Search Results (163)

Background: Semi-occluded vocal tract exercises (SOVTE) improve vocal quality and capacity. Water resistance therapy (WRT), a specific form of SOVTE with a tube submerged under water, generates increased and oscillating oral pressure through bubble formation during phonation, thereby influencing transglottal pressure and vocal fold dynamics. While the physiological effects of WRT using tube-based systems have been extensively studied, the influence of vowel-specific vocal tract configurations during WRT remains unclarified. This study examined how different vowel qualities during WRT affect vocal fold oscillation using the DoctorVox^® mask, which allows near-natural mouth opening and vowel articulation. Methods: Ten vocally healthy, untrained adults (25–50 years) performed a continuous vowel glide (/i/–/a/–/u/-/i/) at constant fundamental frequency and habitual loudness during WRT using the DoctorVox^® mask, with the tube submerged 2 cm in water. Simultaneous recordings included transnasal high-speed videoendoscopy (20,000 fps), electroglottography (EGG), acoustic signals and intra-tube oral pressure measurements. Glottal area waveforms (GAW) were derived to calculate the open quotient (OQ_GAW) and closing quotient (ClQ_GAW). Analyses were conducted separately for intra-tube pressure maxima, minima and intermediate phases within the bubble cycle during WRT. Statistical analysis used Wilcoxon signed-rank tests with Bonferroni correction. Results: In the baseline condition without WRT, significant vowel-related differences were found: /u/ showed a higher open quotient than /i/ and /a/ (p < 0.05) and a higher closing quotient than /a/ (p < 0.05). During WRT, these vowel-specific differences were no longer statistically significant. A non-significant trend toward reduced OQ_GAW during WRT was observed, most notably for /u/, while differences between pressure phases within the bubble cycle were minimal. Conclusions: WRT using the DoctorVox^® mask reduces vowel-specific differences in vocal fold vibration patterns, suggesting that for voice therapy, vowel quality modifications during WRT have little impact on vocal outcomes. Full article

Background/Objectives: Chronic Obstructive Pulmonary Disease (COPD) is frequently associated with dyspnea, impaired health-related quality of life (HRQoL), and cognitive dysfunction. Although pulmonary rehabilitation (PR) is considered a core therapeutic strategy, its specific effects on cognitive function, dyspnea, and dysphonia remain unclear. This systematic review aimed to evaluate the impact of PR and respiratory or cognitive-focused rehabilitative interventions on dyspnea, quality of life, cognitive performance, and voice outcomes in adults with COPD. Methods: This review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251131325). A systematic search of PubMed, Scopus and Web of Science identified studies published between 2010 and 21 August 2025. Eligible designs included randomized and non-randomized controlled studies, cohort, and mixed-method studies involving adults with COPD undergoing rehabilitative interventions targeting dyspnea, cognition, dysphonia, or swallowing. Outcomes included cognitive measures, dyspnea scales, voice parameters, and HRQoL indices. Results: Twelve studies (n ≈ 810 participants) met inclusion criteria. Most PR and exercise-based programs showed improvements in global cognition and executive functions, particularly when combined with cognitive training or high-intensity exercise modalities. Dyspnea improved consistently following short- to medium-term PR or respiratory muscle training, whereas low-frequency long-term programs yielded limited benefit. HRQoL improved across structured PR programs, especially in multidimensional interventions. Only one study assessed dysphonia, reporting transient improvements in maximum phonation time following inspiratory muscle training. No included study evaluated dysphagia-related outcomes. Conclusions: PR and respiratory muscle training can enhance cognition, dyspnea, and HRQoL in COPD, although evidence for dysphonia remains scarce and dysphagia is entirely unaddressed. Future high-quality trials should adopt standardized outcome measures, include long-term follow-up, and integrate voice and swallowing assessments within PR pathways. Full article

