Search Results (105)

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

Selective Mutism (SM) is a childhood anxiety disorder characterized by the persistent inability to speak in specific social settings while being able to speak freely in more comfortable environments, such as at home with family. This condition often leads to significant impairments in social, academic, and occupational functions. This article presents a novel treatment methodology that integrates the physiology of vocal production with pragmatic language instruction through teletherapy, administered to two adolescents diagnosed with selective mutism (SM). The frequency of speaking on the Selective Mutism Questionnaire increased from 35% to 86% and from 25% to 55% for the two children. Pragmatic language skills on the Social Communication Skills: Pragmatics Checklist improved from 47% to 96% and 13% to 40% after treatment. It is crucial to emphasize vocal control for speech initiation and pragmatic language for verbal expression. Detailed strategies, specific activities, and treatment outcomes are provided. Full article

Interspecific interactions among sympatric carnivores are critical for understanding patterns of coexistence, competition, and community structure. Among mesocarnivores, dominance hierarchies are typically shaped by differences in body size, social organization, and competitive ability. The golden jackal (Canis aureus) is generally assumed to dominate the red fox (Vulpes vulpes) across shared landscapes, particularly at high-value resources such as carcasses. However, here, we present rare behavioral evidence that challenges this prevailing assumption. Using motion-triggered camera traps deployed at a carcass in Lake Kerkini National Park, Greece, we recorded a sequence of interactions in which a golden jackal displayed clear submissive behavior toward a red fox, including lowered body posture, tail tucking, and conflict avoidance. Subsequent footage revealed two additional agonistic encounters, during which the same red fox successfully displaced two separate jackals, one of which emitted a distress vocalization while retreating. These findings represent the first documented case of interspecific submission by golden jackals toward a red fox and suggest that context-specific factors—such as immediate carcass possession, individual experience, or body condition—may modulate expected dominance outcomes. Our observations underscore the importance of fine-scale behavioral studies in revealing plasticity in interspecific relationships and contribute to a more nuanced understanding of carnivore competition under semi-natural conditions. 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

The human voice is an important medium of communication and expression of feelings or thoughts. Disruption in the regulatory systems of the human voice can be analyzed and used as a diagnostic tool, labeling voice as a potential “biomarker”. Conversational artificial intelligence is at the core of voice-powered technologies, enabling intelligent interactions between machines. Due to its richness and availability, voice can be leveraged for predictive analytics and enhanced healthcare insights. Utilizing this idea, we reviewed artificial intelligence (AI) models that have executed vocal analysis and their outcomes. Recordings undergo extraction of useful vocal features to be analyzed by neural networks and machine learning models. Studies reveal machine learning models to be superior to spectral analysis in dynamically combining the huge amount of data of vocal features. Clinical applications of a vocal biomarker exist in neurological diseases such as Parkinson’s, Alzheimer’s, psychological disorders, DM, CHF, CAD, aspiration, GERD, and pulmonary diseases, including COVID-19. The primary ethical challenge when incorporating voice as a diagnostic tool is that of privacy and security. To eliminate this, encryption methods exist to convert patient-identifiable vocal data into a more secure, private nature. Advancements in AI have expanded the capabilities and future potential of voice as a digital health solution. Full article

Background: Endotracheal tube (ETT) intubation during general anesthesia (GA) is commonly associated with postoperative sore throat. This study aimed to evaluate whether thermal-softened ETTs reduce the postoperative sore throat incidence in patients undergoing elective surgery under GA. Methods: We conducted a comprehensive search of the literature across PubMed, Cochrane Library, and EMBASE to identify randomized controlled trials (RCTs) evaluating the effect of thermal-softened ETTs on postoperative sore throat in patients undergoing elective surgeries under GA. The primary outcome was postoperative sore throat incidence, while secondary outcomes included hoarseness, vocal cord lesions, and time to intubation. Data were extracted independently by two authors, and the risk of bias was assessed using the Revised Cochrane risk of bias tool (version 2.0). A meta-analysis was then performed using the random-effects model, with the results expressed as risk ratios (RRs) and mean difference (MDs). Results: Eight studies, with a total of 970 participants, were included. Thermal-softened ETTs significantly reduced postoperative sore throat incidence (RR: 0.60, 95% CI: 0.44 to 0.82, p = 0.001). Subgroup analysis showed no difference for single-lumen tubes (RR: 0.76, 95% CI: 0.45 to 1.26, p = 0.28), but remained significant for double-lumen tubes (RR: 0.5, 95% CI: 0.39 to 0.65, p < 0.00001). No significant difference was found in hoarseness (RR: 0.86, 95% CI: 0.64 to 1.17, p = 0.34), but a lower incidence of vocal cord lesions (RR: 0.52, 95% CI: 0.40 to 0.68, p < 0.00001) was observed. No difference was found in the time to intubation (MD: −6.51, 95% CI: −20.04 to 7.02, p = 0.35). Conclusions: Thermal-softened ETTs may reduce the incidence of postoperative sore throat and vocal cord lesions but have no significant effect on hoarseness or intubation time. Full article

