Systematic Review: Singing-Based Interventions to Improve Physical Functions Related to Aging Voice in Older Adults.

PURPOSE: This systematic review aimed to evaluate the effects of singing as an intervention for aging voice. METHOD: Quantitative studies of interventions for older adults with any medical condition that involves singing as training were reviewed, measured by respiration, phonation, and posture, which are the physical functions related to the aging voice. English and Chinese studies published until April 2024 were searched using 31 electronic databases, and seven studies were included. The included articles were assessed according to the Grading of Recommendations, Assessment, Development, and Evaluations rubric. RESULTS: Seven studies were included. These studies reported outcome measures that were related to respiratory functions only. For the intervention effect, statistically significant improvements were observed in five of the included studies, among which three studies had large effect sizes. The overall level of evidence of the included studies was not high, with three studies having moderate levels and the rest having lower levels. The intervention activities included trainings other than singing. These non-singing training items may have caused co-intervention bias in the study results. CONCLUSIONS: This systematic review suggests that singing as an intervention for older adults with respiratory and cognitive problems could improve respiration and respiratory-phonatory control. However, none of the included studies covers the other two of the physical functions related to aging voice (phonatory and postural functions). The overall level of evidence of the included studies was not high either. There is a need for more research evidence in singing-based intervention specifically for patient with aging voice.

The Relationship Between Voice Parameters and Speech Intelligibility: A Scoping Review.

OBJECTIVE: To synthesize existing evidence of the relationship between voice parameters and speech intelligibility. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Review (PRISMA-ScR) guidelines, 13 databases were searched and a manual search was conducted. A narrative synthesis of methodological quality, study characteristics, participant demographics, voice parameter categorization, and their relationship to speech intelligibility was conducted. A Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment was also performed. RESULTS: A total of 5593 studies were retrieved, and 30 eligible studies were included in the final scoping review. The studies were given scores of 10-25 (average 16.93) out of 34 in the methodological quality assessment. Research that analyzed voice parameters related to speech intelligibility, encompassing perceptual, acoustic, and aerodynamic parameters, was included. Validated and nonvalidated perceptual voice assessments showed divergent results regarding the relationship between perceptual parameters and speech intelligibility. The relationship between acoustic parameters and speech intelligibility was found to be complex and the results were inconsistent. The limited research on aerodynamic parameters did not reach a consensus on their relationship with speech intelligibility. Studies in which listeners were not speech-language pathologists (SLPs) far outnumbered those with SLP listeners, and research conducted in English contexts significantly exceeded that in non-English contexts. The GRADE evaluation indicated that the quality of evidence varied from low to moderate. DISCUSSION: The results for the relationship between voice parameters and intelligibility showed significant heterogeneity. Future research should consider age-related voice changes and include diverse age groups. To enhance validity and comparability, it will be necessary to report effect sizes, tool validity, inter-rater reliability, and calibration procedures. Voice assessments should account for the validation status of tools because of their potential impact on the outcomes. The linguistic context may also influence the results.

Management of Pediatric Voice Disorders: Perceived Knowledge, Confidence, Attitude and Practice Patterns Among School-based Speech-language Pathologists in Hong Kong.

OBJECTIVE: This survey evaluated the levels of self-perceived knowledge, confidence, attitude and practice patterns of school-based speech-language pathologists (SLPs) in Hong Kong regarding their management of pediatric voice disorders. METHODS: SLPs with experience working in school settings in Hong Kong were invited to complete an anonymous online survey. The survey ascertained SLPs' perception of their knowledge, confidence, attitude and practice patterns regarding their management of pediatric voice disorders. It also explored the barriers and facilitators to effective service provision for children with voice problems in schools. RESULTS: A total of 85 responses were received, of which 56 respondents with complete responses were selected for analysis. Results showed that respondents in general did not consider themselves having sufficient knowledge on pediatric voice. They did not feel fully confident in managing pediatric voice cases. Even though they exhibited a positive attitude and agreed that pediatric voice management was important, discrepancies were noted between their attitude and practice. Barriers that hinder practice include the lack of professional guidelines, insufficient time and resource as well as difficulties to conduct comprehensive voice assessments with children. CONCLUSION: The study findings urge the needs of enhancing school-based SLPs' perceived knowledge and competence in managing pediatric voice disorders. The study also identifies strategic directions to improve service provision for children with voice disorders in schools.

