Reliability of the Acoustic Voice Quality Index AVQI and the Acoustic Breathiness Index (ABI) when wearing CoViD-19 protective masks.

PURPOSE: Investigating whether the Acoustic Voice Quality Index (AVQI) and the Acoustic Breathiness Index (ABI) are valid and comparable to previous unmasked measurements if the speaker wears a surgical mask or a FFP-2 mask to reduce the risk of transmitting air-borne viruses such as SARS-CoV-2. METHODS: A convenience sample of 31 subjectively healthy participants was subjected to AVQI and ABI voice examination four times: Twice wearing no mask, once with a surgical mask and once with a FFP-2 mask as used regularly in our hospital. The order of the four mask conditions was randomized. The difference in the results between the two recordings without a mask was then compared to the differences between the recordings with each mask and one recording without a mask. RESULTS: Sixty-two percent of the AVQI readings without a mask represented perfectly healthy voices, the largest AVQI without a mask value was 4.0. The mean absolute difference in AVQI was 0.45 between the measurements without masks, 0.48 between no mask and surgical mask and 0.51 between no mask and FFP-2 mask. The results were neither clinically nor statistically significant. For the ABI the resulting absolute differences (in the same order) were 0.48, 0.69 and 0.56, again neither clinically nor statistically different. CONCLUSION: Based on a convenience sample of healthy or only mildly impaired voices wearing CoViD-19 protective masks does not substantially impair the results of either AVQI or ABI results.

[Tasteless thickening agents? A competitive comparison]. / Geschmacksneutrale Andickungsmittel? ­ Ein kompetitiver Vergleich.

BACKGROUND: Thickening of drinks is a standard procedure in dysphagia therapy. Among other things, this adaptive procedure aims to prevent posterior leakage and reduce the demands placed on retarded swallowing reflexes by decelerating boluses. Studies show that taste perception can induce a negative attitude towards thickened fluids in patients. This study investigates whether different thickeners differ in taste. METHODS: The taste of eight arbitrarily chosen thickeners available on the German market were compared by 37 healthy adults. In the test setting, two thickeners combined with water competed against each other. Participants decided which one they preferred. Up to seven pairwise comparisons were performed by each participant. Overall, 224 comparisons were carried out. Based on these results, a relative taste grade was calculated using a probabilistic model and significance tests for differences were performed. RESULTS AND CONCLUSION: There are significant differences in taste between the different products, presumably depending on their respective basic ingredients. To respect individual patient's preferences, different thickeners should be tried out in dysphagia therapy. It remains unclear whether thickeners' taste differences remain relevant once other liquids such as coffee, tea, or juice are thickened.

Smell and taste in idiopathic blepharospasm.

The pathophysiology of blepharospasm is incompletely understood. Current concepts suggest that blepharospasm is a network disorder, involving basal ganglia, thalamus, cortex, and, possibly, the cerebellum. Tracing, imaging, and clinical studies revealed that these structures are also concerned with olfaction and taste. Because of this anatomical overlap, dysfunction of the chemical senses in blepharospasm is expected. Injections of botulinum toxin into the eyelid muscles are the first-line treatment of blepharospasm. Yet, the effects of botulinum toxin on the chemical senses have not been systematically assessed. To contribute to a better understanding of blepharospasm, olfactory and gustatory abilities were assessed in 17 subjects with blepharospasm and 17 age-/sex-matched healthy controls. Sniffin Sticks were used to assess odor threshold, odor discrimination, and odor identification. Results of these three Sniffin Sticks subtests were added to the composite olfactory score. The Taste Strips were applied to assess taste. In an adjacent study, we assessed the sense of smell and taste in eight subjects with blepharospasm before and 4 weeks after botulinum toxin treatment. Subjects with blepharospasm had significantly lower (= worse) scores for odor threshold and for the composite olfactory score than healthy controls, while odor discrimination, odor identification, and the composite taste score were not different between groups. The adjacent study revealed that botulinum toxin did not impact the chemical senses. In this study, subjects with blepharospasm had a lower (= worse) odor threshold than healthy controls. As olfaction is important in daily life, findings justify further research of olfaction in blepharospasm.

Effects of a conservative in-patient voice treatment on the voice-related self-concept.

