Analysis of factors on voice quality in thyroidectomy patients.

OBJECTIVE: Vocal cord paralysis (VCP) is a serious complication in thyroidectomy operations; however, its management remains unclear. The present study evaluated the voice parameters of patients who underwent surgery using Intraoperative Neurophysiologic Monitoring (IONM). PATIENTS AND METHODS: A total of 52 patients (41 females and 11 males) who underwent a total thyroidectomy operation were evaluated using objective and subjective voice analysis examinations before and after surgery. Acoustic parameters, such as Fundamental Frequency (F0), Shimmer, Jitter, Noise-to-Harmonic ratio (NHR), and aerodynamic parameters, including S/Z ratio and maximum phonation time (MPT), were analyzed. Objective findings, including the VHI-10 (Voice Handicap Index) and V-RQOL (Voice-Related Quality of Life), were also analyzed. The relationship between voice parameters and IONM values was investigated. RESULTS: The objective analysis (acoustic and aerodynamic parameters) showed no difference (p>0.05). However, the subjective analysis, which involved the VHI-10 and V-RQOL measures, revealed a significant difference before and after the operation (p<0.05). The Spearman correlation analysis showed that the NHR postoperative 1st-month parameter negatively correlated (rho=-0.317, p<0.059), while the F0 postoperative 6th-month parameter positively correlated (rho=0.347) with the amplitude difference before and after dissection (Right R2-R1 difference) for the right RLN measured in IONM. CONCLUSIONS: Patients who are planning to undergo a thyroidectomy procedure should undergo voice assessment during both the preoperative and postoperative periods. IONM could improve voice quality outcomes.

Paediatric voice disorder: who to refer and how to assess? A summary of recent literature.

PURPOSE OF REVIEW: The purpose of this review is to update the reader with recent advances and current opinion on the assessment and management of paediatric voice disorders. RECENT FINDINGS: Access to advanced multidisciplinary paediatric voice clinics has increased over the last decade. Often the assessment is combined between speech therapy/pathology and ENT surgery. Vocal fold nodules remain the most prevalent diagnosis at a paediatric voice clinic, but significant diseases will also present, for example laryngeal papilloma. Recently, more consideration of the psychosocial aspect of voice disorders and evaluation of auditory processing disorders have shown how these can have a negative impact. There also appears to be a lack of parental and teacher awareness of paediatric voice disorders and their significance. SUMMARY: We would recommend multiparametric assessment and analysis of all children with a voice disorder. Most paediatric voice conditions will respond to skilled voice therapy. However, the exact techniques and dosage requires further evaluation and research. Paediatric voice conditions are common and should not be dismissed, as they may represent significant disease, for example papilloma, vagal palsy or have a significant psychosocial impact on the child.

Percepção de professores quanto ao impacto do ruído no ambiente escolar / Teachers' perception of the impact of noise in the school environment / Percepción del docente sobre el impacto del ruido en el entorno escolar

Introdução: a poluição sonora está presente na escola, sendo assim, é importante conhecer as fontes de ruído, o impacto na saúde do professor e no ensino. Objetivo: avaliar a percepção de professores do ensino fundamental I quanto ao impacto do ruído no ambiente escolar, bem como seus sintomas vocais. Método: estudo observacional, descritivo, analítico, transversal. Aplicou-se inventário, do qual participaram 26 professoras da rede municipal da cidade de Santo Amaro da Imperatriz, SC. Aplicou-se um questionário com questões referentes à idade, sexo, tempo de trabalho, carga horária diária, impacto e percepção do ruído no ambiente escolar. Utilizou-se o Índice de Triagem para Distúrbios da Voz, uma triagem para identificação de risco para distúrbio de voz em professores. Para a análise de associação dos resultados foi utilizado o teste de Qui Quadrado, com nível de significância de 5%. Resultados: 53,57% das professoras responderam que há excesso de ruído na escola e 57,14% consideram que o ruído dentro da sala prejudica as atividades. As fontes externas e internas de ruído que mais atrapalham são: pátio, corredor, conversas paralelas e ventilador. Quanto aos sintomas vocais referidos, destacaram-se: garganta seca, cansaço ao falar, pigarro e rouquidão. Professoras que lecionam em período integral apresentaram mais queixas para o pigarro. Conclusão: os sujeitos têm a percepção de que o ambiente escolar é excessivamente ruidoso e causa prejuízos no desenvolvimento das atividades. As participantes têm poucas queixas relacionadas à voz, sendo a mais frequente, garganta seca. Além disso, professoras que lecionam em período integral apresentaram, significativamente, mais queixas de pigarro. (AU)

