Search Results (435)

Objectives: To investigate the reliability and validity of the Singer Reflux Symptom Score (sRSS), a new patient-reported outcome questionnaire documenting the severity of reflux symptoms in singing voice is proposed. Methods: Amateur and professional singers consulting the European Reflux Clinic for laryngopharyngeal reflux disease (LPRD) symptoms and findings were prospectively recruited from January 2022 to February 2023. The diagnosis was based on a Reflux Symptom Score (RSS) > 13 and Reflux Sign Assessment (RSA) > 14. A control group of asymptomatic singer subjects was recruited from the University of Mons. The sRSS was rated within a 7-day period to assess test–retest reliability. Internal consistency was measured using Cronbach’s α in patients and controls. A correlation analysis was performed between sRSS and Singing Voice Handicap Index (sVHI) to evaluate convergent validity. Responsiveness to change was evaluated through pre- to post-treatment sRSS changes. The sRSS threshold for suggesting a significant impact of LPRD on singing voice was determined by receiver operating characteristic (ROC) analysis. Results: Thirty-three singers with suspected LPRD (51.5% female; mean age: 51.8 ± 17.2 years) were consecutively recruited. Difficulty reaching high notes and vocal fatigue were the most prevalent LPRD-related singing complaints. The sRSS demonstrated high internal consistency (Cronbach-α = 0.832), test–retest reliability, and external validity (correlation with sVHI: r = 0.654; p = 0.015). Singers with suspected LPRD reported a significant higher sRSS compared to 68 controls. sRSS item and total scores significantly reduced from pre-treatment to 3 months post-treatment except for the abnormal voice breathiness item. ROC analysis revealed superior diagnostic accuracy for sRSS (AUC = 0.971) compared to sRSS-quality of life (AUC = 0.926), with an optimal cutoff at sRSS > 38.5 (sensitivity: 90.3%; specificity: 85.0%). Conclusions: The sRSS is a reliable and valid singer-reported outcome questionnaire for documenting singing symptoms associated with LPRD leading to personalized management of Singers. Future large-cohort studies are needed to evaluate its specificity for LPRD compared to other vocal fold disorders in singers. Full article

Background/Objective: Puberphonia is a voice disorder characterized by the persistence of a high-pitched voice in sexually mature males. In phoniatrics and speech-language pathology, it is also known as post-mutational voice instability, mutational falsetto, persistent fistulous voice, or functional falsetto. The absence of an age-appropriate vocal pitch may adversely affect psychological well-being and hinder personal, social, and occupational functioning. The aim of this study was to evaluate of the impact of phoniatric and logopedic rehabilitation on voice quality in patients with puberphonia. Methods: The study included 18 male patients, aged 16 to 34 years, rehabilitated for voice mutation disorders. Phoniatric and logopedic rehabilitation included voice therapy tailored to each subject. A logopedist led exercises aimed at lowering and stabilizing the pitch of the voice and improving its quality. A phoniatrician supervised the therapy, monitoring the condition of the vocal apparatus and providing additional diagnostic and therapeutic recommendations as needed. The duration and intensity of the therapy were adjusted for each patient. Before and after voice rehabilitation, the subjects completed the following questionnaires: the Voice Handicap Index (VHI), the Vocal Tract Discomfort (VTD) scale, and the Voice-Related Quality of Life (V-RQOL). They also underwent an acoustic voice analysis. Results: Statistical analysis of the VHI, VTD, and V-RQOL scores, as well as the voice’s acoustic parameters, showed statistically significant differences before and after rehabilitation (p < 0.005). Conclusions: Phoniatric and logopedic rehabilitation is an effective method of reducing and maintaining a stable, euphonic male voice in patients with functional puberphonia. Effective voice therapy positively impacts selected aspects of psychosocial functioning reported by patients, improves voice-related quality of life, and reduces physical discomfort in the vocal tract. Full article