PURPOSE: Observational study to determine if the voice-related self-concept as measured via the Fragebogen zur Erfassung des Stimmlichen Selbstkonzepts FESS (questionnaire for the assessment of the voice self-concept) can be improved through in-patient voice therapy. METHODS: 234 female and 80 male patients that underwent an intensive 3- to 4-week in-patient voice treatment due to varying types of dysphonia. After imputation of missing items but not missing questionnaires, 255 patients were eligible for FESS evaluation, 313 for VHI-12 evaluation. The German questionnaire for the assessment of the voice self-concept (FESS) and the German 12-item short-form of the Voice Handicap Index (VHI-12) were administered at the beginning and at the end of the hospital stay. Before-after comparisons are made visually and via t test. RESULTS: The Voice Handicap was significantly reduced, demonstrating the effectiveness of the administered therapy. Of the three scales of the FESS, the relationship with one's own voice and the awareness of the use of one's own voice was increased and thus improved. The connection between voice and emotional changes decreased significantly but only slightly. CONCLUSION: Conservative voice rehabilitation can not only reduce the voice handicap, but also improve the voice self-concept and the results can be measured.

Smell and taste in cervical dystonia.

The pathophysiology of cervical dystonia is not completely understood. Current concepts of the pathophysiology propose that it is a network disorder involving the basal ganglia, cerebellum and sensorimotor cortex. These structures are primarily concerned with sensorimotor control but are also involved in non-motor functioning such as the processing of information related to the chemical senses. This overlap lets us hypothesize a link between cervical dystonia and altered sense of smell and taste. To prove this hypothesis and to contribute to the better understanding of cervical dystonia, we assessed olfactory and gustatory functioning in 40 adults with idiopathic cervical dystonia and 40 healthy controls. The Sniffin Sticks were used to assess odor threshold, discrimination and identification. Furthermore, the Taste Strips were applied to assess the combined taste score. Motor and non-motor deficits of cervical dystonia including neuropsychological and psychiatric alterations were assessed as cofactors for regression analyses. We found that cervical dystonia subjects had lower scores than healthy controls for odor threshold (5.8 ± 2.4 versus 8.0 ± 3.2; p = 0.001), odor identification (11.7 ± 2.3 versus 13.1 ± 1.3; p = 0.001) and the combined taste score (9.5 ± 2.2 versus 11.7 ± 2.7; p < 0.001), while no difference was found in odor discrimination (12.0 ± 2.5 versus 12.9 ± 1.8; p = 0.097). Regression analysis suggests that age is the main predictor for olfactory decline in subjects with cervical dystonia. Moreover, performance in the Montreal Cognitive Assessment is a predictor for gustatory decline in cervical dystonia subjects. Findings propose that cervical dystonia is associated with diminished olfactory and gustatory functioning.

[Questionnaire for the assessment of the voice self-concept in a neurological practice : Applicability for the identification of patients with high consultation needs]. / Fragebogen zur Erfassung des stimmlichen Selbstkonzepts in einer Nervenarztpraxis : Anwendbarkeit zur Identifikation von Patienten mit hohem Beratungsbedarf.

INTRODUCTION: Hoarseness occurs as a symptom of a multitude of neurological diseases. The importance people attribute to their voice differs greatly and it seems advisable to take this into account during consultation. The Questionnaire for the assessment of the voice self-concept (FESS) is able to measure this importance. The aim of this study was to determine the applicability of the FESS in a neurological and psychiatric medical practice. MATERIAL AND METHODS: A total of 556 patients of a neurological and psychiatic medical practice completed the FESS and the severity of hoarseness was measured objectively by means of the Acoustic Voice Quality Index (AVQI). Another 75 patients only completed the questionnaire. The value distribution of the questionnaire, the correlation with age and gender, the voice quality as well as the daily strain on the voice were investigated. RESULTS: The value distribution ranges of all three scales of the FESS are completely utilized. Floor and ceiling effects do not play a relevant role. Gender and age do not seem to be of significance. The influence of the measurable voice quality is minor. In contrast a correlation between voice self-concept and the daily voice strain was detected. DISCUSSION: The FESS has the potential to be an interesting instrument for the measurement of the subjective importance of a patient's voice. Here reference values are generated, against which individual results can be correlated. The AVQI provides an inexpensive fast instrument for the objective measurement of hoarseness in a neurological and psychiatric medical practice.