Music has been shown to increase arousal and attention and even facilitate processing during non-musical tasks, including those related to speech and language functions. Mind wandering has been studied in many sustained attention tasks. Here, we investigated the intersection of these two phenomena: the role of mind wandering while listening to familiar/unfamiliar musical excerpts, and its effects on concurrent linguistic processing. We hypothesized that familiar music would be less distracting than unfamiliar music, causing less mind wandering, and consequently benefit concurrent speech perception. Participants (N = 96 young adults) performed a lexical-semantic congruity task where they judged the relatedness of visually presented word pairs while listening to non-vocal classical music (familiar or unfamiliar orchestral pieces), or a non-music environmental sound clip (control) played in the background. Mind wandering episodes were probed intermittently during the task by explicitly asking listeners if their mind was wandering in that moment. The primary outcome was accuracy and reactions times measured during the lexical-semantic judgment task across the three background music conditions (familiar, unfamiliar, and control). We found that listening to familiar music, relative to unfamiliar music or environmental noise, was associated with faster lexical-semantic decisions and a lower incidence of mind wandering. Mind wandering frequency was similar when performing the task when listening to familiar music and control environmental sounds. We infer that familiar music increases task enjoyment, reduces mind wandering, and promotes more rapid lexical access during concurrent lexical processing, by modulating task-related attentional resources. The implications of using music as an aid during academic study and cognitive tasks are discussed. Full article

Background: The application of intermittent intraoperative neuromonitoring (I-IONM) and continuous intraoperative neuromonitoring (C-IONM) has been widely accepted to improve surgical outcomes after thyroid surgery. This observational study aimed to evaluate the impact of vocal cord paralysis (VCP) in thyroid surgery conducted with I-IONM and C-IONM. Materials and Methods: From January 2018 to December 2022, 147 patients operated on with I-IONM and C-IONM for thyroid surgery were analyzed. Variations in the rates of the occurrence of temporary and permanent vocal cord paralysis between the two groups were compared. A p-value < 0.05 was considered statistically significant. Results: In total, 147 patients were eligible for inclusion in the study. Of these, 96 (65%) patients underwent thyroid surgery with I-IONM, 52 patients (35%) underwent surgery with C-IONM by a single surgeon. The percentage of temporary VCP was 4.1% (4 patients) in the I-IONM group; no patients had permanent VCP. In the C-IONM group, two patients (3.9%) had permanent vocal cord paralysis, and temporary vocal cord paralysis was observed in other two patients (3.9%), who recovered their nerve function after speech therapy. No statistically significant differences were found in the two groups. Conclusions: In our study, both I-IONM and C-IONM proved effective in predicting VCP, and no significant differences were observed between the two techniques in our series. Full article

