Submit to Special Issue Submit Abstract to Special Issue Review for JCM Propose a Special Issue

Journal Menu

Journal Browser

New Advances in the Management of Voice Disorders

Print Special Issue Flyer
Special Issue Editors
Special Issue Information
Keywords
Published Papers

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Otolaryngology".

Deadline for manuscript submissions: 25 May 2024 | Viewed by 10624

Share This Special Issue

Special Issue Editor

Prof. Dr. Ben Barsties v. Latoszek

E-Mail Website
Guest Editor

Speech-Language Pathology, SRH University of Applied Health Sciences, 40476 Düsseldorf, Germany
Interests: voice diagnostics; acoustics; voice treatment; voice therapy; voice quality; vocal function; larynx; voice disorders; auditory-perceptual judgment; meta-analysis; self-evaluation

Special Issue Information

Dear Colleagues,

Voice production is achieved by a modulation of the air stream during phonation in which the vibratory motion of the vocal folds is of central importance for the indispensable source of voice production, apart from the resonator characteristics of the vocal apparatus. For example, voice disorders affect volume, quality, pitch, resonance, flexibility, and stamina. These vocal changes are the manifestation of disordered respiratory, chest resonator, laryngeal, and vocal tract functions, which might result from heterogeneous local etiologies.

The complexity of the processes involved in phonation, with acoustic, aerodynamic, morphological, physiological, external perceptual, and self-perceptual components, necessitates a multidimensional voice assessment. The multidimensional approach in voice diagnostics only makes the extent of a voice disorder clear and is the basis for an efficient and effective treatment. A voice assessment battery identifies the degree of dysphonia more precisely and allows patient deficits in phonation to be recognized more clearly. Technical progress is constantly setting new frontiers, which do not affect the basic pillars of the multidimensional voice examination, but the measures continue to develop and new advances in accuracy and reliability can be achieved.

Despite recurring symptoms in voice disorder patterns, experience and know-how of clinicians—the practical knowledge acquired over the years on various medical or therapeutic methods of providers—the extent of the voice disorder, prognosis, and effective as well as efficient treatments for the individual patient remains unaffected. In order to optimize medical-therapeutic action, it is necessary to be regularly informed about the selection of appropriate treatment options for voice disorders based on new research evidence from, for example, clinical trials, systematic reviews, and meta-analyses, in order to pursue better clinical reasoning and treatment success.

This Special Issue on voice disorders focuses on studies aiming to improve voice assessments and management from the perspective of otolaryngologists or speech-language pathologists. This issue also welcomes the submission of newly developed measures in the assessment of voice disorders. This includes, but is not limited to, studies investigating screening tools and methods for assessing voice production such as visual analysis, auditory-perceptual judgment, aerodynamic analysis, acoustic analysis, and self-assessment. Furthermore, clinical interventions with high levels of evidence in voice therapy, phonosurgery, and/or pharmacological therapy in voice disorders are of great interest.

This issue will provide an overview of new frontiers in voice disorders.

Prof. Dr. Ben Barsties v. Latoszek
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

voice disorder
voice treatment/therapy
voice assessment/measures
laryngology
phonosurgery
voice/dysphonia
larynx

Published Papers (9 papers)

Download All Papers

Order results

Result details

Show export options Show export options

Select all

Export citation of selected articles as:

Research

12 pages, 560 KiB

Open AccessArticle

Accuracy Analysis of the Multiparametric Acoustic Voice Indices, the VWI, AVQI, ABI, and DSI Measures, in Differentiating between Normal and Dysphonic Voices

by Virgilijus Uloza, Kipras Pribuišis, Nora Ulozaite-Staniene, Tadas Petrauskas, Robertas Damaševičius and Rytis Maskeliūnas