[Evaluation of the questionnaire on voice self-concept by ENT tumor patients]. / Evaluation des Fragebogens zur Erfassung des stimmlichen Selbstkonzepts durch HNO-Tumorpatienten.

OBJECTIVE: The questionnaire for the assessment of the voice self-concept (Fragebogen zur Erfassung des stimmlichen Selbstkonzepts, FESS) measures personal aspects such as the relationship with one's own voice and its self-perception. This study is concerned with its applicability in patients with head & neck malignancy. In an earlier anonymous study, a majority of patients rated the questionnaire as easy-to-answer. To gain a better understanding of the remaining difficulties, in this study one-on-one interviews with patients were conducted. Also, the time needed to answer the questionnaire and the Acoustic Voice Quality Index (AVQI) were collected. MATERIALS AND METHODS: 113 patients after head & neck malignancy completed the questionnaire in the presence of an investigator and were then interviewed on it. Time and voice recordings for AVQI analysis were taken. RESULTS: From the perspective of a majority of patients, it was easy to complete the questionnaire. For a minority certain items were difficult to answer, some were incomprehensible or the answering scheme too complicated. Mean time consumption was 3 minutes, 90 % finished within 4,5 minutes. CONCLUSIONS: The interviews do not object to the applicability of the questionnaire in general. However, it is not suitable for a minority of patients. The interviews identify a number of critical items and the associated difficulties, so investigators hopefully get a better idea of the limitations in this particular clientele.

[Voice self-concept in 230 German patients after head-and-neck malignancy]. / Das Stimmliche Selbstkonzept bei 230 Patienten nach Kopf-Hals-Tumortherapie.

INTRODUCTION: The German questionnaire 'Fragebogen zur Erfassung des Stimmlichen Selbstkonzepts (FESS)', published by Nusseck et al 2015, evaluates voice self-concept in 3 scales. There are no normative data for clinical populations published. Gaining an insight into patients' voice self-concept might help in taking individualized decisions in head & neck cancer. MATERIAL AND METHODS: 230 patients visiting our clinic in head & neck cancer follow-up care were administered the questionnaire. Scale value distributions in this population are described, influences of age and gender investigated. RESULTS: The questionnaire performs very well with regard to the scale value distributions. Age and gender effects are tiny, so our data can be used for clinical comparison purposes without respect to gender and age. CONCLUSIONS: The FESS questionnaire appears to be suitable for patients after head & neck malignancy and normative data for this population are published here.

[Internal Validation of the Acoustic Voice Quality Index version 03.01 und Acoustic Breathiness Index]. / Interne Validität des Acoustic Voice Quality Index Version 03.01 und des Acoustic Breathiness Index.

OBJECTIVE: Acoustics might have the potential to objectify voice quality (eg, hoarseness and breathiness). The Acoustic Voice Quality Index (AVQI) and the Acoustic Breathiness Index (ABI) revealed sufficient valid and reliable results in the evaluation of voice quality. The aim of the present study is to validate the recent version of AVQI 03.01 and ABI in their internal validation. The responsiveness of change is evaluated on the hoarseness and breathiness severity after voice therapy. MATERIALS AND METHODS: In total, 84 voice samples of continuous speech and sustained vowel [a:] before and after a voice therapy were used. All 42 subjects presented organic and nonorganic voice disorders and various degrees of dysphonia severity before and after behavioral voice therapy. The voice samples were judged by three voice experts using the RBH-scale, which is based on the GRBAS-scale. RESULTS: The intra-rater reliability was high for hoarseness (mean kappa = 0.76) and breathiness (mean kappa = 0.69).The inter-rater reliability was lower for both voice quality characteristics and ranged between kappa = 0.27 to 0.29. A strong correlation was identified between the perceived rating of hoarseness and breathiness and AVQI and ABI before and after voice therapy (r = 0.715, p < 0.01, and r = 0.712, p < 0.01, respectively). Additionally, no significant differences were revealed. CONCLUSION: The present results showed that AVQI version 03.01 und ABI had a high internal validity to assess voice changes after voice therapy. AVQI and ABI are two valid and robust voice measures to objectify hoarseness and breathiness.