Background/Objectives: Cochlear “injury” is thought to be a significant cause of tinnitus in patients with hearing loss. Interestingly, individuals with normal hearing may also experience tinnitus. This study evaluates otoacoustic distortion product emissions (DPOAEs) in individuals with normal hearing who experience tinnitus perception. Methods: In this prospective study, the tinnitus group (TG) consisted of 34 subjects with tinnitus (four unilaterally) and normal hearing (threshold ≤ 25 dBHL at 0.25–8 kHz). The control group (CG) comprised 10 healthy volunteers (20 ears) without tinnitus and normal hearing. Medical history was recorded, and all participants underwent a complete otolaryngological examination, pure tone audiometry, and DPOAE recording (DP-gram, L1 = 55 dB, L2 = 65 dB, for F2: 619–10,000 Hz). Moreover, participants in the TG completed a detailed tinnitus history (with self-rated loudness scoring) and the Tinnitus Handicap Inventory (Greek-version THI-G) and underwent tinnitus analysis. Results: The recorded mean DPOAE values during the DP-gram of the CG were significantly larger in amplitude at low (t-test, Bonferroni-corrected p < 0.09) and high frequencies (t-test, Bonferroni-corrected p < 0.02) compared with the TG. Tinnitus assessment showed tinnitus pitch matching at the frequency area in the DP-gram, where the acceptance recording criteria were not met. There were no statistically significant differences in tinnitus onset, self-rated loudness scores of >70, and severe disability (THI-G > 58) for TG subjects in whom DPOAEs were not recorded at frequencies of ≤1000 Hz. Participants with abnormal DPOAEs at around 4000 Hz had tinnitus of sudden onset and severe disability (THI-G > 58). Finally, those with pathological recordings of DPOAEs at ≥6000 Hz had gradual onset tinnitus (Pearson Chi-square test, p < 0.05). Conclusions: DPOAEs in normal hearing individuals with tinnitus show lower amplitudes in low and high frequencies compared with normal hearing individuals without tinnitus. The tinnitus matched-frequency coincided with the frequency area where DPOAEs were abnormal. Full article

Nowadays, Fused Filament Fabrication (FFF) 3D printing offers promising opportunities for the customized manufacturing of ankle–foot orthoses (AFOs) targeted towards rehabilitation purposes. Polypropylene (PP) represents an ideal candidate in orthotic applications due to its light weight and superior mechanical properties, offering an excellent balance between flexibility, chemical resistance, biocompatibility, and long-term durability. However, Additive Manufacturing (AM) of AFOs based on PP remains a major challenge due to its limited bed adhesion and high shrinkage, especially for making large parts such as AFOs. The primary innovation of the present study lies in the optimization of FFF 3D printing parameters for the fabrication of functional, patient-specific orthoses using PP, a material still underutilized in the AM of medical devices. Firstly, a thorough thermomechanical characterization was conducted, allowing the implementation of a (thermo-)elastic material model for the used PP filament. Thereafter, a Taguchi design of experiments (DOE) was established to study the influence of several printing parameters (extrusion temperature, printing speed, layer thickness, infill density, infill pattern, and part orientation) on the mechanical properties of 3D-printed specimens. Three-point bending tests were conducted to evaluate the strength and stiffness of the samples, while additional tensile tests were performed on the 3D-printed orthoses using a home-made innovative device to validate the optimal configurations. The results showed that the maximum flexural modulus of 3D-printed specimens was achieved when the printing speed was around 50 mm/s. The most significant parameter for mechanical performance and reduction in printing time was shown to be infill density, contributing 73.2% to maximum stress and 75.2% to Interlaminar Shear Strength (ILSS). Finally, the applicability of the finite element method (FEM) to simulate the FFF process-induced deflections, part distortion (warpage), and residual stresses in 3D-printed orthoses was investigated using a numerical simulation tool (Digimat-AM^®). The combination of Taguchi DOE with Digimat-AM for polypropylene AFOs highlighted that the 90° orientation appeared to be the most suitable configuration, as it minimizes deformation and von Mises stress, ensuring improved quality and robustness of the printed orthoses. The findings from this study contribute by providing a reliable method for printing PP parts with improved mechanical performance, thereby opening new opportunities for its use in medical-grade additive manufacturing. Full article