J. Clin. Med. 2024, 13(1), 99; https://doi.org/10.3390/jcm13010099 - 23 Dec 2023

Viewed by 770

Abstract

The study aimed to investigate and compare the accuracy and robustness of the multiparametric acoustic voice indices (MAVIs), namely the Dysphonia Severity Index (DSI), Acoustic Voice Quality Index (AVQI), Acoustic Breathiness Index (ABI), and Voice Wellness Index (VWI) measures in differentiating normal and dysphonic voices. The study group consisted of 129 adult individuals including 49 with normal voices and 80 patients with pathological voices. The diagnostic accuracy of the investigated MAVI in differentiating between normal and pathological voices was assessed using receiver operating characteristics (ROC). Moderate to strong positive linear correlations were observed between different MAVIs. The ROC statistical analysis revealed that all used measurements manifested in a high level of accuracy (area under the curve (AUC) of 0.80 and greater) and an acceptable level of sensitivity and specificity in discriminating between normal and pathological voices. However, with AUC 0.99, the VWI demonstrated the highest diagnostic accuracy. The highest Youden index equaled 0.93, revealing that a VWI cut-off of 4.45 corresponds with highly acceptable sensitivity (97.50%) and specificity (95.92%). In conclusion, the VWI was found to be beneficial in describing differences in voice quality status and discriminating between normal and dysphonic voices based on clinical diagnosis, i.e., dysphonia type, implying the VWI’s reliable voice screening potential. Full article

(This article belongs to the Special Issue New Advances in the Management of Voice Disorders)

► Show Figures

Figure 1

11 pages, 910 KiB

Open AccessArticle

Validation of the Acoustic Breathiness Index in Speakers of Finnish Language

by Elina Kankare and Anne-Maria Laukkanen

J. Clin. Med. 2023, 12(24), 7607; https://doi.org/10.3390/jcm12247607 - 10 Dec 2023

Viewed by 680

Abstract

Breathiness (perception of turbulence noise in the voice) is one of the major components of hoarseness in dysphonic voices. This study aims to validate a multiparameter analysis tool, the Acoustic Breathiness Index (ABI), for quantification of breathiness in the speaking voice, including both sustained vowels and continuous speech. One hundred and eight speakers with dysphonia (28 M, 80 F, mean age 50, SD 15.4 years) and 87 non-dysphonic controls (18 M, 69 F, mean age 42, SD 14 years) volunteered as participants. They read a standard text and sustained vowel /a:/. Acoustic recordings were made using a head-mounted microphone. Acoustic samples were evaluated perceptually by nine voice experts of different backgrounds (speech therapists, vocologists and laryngologists). Breathiness (B) from the GRBAS scale was rated. Headphones were used in the perceptual analysis. The dysphonic and non-dysphonic speakers differed significantly from each other in the auditory perceptual evaluation of breathiness. A significant difference was also found for ABI, which had a mean value of 2.26 (SD 1.15) for non-dysphonic and 3.07 (SD 1.75) for dysphonic speakers. ABI correlated strongly with B (r_s = 0.823, p = 0.01). ABI’s power to distinguish the groups was high (88.6%). The highest sensitivity and specificity of ABI (80%) was obtained at threshold value 2.68. ABI is a valid tool for differentiating breathiness in non-dysphonic and dysphonic speakers of Finnish. Full article

(This article belongs to the Special Issue New Advances in the Management of Voice Disorders)

► Show Figures

Figure 1

16 pages, 7253 KiB

Open AccessArticle

Determining the Mouth-to-Microphone Distance in Rigid Laryngoscopy: A Simple Solution Based on the Newly Measured Values of the Depth of Endoscope Insertion into the Mouth

by Dominika Valášková, Jitka Vydrová and Jan G. Švec

J. Clin. Med. 2023, 12(24), 7560; https://doi.org/10.3390/jcm12247560 - 07 Dec 2023

Viewed by 1365

Abstract

Mouth-to-microphone (MTM) distance is important when measuring the sound of voice. However, determining the MTM distance for laryngoscope-mounted microphones during laryngoscopic examinations is cumbersome. We introduce a novel solution for such cases, using the depth of insertion of the laryngoscope into the mouth D_I as a reference distance. We measured the average insertion depth, D_I, in 60 adult women and 60 adult men for rigid laryngoscopes with 70° and 90° view. We found the D_I for the 70°/90° laryngoscope to be 9.7 ± 0.9/9.4 ± 0.6 cm in men, 8.9 ± 0.9/8.7 ± 0.7 cm in women, and 9.3 ± 0.9/9.0 ± 0.7 cm in all adults. Using these values, we show that, for microphones fixed at 15–40 cm from the tip of the laryngoscope, the final MTM distances are between 5 and 35 cm from the lips, and the standard uncertainties of these distances are between 16% and 2.5%. Our solution allows laryngologists and laryngoscope manufacturers to set and estimate the MTM distance for any rigid laryngeal endoscope with a microphone attached with reasonable accuracy, avoiding the need to measure this distance in vivo in routine practice. Full article

