Search Results (173)

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

The use of implants in the trachea is increasing in respiratory diseases as an alternative to address pathological problems with airway obstruction. This article presents the design and development of a three-way cannula and its evaluation in a testbed capable of emulating the human breathing cycle. The new tracheal cannula allows airflow through a third duct (vertical one) towards the vocal folds, enabling phonation. The testbed assesses Total Lung Capacity (TLC) and endotracheal pressure by considering the cannula inside a replica of a trachea. The flow is generated by a mechanism composed of electronic elements, and the implementation of instruments for measuring pressure and lung capacity enables the visual and continuous collection of data. The three-way cannula offers improvements in airway capacity, with an average of up to 1.766 L of airflow and a pressure of 17.083 mbar. The airflow at the upper branch allows for improvement, enabling the patient to phonate even with the implant in place, while preserving patency due to the biocompatibility and elasticity of platinum silicone. Full article

Introduction: The vascular architecture of the vocal folds plays a critical role in sustaining the dynamic demands of phonation. Disruptions in this microvascular system are linked to various pathological conditions, including Reinke’s edema, hemorrhage, and laryngeal carcinoma. This review explores the structural and functional components of vocal fold microvascularization, with emphasis on pericytes, endothelial interactions, and neurovascular regulation. Materials and Methods: A systematic review of the literature was conducted using databases such as PubMed, Scopus, Web of Science, and Embase. Keywords included “pericytes”, “Reinke’s edema”, and “vocal fold microvascularization”. Selected studies were peer-reviewed and met criteria for methodological quality and relevance to laryngeal microvascular physiology and pathology. Results: The vocal fold vasculature is organized in a parallel, tree-like pattern with distinct arterioles, capillaries, and venules. Capillaries dominate the superficial lamina propria, while transitional vessels connect to deeper arterioles surrounded by smooth muscle. Pericytes, present from birth, form tight associations with endothelial cells and contribute to capillary stability, vessel remodeling, and mechanical protection during vibration. Their thick cytoplasmic processes suggest a unique adaptation to the biomechanical stress of phonation. Arteriovenous anastomoses regulate perfusion by shunting blood according to functional demand. Furthermore, neurovascular control is mediated by noradrenergic fibers and neuropeptides such as VIP and CGRP, modulating vascular tone and glandular secretion. The limited lymphatic presence in the vocal fold mucosa contributes to edema accumulation while also restricting carcinoma spread, offering both therapeutic challenges and advantages. Conclusions: A deeper understanding of vocal fold microvascularization enhances clinical approaches to voice disorders and laryngeal disease, offering new perspectives for targeted therapies and regenerative strategies. Full article

Objectives: This study aimed to endoscopically assess nasal patency in terms of adenoid obstruction and its mucous coverage, as well as nasal obstruction caused by the inferior nasal turbinate in children with vocal fold nodules. Methods: A retrospective study was conducted involving 54 children admitted to an ENT clinic due to hoarseness caused by vocal fold nodules from 2022 to 2024. The study analyzed medical history, the results of performed flexible nasofiberoscopy and tympanometry. Results: Children with vocal fold nodules snored and slept with open mouths less frequently than the control group of other patients admitted to the ENT outpatient clinic without voice disorders (p = 0.003 and 0.004, respectively). Pathological mucous coverage of the adenoid was observed more often (p = 0.02). The mean adenoid size in the A/C ratio was 52.1% compared to 63.4% in the control group (p = 0.01). Conclusions: Children with vocal fold nodules typically have smaller adenoids, fewer incidents of snoring and open-mouth breathing, but more frequent pathological nasal mucus. It was not possible to prove that the incorrect breathing path through the mouth, causing reduced humidity of the inhaled air, affects the formation of vocal fold nodules. Full article