Objectives: Muscular dysfunction of the cervical spine is the most likely cause of somatosensory tinnitus and dizziness. Some patients can modulate their tinnitus through movement or palpation. This study aimed to investigate the effect of manual therapy on muscle pressure pain, range of motion in the cervical spine, and tinnitus and dizziness. Methods: A pilot randomized controlled trial with a waiting-group design was conducted in a university hospital setting. Participants in the intervention group received manual therapy to the head and neck region combined with stretching exercises and muscle relaxation techniques such as releasing tense muscles and myofascial trigger point therapy involving muscle and connective tissue techniques. The primary and secondary outcome measures were pressure pain, tinnitus modulation by head and neck muscles, and range of motion of the cervical spine. Tinnitus and dizziness were assessed before and after the intervention using the Tinnitus Handicap Inventory and the Dizziness Handicap Inventory. Results: After the intervention, significant differences were observed in pressure pain, tinnitus modulation, and range of motion as well as the Tinnitus Handicap Inventory (U = 644; p < 0.001) and the Dizziness Handicap Inventory (U = 133.5; p = 0.010), favoring the intervention group. Conclusions: The results demonstrate that manual therapy significantly altered pressure pain in the head and neck muscles as well as symptoms such as tinnitus and dizziness in the intervention group. Manual therapy may be beneficial in treating cervicogenic somatosensory tinnitus, provided that other potential causes such as otorhinolaryngological pathology have been ruled out. Full article

Voice disorders occur frequently in schoolteachers. The aim of the present cross-sectional study involving 124 German teachers was to investigate whether singing, voice training, and high self-efficacy are protective factors for vocal health. Furthermore, vocal self-concept was examined as a potential mediator explaining this relationship. Participants were assigned to the cases group if they had a clinically significant finding in voice examinations consisting of video laryngoscopy (VLS), auditory assessment (RBH), and the Voice Handicap Index (VHI) were assigned to the cases group. Psychosocial assessments comprised questions about singing activities and participation in voice training as well as validated questionnaires regarding self-efficacy (LSWS) and vocal self-concept (FESS). Group comparisons and mediation analyses were conducted. Analyses revealed a decreased risk of voice problems for teachers who sing regularly (OR: 0.442, p = 0.038). Furthermore, the absence of voice problems was associated significantly with higher self-efficacy ratings (t(113) = 1.71, p = 0.045). Both associations were mediated by vocal self-concept ratings (singing: ab = −0.422, 95%-CI [−1.102, −0.037]; self-efficacy: ab = −0.075, 95%-CI [−0.155, −0.022]). Participation in voice training in the past did not reduce the risk of voice problems significantly. The presented data suggest that regular singing and self-efficacy should be promoted in health care and prevention programs. Since no impact of sporadic participation in voice training activities on the occurrence of voice problems was found, efforts regarding the transfer of regular vocal exercises into daily life need to be intensified. Full article

Background/Objectives: Cognitive impairment and vestibular dysfunction commonly co-occur in older adults and may share overlapping neuroanatomical pathways. Understanding their association may enhance the early identification of cognitive decline using clinically feasible vestibular assessments. This study aimed to examine the relationship between vestibular dysfunction and early cognitive impairment, assess the diagnostic accuracy of vestibular markers, and explore the association of subjective dizziness and balance measures with cognitive performance. Methods: Our cross-sectional study included 90 participants aged ≥60 years, classified into cognitively healthy, mild cognitive impairment (MCI), and early Alzheimer’s disease (AD) groups. Cognitive function was assessed using the MoCA and the MMSE; vestibular function was evaluated via posturography sway and horizontal vHIT gain. Subjective dizziness and balance were measured using the Dizziness Handicap Inventory (DHI), gait speed, and eyes-closed balance time. The data were analyzed using SPSS v24 with ANOVA, Pearson correlations, linear regression, and ROC curve analyses. Results: Significant group differences were found across the cognitive and vestibular scores (MoCA: p = 0.001. Sway: p = 0.001. vHIT: p = 0.001). vHIT gain and posturography sway independently predicted the MoCA and MMSE scores (adjusted R² = 0.68 and 0.65, respectively). The ROC analysis showed a strong diagnostic accuracy for posturography sway (AUC = 0.87) and vHIT gain (AUC = 0.82). Conclusions: Vestibular dysfunction is significantly associated with early cognitive impairment and may serve as a useful clinical marker for cognitive screening in older adults. Full article