Background/Objectives: The aim of this study was to assess the short-term and long-term effectiveness of group voice therapy in changing vocal behaviour and improving voice quality (VQ) among teachers with hyperfunctional voice disorders (HFVD), using both subjective and objective measures. Methods: Thirty-one teachers participated in a structured group voice therapy programme. Participants underwent videoendostroboscopic evaluation of laryngeal morphology and function, perceptual assessment of voice, acoustic analysis of voice samples, and aerodynamic measurements of phonation. Patients’ self-assessment of VQ and its impact on quality of life were measured using a Visual Analogue Scale (VAS) and the Voice Handicap Index-30 (VHI-30). Evaluations were conducted at four time points: pre-therapy (T0), immediately post-therapy (T1), and at 3-month (T3) and 12-month (T12) follow-up visits. Results: Significant improvement was observed between T0 and T1 in perceptual voice evaluations: grade, roughness, asthenia, strain, loudness, fast speaking rate, as well as in neck muscle tension, shimmer, patients’ most harmful vocal behaviours, VHI-30 scores, patients VQ evaluation, and its impact on quality of life (all p < 0.05). Almost all parameters of subjective and objective voice assessment improved over the 12-month observation period, with the greatest improvement between T0 and T12 (all p < 0.05), indicating lasting reduced laryngeal tension and improved phonatory efficiency. Conclusions: Group voice therapy has been shown to be an effective treatment for teachers with HFVD, leading to significant and long-lasting improvements in perceptual, acoustic, and self-assessment outcomes. Therapy also promoted healthier vocal and lifestyle behaviours, supporting its role as a successful and cost-effective rehabilitation and prevention method for occupational voice disorders. Full article

This study examines the impact of vocal fold (VF) lesions located on the superior surface on glottal airflow dynamics and tissue oscillatory behaviors using biomechanical simulations of a two-layered realistic VF model. It is hypothesized that morphological changes in the VFs due to the presence of a lesion cause changes in tissue elasticity and rheological properties, contributing to dysphonia. Previous research has lacked the integration of lesions in computational simulations of anatomically accurate larynx-VF models to explore their effects on phonation and contribution to voice disorders. Addressing the current gap in literature, this paper considers a computational model of a two-layered VF structure incorporating a lesion that represents a hemorrhagic polyp. A three-dimensional, subject-specific, multilayered geometry of VFs is constructed based on STL files derived from a human larynx CT scan, and a fluid–structure interaction (FSI) methodology is employed to simulate the coupling of glottal airflow and VF tissue dynamics. To evaluate the effects of the lesion’s presence, two FSI models, one with a lesion embedded in the cover layer and one without, are simulated and compared. Analysis of airflow dynamics and tissue vibrational patterns between these two models is used to determine the impact of the lesion on the biomechanical characteristics of phonation. The polyp is found to slightly increase airflow resistance through the glottis and disrupt vibratory symmetry by decreasing the vibration frequency of the affected fold, leading to weaker and less rhythmic oscillations. The results also indicate that the lesion increases tissue stress in the affected fold, which agrees with clinical observations. While quantitative ranges depend on lesion size and tissue properties, these consistent and physically meaningful trends highlight the biomechanical mechanisms by which lesions influence phonation. Full article

Background and Objectives: This study aimed to evaluate postoperative changes in voice quality and glottic function following early injection laryngoplasty with hyaluronic acid performed using a modified general anesthesia approach without airway instrumentation in patients with unilateral vocal fold paralysis. Materials and Methods: Thirty-two patients (19 females, 13 males; mean age 51.8 years, range 21–70) who underwent injection laryngoplasty within the first three months after the onset of paralysis were included in this retrospective study. All procedures were performed under general anesthesia without endotracheal intubation, using endoscopic visualization. Objective acoustic and aerodynamic analyses and videostroboscopic examinations were performed preoperatively and postoperatively. Data were analyzed using the Wilcoxon signed-rank test, with p < 0.05 considered statistically significant. Results: Significant postoperative improvement was observed in acoustic and aerodynamic parameters. Shimmer, jitter, and noise-to-harmonic ratio (NHR) values significantly decreased (p < 0.001, p < 0.001, and p = 0.001, respectively), while maximum phonation time (MFT) increased markedly (p < 0.001) and the S/Z ratio decreased (p = 0.006). The mean fundamental frequency (F0) decreased slightly but not significantly (p = 0.085). Videostroboscopic findings demonstrated improved glottic closure and vocal fold vibration. No major complications occurred. Conclusions: Early injection laryngoplasty with hyaluronic acid performed under general anesthesia and endoscopic guidance provides significant improvement in objective voice parameters and glottic efficiency in unilateral vocal fold paralysis. Early intervention appears to enhance phonatory stability and may prevent maladaptive laryngeal changes. Full article

