science, and EMBASE including a novel case presentation
Methods
A systematic search according to the PRISMA guidelines was performed to isolate the reports of solitary fibrous tumors arising in the larynx and its subsites. Variables analyzed included patient demographics, presenting symptoms, smoking status, concurrent tumors, imaging studies, biopsy results, treatment, outcomes, and follow‐up. Our additional report provides the second such description of this lesion originating within the true vocal fold.
Results
Systematic review revealed 21 previous reports of solitary fibrous tumors originating from laryngeal subsites. The most common presenting symptom was dysphonia. All patients underwent local excision. Two patients had recurrences. Our patient presented with progressive dysphonia over 4 years. Stroboscopic examination revealed a large translucent mass of the left vocal fold. Local excision of the tumor was achieved with transoral resection with KTP laser. Immunohistochemical staining demonstrated a strong positivity for CD34 and HMW CK34BE12. Nine-month follow-up has not revealed any evidence of persistent or recurrent disease.
Conclusion
Laryngeal solitary fibrous tumors are rare and are unlikely to recur in the absence of malignant findings. Complete surgical resection is an acceptable treatment for this lesion accompanied by appropriate follow-up.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in Press
Korean Voice Catastrophization Index (K-VCI): Validation of the Voice Catastrophization Index for Koreans
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Journal of Voice
Accepted: July 23, 2019; Published online: September 05, 2019
Publication stage: In Press Corrected Proof
Summary
Objective
The purpose of present study was to validate a Korean version of the Voice Catastrophization Index for assessing catastrophization in patients with voice problems in a Korean population.
Methods
Case group patients with voice problems (n = 80) and control group patients without voice problems (n = 25) participated in the study. They were asked to complete three questionnaires: Korean Voice Handicap Index, Korean Voice-Related Quality of Life, and Korean Voice Catastrophization Index (K-VCI). Some of case group with voice problems completed the same three questionnaires again to assess test-retest reliability. Clinicians implemented the Consensus Auditory-Perceptual Evaluation of Voice evaluation to rate the overall severity on voice quality.
Results
K-VCI scores for case group were significantly higher than those for control group. K-VCI scores were significantly correlated with Korean Voice Handicap Index, Korean Voice-Related Quality of Life, and overall severity. The K-VCI had significant test-retest reliability and its internal consistency was good to excellent (range of Cronbach alpha correlation coefficients: 0.789–0.930). The K-VCI was not affected by patient sex, age, symptom duration, or diagnosis types. K-VCI scores were highest among patients with primary muscle tension dysphonia.
Conclusion
We validated the K-VCI questionnaire for use in measuring the degree of catastrophization of voice problems in a Korean population. Future studies with a larger sample size will be necessary to further verify this and determine the clinical usefulness of the K-VCI.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in Press
Using Pitch Height and Pitch Strength to Characterize Type 1, 2, and 3 Voice Signals
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Journal of Voice
Accepted: August 8, 2019; Published online: September 05, 2019
Publication stage: In Press Corrected Proof
ABSTRACT
Objective
Classifying dysphonic voices as type 1, 2, and 3 signals based on their periodicity enables researchers to determine the validity of acoustic measures derived from them. Existing methods of signal typing are commonly performed by listening to the voice sample and visualizing them on narrow-band spectrograms that require training, time, and are subjective in nature. The current study investigated pitch-based metrics (pitch height and pitch strength) as correlates to characterizing voice signal types. The computational estimates were validated with perceptual judgments of pitch height and pitch strength.
Methods
Pitch height and pitch strength were estimated from Auditory-Sawtooth Waveform Inspired Pitch Estimator Prime algorithm for 30 dysphonic voice segments (10 per type). Ten listeners evaluated pitch height through a single-variable matching task and pitch strength through an anchored magnitude estimation task. One way analyses of variance were used to determine the effects of signal type on pitch height and pitch strength estimates. Relationship between computational and perceptual estimates was evaluated using correlation coefficients and their significance.
Results
There was a significant difference between signal types in both computational and perceptual pitch strength estimates. Periodic type 1 signals had greater pitch strength compared to type 2 and 3 signals. Auditory-Sawtooth Waveform Inspired Pitch Estimator Prime produced robust computational estimates of pitch height even in type 3 signals when compared to other acoustic software. Listeners were able to reliably judge pitch height in type 2 and 3 signals despite their lack of a clear fundamental frequency.
Conclusions
Pitch height and pitch strength can be measured in all dysphonic voices irrespective of signal periodicity.
© 2019 Published by Elsevier Inc.
Article in Press
Does Dysphagia Improve Following Laryngeal Reinnervation for Treatment of Hoarseness in Unilateral Vocal Fold Paralysis?