Background and Objectives: Major trauma ranks among the leading causes of mortality and handicap in both developing and developed countries, consuming substantial healthcare resources. Its unpredictable nature and diverse clinical presentations often lead to rapid and challenging-to-predict changes in patient conditions. An increasing number of models have been developed to address this challenge. Given our access to extensive and relatively comprehensive data, we seek assistance in making a meaningful contribution to this topic. This study aims to leverage artificial intelligence (AI)/machine learning (ML) to forecast potential adverse effects in major trauma patients. Methods: This retrospective analysis considered major trauma patient admitted to Chi Mei Medical Center from 1 January 2010 to 31 December 2019. Results: A total of 5521 major trauma patients were analyzed. Among five AI models tested, XGBoost showed the best performance (AUC 0.748), outperforming traditional clinical scores such as ISS and GCS. The model was deployed as a web-based application integrated into the hospital information system. Preliminary clinical use demonstrated improved efficiency, interpretability through SHAP analysis, and positive user feedback from healthcare professionals. Conclusions: This study presents a predictive model for estimating recovery probabilities in severe burn patients, effectively integrated into the hospital information system (HIS) without complex computations. Clinical use has shown improved efficiency and quality. Future efforts will expand predictions to include complications and treatment outcomes, aiming for broader applications as technology advances. Full article

Background: One of the major contributors to homeostasis at the level of the central nervous system, specifically the brain, is the glymphatic system, which is described as an exchange occurring at the level of and between the interstitial fluid and cerebrospinal fluid that has been linked to neurodegenerative processes. Methods: Fourteen studies were included after PROSPERO registration and a literature search. Screening, reviewing, and data extraction were performed by two reviewers. Quality assessment scales were used. General continuous and subgroup analysis, heterogeneity tests, and random effect models were run using SPSS. Forest plots were constructed based on subgroup analysis. Results: Significant correlations (p < 0.05) were detected between MRI indices and outcomes quantifying neurodegenerative diseases. Studies on Alzheimer’s disease showed a positive correlation between diffusivity indices and cognitive scores. Studies on Parkinson’s disease showed negative correlations between diffusivity indices and disease severity, progression, and motor function (p < 0.05). As for other conditions, the conclusions remain uncertain, yet positive results were detected (p < 0.05). Conclusions: Positive significant correlations were deduced between the ALPS index and cognitive scores, indicating that low cognition is correlated with a low ALPS index and enlarged PVSs. Negative significant correlations were deduced between ALPS indices and UPDRS scores, indicating motor dysfunction is correlated with lower ALPS indices and enlarged PVSs. Finally, MRI parameters may help to deduce disease progression across subgroups. Despite the presence of heterogeneity between studies, significant correlations with moderate to large effect sizes were detected. Glymphatic dysfunction measured through MRI indices is correlated with neurodegenerative changes across various neurological conditions. Full article

Objectives: This study aimed to analyse the haematological parameters in relation to subjective tinnitus. We hypothesise that abnormal haematological findings may correlate with increased severity and chronicity of tinnitus. This research could lead to improved diagnostic methods and more targeted treatments. Material and Methods: A total of 439 patients with primary subjective tinnitus and 274 individuals without tinnitus were enrolled. These participants underwent comprehensive laboratory testing, which included haematological parameters. Results: When comparing the white blood cell levels between the tinnitus group and the control group, no statistically significant differences were found (p = 0.743). Similarly, comparisons of red blood cell levels (p = 0.250), haemoglobin levels (p = 0.087), and haematocrit levels (p = 0.066) also revealed no significant differences. The platelet levels showed no significant difference between the two groups (p = 0.782). According to a logistic regression model, lower levels of haemoglobin (p = 0.000) and platelets (p = 0.000) significantly predicted higher scores on the Tinnitus Handicap Inventory, indicating self-reported tinnitus severity. Furthermore, lower haemoglobin levels were significant predictors (p = 0.04) of developing bilateral tinnitus. Using Spearman’s correlation test, a statistically significant negative correlation (p = 0.029) was observed between red blood cell levels and the onset of tinnitus. The frequency of tinnitus demonstrated a significant positive correlation with haemoglobin levels (p = 0.04) and haematocrit levels (p = 0.043). Conversely, platelet levels showed a significant negative correlation with both tinnitus intensity (p = 0.002) and the onset of tinnitus (p = 0.033). Conclusions: While the haematological parameters showed no significant differences between the tinnitus and control groups, further analyses indicated that certain parameters, such as haemoglobin and haematocrit levels, could potentially influence tinnitus, necessitating further investigation. Full article

