Search Results (17)

Thyroid cancer survivors often experience worse quality of life than other cancer survivors, with fatigue and sleep disturbance being common contributors. In this prospective cohort from the ICaRe2 cancer registry, survivors completed the Brief Fatigue Inventory (BFI) and Pittsburgh Sleep Quality Index (PSQI) at enrollment and follow-up, with univariate and multivariable analyses identifying factors associated with fatigue and sleep quality. Among 249 survivors (83% female, median age 42), 205 completed the BFI and 224 the PSQI. Most were low (57%) or intermediate (34%) risk or recurrence at diagnosis, and 74% had no structural recurrence. Poor sleep and greater fatigue were significantly associated with female sex (p = 0.0003 and 0.001), younger age at diagnosis (p = 0.02 and 0.0006), and vocal cord paralysis (p = 0.01 and 0.046). Fatigue was also higher in those with hypoparathyroidism (p = 0.04). No associations were found with recurrence risk, therapy response, thyroid hormone type, or TSH levels. Younger female survivors, particularly those with vocal cord paralysis or hypoparathyroidism, are more prone to fatigue and poor sleep, highlighting potential targets for interventions to improve quality of life. Full article

Background/Objectives: The voice is often perceived as a natural and spontaneous means of communication, but it involves complex interactions among physiological, psychological, and environmental factors. For teachers, whose profession relies heavily on vocal use, understanding and managing vocal strain is crucial. This study investigates the correlation between ambient noise levels in classrooms and teachers’ self-assessed voice-related quality of life, as measured by the Voice Handicap Index (VHI). The focus is on how classroom acoustics affect vocal health, considering the high incidence of vocal fatigue among educators. Methods: A pilot exploratory study was conducted from September 2022 to November 2022 involving four primary school teachers (two language and two science) from an Italian primary school. Classroom noise levels were recorded using the “Listen Responsibly” app at intervals during lessons. Following each lesson, teachers completed the VHI questionnaire to evaluate their voice-related quality of life. Statistical analyses included simple and multiple linear regressions, logistic regression, and Spearman’s correlation to assess the relationships between noise levels and VHI scores. Results: The study yielded 60 observations categorized into VHI Grade 1 (0–30) and Grade 2 (31–60). Significant differences were observed in average noise levels between these groups, with Grade 2 exhibiting higher noise levels (p < 0.0001). Simple and multiple linear regression analyses confirmed a positive correlation between average recorded noise and VHI scores, with each unit increase in noise associated with a 0.72 unit increase in VHI score (p < 0.0001). Logistic regression identified average recorded noise > 59.5 dB as a significant predictor of higher VHI grades (p < 0.0001). Spearman’s correlation confirmed a strong positive correlation (ρ = 0.77, p < 0.01). Conclusions: The study demonstrates a significant relationship between increased classroom noise levels and worse voice-related quality of life among teachers. These findings highlight the need for improved acoustic management in schools to reduce vocal strain. Implementing noise reduction strategies and enhancing classroom acoustics can help mitigate vocal health issues among educators, ultimately improving their professional and personal well-being. Full article

Background/Objectives: Voice disorders caused by laryngeal hypertension can impact volume, quality, pitch, resonance, flexibility, and stamina. The laryngeal palpation is a tactile-perceptual assessment, which is one of a few examination methods to evaluate laryngeal hypertension. Laryngeal palpation is a manual examination of the extrinsic and paralaryngeal tissues of the larynx (e.g., lateral laryngeal mobility, thyrohyoid and cricothyroid spaces, vertical laryngeal position/mobility, and pain) through the examiner’s fingers. It can be performed during rest (static assessment) or during phonation (dynamic assessment) of the individual being evaluated. This study aimed to validate a novel laryngeal palpation tool with quantitative ordinal scores by assessing its reliability and diagnostic accuracy establishing preliminary clinical cut-off values, and examining its correlations with self-reported voice disorder symptoms. Methods: In a prospective, controlled validation study, 33 participants were selected to assess the validity and reliability of the novel diagnostic tool in a clinical sample and healthy controls. The clinical sample (n = 19) comprised individuals diagnosed with voice disorders, whereas the healthy control group (n = 14) included participants with no history or symptoms of voice pathology. The novel laryngeal palpation tool was employed by two independent examiners to assess both static and dynamic laryngeal function in all participants. In addition, each participant completed the following questionnaires: Voice Handicap Index (VHI-30) with the 30-item, Vocal Fatigue Index (VFI), and the Vocal Tract Discomfort Scale (VTD). Results: Static palpatory assessment of laryngeal tension demonstrated excellent discriminatory power between groups and tension levels (AROC = 0.979), along with high intra-rater (ICC = 0.966) and inter-rater reliability (ICC = 0.866). Significant correlations were revealed between the static palpation results and the VHI scores (r = 0.496; p < 0.01) and VFI (r = 0.514; p < 0.01). For the dynamic evaluation of the palpation tool, comparable results for the validity (AROC = 0.840) and reliability (inter-rater: ICC = 0.800, and intra-rater: ICC = 0.840) were revealed. However, no significant correlations were found between dynamic palpation and self-perceived questionnaires, although some were likely found with static palpation. The validity of the total score was found to be AROC = 0.992. Conclusions: The static and dynamic assessments using the novel laryngeal palpation tool demonstrated promising reliability and diagnostic accuracy, providing initial evidence to support its clinical utility. Further studies are needed to establish broader validation. Full article