Survey of Referral Patterns in Southwestern Mainland China: How Do Pediatricians Manage Children with Dysphonia.

OBJECTIVE: Voice disorders are common in children and have a negative impact on their quality of life. However, presently, voice assessment and therapy are inaccessible in most pediatric departments of Mainland China. Thus, referring pediatric patients with voice disorders to otolaryngology is warranted for prompt and appropriate treatment. The purpose of this study is to investigate referral patterns and their influencing factors for pediatricians' managing children with dysphonia in Southwestern Mainland China. STUDY DESIGN: Observational study. METHODS: A 28-item questionnaire was designed by multidisciplinary experts, and an anonymous survey was performed online via Wenjuanxing between September 8, 2021 and October 8, 2021. The statistical analyses were performed using the independent sample median test, the linear/logistic regression model, the Kruskal-Wallis test, and Spearman's correlation test to determine any statistically significant relationships between the variables of interest. RESULTS: Predominantly recruited from institutions in Southwestern China, 368 pediatricians were surveyed. (1) The majority of the pediatricians reported that ≤10% of children sought medical help for voice disorders; (2) only 22.1% of the pediatricians' hospitals had equipment for evaluating voice disorders; (3) 74.6% of the pediatricians would refer children with dysphonia to otolaryngology, and the older pediatricians were more likely to refer their patients than were the younger pediatricians (P = 0.022); (4) in the group that would make a referral (n = 250), the pediatricians who had worked longer (P = 0.037) and practised in the Grade-A tertiary hospitals (P = 0.044) were more likely to trust their experience as a reason for making a referral. For each year worked the probability of referring children with dysphonia depending on the pediatrician's experience increased by 3.4%. CONCLUSION: Although the pediatricians encountered some barriers to diagnosing voice disorders, their attitude towards making referrals was positive. The age and work duration of the pediatricians and the hospital grade were the influencing factors in the referral patterns. Further publicity of vocal hygiene, ongoing education among Chinese pediatricians and the improvement of referral systems may be most useful for better managing children with dysphonia.

Cross-cultural adaptation of the Brazilian version of the Speech-Specific Reinvestment Scale - SSRS. / Equivalência cultural da versão brasileira do protocolo Speech-Specific Reinvestment Scale­ SSRS.

PURPOSE: To present the cross-cultural equivalence of the Brazilian version of the Specific Reinvestment Scale in Speech - SRRS through its cultural and linguistic adaptation. METHODS: After the SSRS was translated into Brazilian Portuguese, the back-translation was done and the items were compared. Discrepancies were modified by consensus of a committee of SLPs. The SSRS, named "Escala de Reinvestimento Específico na Fala - EREF", has 39 questions and six alternatives in the answer key: "strongly disagree", "disagree", "slightly disagree", "slightly agree", "agree" and "strongly agree". The mean score is computed by the sum of each subdimension. Negative items may not be included in the EREF scoring or need reversed coding process before using them. For cultural equivalence, the EREF was applied to a total of 74 professionals working in an activity involving communication with the public, speakers of Brazilian Portuguese as a first language, with an extra item in the answer key - "not applicable" - to identify issues that might not have been understood or were not appropriate for the target population and Brazilian culture. RESULTS: The scale was initially applied to 56 participants, thirteen of whom found it difficult to complete 27 questions. After adaptation of those sentences, the modified EREF was applied to 13 more participants and no further cultural and / or conceptual barriers were found. CONCLUSION: Cultural equivalence between the SSRS and its translated version to Brazilian Portuguese - EREF was verified. The next steps for the EREF validation for Brazilian Portuguese will be carried out.