Background: Primary hyperparathyroidism (PHPT) represents a multi-faced disease with a wide spectrum of manifestations. Familial forms of PHPT (affecting up to 10% of the cases) involve a particular category that encompasses a large range of hereditary syndromes, including parathyroid hyper-function, frequently in the setting of a multi-glandular disease. Objective: The aim was to analyze the most recent findings regarding PHPT in multiple endocrine neoplasia type 2 (MEN2) to a better understanding of the timing with respect to the associated ailments, MEN2-related PHPT (MEN2-PHPT) clinical and genetic particularities, optimum diagnostic, and overall management, particularly, surgical outcomes. Methods: This was a PubMed-based compressive review with regard to the latest data published in English from January 2020 until January 2025, using the following keywords: “primary hyperparathyroidism” and “multiple endocrine neoplasia”, “multiple endocrine neoplasia type 2”, “MEN2”, or “MEN2A”. We included original full-length studies of any study design that provided clinically relevant data in MEN2-PHPT and excluded reviews, meta-analysis, and case reports/series. Results: A total of 3783 individuals confirmed with MEN2 or RET pathogenic variants carriers were analyzed across 14 studies that provided data on PHPT. The prevalence of MEN2-PHPT subjects varied between 7.84% and 31.3%, with particularly low rates in non-index patients (3.8%). PHPT was the first syndrome manifestation in 0.9% of MEN2 patients. In terms of gender distribution, females represented 42.85% or 54.9% (similar rates between women and men, and only a single cohort showed a female rate up to 80%). Most subjects were diagnosed with PHPT and underwent surgery in the third or fourth decade of life. The highest median age at MEN2 diagnosis was 42 years. The youngest patients were RET pathogenic variants carriers who underwent (genetic) screening with median ages of 12 or 14 years. RET pathogenic variants analysis (n = 10/14 studies) showed that 16.67% of patients with p.Cys634Arg and 37.5% of those with p.Cys611Tyr had symptomatic PHPT, while those with p.Cys618Phe and p.Leu790Phe were asymptomatic. Timing analysis with respect to the medullary thyroid carcinoma diagnosis showed synchronous PHPT diagnosis in 80% and metachronous in 10% of MEN2 patients; with respect to MEN2-pheochromocytoma, synchronous diagnosis of PHPT was found in 56%, while pheochromocytoma was identified before PHPT in 22% of the cases and after PHPT in 22%. Studies (n = 10/14, N = 156 subjects with MEN2-PHPT) on parathyroidectomy identified that 72.7% to 100% of the individuals underwent surgery, typically performed in adulthood, at ages spanning from a mean of 34.7 to 48.5 years. The post-surgery outcomes varied (e.g., the rate for persistent PHPT was of 0%, 8% to 16.7%; recurrent PHPT of 12.5% to 23%; permanent hypoparathyroidism of 33% to 46%; permanent unilateral vocal cord palsy of 0% up to16.7%). Data regarding the number of involved glands (n = 7, N = 77): the prevalence of multi-glandular disease was pinpointed between 12.5% and 50%. Conclusions: MEN2-PHPT involved unexpected high rates of single-gland involvement (from 33.3% to 87.5%), probably due to an early detection across genetic screening. Traditional female higher prevalence in PHPT was not confirmed in most MEN2 cohorts. As expected, a younger age at PHPT diagnosis and surgery than seen in non-MEN2 patients was identified, being tidily connected with the syndromic constellation of tumors/malignancies. Overall, approximately, one out of ten patients were further confirmed with MEN2 starting with PHPT as the first clinically manifested element. Full article

This retrospective study aims to investigate whether dogs with a contusive and dogs with a compressive intervertebral disc disease share comparable outcomes and prognoses when presenting with the same neurological grade. A total of 50 dogs with IVDE (compression group) and 45 dogs with ANNPE (contusion group) were included in this study. The protocol involved a thorough review of the medical records and CT/MRI images of the included dogs. Data encompassing signalment, initial clinical signs, post-diagnosis treatment and short-term outcomes (less than 8 months) were collected from the patient records. Information on long-term outcomes (more than 8 months) was obtained through interviews with the owners. Dogs in the compression group displayed clinical signs at a statistically significant younger age and were more likely to experience deteriorating neurological deficits compared to the contusion group. Conversely, dogs with contusions had a significantly higher incidence of external trauma history and vocalization at the onset of clinical signs. In both groups, the most affected spinal cord segment was T3-L3. The overall recovery rate to regain independent ambulation was 71% in the contusion group vs. 80% in the compression group. While some of the examined parameters revealed differences, most did not significantly differ between the groups. Full article

Background/Objectives: This paper is significant in highlighting the importance of early and precise diagnosis of Parkinson’s Disease (PD) that affects both motor and non-motor functions to achieve better disease control and patient outcomes. This study seeks to assess the effectiveness of machine learning algorithms optimized to classify PD based on vocal characteristics to serve as a non-invasive and easily accessible diagnostic tool. Methods: This study used a publicly available dataset of vocal samples from 188 people with PD and 64 controls. Acoustic features like baseline characteristics, time-frequency components, Mel Frequency Cepstral Coefficients (MFCCs), and wavelet transform-based metrics were extracted and analyzed. The Chi-Square test was used for feature selection to determine the most important attributes that enhanced the accuracy of the classification. Six different machine learning classifiers, namely SVM, k-NN, DT, NN, Ensemble and Stacking models, were developed and optimized via Bayesian Optimization (BO), Grid Search (GS) and Random Search (RS). Accuracy, precision, recall, F1-score and AUC-ROC were used for evaluation. Results: It has been found that Stacking models, especially those fine-tuned via Grid Search, yielded the best performance with 92.07% accuracy and an F1-score of 0.95. In addition to that, the choice of relevant vocal features, in conjunction with the Chi-Square feature selection method, greatly enhanced the computational efficiency and classification performance. Conclusions: This study highlights the potential of combining advanced feature selection techniques with hyperparameter optimization strategies to enhance machine learning-based PD diagnosis using vocal characteristics. Ensemble models proved particularly effective in handling complex datasets, demonstrating robust diagnostic performance. Future research may focus on deep learning approaches and temporal feature integration to further improve diagnostic accuracy and scalability for clinical applications. 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