Background/Objectives: Vestibular dysfunction is one of the main complications after cochlear implant (CI) surgery, and there are currently no standardized protocols for vestibular assessment in CI candidates. Our objectives were to investigate the incidence of vestibular impairment after CI surgery, anamnestic (age, known systemic pathologies and cause of deafness) and surgical (intraoperative complications, malposition of the CI) risk factors, and the role of vestibular assessment in the selection of the suitable ear for implantation. Methods: We included 68 adult patients (80 ears) affected by moderate-to-profound SNHL undergoing CI. The dizziness handicap inventory (DHI), the video head impulse test (VHIT), the caloric test, and dynamic posturography (DP) were used to study the vestibular function and balance before and one month after CI. The DHI was also administered 24 h after surgery. Results: Despite significative impairment 24 h after surgery (29.6 ± 30), the mean DHI score returned to preoperative values (17.9 ± 26) after one month. Dizziness persisted in case of age ≥ 65 years old, surgical difficulties, simultaneous bilateral CI, Meniere’s disease and otosclerosis, comorbidities ≥ 3, anxiety/depression, and neurological diseases. The VHIT significantly worsened in 25% of ears, while the caloric test SPV nystagmus significantly decreased in 30% of ears. In cases of preoperative unilateral weakness, the implantation of the better ear was significantly related to higher DHI scores. Only 4/68 patients had a significant persistent reduction in the postural composite score after surgery, with an increased risk of falls. Conclusions: Medical history and vestibular assessment predict the risk of vestibular damage and help to choose the CI’s side and to manage vertigo after surgery. Full article

Background: Vagus nerve stimulation (VNS) is a frequently used neuromodulation method in recent years. While the mechanism of improvement in diseases such as epilepsy, dementia, and depression is being studied, its potential effect on vestibular dysfunction is also being investigated. The aim of our study was to investigate the effect of transcutaneous auricular VNS (taVNS) on the vestibular symptoms of unilateral vestibular hypofunction (UVH). Methods: Forty patients diagnosed with UVH were randomly divided into two groups. Group 1 received vestibular rehabilitation. Group 2 received taVNS and vestibular rehabilitation. Both groups received treatment one day a week for eight weeks. Before and after the treatment, balance of the participants was assessed with modified-CTSIB (m-CTSIB), limit of stability (LOS), Tandem and One-Leg Stance (OLS) tests; visual acuity was assessed with dynamic visual acuity (DVA), dizziness severity, and fatigue severity with a visual analog scale (VAS); kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK); depression and anxiety was assessed with the Hospital Anxiety and Depression Scale (HADS); and quality of life was assessed with the Dizziness Handicap Inventory (DHI). Results: At the end of eight weeks, patients in Group 2 showed significantly greater improvement in balance, dizziness, fatigue, kinesiophobia, anxiety, and depression. There was no significant difference in visual acuity and quality of life between the groups. Conclusions: The positive effects of taVNS on vestibular symptoms have been observed. As a new approach, taVNS can be included in the treatment of patients with UVH in addition to vestibular rehabilitation. Full article

Background: The role of the periarticular muscles of the knee joint in ensuring body balance is still ambiguous. Therefore, we conducted clinical and biomechanical assessments on 52 older adults (36 women and 16 men, age of 67.58 ± 7.30 years, body weight of 75.10 ± 13.42 kg, and height of 163.92 ± 8.80 cm) to determine the role of the knee muscles in balance maintenance. Methods: The clinical examination included the Dizziness Handicap Inventory (DHI), the Geriatric Depression Scale (GDS), the Performance-Oriented Mobility Assessment (POMA), the Functional Reach Test (FRT), the Falls Efficacy Scale—International (FES-I), and bioimpedance parameters (skeletal muscle mass—SMM—and its derived parameter—Diff SMM). The biomechanical assessment involved parameters that characterize muscle torques of knee joint extensors and flexors in isokinetic and isometric conditions, as well as changes in the centre of pressure (COP) position while standing with eyes open and closed. Results: Based on treatment history and DHI results (>10 points), 26 participants were identified as having balance disorders, while the remaining participants formed the control group. Statistical analysis was performed to determine differences between the groups. The groups significantly differed in terms of the results obtained from the DHI (p < 0.001) and GDS (p = 0.04) questionnaires as well as FES-I (p < 0.001) and POMA (p = 0.002) tests. While SMM (p = 0.012) was similar in the groups, Diff SMM (p = 0.04) significantly differed. The multiple regression analysis confirmed the knee joint extensor parameters’ significant role in predicting the COP path (p = 0.03 and p = 0.04 for two assumed models). Conclusions: The obtained results proved that the muscle torques of knee extensors can be used in the diagnostic process of older patients with balance disorders, indicating possible rehabilitation directions. Full article