Advances in Clinical Voice Quality Analysis with VOXplot.

BACKGROUND: The assessment of voice quality can be evaluated perceptually with standard clinical practice, also including acoustic evaluation of digital voice recordings to validate and further interpret perceptual judgments. The goal of the present study was to determine the strongest acoustic voice quality parameters for perceived hoarseness and breathiness when analyzing the sustained vowel [a:] using a new clinical acoustic tool, the VOXplot software. METHODS: A total of 218 voice samples of individuals with and without voice disorders were applied to perceptual and acoustic analyses. Overall, 13 single acoustic parameters were included to determine validity aspects in relation to perceptions of hoarseness and breathiness. RESULTS: Four single acoustic measures could be clearly associated with perceptions of hoarseness or breathiness. For hoarseness, the harmonics-to-noise ratio (HNR) and pitch perturbation quotient with a smoothing factor of five periods (PPQ5), and, for breathiness, the smoothed cepstral peak prominence (CPPS) and the glottal-to-noise excitation ratio (GNE) were shown to be highly valid, with a significant difference being demonstrated for each of the other perceptual voice quality aspects. CONCLUSIONS: Two acoustic measures, the HNR and the PPQ5, were both strongly associated with perceptions of hoarseness and were able to discriminate hoarseness from breathiness with good confidence. Two other acoustic measures, the CPPS and the GNE, were both strongly associated with perceptions of breathiness and were able to discriminate breathiness from hoarseness with good confidence.

Evaluation of a Non-Personalized Optopalatographic Device for Prospective Use in Functional Post-Stroke Dysphagia Therapy.

OBJECTIVE: Stroke survivors commonly suffer from dysphagia, originating from oro-facial impairments which affect swallowing function. Functional therapy often employs tongue exercises that require the patient to perform short motion sequences. Evaluating the patient's performance on those exercises is difficult, because there is no reliable form of visual feedback. METHODS: We propose an optopalatographic device that does not require a personalized dental retainer and is capable of measuring tongue movement trajectories intraorally. The device features nine optical proximity sensors at 100 Hz and is fixated against the hard palate with a specifically developed palatal adhesive. The sensing capabilities of the device were evaluated on a tongue gesture corpus recorded from nine healthy individuals, containing eight different tongue exercises commonly used in functional dysphagia therapy. RESULTS: The measured tongue trajectories contained temporally and spatially resolved information about the tongue movement and location during each exercise. Furthermore, a simple DTW-kNN classifier was able to distinguish the exercises from one another with an average classification accuracy of 97.9 % and 61.4 % (cross-validation and inter-speaker test accuracy, respectively). CONCLUSION: the device can provide real-time feedback for tongue motion and we obtained promising gesture recognition results with relatively few sensors, even in the absence of a personalized dental retainer. SIGNIFICANCE: Non-personalized optopalatography is readily available and could aid in improving functional dysphagia therapy by providing visual feedback to both the physician and patient.

Validation of the Acoustic Voice Quality Index Version 03.01 and Acoustic Breathiness Index in German.

OBJECTIVE: The aim of this study was to validate the acoustic voice quality index (AVQI) version 03.01 and the acoustic breathiness index (ABI) in the German language. METHODS: Concatenated voice samples of continuous speech (cs) and sustained vowel (sv) [a:] from 175 subjects with dysphonia and 43 vocally healthy subjects were perceptually judged for overall voice quality and breathiness severity. First, to reach a higher level of ecological validity, the proportions of cs and sv were equalized regarding the time length. Second, concurrent validity and diagnostic accuracy were statistically verified using the Spearman rank-order correlation coefficient (rs) and several estimates of the receiver operating characteristics, likelihood ratio, and Youden index. RESULTS: A moderate reliability of overall voice quality and breathiness severity from three experts were found. It was found that 27 syllables as standardization of the cs part, which represents 3 seconds of voiced cs, allows the equalization of both speech tasks. A strong correlation was revealed between AVQI and overall voice quality (rs = 0.86, P < 0.01), and ABI and perceived breathiness severity (rs = 0.85, P < 0.01). Additionally, the best diagnostic outcome for AVQI and ABI was identified at a threshold of 1.85 (sensitivity of 72 % and specificity of 90 %) and 3.42 (sensitivity of 72 % and specificity of 95 %), respectively. CONCLUSION: AVQI and ABI showed in the German language valid and robust results to quantify abnormal voice qualities regarding overall voice quality and breathiness severity.