OBJETIVO: Realizar a equivalência cultural da versão brasileira da escala SSRS, por meio de sua adaptação cultural e linguística. MÉTODO: Após tradução da SSRS para o português brasileiro e retro tradução para o inglês, os itens foram comparados com o instrumento original. As discrepâncias existentes foram modificadas por consenso por um comitê de fonoaudiólogos, resultando na Escala de Reinvestimento Específico na Fala ­ EREF. A EREF tem 39 questões e seis alternativas na chave de resposta: "discordo totalmente", "discordo", "discordo ligeiramente", "concordo ligeiramente", "concordo" e "concordo totalmente". A pontuação é a soma das pontuações médias de cada subdimensão da escala, sendo que os itens negativos não entram na contabilidade ou exigem pontuação reversa. Para a equivalência cultural, a EREF foi aplicada em um total de 74 profissionais em exercício de atividade envolvendo comunicação com público, falantes do português brasileiro como primeira língua, com acréscimo da opção "não aplicável" na chave de respostas, para identificação de questões não compreendidas ou não apropriadas para a população alvo e cultura brasileira. RESULTADOS: A escala foi inicialmente aplicada em 56 participantes. Treze encontraram dificuldade para o preenchimento de 27 questões. Após a adaptação da tradução das sentenças não compreendidas ou consideradas inapropriadas, a EREF modificada foi aplicada em mais 13 respondentes e não foram encontradas barreiras culturais e/ou conceituais. CONCLUSÃO: Foi verificada equivalência cultural entre a SSRS e sua versão traduzida para o português brasileiro, a EREF. As próximas etapas para validação da EREF para o Português Brasileiro serão realizadas com a conclusão desta fase.

Equivalência cultural da versão brasileira do protocolo Speech-Specific Reinvestment Scale- SSRS / Cross-cultural adaptation of the Brazilian version of the Speech-Specific Reinvestment Scale - SSRS

RESUMO Objetivo Realizar a equivalência cultural da versão brasileira da escala SSRS, por meio de sua adaptação cultural e linguística. Método Após tradução da SSRS para o português brasileiro e retro tradução para o inglês, os itens foram comparados com o instrumento original. As discrepâncias existentes foram modificadas por consenso por um comitê de fonoaudiólogos, resultando na Escala de Reinvestimento Específico na Fala - EREF. A EREF tem 39 questões e seis alternativas na chave de resposta: "discordo totalmente", "discordo", "discordo ligeiramente", "concordo ligeiramente", "concordo" e "concordo totalmente". A pontuação é a soma das pontuações médias de cada subdimensão da escala, sendo que os itens negativos não entram na contabilidade ou exigem pontuação reversa. Para a equivalência cultural, a EREF foi aplicada em um total de 74 profissionais em exercício de atividade envolvendo comunicação com público, falantes do português brasileiro como primeira língua, com acréscimo da opção "não aplicável" na chave de respostas, para identificação de questões não compreendidas ou não apropriadas para a população alvo e cultura brasileira. Resultados A escala foi inicialmente aplicada em 56 participantes. Treze encontraram dificuldade para o preenchimento de 27 questões. Após a adaptação da tradução das sentenças não compreendidas ou consideradas inapropriadas, a EREF modificada foi aplicada em mais 13 respondentes e não foram encontradas barreiras culturais e/ou conceituais. Conclusão Foi verificada equivalência cultural entre a SSRS e sua versão traduzida para o português brasileiro, a EREF. As próximas etapas para validação da EREF para o Português Brasileiro serão realizadas com a conclusão desta fase.