Unilateral vocal fold paralysis (UVFP) can lead to significant dysphonia. Medialization thyroplasty type 1 (TT1) is a common surgical intervention aiming at improving vocal quality by optimally positioning the paralyzed fold to generate the necessary vibrations for phonation. Implants are generally placed through the thyroid cartilage in a sedated patient and positioned either underneath the level of the vocal folds (infraglottal medialization or IM) or at the level of the vocal folds (glottal medialization or GM). Using high-speed three-dimensional digital image correlation (3D-DIC) in an ex vivo canine hemilarynx model, this study explores the impact of implant location, specifically IM versus GM on the pre-phonatory and dynamic vertical thickness, glottal divergence, flow rate (Q), and cepstral peak prominence (CPP) under varying adduction and subglottal pressure conditions. IM consistently increased glottal divergence and dynamic vertical thickness, particularly in under-adducted states (AL1), despite producing lower static thickness than GM. CPP remained unaffected by the implant condition, but Q decreased significantly with IM under AL1, indicating enhanced glottal resistance and closure. These findings suggest that IM may offer superior functional outcomes by restoring divergent glottal shaping and improving vibratory efficiency. This study also introduces a validated method for dynamically quantifying vocal fold thickness and emphasizes the importance of implant depth in medialization thyroplasty strategies. Full article

Background: Immunological and rheological properties are important factors of the surfactant protein (SP) family, whose impact on tumorigenesis is not yet known, although some SPs have been identified as tumor marker candidates for various malignancies. This study describes the detection of the two surfactant family proteins SP-G and PLUNC in healthy glottis, the presence of SP-G in glottic cancer, and the in vitro tissue regeneration potential of SP-G and PLUNC on epithelial cells. Methods: The expression and distribution of SP-G and PLUNC were investigated immunohistochemically in squamous cell carcinomas of the vocal folds. The expression of both proteins was analyzed by Western blot in micro-dissected healthy vocal fold mucosa from body donors. The hypopharyngeal squamous carcinoma cell line (FaDu) was used as an in vitro model for wound healing experiments with Electric cell–substrate impedance sensing (ECIS). Results: The results show the presence of SP-G and PLUNC in epithelial cells of the healthy vocal folds and the submucosal glands of the vestibular folds. SP-G was detected in squamous cell carcinomas of the vocal folds. SP-G and PLUNC show accelerated wound healing of FaDu cells in vitro. Conclusions: SP-G and PLUNC were first detected in the vocal fold of the human larynx. SP-G shows a distinct presence in glottic carcinoma, whose relevance needs to be determined in future studies. SP-G and PLUNC exhibit a positive influence on the repair mechanisms of epithelial lesions of the glottis. The data presented form the basis for follow-up studies focusing on the impact of SP-G in glottic cancer development and the potentially meaningful clinical effect of SP-G and PLUNC on tissue repair of the human vocal fold. Full article

Background: Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease affecting both upper and lower motor neurons, with bulbar dysfunction manifesting in up to 80% of patients. Dysarthria, characterized by impaired speech production, is common in ALS and often correlates with disease severity. Voice analysis has emerged as a promising tool for detecting disease progression and monitoring functional status. Methods: This study investigates acoustic and biomechanical voice alterations in ALS patients and their association with clinical measures of functional independence. A descriptive observational case series study was conducted, involving 43 ALS patients and 43 age and sex matched controls with non-neurological voice disorders. Sustained vowel /a/ recordings were obtained and analyzed using Voice Clinical Systems^® and Praat software (version 6.2.22). Biomechanical and acoustic parameters were correlated with ALS Functional Rating Scale-Revised (ALSFRS-R) and Barthel Index scores. Results: Significant differences were observed between ALS and control groups (elevated muscle force and tension and interedge distance in non-ALS individuals). Between bulbar and spinal ALS subtypes, elevated values were observed in certain parameters in Bulbar ALS patients, indicating irregular vocal fold contact and weakened phonatory control, while spinal ALS exhibited increased values, suggesting higher phonatory muscle tension. Elevated biomechanical parameters were significantly correlated with low ALSFRS-R scores, suggesting a possible relationship between voice measures and functional decline. However, acoustic measurements showed no relationship with performance status. Conclusions: These results highlight the potential of voice analysis as a non-invasive, objective tool for monitoring ALS stage and differentiating between subtypes. Further research is needed to validate these findings and explore their clinical applications. Full article