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

Objectives: This study aimed to determine the positive predictive value of our NMD Suspicion Criteria in the diagnosis of NMDs. Other clinical factors routinely examined in our voice and swallowing examinations were also investigated to see if they had a significant association with the diagnosis of NMDs. Methods: This study retrospectively investigated the medical charts of patients who visited our Voice and Swallowing outpatient clinic between 2013 and 2022. Patients with previously diagnosed NMDs were excluded from the analysis. Among the remaining patients, we included those that were referred to neurologists for further evaluation due to suspicion of having an NMD based on the NMD Suspicion Criteria. The patients were then divided into groups according to the status of their diagnosis within 2 years of referral as “diagnosed”, “denied”, or “observed”. These three groups of patients were then compared according to the following clinical findings; velopharyngeal insufficiency (VPI), tongue atrophy, impaired tongue movement, dysarthria, vocal fold mobility impairment, dysphagia, involuntary movement, gait disturbances, weight loss, and a sense of fatigue in order to see if they were significantly associated with the diagnosis of NMDs. Results: Of 3769 outpatients without a confirmed diagnosis of NMDs, 37 were referred to neurologists for suspected NMDs, and 19 (51%) were diagnosed with NMDs. VPI and impaired tongue movement were significant diagnostic factors for NMDs (p = 0.014, 0.033). VPI during speech (p = 0.045) was more strongly associated with the diagnosis of NMDs than VPI during swallowing (p = 0.076). Fatigue was a significant related factor for other diseases (non-NMDs) causing Voice and Swallowing problems (p = 0.049). Conclusions: In the outpatient clinic setting, suspicion of NMD should be raised, particularly when VPI and impaired tongue movement are observed, prompting a thorough assessment of velopharyngeal closure during both speech and swallowing. Full article

Traditional broadcasting methods often result in fatigue and decision-making errors when dealing with complex and diverse live content. Current research on intelligent broadcasting primarily relies on preset rules and model-based decisions, which have limited capabilities for understanding emotional dynamics. To address these issues, this study proposed and developed an emotion-driven intelligent broadcasting system, EmotionCast, to enhance the efficiency of camera switching during live broadcasts through decisions based on multimodal emotion recognition technology. Initially, the system employs sensing technologies to collect real-time video and audio data from multiple cameras, utilizing deep learning algorithms to analyze facial expressions and vocal tone cues for emotion detection. Subsequently, the visual, audio, and textual analyses were integrated to generate an emotional score for each camera. Finally, the score for each camera shot at the current time point was calculated by combining the current emotion score with the optimal scores from the preceding time window. This approach ensured optimal camera switching, thereby enabling swift responses to emotional changes. EmotionCast can be applied in various sensing environments such as sports events, concerts, and large-scale performances. The experimental results demonstrate that EmotionCast excels in switching accuracy, emotional resonance, and audience satisfaction, significantly enhancing emotional engagement compared to traditional broadcasting methods. Full article