ABSTRACT Purpose To present the cross-cultural equivalence of the Brazilian version of the Specific Reinvestment Scale in Speech - SRRS through its cultural and linguistic adaptation. Methods After the SSRS was translated into Brazilian Portuguese, the back-translation was done and the items were compared. Discrepancies were modified by consensus of a committee of SLPs. The SSRS, named "Escala de Reinvestimento Específico na Fala - EREF", has 39 questions and six alternatives in the answer key: "strongly disagree", "disagree", "slightly disagree", "slightly agree", "agree" and "strongly agree". The mean score is computed by the sum of each subdimension. Negative items may not be included in the EREF scoring or need reversed coding process before using them. For cultural equivalence, the EREF was applied to a total of 74 professionals working in an activity involving communication with the public, speakers of Brazilian Portuguese as a first language, with an extra item in the answer key - "not applicable" - to identify issues that might not have been understood or were not appropriate for the target population and Brazilian culture. Results The scale was initially applied to 56 participants, thirteen of whom found it difficult to complete 27 questions. After adaptation of those sentences, the modified EREF was applied to 13 more participants and no further cultural and / or conceptual barriers were found. Conclusion Cultural equivalence between the SSRS and its translated version to Brazilian Portuguese - EREF was verified. The next steps for the EREF validation for Brazilian Portuguese will be carried out.

The Effectiveness of Vocal Hygiene Education With Resonant Voice Therapy for School-Aged Children With Vocal Nodules.

OBJECTIVE: This study evaluated the effectiveness of vocal hygiene education with resonant voice therapy for school-aged children with vocal nodules. STUDY DESIGN: A pre-test/post-test control group design was employed. METHODS: Seventeen children aged between 6 and 9 years old with vocal nodules were randomly assigned to three groups: a treatment group, a placebo group and a control group. Children in the treatment group (n = 7) received six consecutive, weekly, one-hour sessions of vocal hygiene education with resonant voice therapy. Children in the placebo group (n = 5) received six consecutive, weekly, one-hour sessions on presentation skills training. Children in the control group (n = 5) did not receive any form of treatment. Subjective outcome measures included auditory-perceptual evaluation of overall dysphonia severity, the Pediatric Voice Handicap Index (pVHI) and the Children's Voice Handicap Index-10 (CVHI-10). Objective outcome measures included acoustic analysis of fundamental frequency, jitter, shimmer and noise-to-harmonic ratio. RESULTS AND CONCLUSIONS: Significant improvements in perceptual ratings of overall dysphonia severity levels and pVHI scores were found in the treatment group. No significant changes in acoustic measures and CVHI-10 scores were noted in any of the three groups. Interestingly, an improvement in perceptual overall dysphonia severity levels at post-evaluation was observed in the no treatment control group.

Self-Perceived Voice Problems in a Nontreatment Seeking Older Population in Hong Kong.

OBJECTIVE: To evaluate the prevalence of self-perceived voice problems and voice-related quality of life in a nontreatment seeking older population in Hong Kong. STUDY DESIGN: Prospective, cross-sectional survey. METHODS: One hundred and one older individuals aged 65 years or above were recruited from senior citizen community centers in Hong Kong. Each participant received a face-to-face interview with the researcher. The participants were asked to report the presence of voice problems and the voice symptoms that they experienced. They were also asked to complete the Cantonese version of the Voice Handicap Index to ascertain their voice-related quality of life. RESULTS: Over one-fourth (27.7%) of participants reported having current voice problems. Perceived voice problems were found to pose significant negative impacts on the older individuals' voice-related quality of life. The prevalence of voice problems and extent of impacts of voice-related quality of life were similar across the young-old, old-old, and the oldest-old groups of participants. CONCLUSION: The results suggest that voice problems are common in the older population and should not be underestimated. The study urges the need to allocate more resources to provide voice-related services from the young-old group for promoting positive aging.

One-Year Follow-Up of a Vocal Hygiene Program for School-Age Children.

OBJECTIVE: This study investigated the effects of a school-based vocal hygiene education program "Green Voice for School" on promoting knowledge of healthy voice use for primary school students. METHODS: Thirty-nine grade 4 and 5 students from local primary schools participated in the "Green Voice for School" program. Students received 6 weekly vocal hygiene training sessions with the aim of enhancing their voice care knowledge. Their voice care knowledge was assessed by a 15-item questionnaire. Students' voice care knowledge was examined before training, immediately after, and 1 year after completion of the program. RESULTS: Students showed significant improvements in their voice care knowledge immediately after they received the vocal hygiene training sessions. Such improvements were maintained 1 year after the students completed training. CONCLUSIONS: The results suggest that "Green Voice for School", a school-based vocal hygiene education program, can be effective in promoting long-term improvements of voice care knowledge in school-age children.