(This article belongs to the Special Issue New Advances in the Management of Voice Disorders)

► Show Figures

Graphical abstract

11 pages, 1930 KiB

Open AccessArticle

The Impact of Protective Face Coverings on Acoustic Markers in Voice: A Systematic Review and Meta-Analysis

by Ben Barsties v. Latoszek, Viktoria Jansen, Christopher R. Watts and Svetlana Hetjens

J. Clin. Med. 2023, 12(18), 5922; https://doi.org/10.3390/jcm12185922 - 12 Sep 2023

Viewed by 775

Abstract

Background: Wearing respiratory protective masks (RPMs) has become common worldwide, especially in healthcare settings, since the onset of the COVID-19 pandemic. Hypotheses have suggested that sound transmission could be limited by RPMs, which possibly affects the characteristics of acoustic energy and speech intelligibility. The objective of this study was to investigate the effect of RPMs on acoustic measurements through a systematic review with meta-analysis. Methods: Five database searches were conducted, ranging from their inception to August 2023, as well as a manual search. Cross-sectional studies were included that provided data on widely used gender-independent clinical acoustic voice quality measures (jitter, shimmer, HNR, CPPS, and AVQI) and habitual sound pressure level (SPL). Results: We found nine eligible research studies with a total of 422 participants who were compared both without masks and with different types of masks. All included studies focused on individuals with vocally healthy voices, while two of the studies also included those with voice disorders. The results from the meta-analysis were related to medical/surgical and FFP2/(K)N95 masks. None of the acoustic measurements showed significant differences between the absence and presence of masks (p > 0.05). When indirectly comparing both mask types, statistical significance was identified for parameters of jitter, HNR, CPPS and SPL (p < 0.001). Conclusions: The present meta-analysis indicates that certain types of RPMs have no significant influence on common voice quality parameters and SPL compared to recordings without masks. Nevertheless, it is plausible that significant differences in acoustic parameters might exist between different mask types. Consequently, it is advisable for the clinical practice to always use the same mask type when using RPMs to ensure high comparability and accuracy of measurement results. Full article

(This article belongs to the Special Issue New Advances in the Management of Voice Disorders)

► Show Figures

Figure 1

16 pages, 354 KiB

Open AccessArticle

It Sounds like It Feels: Preliminary Exploration of an Aeroacoustic Diagnostic Protocol for Singers

by Calvin Peter Baker, Suzanne C. Purdy, Te Oti Rakena and Stefano Bonnini

J. Clin. Med. 2023, 12(15), 5130; https://doi.org/10.3390/jcm12155130 - 04 Aug 2023

Viewed by 1152

Abstract

To date, no established protocol exists for measuring functional voice changes in singers with subclinical singing-voice complaints. Hence, these may go undiagnosed until they progress into greater severity. This exploratory study sought to (1) determine which scale items in the self-perceptual Evaluation of Ability to Sing Easily (EASE) are associated with instrumental voice measures, and (2) construct as proof-of-concept an instrumental index related to singers’ perceptions of their vocal function and health status. Eighteen classical singers were acoustically recorded in a controlled environment singing an /a/ vowel using soft phonation. Aerodynamic data were collected during a softly sung /papapapapapapa/ task with the KayPENTAX Phonatory Aerodynamic System. Using multi and univariate linear regression techniques, CPPS, vibrato jitter, vibrato shimmer, and an efficiency ratio (SPL/P_Sub) were included in a significant model (p < 0.001) explaining 62.4% of variance in participants’ composite scores of three scale items related to vocal fatigue. The instrumental index showed a significant association (p = 0.001) with the EASE vocal fatigue subscale overall. Findings illustrate that an aeroacoustic instrumental index may be useful for monitoring functional changes in the singing voice as part of a multidimensional diagnostic approach to preventative and rehabilitative voice healthcare for professional singing-voice users. Full article