Post-thyroidectomy syndrome (PTS), characterized by voice issues after thyroidectomy without recurrent laryngeal nerve injury, was investigated in this study. The Voice Fatigue Index (VFI) and cepstral analysis were employed for subjective and objective voice evaluation. Retrospective analysis involved 96 patients (37 males, 59 females) who underwent thyroidectomy without nerve injury from April 2018 to June 2022. Assessments pre- and post-thyroidectomy included the Voice Handicap Index (VHI) and VFI, along with auditory perceptual, acoustic (including cepstral), aerodynamic, and glottal vibration analyses. In females, although the GRBAS scale showed no significant change, both VHI and VFI increased post-thyroidectomy. Significant correlations were observed between the VHI and VFI in females. Acoustic analysis indicated a decrease in the cepstral peak prominence (CPP) of vowels (/a/) and sentences in females, with significant correlations between changes in the CPP/a/ and VHI/VFI. The maximum fundamental frequency (F₀max) exhibited a significant decrease, correlating with the VHI and VFI changes. The VFI demonstrated effectiveness in subjective PTS voice evaluation, comparable to the VHI. The present study highlights the potential of cepstral analysis as an index reflecting subjective voice discomfort, suggesting its promise for a comprehensive PTS voice evaluation. Full article

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

Fado is an urban Portuguese musical style rooted in popular culture. Previously found data suggests that Fado singers may have an increased risk of developing voice disorders. (1) Aim: To determine the risk factors for the development of voice disorders among Fado singers. (2) Methods: A cross-sectional study was conducted through the administration of a questionnaire containing questions related to voice disorders in singers. The relationship between personal and social data, musical background, performance demands and habits, vocal health and wellbeing, and strategies to overcome voice problems are reported. Beyond a comprehensive characterization, odds ratios (ORs) and their 95% confidence intervals (CIs) for the association with voice disorders were calculated through univariate and multivariate logistic regression analyses. (3) Results: The significant risk factors for voice disorders were as follows in decreasing order: nose-related disorders; decongestants or antihistamines; oral contraceptives or hormone replacement therapy; previous smoking habits; and vocal fatigue after performances. (4) Conclusion: These activities significantly increased the risk of developing voice disorders. The evidence from this study and the relative low prevalence of self-reported voice disorders suggest that these singers may develop a kind of protective combination of factors beyond the scope of this research. Full article

Introduction: Muscle tension dysphonia (MTD) describes a condition affecting the feeling or quality of the voice due to increased muscle tension in and/or around the neck and larynx. Ankyloglossia is a condition of restricted tongue mobility that has been shown to be associated with increased muscle tension. This case series explores outcomes for voice users with MTD who have been treated for ankyloglossia. Methods: Twelve professional or recreational voice users diagnosed with ankyloglossia were surveyed on their symptoms of MTD before and after treatment with lingual frenuloplasty and pre- and post-operative orofacial myofunctional therapy (OMT), a multidisciplinary approach known as functional frenuloplasty. Two investigators independently compiled a list of themes reported by participants and agreed upon common themes. Results: Eleven out of twelve patients (91.6%) reported clinical improvement in the use of their voice after functional frenuloplasty; one patient reported no change. Five primary themes were noted: improved voice quality, improved ease of singing and/or speaking, increased stamina, increased pitch range, and improved breath support. Discussion: OMT with lingual frenuloplasty can be an effective adjunctive intervention for treatment of symptoms of vocal tension and fatigue for singers and professional speakers with ankyloglossia. These findings suggest a possible association between MTD and restricted tongue mobility presumably due to underlying myofascial tension. Full article

Noise exposure may cause auditory and extra-auditory effects. School teachers and students are exposed to high noise levels which have an impact on perceptual-cognitive and neurobehavioral aspects. The latter influence teaching conditions and student school performance. A Protocol was defined and parameters to be investigated were identified for acoustic characterization of unoccupied and occupied school environments, assessment of users by means of questionnaires completed by teachers and students, and vocal effort evaluation. Classrooms, laboratories, auditoriums, gymnasiums, common areas, canteens and outdoor areas were analysed in terms of acoustic features and identification of the origin of noise. The Protocol was tested in three kindergartens, three primary schools and three secondary schools placed in Rome, Florence and Perugia. Results of nine case studies are presented, including comparisons of objective and subjective investigations. Generally, the acoustic performances of the spaces under investigation do not meet the requirements of current Italian legislation. In particular, student activity determines high noise levels in laboratories, gymnasiums, and canteens. Students notice that noise mainly causes loss of concentration, fatigue, boredom, and headache. The outcomes of this research will be the starting point to define strategies and solutions for noise control and mitigation in schools and to draft guidelines for the acoustical school design. Full article