Millions worldwide are affected by Parkinson’s disease, with the World Health Organization highlighting its growing prevalence. Early neuromotor speech impairments make voice analysis a promising tool for detecting Parkinson’s, aided by advances in deep speech embeddings. However, existing approaches often rely on either handcrafted acoustic features or opaque deep representations, limiting diagnostic performance and interoperability. To address this, we propose a multi-modal decentralized hybrid learning framework that combines structured voice biomarkers from the UCI Parkinson’s dataset (195 sustained-phonation samples from 31 subjects) with contrastive speech embeddings derived from the DAIC-WOZ corpus (189 interview recordings originally collected for depression detection) using Wav2Vec 2.0. This system employs an early fusion strategy followed by a dense neural classifier optimized for binary classification. By integrating both clinically interpretable and semantically rich features, the model captures complementary phonatory and affective patterns relevant to early-stage Parkinson’s detection. Extensive evaluation demonstrates that the proposed method achieves an accuracy of 96.2% and an AUC of 97.1%, outperforming unimodal and baseline fusion models. SHAP-based analysis confirms that a subset of features have disproportionately high discriminative value, enhancing interpretability. Overall, the proposed framework establishes a promising pathway toward data-driven, non-invasive screening for neurodegenerative conditions through voice analysis. Full article

Background/Objectives: Swallowing and speech rely on shared brainstem circuits coordinating oropharyngeal motor functions. In neurodegenerative diseases affecting the brainstem—such as progressive supranuclear palsy (PSP), amyotrophic lateral sclerosis (ALS), and multiple system atrophy (MSA)—bulbar dysfunction often impairs tongue propulsion and motility, affecting both swallowing (dysphagia) and phonation (dysarthria). This study aimed to investigate whether vowel-based acoustic features are associated with swallowing severity in brainstem-related disorders and to explore their potential as surrogate markers of bulbar involvement. Methods: This was a cross-sectional observational study. Thirty-one patients (13 PSP, 12 ALS, 6 MSA) underwent clinical dysarthria assessment, acoustic analysis of the first (F1) and second (F2) formants during sustained phonation of /a/, /i/, /e/, and /u/, and swallowing evaluation using standardized clinical scales (DOSS, FOIS, ASHA-NOMS) and fiberoptic endoscopic evaluation (Pooling Score, Penetration-Aspiration Scale). The vowel space area (tVSA, qVSA) and Formant Centralization Ratio (FCR) were computed. Results: Significant correlations emerged between acoustic vowel metrics and dysphagia severity, especially for liquids. The FCR showed strong correlations with DOSS (ρ = −0.660, p < 0.0001), FOIS (ρ = −0.531, p = 0.002), ASHA-NOMS (ρ = −0.604, p < 0.0001), and instrumental scores for liquids: the Pooling Score (ρ = 0.538, p = 0.002) and PAS (ρ = 0.630, p < 0.0001). VSA measures were also associated significantly with liquid swallowing impairment. F2u correlated with dysarthria severity and all liquid-related dysphagia scores. Conclusions: Vowel-based acoustic parameters, particularly FCR and F2u, reflect the shared neuromotor substrate of articulation and swallowing. Acoustic analysis may support early detection and monitoring of bulbar dysfunction, especially where instrumental assessments are limited. Full article

Injectable biomaterials for vocal fold disorders are being developed to provide not only mechanical reinforcement but also a regenerative microenvironment. Recent hydrogels based on hyaluronic acid (HA) derivatives, calcium hydroxylapatite and decellularized matrix scaffolds are designed to approximate the viscoelastic behavior of native tissue, allow controlled degradation, and modulate local immune responses. Rather than serving merely as space-filling agents, several of these materials deliver extracellular matrix (ECM)-like biochemical signals that help maintain pliability and overcome some limitations of conventional augmentation. Experimental and early clinical studies involving growth factor delivery, stem cell-based injections, and ECM-mimetic hydrogels have demonstrated improved mucosal wave vibration and reduced fibrosis in cases of scarring. In clinical series, benefits from basic fibroblast growth factor can persist for up to 12 months. Further progress will depend on correlating material properties with objective vibratory performance to achieve lasting restoration of phonation and advance true tissue-regenerative therapy. Full article