(This article belongs to the Special Issue New Advances in the Management of Voice Disorders)

9 pages, 1634 KiB

Open AccessFeature PaperArticle

A Pilot Study of the Effect of a Non-Contact Boxing Exercise Intervention on Respiratory Pressure and Phonation Aerodynamics in People with Parkinson’s Disease

by Christopher R. Watts, Zoë Thijs, Adam King, Joshua C. Carr and Ryan Porter

J. Clin. Med. 2023, 12(14), 4806; https://doi.org/10.3390/jcm12144806 - 21 Jul 2023

Viewed by 1073

Abstract

This study investigated the effects of a non-contact boxing exercise program on maximum expiratory pressure and aerodynamic voice measurements. Methods: Eight adult males diagnosed with Parkinson’s disease participated in the study. Individuals participated in twice-weekly exercise classes lasting one hour across 12-months. Dependent variables were measured on three baseline days and then at six additional time points. A pressure meter acquired maximum expiratory pressure, and a pneumotachograph system acquired transglottal airflow and subglottal air pressure. Results: Measures of average maximum expiratory pressure significantly increased after 9- and 12- months of exercise when compared to baseline. There was an increasing trend for these measures in all participants, with a corresponding large effect size. Measures of transglottal airflow and subglottal pressure did not change over the course of 9- or 12-months, although their stability may indicate that the exercise program influenced maintenance of respiratory-phonatory coordination during voicing. Conclusions: A non-contact boxing exercise program had a significant effect on maximum expiratory pressure in people with Parkinson’s disease. The aerobic nature of the program and challenges to the respiratory muscles potentially explain the “ingredient” causing this effect. The small sample size of this pilot study necessitates future research incorporating larger and more diverse participants. Full article

(This article belongs to the Special Issue New Advances in the Management of Voice Disorders)

► Show Figures

Figure 1

10 pages, 1294 KiB

Open AccessArticle

Advances in Clinical Voice Quality Analysis with VOXplot

by Ben Barsties v. Latoszek, Jörg Mayer, Christopher R. Watts and Bernhard Lehnert

J. Clin. Med. 2023, 12(14), 4644; https://doi.org/10.3390/jcm12144644 - 12 Jul 2023

Cited by 5 | Viewed by 1384

Abstract

Background: The assessment of voice quality can be evaluated perceptually with standard clinical practice, also including acoustic evaluation of digital voice recordings to validate and further interpret perceptual judgments. The goal of the present study was to determine the strongest acoustic voice quality parameters for perceived hoarseness and breathiness when analyzing the sustained vowel [a:] using a new clinical acoustic tool, the VOXplot software. Methods: A total of 218 voice samples of individuals with and without voice disorders were applied to perceptual and acoustic analyses. Overall, 13 single acoustic parameters were included to determine validity aspects in relation to perceptions of hoarseness and breathiness. Results: Four single acoustic measures could be clearly associated with perceptions of hoarseness or breathiness. For hoarseness, the harmonics-to-noise ratio (HNR) and pitch perturbation quotient with a smoothing factor of five periods (PPQ5), and, for breathiness, the smoothed cepstral peak prominence (CPPS) and the glottal-to-noise excitation ratio (GNE) were shown to be highly valid, with a significant difference being demonstrated for each of the other perceptual voice quality aspects. Conclusions: Two acoustic measures, the HNR and the PPQ5, were both strongly associated with perceptions of hoarseness and were able to discriminate hoarseness from breathiness with good confidence. Two other acoustic measures, the CPPS and the GNE, were both strongly associated with perceptions of breathiness and were able to discriminate breathiness from hoarseness with good confidence. Full article

(This article belongs to the Special Issue New Advances in the Management of Voice Disorders)