Introducción: la contaminación acústica está presente en la escuela, entonces es importante conocer las fuentes del ruido, el impacto en la salud del docente y en la enseñanza. Propósito: evaluar la percepción de docentes sobre el impacto del ruido en el ambiente escolar, así como sus síntomas vocales. Método: estudio observacional, descriptivo, analítico, transversal. Se aplicó un inventario, en el que participaron 26 docentes de la red municipal de la ciudad de Santo Amaro da Imperatriz, (SC). con preguntas relacionadas con edad, género, tiempo de trabajo, carga diaria de trabajo, impacto y percepción del ruido en el ambiente escolar. Se utilizó el Índice de Detección de Trastornos de la Voz para identificar el riesgo de trastornos de la voz. Para el análisis de asociación se utilizó la prueba de chi-cuadrado, con un nivel de significación del 5%. Resultados: 53,57% respondió que en la escuela hay exceso de ruido y 57,14% consideram que el ruido dentro del salón perjudica las actividades. Las fuentes de ruido más molestas son: patio, pasillo, conversaciones paralelas y ventilador. En cuanto a los síntomas vocales reportados destacan sequedad de garganta, cansancio al hablar, carraspeo y ronquera. Los maestros de tiempo completo se quejaron más de carraspear. Conclusión: los sujetos tienen la percepción de que el ambiente escolar es excesivamente ruidoso y provoca perjuicios para el desarrollo de las actividades. Los participantes tienen pocas quejas relacionadas con la voz, siendo la garganta seca la más frecuente. Además, los maestros que enseñan a tiempo completo tenían muchas más quejas de carraspeo. (AU)

Introduction: noise pollution is present at school; therefore, it is important to know the sources of noise, the impact on the teacher's health and on teaching. Purpose: to evaluate the perception of elementary school teachers regarding the impact of noise in the school environment, as well as their vocal symptoms. Method: observational, descriptive, analytical, cross-sectional study. An inventory was applied, in which 26 teachers from the municipal network of the city of Santo Amaro da Imperatriz, (SC). participated. A questionnaire was applied with questions related to age, gender, working time, daily workload, impact and perception of noise in the school environment. The Voice Disorders Screening Index was used, a screening to identify risk for voice disorders in teachers. For the analysis of the association of results, the chi-square test was used, with a significance level of 5%. Results: 53.57% of the teachers answered that there is excessive noise in the school and 57.14% consider that the noise inside the room harms the activities. The most disturbing external and internal sources of noise are courtyard, corridor, parallel conversations and fan. As for the reported vocal symptoms, the following stand out: dry throat, tiredness when speaking, throat clearing and hoarseness. Full-time teachers complained more about throat clearing. Conclusion: the subjects have the perception that the school environment is excessively noisy and causes damage to the development of activities. The participants have few voice-related complaints, the most frequent being dry throat. In addition, teachers who teach full-time had significantly more complaints of throat clearing. (AU)

Impact of Sternothyroid Muscle Division on Patient-Reported Voice Outcomes After Thyroid Surgery: A Prospective Study.