Aim: The aim of this study was to develop and test a surface electromyography (sEMG) assessment protocol to characterise the activity of the extrinsic laryngeal muscles (suprahyoid and infrahyoid) during phonatory tasks and vocal techniques. Methodology: The protocol of assessment was based on electromyographic assessment guidelines and on clinical voice evaluation needs and was tested in six healthy adults with no vocal disorders. Surface electromyographic activity of suprahyoid and infrahyoid muscles was acquired during different reference tasks (rest, reading, maximum contractions) and six vocal tasks, including nasal sounds, fricatives, and semi-occluded vocal tract exercises. A laryngeal accelerometer was used for detecting the beginning and end of each exercise. The average activity during each task was normalised by the signal obtained in the incomplete swallowing task for the SHM and by the sniff technique for the IHM. Results: The range of activation values varied across tasks, with higher percentages observed in plosive production and in the “spaghetti” technique, while nasal and fricative sounds tended to show lower activation values within the group. A consistent pattern of simultaneous activation of suprahyoid and infrahyoid muscles was observed during phonation. Conclusions: The protocol proved potential for clinical application in speech–language pathology as it enabled the characterisation of muscle activity in determinant muscles for vocal function. Larger samples and further validation of the time-marking system are needed. This study provides a foundation for integrating sEMG measures into functional voice assessment. Full article

Objective: This article evaluates the reconstructive potential and functional outcomes, as well as the risks and potential perioperative complications of using free flaps in patients with advanced-stage malignant laryngeal neoplasms who require salvage surgery and reconstruction. Additionally, it assesses the effectiveness of various flap harvesting and in-setting techniques, including the performance of microvascular anastomoses. Materials and Methods: This retrospective study included 13 male patients (age range 47–76 years) diagnosed with laryngeal neoplasms, who were referred to the Department of Otolaryngology at the University of Verona between 2017 and 2022. All patients underwent salvage total laryngectomy followed by concurrent reconstructive surgery utilizing microvascular flaps. Recovery of function (phonation) and incidence of complications were evaluated in a follow-up of at least three years. Results: Only one patient experienced necrotic failure of the microvascular free flap, probably due to post-op complications. The patient required revision on the 10th day after surgery and was reconstructed using a pedicled pectoralis major muscle flap. Two patients developed a pharyngocutaneous fistula. Other three patients had pharyngoesophageal stenosis, two experienced recurrence, and one patient passed away due to septic shock. All patients achieved satisfactory functional outcomes regarding vocalization, while complete oral intake was restored in eight patients. Conclusions: Considering the limited sample size, the findings suggest that microvascular flaps represent a feasible option for reconstructing advanced laryngeal tumors, though complication rate may still be considerable. Tailoring reconstructive approaches to individual patients may enhance surgical outcomes. Full article

Vocal production requires the coordinated control of respiratory, laryngeal, and autonomic systems. In individuals with high vocal demand, this physiological load may influence autonomic regulation, even in the absence of voice disorders. This scoping review systematically mapped current evidence on the relationship between voice production and autonomic nervous system (ANS) activity in adults, focusing exclusively on studies that assessed both systems simultaneously. A systematic search was conducted in PubMed, Scopus, Web of Science, Embase, and CINAHL, following PRISMA-ScR guidelines. Eligible studies included adults performing structured vocal tasks with concurrent autonomic measurements. Data were extracted and synthesized descriptively. Fifteen studies met the inclusion criteria. Most involved healthy adults with high vocal demand, while some included participants with subclinical or functional voice traits. Vocal tasks ranged from singing and sustained phonation to speech under cognitive or emotional load. Autonomic measures included heart rate (HR), heart rate variability (HRV), and electrodermal activity (EDA), among others. Four thematic trends emerged: autonomic synchronization during group vocalization; modulation of autonomic tone by vocal rhythm and structure; voice–ANS interplay under stress; and physiological coupling in hyperfunctional vocal behaviours. This review’s findings suggest that vocal activity can modulate autonomic function, supporting the potential integration of autonomic markers into experimental and clinical voice research. Full article