The Effects of Dysphonic Voice on Speech Intelligibility in Cantonese-Speaking Adults.

Purpose This study aims to investigate the effects of dysphonic voice on speech intelligibility in Cantonese-speaking adults. Method Speech recordings from three speakers with dysphonia secondary to phonotrauma and three speakers with healthy voices were presented to 30 healthy listeners (15 men and 15 women; M age = 22.7 years) under six noise conditions (signal-to-noise ratio [SNR] -10, SNR -5, SNR 0, SNR +5, SNR +10) and quiet conditions. The speech recordings were composed of sentences with five different lengths: five syllables, eight syllables, 10 syllables, 12 syllables, and 15 syllables. The effects of speaker's voice quality, background noise condition, and sentence length on speech intelligibility were examined. Speech intelligibility scores were calculated based on the listener's correct judgment of the number of syllables heard as a percentage of the total syllables in each stimulus. Results Dysphonic voices, as compared to healthy voices, were significantly more affected by background noise. Speech presented with dysphonic voices was significantly less intelligible than speech presented with healthy voices under unfavorable SNR conditions (SNR -10, SNR -5, and SNR 0 conditions). However, there was no sufficient evidence to suggest effects of sentence length on intelligibility, regardless of the speaker's voice quality or the level of background noise. Conclusions This study provides empirical data on the impacts of dysphonic voice on speech intelligibility in Cantonese speakers. The findings highlight the importance of educating the public about the impacts of voice quality and background noise on speech intelligibility and the potential of compensatory strategies that specifically address these barriers. Supplemental Material https://doi.org/10.23641/asha.13335926.

Development of a Psychometric Measure of the Propensity to Consciously Control and Monitor Speech Production.

Purpose A speech-specific reinvestment scale (SSRS) is a psychometric measure of the propensity to consciously control and monitor speech production. This study develops and validates an SSRS as well as examines its relationship with speech performance with the moderating effects of trait social anxieties (i.e., social interaction anxiety, public speaking anxiety, and social phobia). Method Scale development involves the following stages: (a) initial item generation based on relevant literature, (b) item evaluation through cognitive interviews with 24 healthy respondents, (c) scale reliability and validity tests using cross-sectional survey data from 498 healthy respondents, and (d) test-retest reliability assessment using longitudinal survey data from 185 healthy respondents. Respondents' speech performance is quantified using speech examination scores. Hierarchical moderated regression analyses are conducted to examine the moderating effects of trait social anxieties. Results The validated SSRS comprises 35 items, which can be categorized into four subdimensions, namely, speech movement self-consciousness, public consciousness of speech content, speech manner, and speech movement. Results show that respondents with low trait social anxieties indicate a generally positive relationship between public consciousness of speech movement and speech performance, whereas respondents with high trait social anxieties exhibit a nonsignificant relationship. Conclusions SSRS offers a reliable and valid method for assessing the predisposition for conscious speech control and monitoring, which plays a role in speech performance and is moderated by an individual's level of trait social anxiety. SSRS is a potential assessment tool for speech-language pathologists to evaluate the impacts of conscious speech control and monitoring on individuals with speech impairment.

Effects of Error Experience on Learning to Lower Speech Nasalance Level.