Background/Objectives: Functional spinal instability from multifidus dysfunction has been proposed as a mechanism for chronic postsurgical pain. Prior studies reported structural impairments in the lumbar multifidus in patients with chronic low back pain, including a reduced cross-sectional area, muscle thickness, and increased fat infiltration. This preliminary report examined the prevalence of multifidus fat infiltration after Spinal Cord Stimulation (SCS), an established pain management technique. It also assessed inter-rater reliability in evaluating fat infiltration using MRI. Methods: The medical imaging data from four patients with Persistent Spinal Pain Syndrome Type II (PSPS II) treated with SCS were collected. Two independent operators performed the manual segmentation of the multifidus muscle on axial MRI images of the lumbar spine. The fat-to-muscle ratio was quantified and rated using a four-point classification system, categorizing multifidus fat infiltration as normal, mild, moderate, or severe. To assess the reliability of the manual segmentations, inter-rater reliability was determined. Results: The median fat-to-muscle ratio at the levels L2–L3 was 46.12 (Q1–Q3: 44.88–47.35). At the levels L3–L4, L4–L5, and L5–S1, the median values were 50.45 (Q1–Q3: 45.57–52.98), 52.11 (Q1–Q3: 48.81–52.80), and 52.84 (Q1–Q3: 49.09–56.39), respectively. An ICC value of one (95% CI from 0.999 to 1, p < 0.001) was found for inter-rater agreement on the muscle volume of the multifidus muscle. Conclusions: All the patients had moderate-to-severe fat infiltration of the multifidus muscle at each lumbar spinal level. Although time-consuming, the manual segmentation of the multifidus muscle in patients treated with SCS was feasible and yielded excellent inter-rater reliability when determining muscle volume. Future endeavors should focus on the automation of segmentation and classification. Full article

Background: Vestibular hypofunction occurs in 29.5% of older adults with benign paroxysmal positional vertigo (BPPV), but its impact on postural control, well-being and frailty was not studied before. This study compared the well-being, frailty and postural control between older adults with BPPV and vestibular hypofunction (oaBPPV+), and older adults with only BPPV (oaBPPV). Methods: Thirty-one older adults (≥65 years old) diagnosed with BPPV were recruited. Unilateral vestibular hypofunction was defined as a >25% caloric asymmetry, and bilateral vestibular hypofunction as a total response <6°/s per ear, using bithermal caloric irrigations. The oaBPPV+ group was compared to the oaBPPV group using the measures of well-being (Dizziness Handicap Inventory, Falls Efficacy Scale and 15-item Geriatric Depression Scale), frailty (Modified Fried Criteria), and postural control (timed chair stand test, mini-Balance Evaluation Systems test and Clinical Test of Sensory Interaction on Balance (CTSIB)). Falls and the number of repositioning maneuvers were documented. Significance level was set at α = 0.05. Results: Unilateral vestibular hypofunction was present in 32% of participants, mainly in females (p = 0.04). Bilateral vestibular hypofunction was not found. The oaBPPV+ group (n = 10, mean age 72.5 (4.5)) experienced more comorbidities (p = 0.02) than the oaBPPV group (n = 21, mean age 72.6 (4.9)). Groups did not differ regarding dizziness symptoms (p = 0.46), fear of falling (p = 0.44), depression (p = 0.48), falls (p = 0.08) or frailty (p = 0.36). However, the oaBPPV+ group showed significantly worse postural control under vestibular-dependent conditions (p < 0.001). Conclusions: Despite equally impaired well-being and frailty, the oaBPPV+ group showed greater sensory orientation deficits. Clinicians and researchers should be alert for co-existing vestibular hypofunction in older adults with BPPV, since this may exacerbate their already impaired postural control more than only BPPV. Full article