Background: This work presents an artificial intelligence-based algorithm for detecting Parkinson’s disease (PD) from voice signals. The detection of PD at pre-symptomatic stages is imperative to slow disease progression. Speech signal processing-based PD detection can play a crucial role here, as it has been reported in the literature that PD affects the voice quality of patients at an early stage. Hence, speech samples can be used as biomarkers of PD, provided that suitable voice features and artificial intelligence algorithms are employed. Methods: Advanced signal-processing techniques are used to extract audio features from the sustained vowel ‘/a/’ sound. The extracted audio features include baseline features, intensities, formant frequencies, bandwidths, vocal fold parameters, and Mel-frequency cepstral coefficients (MFCCs) to form a feature vector. Then, this feature vector is further enriched by including wavelet-based features to form the second feature vector. For classification purposes, two popular machine learning models, namely, support vector machine (SVM) and k-nearest neighbors (kNNs), are trained to distinguish patients with PD. Results: The results demonstrate that the inclusion of wavelet-based voice features enhances the performance of both the SVM and kNN models for PD detection. However, kNN provides better accuracy, detection speed, training time, and misclassification cost than SVM. Conclusions: This work concludes that wavelet-based voice features are important for detecting neurodegenerative diseases like PD. These wavelet features can enhance the classification performance of machine learning models. This work also concludes that kNN is recommendable over SVM for the investigated voice features, despite the inclusion and exclusion of the wavelet features. Full article

Objectives: This study evaluates the potential of high-speed videoendoscopy (HSV) in differentiating between benign and malignant glottic lesions, offering a non-invasive diagnostic tool for clinicians. Moreover, a new parameter derived from high-speed videoendoscopy (HSV) had been proposed and implemented in the analysis for an objective assessment of the vocal fold stiffness. Methods: High-speed videoendoscopy (HSV) was conducted on 102 participants, including 21 normophonic individuals, 39 patients with benign vocal fold lesions, and 42 with glottic cancer. Laryngotopographic parameter describing the stiffness of vocal fold (SAI) and kymographic parameters describing amplitude, symmetry, and glottal dynamics were quantified. Statistical differences between groups were assessed using receiver operating characteristic (ROC) analysis and lesion classification was performed using a machine learning model. Results: Univariate receiver operating characteristic (ROC) analysis revealed that SAI (AUC = 0.91, 95% CI: 0.839–0.962) and weighted amplitude asymmetry (AUC = 0.92, 95% CI: 0.85–0.974) were highly effective in distinguishing between normophonic and organic lesions (p < 0.01). Further multivariate analysis using machine learning models demonstrated improved accuracy, with the SVM classifier achieving an AUC of 0.93 for detecting organic lesions and 0.83 for distinguishing benign from malignant lesions. Conclusions: The study demonstrates the potential value of parameter describing the pliability of infiltrated vocal fold (SAI) as a non-invasive tool to support histopathological evaluation in laryngeal lesions, with machine learning models enhancing diagnostic performance. Full article