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Journal of Voice
Accepted: August 6, 2019; Published online: September 03, 2019
Publication stage: In Press Corrected Proof
Abstract
Purpose
There are many reports of the efficacy of laryngeal reinnervation on voice, but there is a paucity of literature regarding its impact on swallowing function. The goal of this study was to explore the impact of laryngeal reinnervation on swallowing outcomes among unilateral vocal fold paralysis (UVFP) patients.
Methods
We reviewed 22 UVFP cases treated with laryngeal reinnervation at our institution. Ten patients had complete datasets, including Eating Assessment Tool (EAT-10) scores and appropriate follow-up. Wilcoxon signed-rank test was used to compare pre- and postoperative scores.
Results
Over the study period, 10 cases (mean age 45.7 ± 13.3 years; 6/10 men) with UVFP underwent ansa cervicalis to recurrent laryngeal nerve anastomosis (6/10) or nerve-muscle pedicle procedure (4/10). The median time between injury and surgical reinnervation was 12.4 months (range 2.7–88.5 months). Based on EAT-10 scores 6/10 patients were found to have dysphagia. Of these, four improved their score after surgery, one remained stable, and one deteriorated. The median EAT-10 score of these patients improved from 13 to 7 after surgery, but this difference was not statistically significant (P = 0.138).
Conclusion
Laryngeal reinnervation procedure has the potential for restoring a near normal voice in UVFP. Laryngeal reinnervation of the vocal fold may be associated with a tendency toward improvement in the EAT-10 score in patients after surgery for hoarseness in the setting of UVFP.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in Press
Acoustic and Aerodynamic Comparisons of Voice Qualities Produced After Voice Training
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Journal of Voice
Accepted: July 15, 2019; Published online: September 03, 2019
Publication stage: In Press Corrected Proof
Summary
Characteristics of true vocal fold vibration such as the proportion of closed phase of vibration to open phase, longitudinal tension, and the amount of medial compression are used to define four conditions during Estill Voice Training. However, it is unknown whether trainees achieve these phonatory differences after training. Acoustic and aerodynamic measures were used to determine differences in Slack, Thick, Thin, and Stiff conditions. Twenty-four female speech-language pathology graduate students received training perceiving and producing these four conditions and volunteered to participate 3–5 months later. After a 20-minute refresher training, participants were recorded using the Phonatory Aerodynamic System with electroglottography and Computerized Speech Lab. Four Estill Voice Training experts independently categorized the voice quality productions. Aerodynamic and acoustic measures of productions classified by at least three of four experts as having the intended quality determined if measures differentiated among voice qualities and supported the hypothesized physiological concepts used in training at Bonferroni corrected P ≤ 0.0063. Results showed that Slack had low fundamental frequency (fo), low sound pressure level (SPL), and high vibratory instability; Thick had high subglottal pressure (Psg), high SPL, and high vibratory stability; Stiff had high airflow while Thin had lower Psg than Thick. Seven measures differentiated the four qualities with 88.1% accuracy while only Psg, airflow, and jitter were required to differentiate Thick, Stiff, and Thin with 88.7% accuracy. As acoustic and aerodynamic measures differentiated among voice qualities and supported the theoretical physiological characteristics used in training, they could be used to track accuracy during training.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Article in Press
Cross-Cultural Adaption and Validation of the Vocal Fatigue Index in German
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Journal of Voice
Accepted: August 2, 2019; Published online: September 02, 2019
Publication stage: In Press Corrected Proof
Summary
Objective
The purpose of the study was to implement a cross-validation and adaption of the Vocal Fatigue Index (VFI) in German language.
Methods
The translation process for the German version (GV) of the VFI passed through three steps of translation before a final version was completed. Study subjects included 100 vocally healthy subjects and 101 voice-disordered subjects with various types of dysphonia. The internal consistency was determined using Cronbach's alpha (cron α) and the item-total analysis. Test-retest reliability was measured with the Pearson correlation coefficient. To assess the validity, the independent sample t test, the receiver-operating characteristic curve, the likelihood ratios, and Youden Index were used.
Results
The internal consistency across all three domains were good (#1: cron α = 0.945, #2: cron α = 0.904, and #3: cron α = 0.871) and no item of the GV of the VFI had to be deleted for further analysis relating to the item-total analysis. The test-retest reliability was high to very high (r = 0.86–0.93). Significant higher scores were revealed in voice-disordered subjects in comparison with vocally healthy subjects in all three domains (all Pvalues <0.01). Thresholds for the three domains of the GV of the VFI were determined at ≥15.5 (76.2% sensitivity and 90.0% specificity) for #1, ≥2.5 (71.5% sensitivity and 81.0% specificity) for #2, and ≤7.5 (50.5% sensitivity and 80.0% specificity) for #3.
Conclusions
It can be considered that the VFI is a valid and reliable tool identifying vocal fatigue symptoms and its severity in the German-speaking population.
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
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