Purpose This research aims to examine the effects of error experience when learning to speak with lowered nasalance level. Method A total of 45 typical speakers were instructed to learn to lower speech nasalance level in either an errorless (restricted possibility for committing errors) or an errorful (unrestricted possibility for committing errors) learning condition. The nasality level of the participants' speech was measured by a nasometer and quantified by nasalance scores (in percent). Errorless learners practiced producing speech with lowered nasalance level with a threshold nasalance score of 50% (the easiest target) at the beginning, which gradually decreased to a threshold of 10% (the most difficult target) at the end. The same set of threshold targets was presented to errorful learners, but in reverse order. Errors were defined by the proportion of speech, with a nasalance score exceeding the threshold. Retention and transfer tests were administered. Results Errorless learners displayed fewer errors and lower mean nasalance scores than errorful learners during the acquisition phase. Furthermore, errorless learners achieved lower mean nasalance scores than errorful learners in the retention and transfer tests. Conclusion These results suggest that errorless learning is more effective than errorful learning and that error experience has a detrimental effect on the acquisition of a novel speech motor task that requires minimization of the nasality level. Errorless learning may be a useful paradigm for the intervention and management of hypernasality in clinical settings where behavioral treatments are needed.

Parental knowledge, attitudes, and practices about vocal hygiene for their children in Chengdu, a city from China.

This study aimed to investigate the knowledge, attitudes, and practices of parents towards vocal hygiene for their children and explore the barriers against implementation of vocal hygiene in Chengdu, a city from mainland China.An online questionnaire on knowledge, attitudes, and practice was available for parents to complete between March 1 and March 31, 2017. The questionnaire included 5 sections, general demographics; knowledge; attitudes; practices and barriers; and expectation. Scores were calculated for each category of knowledge, attitudes, and practices; and were compared using nonparametric Mann-Whitney U tests between the parents with and without a history of voice disorders. The internal consistency was assessed by Cronbach alpha coefficient. The correlations between vocal hygiene knowledge, attitude, and practice were analyzed using Spearman correlation test.The questionnaire was completed by 1075 parents. There were certain misconceptions in vocal hygiene knowledge among parents, and the parents had higher level knowledge of positive factors than negative factors about vocal hygiene. Attitudes towards vocal hygiene were positive. Practices of vocal hygiene were poor. The most common barriers to implementation of vocal hygiene practices were related to lack of awareness and knowledge for this topic.The level of parental vocal hygiene knowledge, practice, and barriers suggest that carry out vocal hygiene programs extremely urgent for school-aged children and their parents.

Mandarin (Simplified) Chinese Version of the Voice Activity and Participation Profile: Adaptation and Validation.

OBJECTIVE: The purpose of this study was to evaluate the reliability and validity of the Mandarin (simplified) Chinese version of Voice Activity and Participation Profile (MC-VAPP) in mainland China. METHODS: This study enrolled 786 subjects from February 2015 to March 2017, including 456 individuals with voice disorders (dysphonic group) and 330 vocally healthy individuals (nondysphonic group). The internal consistency (Cronbach alpha coefficient), test-retest reliability (intraclass correlation coefficient [ICC]), and differences in the MC-VAPP scores were compared between the two groups. Exploratory factor analysis was performed. The receiver operating characteristic curve and cutoff point were calculated. RESULTS: The MC-VAPP had a high internal consistency. Cronbach alpha coefficients for the subsection scores were from 0.86 and 0.96, with 0.98 for the total score. Test-retest reliability was high for the total score (ICC = 0.98). The four factors' cumulative contribution was determined to be 74.68%. The dysphonic participants displayed significantly higher total score and subsection scores than the nondysphonic participants (P < 0.001). There were significant differences in total activity limitation scores and the total participation restriction scores between the two groups (P < 0.001). The cutoff point for screening between the two groups was 36.5, with a sensitivity of 76.80% and specificity of 80.30%. CONCLUSION: The MC-VAPP is a reliable and valid instrument for the evaluation of voice-related quality of life in Chinese-speaking individuals. It is also recommended that the MC-VAPP would be a useful tool for screening individuals with and without voice disorders based on the cutoff value of 36.5.

The Impact of Dysphonic Voices on Children's Comprehension of Spoken Language.