The metaverse, where users interact through avatars, is evolving to closely mirror the real world, requiring realistic object responses based on users’ emotions. While technologies like eye-tracking and hand-tracking transfer physical movements into virtual spaces, accurate emotion detection remains challenging. This study proposes the “Face and Voice Recognition-based Emotion Analysis System (EAS)” to bridge this gap, assessing emotions through both voice and facial expressions. EAS utilizes a microphone and camera to gauge emotional states, combining these inputs for a comprehensive analysis. It comprises three neural networks: the Facial Emotion Analysis Model (FEAM), which classifies emotions using facial landmarks; the Voice Sentiment Analysis Model (VSAM), which detects vocal emotions even in noisy environments using MCycleGAN; and the Metaverse Emotion Recognition Model (MERM), which integrates FEAM and VSAM outputs to infer overall emotional states. EAS’s three primary modules—Facial Emotion Recognition, Voice Emotion Recognition, and User Emotion Analysis—analyze facial features and vocal tones to detect emotions, providing a holistic emotional assessment for realistic interactions in the metaverse. The system’s performance is validated through dataset testing, and future directions are suggested based on simulation outcomes. Full article

Background and Objective: Arytenoid dislocation (AD) and subluxation (AS) impact vocal fold mobility, potentially affecting the quality of life. Their management, including the timing and modality of treatment, remains a subject of research. Our primary objective was to assess and compare the available treatment strategies for AS and AD. Material and methods: the protocol was registered on PROSPERO (CRD42023407521). Manuscripts retrieved from a previously published systematic review were evaluated. To comprehensively cover the last 25 years, an updated literature search was conducted, screening PubMed, Scopus, and Cochrane databases. Review Methods: We included studies that reported treatment modalities and the time to treatment (TT) for AS/AD, with outcomes objectively evaluated. Data on treatment success were pooled, and the impact of TT on recovery outcomes was analyzed. Results: Thirteen studies involving 361 patients were included. The majority of cases were attributed to iatrogenic trauma following intubation. Closed reduction (CR) was the primary treatment, with high success rates for both general (success rate: 77%, CI: 62–87%) and local anesthesia (success rate: 89%, CI: 70–97%). The standardized mean difference for the TT effect on treatment outcome was −1.24 (CI: −2.20 to −0.29). Conclusions: The absence of randomized controlled trials and the overall moderate-to-low quality of the studies highlighted the importance of the finding’s careful interpretation. This meta-analysis underscores the effectiveness of CR in managing AS/AD, with both general and local anesthesia yielding high success rates. The findings highlight the importance of TT, suggesting that early intervention is paramount. Future clinical research is needed to further refine these findings and optimize treatment protocols. Full article

Recurrent laryngeal nerve palsy remains a significant complication following minimally invasive esophagectomy for esophageal cancer. Despite advancements in surgical techniques and lymphadenectomy precision, the incidence of recurrent laryngeal nerve palsy has not been improved. Recurrent laryngeal nerve palsy predominantly affects the left side and may lead to unilateral or bilateral vocal cord paralysis, resulting in hoarseness, dysphagia, and an increased risk of aspiration pneumonia. While most cases of recurrent laryngeal nerve palsy are temporary and resolve within 6 to 12 months, some patients may experience permanent nerve dysfunction, severely impacting their quality of life. Prevention strategies, such as nerve integrity monitoring, robotic-assisted minimally invasive esophagectomy, and advanced dissection techniques, aim to minimize nerve injury, though their effectiveness varies. The management of recurrent laryngeal nerve palsy includes voice and swallowing rehabilitation, reinnervation techniques, and, in severe cases, surgical interventions such as thyroplasty and intracordal injection. As recurrent laryngeal nerve palsy can lead to significant postoperative respiratory complications, a multidisciplinary approach involving surgical precision, early detection, and comprehensive rehabilitation is crucial to improving patient outcomes and minimizing long-term morbidity in minimally invasive esophagectomy. This review article aims to inform esophageal surgeons and other clinicians about strategies for the prevention and management of recurrent laryngeal nerve palsy in esophagectomy. Full article