A stretchable double-network (DN) ionogel composed of a physically crosslinked network of chitosan (CS) and a chemically crosslinked network of polyacrylic acid (PAA) was prepared in an ionic liquid ([EMIM][OAc]) using a one-step polymerization method. In this ionogel (CS/PAA), the CS and the PAA polymer chains served as backbones, which constructed an interpenetrating DN structure via numerous hydrogen bonds formed through the hydroxyl, amino and carboxyl groups on the polymer chains. The DN structure improves the mechanical properties of the ionogel. Therefore, the CS/PAA DN ionogel exhibited outstanding mechanical performance in many ways: tensile strength up to 2.04 MPa, strain range up to 1046% and the value of toughness up to 8.52 MJ/m³. The ionogel also showed good self-recovery performance, fatigue resistance, ability to work in a broad temperature range (−20~80 °C) and adhesion properties. As a flexible sensor, the CS/PAA DN ionogel showed high strain sensitivity (gauge factor = 6.235). It can sensitively detect human motion (such as joint-bending, vocal fold vibration, walking gait and other human body motions), revealing the practical application potential of flexible electronic devices. Full article

(1) Objective: Teaching is a particularly voice-demanding occupation. Voice training provided during teachers’ education is often insufficient and thus teachers are at risk of developing voice disorders. Vocal demands during teaching are not only characterized by speaking for long durations but also by speaking in noisy environments. This provokes the so-called Lombard effect, which intuitively leads to an increase in voice intensity, pitch and phonation time in laboratory studies. However, this effect has not been thoroughly investigated in realistic teaching scenarios. (2) Methods: This study thus examined how 13 experienced, but vocally untrained, teachers behaved when reading in a noisy compared to quiet background environment. The quiet and noisy conditions were provided by a live audience either listening quietly or making noise by talking to each other. By using a portable voice accumulator, the fundamental frequency, sound pressure level of the voice and the noise as well as the phonation time were recorded in both conditions. (3) Results: The results showed that the teachers mainly responded according to the Lombard effect. In addition, analysis of phonation time revealed that they failed to increase inhalation time and appeared to lose articulation through the shortening of voiceless consonants in the noisy condition. (4) Conclusions: The teachers demonstrated vocally demanding behavior when speaking in the noisy condition, which can lead to vocal fatigue and cause dysphonia. The findings underline the necessity for specific voice training in teachers’ education, and the content of such training is discussed in light of the results. Full article

Sound production in the blackmouth croaker (Atrobucca nibe) was characterized using acoustic, morphological, and histochemical methods. Their calls consisted of a train of two to seven pulses; the frequency ranged from 180 to 3000 Hz, with a dominant frequency of 326 ± 40 Hz. The duration of each call ranged from 80 to 360 ms. Male A. nibe possess a pair of bilaterally symmetric sonic muscles attached to the body wall adjacent to the swim bladder. The average diameter of the sonic muscle fibers was significantly shorter than that of the abdominal muscle fibers. Semithin sections of the sonic muscle fibers revealed a core-like structure (central core) and the radial arrangement of the sarcoplasmic reticulum and myofibrils. Numerous mitochondria were distributed within the central core and around the periphery of the fibers. Most of the fibers were identified as Type IIa on the basis of their myosin adenosine triphosphatase activities, but a few were identified as Type IIc fibers. All sonic muscle fibers exhibited strong oxidative enzyme activity and oxidative and anaerobic capabilities. The features suggest that the sonic muscles of A. nibe are morphologically and physiologically adapted for fast twitching and fatigue resistance, which support fish vocalization. Full article

Our previous studies demonstrated that it is possible to perform the classification of both simulated pressed and actual vocally fatigued voice productions versus vocally healthy productions through the pattern recognition of sEMG signals obtained from subjects’ anterior neck. In these studies, the commonly accepted Vocal Fatigue Index factor 1 (VFI-1) was used for the ground-truth labeling of normal versus vocally fatigued voice productions. Through recent experiments, other factors with potential effects on classification were also studied, such as sEMG signal normalization, and data imbalance—i.e., the large difference between the number of vocally healthy subjects and of those with vocal fatigue. Therefore, in this paper, we present a much improved classification method derived from an extensive study of the effects of such extrinsic factors on the classification of vocal fatigue. The study was performed on a large number of sEMG signals from 88 vocally healthy and fatigued subjects including student teachers and teachers and it led to important conclusions on how to optimize a machine learning approach for the early detection of vocal fatigue. Full article