BACKGROUND: This study investigated the effect of teachers' dysphonic voices on children's listening comprehension. METHODS: One hundred thirty-four grade three and four students were recruited from local primary schools in Hong Kong. They were required to listen to six passages, three in Cantonese and three in English, which were either read in normal, mildly dysphonic, or severely dysphonic voices. The students were required to complete six multiple-choice comprehension questions upon listening to each passage. Comprehension performance across languages, dysphonic severities, genders, and question types were examined. RESULTS: The results showed that listening comprehension was significantly poorer even when speaker's voice quality was mildly impaired. Performance in Cantonese was generally better than that in English but no significant difference in the pattern of decline was found. Both boys and girls suffered to similar extent under dysphonic situations. Differences in performance in various question types were discussed. CONCLUSIONS: These findings support the urgent need to implement voice care education for the teaching profession.

A propensity-matched analysis of clinical outcomes between open thyroid lobectomy and high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules.

BACKGROUND: High-intensity focused ultrasound is a promising, nonoperative treatment for benign thyroid nodules. Our study aimed to compare treatment outcomes of single-session high-intensity focused ultrasound ablation with open lobectomy after propensity score matching. METHODS: After propensity matching, we compared treatment-related morbidity, treatment time, duration of hospitalization, improvement in symptom score, cost, and acoustic parameters of consecutive patients who underwent high-intensity focused ultrasound ablation or lobectomy. All eligible patients completed the computerized, multidimensional voice program and Voice Handicap Index questionnaire before, and 3 and 6 months after treatment. RESULTS: The matched cohort comprised 154 patients (77 in each group). Although treatment-related morbidity was comparable between the two groups (P = .368), treatment time (P <.001), duration of hospitalization (P <.001), and medical cost (P <.001) were less in the high-intensity focused ultrasound group. After high-intensity focused ultrasound ablation, the 6-month nodule shrinkage (mean ± SD) was 64% ± 26% and the 6-month symptom improvement score was comparable with lobectomy (P = .283). At 6 months, none of the acoustic parameters were changed from the baseline in both groups (P >.05), and the Voice Handicap Index questionnaire did not differ between the two groups (P >.05). CONCLUSION: Despite having similar treatment-related morbidity and voice outcomes, there were possibly some advantages with high-intensity focused ultrasound during open lobectomy, including the avoidance of a neck scar, shorter treatment time and duration of hospitalization, and lower medical cost.

Adaptation and validation of Mandarin Chinese version of the pediatric Voice Handicap Index (pVHI).

OBJECTIVE: The aim of this study was to adapt and validate the English version of pediatric voice handicap index (pVHI) into Mandarin Chinese. METHODS: A cross-sectional study was performed from May 2016 to April 2017. A total of 367 parents participated in this study, and 338 parents completed the translated questionnaire without missing data, including 213 parents of children with voice disorders (patients group), and 125 parents of children without voice disorders (control group). The internal consistency, test-retest reliability, contents validity, construct validity, clinical validity, and cutoff point were calculated. RESULTS: The most common voice disorder in the patients group was vocal fold nodules (77.9%), followed by chronic laryngitis (18.8%), and vocal fold polyps (3.3%). The prevalence for voice disorders was higher in boys (67.1%) than girls (32.9%). The most common vocal misuse and abuse habit was shouting loudly (n = 186, 87.3%), followed by speaking for a long time (n = 158, 74.2%), and crying loudly (n = 99, 46.5%). The internal consistency for the Mandarin Chinese version of pVHI was excellent in patients group (Cronbach α = 0.95). The inter-class correlation coefficient indicated strong test-retest reliability (ICC = 0.99). The principal-component analysis demonstrated three-factor eigenvalues greater than 1, and the cumulative proportion was 66.23%. The mean total scores and mean subscales scores were significantly higher in the patients group than the control group (p < 0.05). The physical domain had the highest mean score among the three subscales (functional, physical and emotional) in the patients group. The optimal cutoff point of the Mandarin Chinese version of pVHI was 9.5 points with a sensitivity of 80.3% and a specificity of 84.8%. CONCLUSION: The Mandarin Chinese version of pVHI was a reliable and valid tool to assess the parents' perception about their children's voice disorders. It is recommended that it can be used as a screening tool for discriminating between children with and without dysphonia.

Single-session high intensity focussed ablation (HIFU) versus open cervical hemithyroidectomy for benign thyroid nodule: analysis on early efficacy, safety and voice quality.