OBJECTIVE: Division of the sternothyroid muscle during thyroidectomy is a widely accepted surgical technique to provide improved exposure of the thyroid gland, thus facilitating the ligation of superior pole vessels and identification of the laryngeal nerves. However, few have examined the impact on voice outcomes. We evaluate the impact of sternothyroid muscle division on patient-perceived voice outcomes after thyroidectomy. STUDY DESIGN: Prospective cohort study. SETTING: Tertiary academic institution. METHODS: A prospective cohort study was conducted comparing pre- and postoperative voice outcome data after thyroidectomy, measured using Voice Handicap Index-10. The cohort of 109 patients underwent lobectomy or total thyroidectomy by a single surgeon at 1 institution. The sternothyroid muscle was fully divided in all surgeries. The integrity of the recurrent laryngeal and external branches of the superior laryngeal nerve was assessed using intraoperative nerve monitoring and postoperative laryngoscopy. Pre- and postoperative Voice Handicap Index-10 scores were compared. RESULTS: No statistically significant difference was found between total pre- and postoperative Voice Handicap Index-10 scores (µpreop = 1.92, µpostop = 1.83, p = .87). There were no questions yielding statistically significant responses between pre- and postoperative groups. This was consistent regardless of whether the sternothyroid muscle was cut unilaterally or bilaterally. Men showed a statistically significant improvement in score after surgery. CONCLUSION: These findings support no difference in postoperative voice outcomes after the intraoperative division of the sternothyroid muscle. This supports the usage of this technique as a safe means to facilitate exposure during thyroid surgery and will serve as important information to guide intraoperative surgical decision-making.

Update on the pediatric adverse vocal behavior voice disorders: a clinical practice review.

The main causes of voice disorders in children with adverse vocal behavior include benign lesions of the vocal folds caused by voice abuse or misuses, such as vocal fold nodules, vocal fold polyps, and laryngitis. Long-term voice disorders can affect the physical and mental health of children. Reviewing the literature of the last two decades on "Vocal Fold Nodules," "Vocal Fold Polyp," "Voice disorder," "Voice Abuse," "Voice Misuse," "Pediatrics," and "Children" with the appropriate Boolean operators.  Conclusion: A total of 315 results were returned on an initial PubMed search. All articles from 2000 to 2022 written in English or Chinese were screened. Duplicate articles, those relating to adults only or concerned with the malignant lesion of the vocal cord, were excluded, resulting in 196 articles of interest. Relevant references and books have also been consulted, and we provide a review of the pathogenesis, diagnosis, and treatment of these maladaptive vocal behavioral voice disorders. What is Known: • Hoarseness is the most common voice symptom in children, and there are various causes of hoarseness in children. However, there is a lack of reviews on voice disorders caused by adverse vocal habits in children. • Voice training is a conservative treatment method for children with voice disorders , and it is important to clarify the factors that influence the effectiveness of voice training for children. What is New: • This review of the personality and family characteristics of children with adverse vocal behavioural voice disorders provides a valuable guide to the clinical planning of subsequent treatment. • This article discusses and summarises some of the factors that may influence the effectiveness of voice training in children and collates some of the scales and questionnaires currently used in children that are important in predicting the effectiveness of voice training.

Persistent subjective voice symptoms for two years after thyroidectomy.

BACKGROUND: Voice change after thyroidectomy is an important issue in thyroid surgery. However, little is known about long-term voice outcomes after thyroidectomy. This study investigates the long-term voice outcomes of thyroidectomy up to two years after surgery. Also, we analyzed the pattern of recovery through acoustic tests over time. METHODS: We reviewed data from 168 patients who underwent thyroidectomy between January 2020 and August 2020 at a single institution. The Thyroidectomy-related Voice and Symptom Questionnaire (TVSQ) score and acoustic voice analysis results were examined preoperatively and postoperative one, three, and six months, and one and two years after surgery. We divided patients into two groups based on the TVSQ score (≥15 or <15) at two years postoperatively. We investigated the difference of acoustic characteristics between the two groups and analyzed correlations between acoustic parameters and various clinical and surgical factors. RESULTS: Voice parameters tended to recover, but some parameters and TVSQ scores exhibited deterioration two years after surgery. In the subgroups, among the many clinicopathologic factors examined, voice abuse history including professional voice users (p = 0.014), greater extent of thyroidectomy and neck dissection (p = 0.019, p = 0.029), and high pitch voice (F0; p = 0.005, SFF; p = 0.016) were associated with high TVSQ score at two years. CONCLUSIONS: Patients frequently experience voice discomfort after thyroidectomy. After surgery, voice abuse history including professional voice users, greater extent of surgery, and higher pitch voice are associated with worse voice quality and increased risk of persistent voice symptoms over the long-term.