► Show Figures

Figure 1

12 pages, 1353 KiB

Open AccessArticle

Reliability of Universal-Platform-Based Voice Screen Application in AVQI Measurements Captured with Different Smartphones

by Virgilijus Uloza, Nora Ulozaitė-Stanienė, Tadas Petrauskas, Kipras Pribuišis, Tomas Blažauskas, Robertas Damaševičius and Rytis Maskeliūnas

J. Clin. Med. 2023, 12(12), 4119; https://doi.org/10.3390/jcm12124119 - 18 Jun 2023

Cited by 1 | Viewed by 888

Abstract

The aim of the study was to develop a universal-platform-based (UPB) application suitable for different smartphones for estimation of the Acoustic Voice Quality Index (AVQI) and evaluate its reliability in AVQI measurements and normal and pathological voice differentiation. Our study group consisted of 135 adult individuals, including 49 with normal voices and 86 patients with pathological voices. The developed UPB “Voice Screen” application installed on five iOS and Android smartphones was used for AVQI estimation. The AVQI measures calculated from voice recordings obtained from a reference studio microphone were compared with AVQI results obtained using smartphones. The diagnostic accuracy of differentiating normal and pathological voices was evaluated by applying receiver-operating characteristics. One-way ANOVA analysis did not detect statistically significant differences between mean AVQI scores revealed using a studio microphone and different smartphones (F = 0.759; p = 0.58). Almost perfect direct linear correlations (r = 0.991–0.987) were observed between the AVQI results obtained with a studio microphone and different smartphones. An acceptable level of precision of the AVQI in discriminating between normal and pathological voices was yielded, with areas under the curve (AUC) displaying 0.834–0.862. There were no statistically significant differences between the AUCs (p > 0.05) obtained from studio and smartphones’ microphones. The significant difference revealed between the AUCs was only 0.028. The UPB “Voice Screen” application represented an accurate and robust tool for voice quality measurements and normal vs. pathological voice screening purposes, demonstrating the potential to be used by patients and clinicians for voice assessment, employing both iOS and Android smartphones. Full article

(This article belongs to the Special Issue New Advances in the Management of Voice Disorders)

► Show Figures

Figure 1

16 pages, 2567 KiB

Open AccessArticle

The Efficacy of Different Voice Treatments for Vocal Fold Polyps: A Systematic Review and Meta-Analysis

by Ben Barsties v. Latoszek, Christopher R. Watts, Svetlana Hetjens and Katrin Neumann

J. Clin. Med. 2023, 12(10), 3451; https://doi.org/10.3390/jcm12103451 - 13 May 2023

Cited by 3 | Viewed by 1518

Abstract

Background: Vocal fold polyps (VFP) are a common cause of voice disorders and laryngeal discomfort. They are usually treated by behavioral voice therapy (VT) or phonosurgery, or a combination (CT) of both. However, the superiority of either of these treatments has not been clearly established. Methods: Three databases were searched from inception to October 2022 and a manual search was performed. All clinical trials of VFP treatment were included that reported at least auditory–perceptual judgment, aerodynamics, acoustics, and the patient-perceived handicap. Results: We identified 31 eligible studies (VT: n = 47–194; phonosurgery: n = 404–1039; CT: n = 237–350). All treatment approaches were highly effective, with large effect sizes (d > 0.8) and significant improvements in almost all voice parameters (p-values < 0.05). Phonosurgery reduced roughness and NHR, and the emotional and functional subscales of the VHI-30 were the most compared to behavioral voice therapy and combined treatment (p-values < 0.001). Combined treatment improved hoarseness, jitter, shimmer, MPT, and the physical subscale of the VHI-30 more than phonosurgery and behavioral voice therapy (p-values < 0.001). Conclusions: All three treatment approaches were effective in eliminating vocal fold polyps or their negative sequelae, with phonosurgery and combined treatment providing the greatest improvement. These results may inform future treatment decisions for patients with vocal fold polyps. Full article

(This article belongs to the Special Issue New Advances in the Management of Voice Disorders)

► Show Figures

Journal Menu

Journal Browser

New Advances in the Management of Voice Disorders

Share This Special Issue

Special Issue Editor

Special Issue Information

Keywords

Published Papers (9 papers)

Research

Further Information

Guidelines

MDPI Initiatives

Follow MDPI