BACKGROUND: High intensity focussed ultrasound (HIFU) is a promising non-surgical treatment for symptomatic benign thyroid nodule. We aimed to compare early efficacy, safety and voice quality between HIFU ablation and open thyroidectomy. METHODS: Consecutive patients who underwent single-session HIFU ablation or a hemithyroidectomy for symptomatic benign thyroid nodule were included. The 6-month extent of nodule shrinkage, symptom improvement score, thyroid function, hospital stay and cost were compared between the two procedures. Safety was defined by absence of major complications like recurrent laryngeal nerve injury and skin burn. Voice quality was assessed by a computerised multi-dimensional voice programme and a Voice Handicap Index (VHI) questionnaire 1-month after treatment. RESULTS: Altogether, 43 patients had HIFU and 103 patients had a hemithyroidectomy. In the HIFU group, the extent of nodule shrinkage at 6-month was 51.71 ± 16.04%. No patients in the HIFU group suffered skin burn or hypothyroidism. The HIFU group had a significantly shorter length of hospital stay (0.3 vs. 1.0 day, p < 0.001), lower incidence of subclinical hypothyroidism (1/43 vs. 21/103, p = 0.008), higher symptom improvement score (p = 0.009) and was less costly (USD 1923.1 vs. USD 5384.6). Relative to HIFU, pitch quality also worsen after surgery (p < 0.05). CONCLUSIONS: Relative to surgery, single HIFU ablation appeared efficacious and safe. Apart from shorter hospital stay, less subclinical hypothyroidism, being scar-less, lower cost and more symptom improvement, HIFU patients were less affected by a pitch problem in the first month. This study provides a strong argument for HIFU ablation as a treatment for symptomatic benign thyroid nodule.

Effects of Coaching and Repeated Trials on Maximum Phonational Frequency Range in Children.

PURPOSE: Maximum phonational frequency range (MPFR) is the frequency range from the lowest to the highest pitch that an individual can produce. This study investigated the effects of coaching and repeated trials on MPFR in a group of school-age children. METHODS: Thirty girls aged 6-11 years were randomly assigned into two groups: coaching and non-coaching. All of the participants produced the lowest and the highest phonational frequency for 10 times each. The participants in the coaching group were prompted by the clinician with verbal encouragement and a visual cue (hand-sweeping) to produce their maximum performance. The participants in the non-coaching group were simply asked to repeat the task 10 times. RESULTS: The clinician's coaching helped the participants in the coaching group reach their MPFR in fewer trials. The MPFRs elicited in 10 trials were significantly greater than those elicited in fewer trials. CONCLUSIONS: These findings suggested that coaching and repeated trials could facilitate the elicitation of MPFR more efficiently.

Examining the cognitive demands of analogy instructions compared to explicit instructions.

PURPOSE: In many learning domains, instructions are presented explicitly despite high cognitive demands associated with their processing. This study examined cognitive demands imposed on working memory by different types of instruction to speak with maximum pitch variation: visual analogy, verbal analogy and explicit verbal instruction. METHOD: Forty participants were asked to memorise a set of 16 visual and verbal stimuli while reading aloud a Cantonese paragraph with maximum pitch variation. Instructions about how to achieve maximum pitch variation were presented via visual analogy, verbal analogy, explicit rules or no instruction. Pitch variation was assessed off-line, using standard deviation of fundamental frequency. Immediately after reading, participants recalled as many stimuli as possible. RESULT: Analogy instructions resulted in significantly increased pitch variation compared to explicit instructions or no instructions. Explicit instructions resulted in poorest recall of stimuli. Visual analogy instructions resulted in significantly poorer recall of visual stimuli than verbal stimuli. CONCLUSION: The findings suggest that non-propositional instructions presented via analogy may be less cognitively demanding than instructions that are presented explicitly. Processing analogy instructions that are presented as a visual representation is likely to load primarily visuospatial components of working memory rather than phonological components. The findings are discussed with reference to speech therapy and human cognition.