Monitoring dolphins in the open sea is essential for understanding their behavior and the impact of human activities on the marine ecosystems. Passive Acoustic Monitoring (PAM) is a non-invasive technique for tracking dolphins, providing continuous data. This study presents a novel approach for classifying dolphin vocalizations from a PAM acoustic recording using a convolutional neural network (CNN). Four types of common bottlenose dolphin (Tursiops truncatus) vocalizations were identified from underwater recordings: whistles, echolocation clicks, burst pulse sounds, and feeding buzzes. To enhance classification performances, edge-detection filters were applied to spectrograms, with the aim of removing unwanted noise components. A dataset of nearly 10,000 spectrograms was used to train and test the CNN through a 10-fold cross-validation procedure. The results showed that the CNN achieved an average accuracy of 95.2% and an F1-score of 87.8%. The class-specific results showed a high accuracy for whistles (97.9%), followed by echolocation clicks (94.5%), feeding buzzes (94.0%), and burst pulse sounds (92.3%). The highest F1-score was obtained for whistles, exceeding 95%, while the other three vocalization typologies maintained an F1-score above 80%. This method provides a promising step toward improving the passive acoustic monitoring of dolphins, contributing to both species conservation and the mitigation of conflicts with fisheries. Full article

Head and neck cancer encompasses a diverse group of malignant neoplasms originating in regions such as the oral cavity, oropharynx, hypopharynx, larynx, sinonasal cavities, and salivary glands. HNC represents a significant public health challenge, and recent reports indicate an increment in the incidence of HNC in young adults. In 2020, approximately 377,700 new HNC cases and 177,800 HNC-related deaths were reported globally. Major risk factors include tobacco smoking, alcohol consumption, and human papillomavirus (HPV) infections. HNC impacts vital functions such as breathing, swallowing, and speech. Treatments for this type of cancer within this complex anatomy include surgery, radiotherapy, and chemotherapy combinations. Radiotherapy is often an essential component of both curative and palliative HNC treatment, balancing tumor control with the preservation of function and appearance. However, its use can damage adjacent normal tissues, causing acute or chronic toxicity. One complication of HNC irradiation is VF fibrosis, which leads to severe voice impairments, significantly affecting patients’ quality of life. Fibrosis involves excessive and aberrant deposition of extracellular matrix, driven by factors such as TGF-β1 and inflammatory cytokines, which ultimately impair the flexibility and function of VF. Current radiation-induced fibrosis treatments primarily focus on symptom management and include systemic therapies like corticosteroids, anti-inflammatory drugs, and antioxidants. However, these treatments have limited efficacy. Experimental approaches targeting molecular pathways involved in fibrosis are being explored. Given the limitations of these treatments, advancing research is crucial to develop more effective therapeutic strategies that can significantly improve the quality of life for HNC patients, especially those vulnerable to VF fibrosis. Full article

Standard endoscopy of vocal folds is in general limited to two-dimensional imaging. Laser-based 3D imaging offers not only absolute measurements but also the possibility of assessing all three spatial directions. However, due to human inter-individuality, a fixed grid configuration (with fixed edge length and spot size) does not necessarily provide the best coverage and resolution. We present a liquid lens optical design for a diffractive spot array generator with dynamic adjustment capabilities for both array size and spot size. The tunable nature of the liquid lenses enables precise control over the spot array generated by a diffractive optical element (DOE). The first liquid lens controls the spot divergence in the observation plane, while the second liquid lens adjusts the zoom factor. The optical configuration provides a dynamic range of 1.8 with respect to array size, significantly enhancing adaptability in imaging across various applications. Full article

Advancements in dynamic laryngeal imaging, particularly high-speed videoendoscopy (HSV), have addressed several limitations of laryngovideostroboscopy (LVS). This study aimed to compare the success rates of LVS and HSV in generating recordings suitable for objective functional assessment of vocal fold movements. Methods: This study included 200 patients with voice disorders (123 with benign glottal lesions, 56 with malignant lesions, and 21 with functional voice disorders) and 47 normophonic individuals. All participants underwent LVS followed by HSV. Kymographic analysis was performed to evaluate phonatory parameters, including amplitude, symmetry, and glottal dynamics. The success of both methods in generating analyzable kymograms was assessed, and statistical comparisons were made using the chi-square test (significance level set at p < 0.05). Results: The failure rate for LVS was significantly higher (43.32%) compared to HSV. HSV successfully generated kymograms in 68.22% of cases where LVS failed. The primary factors contributing to LVS failure included synchronization issues, inadequate recording brightness, unstable phonation, and hidden glottal opening. Failure rates related to structural obstacles were similar between the two methods. HSV demonstrated superior kymogram feasibility across all subgroups, with the highest success observed in cases of organic glottal pathologies (30.73%). A significant advantage of HSV was observed for both benign and malignant glottal lesions, especially in cases of asynchronous vocal fold oscillations. Conclusions. By overcoming the inherent limitations of LVS, HSV provides a more reliable and objective assessment of phonatory function. Its ability to generate suitable kymograms with greater precision makes HSV a valuable tool for routine clinical diagnostics, enabling the accurate identification of subtle laryngeal pathologies and enhancing diagnostic accuracy. Full article