Olfaction as a Marker for Dystonia: Background, Current State and Directions.

Dystonia is a heterogeneous group of hyperkinetic movement disorders. The unifying descriptor of dystonia is the motor manifestation, characterized by continuous or intermittent contractions of muscles that cause abnormal movements and postures. Additionally, there are psychiatric, cognitive, and sensory alterations that are possible or putative non-motor manifestations of dystonia. The pathophysiology of dystonia is incompletely understood. A better understanding of dystonia pathophysiology is highly relevant in the amelioration of significant disability associated with motor and non-motor manifestations of dystonia. Recently, diminished olfaction was found to be a potential non-motor manifestation that may worsen the situation of subjects with dystonia. Yet, this finding may also shed light into dystonia pathophysiology and yield novel treatment options. This article aims to provide background information on dystonia and the current understanding of its pathophysiology, including the key structures involved, namely, the basal ganglia, cerebellum, and sensorimotor cortex. Additionally, involvement of these structures in the chemical senses are reviewed to provide an overview on how olfactory (and gustatory) deficits may occur in dystonia. Finally, we describe the present findings on altered chemical senses in dystonia and discuss directions of research on olfactory dysfunction as a marker in dystonia.

Transsynaptic delivery of nanoparticles to the central auditory nervous system.

CONCLUSION: Silica nanoparticles may serve as a nonviral delivery system to the sensory hair cells, spiral ganglion cells within the cochlea, and the vestibular organ, as well as the cochlear nucleus. OBJECTIVES: At present there are no targeted therapeutics for inner ear disease. A variety of viral vector systems have been tested in the inner ear with variable efficacy but they are still not regarded as safe systems for inner ear delivery. Nanoparticles are a nonviral method of delivering a variety of macromolecules that potentially can be used for delivery within the auditory system. In this study, we evaluated the distribution and safety of nanoparticles in the inner ear. MATERIALS AND METHODS: Cy3-labeled silica nanoparticles were placed on the round window membrane of adult mice. Hearing thresholds were determined after nanoparticle delivery by auditory brainstem responses (ABRs). Distribution of particles was determined by histological evaluation of the cochlea, vestibular organs, and brain stem. RESULTS: Fluorescent microscopy demonstrated Cy3-labeled nanoparticles signals in the sensory hair cells and the spiral ganglion neurons of both the treated and contralateral inner ears. Additionally, the distal part of the central auditory pathway (dorsal cochlear nucleus, superior olivary complex) was found to be labeled with the Cy3-linked silica nanoparticles, indicating a retrograde axonal transport. No hearing loss or inflammation was noted in the treated cochlea.

Fully automated glottis segmentation in endoscopic videos using local color and shape features of glottal regions.

Exact analysis of glottal vibration patterns is indispensable for the assessment of laryngeal pathologies. Increasing demand of voice related examination and large amount of data provided by high-speed laryngoscopy and stroboscopy call for automatic assistance in research and patient care. Automatic glottis segmentation is necessary to assist glottal vibration pattern analysis, but unfortunately proves to be very challenging. Previous glottis segmentation approaches hardly consider characteristic glottis features as well as inhomogeneity of glottal regions and show serious drawbacks in their application for diagnostic purposes. We developed a fully automated glottis segmentation framework that extracts a set of glottal regions in endoscopic videos by using a flexible thresholding technique combined with a refining level set method that incorporates prior glottis shape knowledge. A novel descriptor for glottal regions is presented to remove potential nonglottal fake regions that show glottis-like shape properties. Knowledge of local color distributions is incorporated into Bayesian probability image generation. Glottal regions are then tracked frame-by-frame in probability images with a region-based level set segmentation strategy. Principal component analysis of pixel coordinates is applied to determine glottal orientation in each frame and to remove nonglottal regions if erroneous regions are included. The framework shows very promising results concerning segmentation accuracy and processing times and is applicable for both stroboscopic and high-speed videos.