Objectives: The aim of the study was to gauge the clinical usefulness of the Derkay scale in assessing the severity of voice dysfunction in patients with recurrent respiratory papillomatosis (RRP). Material and Methods: The study included 29 patients (8 women and 21 men) with a mean age of 40.2 years. To subjectively assess each patient’s voice, the Polish version of the Voice Handicap Index questionnaire was used. Acoustic parameters were calculated using the Multidimensional Voice Program, which included mean fundamental frequency (F0), frequency changes (% Jitter), amplitude changes (% Shimmer), noise-to-harmonic ratios (NHRs), and the soft phonation Index (SPI). The stage of RRP was assessed using the Derkay scale, together with the anatomical location of the lesion (from laryngeal endoscopy) and the impact RRP had on the general condition of the patient. Results: In women, Derkay clinical and total scores showed significant, positive, and strong correlations with almost all VHI-30 subscales (rho = 0.73–0.76). In men, the correlations were weaker (rho = 0.38–0.55) but were strong between the Derkay total score and F0 and total score and Jitter (rho = 0.63–0.65). Patients with human papilloma virus HPV-6 had significantly higher soft phonation index values (M = 11.97) compared to patients with HPV-11 (M = 6.91, U = 34.0; p = 0.019). Conclusions: The Derkay classification system correlates well with objective acoustic frequency measures and patient-reported voice outcomes. The system may be helpful in identifying patients at increased risk of voice dysfunction. It could be used to guide decisions about voice assessment and rehabilitation. Full article

Flexible laryngoscopy (FL) is the standard diagnostic tool for vocal cord paralysis (VCP), but it involves patient discomfort, and its interpretation is subjective and operator-dependent. Dynamic digital radiography (DDR) is a novel imaging technique that acquires high-resolution sequential radiographs at a low radiation dose. While DDR has been widely applied in chest and diaphragmatic imaging, its use for laryngeal motion analysis has been poorly investigated. We present the case of a 50-year-old male referred for Computed Tomography (CT) of the neck and chest for suspected vocal cord paralysis. The referring physician did not specify the side of the suspected paralysis. Due to a language barrier and the absence of prior documentation, a detailed history could not be obtained. To assess vocal cord motion, we performed, for the first time in our Institution, a DDR study of the neck. During phonation maneuvers, DDR demonstrated fixation of the left vocal cord in an adducted paramedian position. CT confirmed this finding and did not highlight any further anomaly. This case demonstrates the feasibility of DDR as a low-cost, low-dose, non-invasive technique for functional evaluation of the larynx and may represent a valuable complementary imaging tool in laryngeal functional assessment. Full article

This study analyzes the spectral properties of word-initial and intervocalic ejectives in Wolaytta, an Omotic language of southern Ethiopia. Using tokens embedded in three vowel contexts, we examined mean burst intensity, spectral moments, and vowel perturbation following ejection. Results show that ejectives adjacent to high front vowels were produced with greater intensity, supporting the hypothesis that increased oral cavity tenseness correlates with acoustic energy. Centroid and standard deviation differentiate place of articulation, while skewness and kurtosis distinguish singleton from geminate ejectives. Post-ejective vowel pitch and spectral tilt varied systematically with the ejectives’ place of articulation, indicating creaky phonation induced by ejection. Overall, the findings enhance our understanding of factors impacting acoustic features of ejectives. Full article

Therapeutic advances for vocal fold (VF) disorders are limited by the scarcity of VF-derived epithelial cells (VFEs). Despite their substantial self-renewal capability in vivo, VFEs expand for only a few passages in vitro before succumbing to growth arrest. This has led to the extensive use of alternative cellular sources that are not exposed to physiological stresses of phonation. To address this, we developed an ideal culture strategy that enables long-term expansion of rabbit VFEs (rbVFEs), by utilizing Rho kinase inhibitor (ROCKi), epidermal growth factor (EGF), and mitomycin-treated STO cells or its conditioned media (STO-CM). ROCKi only could support short-term proliferation, and rbVFEs eventually underwent senescence. Further enhancement to ROCKi-containing media with EGF or STO-CM promoted sustained proliferation of rbVFEs. Mechanistically, non-self-renewing rbVFEs exhibited cytoskeletal remodeling associated with increased nuclear YAP localization, elevated focal adhesion, and higher traction forces, whereas self-renewing rbVFEs had cytoplasmic YAP retention, decreased adhesion, and reduced cellular tension. Our optimized culture strategy provides a robust supply of rbVFEs for advancing regenerative approaches in VF research. Full article