Background: This study aimed to investigate the relationships between kymographic parameters derived from high-speed videoendoscopy (HSV) and simultaneously recorded acoustic signals. The research provides insights into the vibratory dynamics of various glottal pathologies, assessed across different glottal widths, and their mutual relations with audio data. Methods: The study included 192 participants categorized as normophonic or having functional or organic lesions (benign, premalignant, and malignant). Parameters describing vocal fold oscillations were calculated using HSV kymography for three glottal widths, along with corresponding acoustic data. Initially, linear correlations between these parameters were assessed. Next, the consistency in cycle detection and its influence on the correlation levels were evaluated. Results: The fundamental frequency (F0) and mean Jitter (Jita) showed the highest correlations between the HSV- and audio-determined parameters (F0: 0.97, Jita: 0.40–0.70), with even stronger correlations when the number of detected cycles was consistent (F0: 0.99, Jita: 0.68–0.98). The correlations for other parameters ranged from low to moderate, with no significant differences observed between the diagnostic subgroups (functional changes and benign and malignant glottal lesions). However, in the premalignant lesions group, high correlations (0.77–0.9) were observed between the HSV and audio parameters, but only for measures describing period perturbations. Beyond F0 and mean Jitter, consistency in cycle detection did not significantly affect correlation levels. Conclusions: The simultaneous audio signal proved useful in verifying the accuracy of HSV quantification measures, particularly for F0, which showed strong agreement between the methods. Discrepancies in other parameters and low correlations between HSV-derived kymography and audio data may suggest the influence of the throat, mouth, and nose resonators, which are added to the glottal signal. While the kymographic analysis based on HSV provides detailed descriptions of vocal fold oscillations, it does not fully capture the three-dimensional structure and complex functionality of the vocal folds. Full article

Background/Objectives: This study aims to assess the rate of complications in patients who underwent thyroid surgery and were monitored post-operatively to explore potential correlations between various parameters that may aid in clinical decision making. Methods: An observational retrospective study was conducted on patients who underwent thyroid surgery and were followed up in our Endocrinology Unit. Patients were selected based on strict criteria. The following data were collected: sex; age; type of thyroid disease; pre-operative symptoms due to thyroid pathology; surgical procedures; post-operative complications; histopathological diagnosis; and post-operative blood levels of TSH, PTH, vitamin D, and calcium. Results: Among 340 patients, 25.29% had benign thyroid disease. Total thyroidectomy was performed in 89.4% of cases. Recurrent laryngeal nerve injury was found in 32 patients. Hypocalcemia occurred in 14 patients within 24 h post-operatively. Histopathological examination identified incidental parathyroid tissue in 5.88% of thyroidectomy specimens. Post-operative hypoparathyroidism was observed in 26 patients, and vitamin D deficiency in 68 patients. Conclusions: The study demonstrated that thyroid surgery is quite a safe procedure; however, complications may occur. A statistically significant correlation was found between the type of surgery and the risk of vocal fold palsy, without correlation with the type of thyroid disease. A thorough pre-operative evaluation by a multidisciplinary team may help reduce the risk of post-operative complications. Despite the extensive knowledge of thyroid surgery, small refinements may further improve surgical outcomes. Full article