Prospective voice assessment after uncomplicated thyroidectomy: A comprehensive analysis of a single centre experience.

OBJECTIVES: Voice change after uncomplicated thyroidectomy has been an important issue in the field of thyroid surgery. The aim of this study was to promote understanding of voice change after uncomplicated thyroidectomy by analysing the results for a large number of patients from a single institute. DESIGN: We retrospectively reviewed the medical records of 2879 consecutive patients who underwent thyroidectomy and voice evaluation between January 2014 and December 2019 in a single institute. All the patients had their vocal status assessed using videostroboscopy, acoustic voice analyses, aerodynamic study, and Thyroidectomy-related Voice and Symptom Questionnaire (TVSQ) scores preoperatively and at 1, 3, and 6 months postoperatively. We analysed the pattern of voice changes over time and differences in voice parameters based on clinical factors. To confirm the usefulness of the TVSQ, the correlation between TVSQ scores and objective parameters was analysed. Lastly, predictive factors for persistent voice symptoms were analysed. SETTING: Tertiary referral hospital. RESULTS: The frequency ranges and TVSQ scores exhibited significant deterioration until 6 months following surgery. Among clinical factors, the extents of thyroidectomy and neck dissection were associated with worse voice parameters. The TVSQ score was significantly correlated with objective voice parameters. The extents of thyroidectomy and neck dissection were predictive of persistent voice symptoms at 6 months after thyroidectomy. CONCLUSION: After uncomplicated thyroidectomy, most voice parameters tended to recover, but some parameters remained aggravated even at 6 months after surgery. With more extensive surgery, worse voice quality and the higher risk of persistent voice symptoms may be anticipated.

Prevalence and Predictors of Post-Thyroidectomy Voice Dysfunction in a Nigerian Cohort.

BACKGROUND: Advances in surgical techniques have significantly improved the safety of thyroidectomy. Quality of life issues, such as voice changes, however continue to be important considerations. This study evaluated the prevalence and determinants of voice changes following thyroidectomies for non-malignant goiters in a Nigerian Hospital. METHODOLOGY: Consecutive adults who had thyroidectomy for non-malignant goiters were evaluated. Preoperatively, each participant had laryngoscopy and voice assessment using the Voice Handicap Index-10. At surgery, the intubation difficulty score, size of endotracheal tubes, and duration of operation were recorded. Laryngoscopy and VHI-10 assessments were repeated 1 week, 1 month, and 3 months after surgery. Pre and postoperative assessments were compared. RESULT: Fifty-four patients completed the study. Subtotal thyroidectomy was the commonest operation performed in 17 patients (31.48%), with 14 (25.93%) having total thyroidectomy. Baseline median VHI-10 score was 6.5(IQR-10). Five patients had abnormal preoperative laryngoscopy findings (benign vocal cord lesions). Postoperatively, seven patients had endoscopic evidence of vocal cord paralysis, six were unilateral while one was bilateral. Ten patients (18.5%) had early voice changes. Median VHI-10 score at one week was significantly higher than baseline (10 vs. 6.5, p = 0.01). At 3 months, VHI-10 reverted back to baseline in five of the ten patients while five patients (9.3%) had persistent voice changes. Abnormal endoscopic findings predicted the occurrence of early postoperative voice changes. CONCLUSION: Thyroidectomy for non-malignant goiters is associated with transient voice changes, many of which revert to normal over time. Abnormal endoscopic findings predict its occurrence.

Effects of Different Voice Rest on Vocal Function After Microlaryngeal Surgery: A Systematic Review and Meta-Analysis.

OBJECTIVES: To compare the results of a voice handicap index (VHI) scale and acoustic parameters in patients who underwent microlaryngeal surgery followed by either short-duration (voice rest for <7 days) or long-duration (≥7 days) voice rest. STUDY DESIGN: Systematic review and meta-analysis. METHODS: The PubMed, Embase, and Cochrane Library databases were systematically searched for articles published before March 1, 2021. Randomized controlled trials (RCTs) that measured the voice outcomes of patients after different durations and extents of postoperative voice restriction were included in the meta-analysis. RESULTS: Four RCTs comprising 112 patients were included in the quantitative meta-analysis. Compared with the long-duration voice rest group, the short-duration group exhibited comparable VHI scores (mean difference [MD], -7.01; 95% CI, -16.12 to 2.09; p = 0.13), maximum phonation time (MD, -2.58; 95% CI, -5.42 to 0.26; p = 0.07), and acoustic variables of jitter (MD, -1.25; 95% CI, -3.43 to 0.94; p = 0.26) and shimmer (MD, -0.79; 95% CI, -2.08 to 0.51; p = 0.24). Subgroup analysis for benign pathology and cold instruments studies demonstrated significantly better VHI scores (MD, -14.45; 95% CI, -26.19 to -2.72; p = 0.02 and MD, -15.98; 95% CI, -28.52 to -3.44; p = 0.01, respectively) in the short-duration group. CONCLUSIONS: The limited evidence does not demonstrate benefit in voice outcomes from long-duration voice rest and suggests potential unfavorable effects on compliance and quality of life, providing a rationale for short-duration voice rest after microlaryngeal surgery. More studies are required to determine the optimal duration and extent of postoperative voice rest. LEVEL OF EVIDENCE: 1 Laryngoscope, 133:154-161, 2023.

Prethyroidectomy voice and swallowing disorders and the possible role of laryngopharyngeal reflux disease.

OBJECTIVES: The aim of the study was to evaluate voice and swallowing function before thyroid surgery and to explore the possible role of thyroid enlargement and laryngopharyngeal reflux (LPR). METHODS: We conducted a prospective study of patients who underwent hemi- or total thyroidectomy (n = 118) and compared the results with patients of laparoscopic cholecystectomy (n = 110). All subjects underwent videolaryngostroboscopy, filled in subjective evaluations of voice, swallowing and reflux complaints. Acoustic voice analysis (AVA), maximum phonation time (MPT) and perceptual voice evaluation were conducted. RESULTS: We found no difference in voice quality between study and control group, neither in subjective complaints nor in AVA or perceptual evaluation. We did find indicative signs of minor laryngeal changes in thyroid group. Swallowing Impairment Score (SIS) revealed worse swallowing function in thyroid patients (p = 0.0006). Comparison of Reflux Symptom Index (RSI) scores revealed that thyroid group patients have higher values compared to control group (p = 0.006). Nevertheless, Reflux Finding Score (RFS) showed identical scores in both groups (p = 0.220). In thyroid group there was a strong positive correlation between RSI and SIS (ρ = 0.641), but no correlation between RFS and SIS (ρ = -0.002). In addition, we found a weak positive correlation between thyroid weight and RFS (ρ = 0.379). CONCLUSIONS: Changes in laryngeal area caused by thyroid disorders do not lead to subjective but indicate slight objective disturbances in voice quality. We detected a decline in swallowing quality within thyroid patients. Higher RSI scores and a positive correlation between RFS and thyroid weight, indicate a possible role of thyroid gland in LPR.

The Evaluation of Beck Anxiety Scale, Voice Handicap Index, and Brief Symptom Inventory on Treatment of Patients With Vocal Fold Nodules.

INTRODUCTION: Vocal fold nodules are benign lesions that cause hoarseness in all age groups including children, adolescents, and adults. These nodules may be caused either by singing or other causes of tension in vocal activity. OBJECTIVE: The aim of this study was to evaluate the psychological symptoms of adult patients with hoarseness and to investigate the relationship in psychological symptoms before and after voice therapy. METHODS: 23 Patients who were admitted with a voice complaint and diagnosed with vocal fold nodules and a matched control group were evaluated. Two inventories recommended by our psychiatrist (The Beck Anxiety Inventory, Brief Symptom Inventory) and Voice Handicap Index-10 (VHI-10), were completed to evaluate the treatment outcomes and psychosocial properties of the patients before and after voice therapy. RESULTS: A significant difference was observed in the BAI and BSI scores between the nodule (+) group and the control group at the beginning of the study, before voice therapy. A significant difference was found between the mean scores on the BAI and the BSI before and after therapy in the vocal fold nodules group. CONCLUSION: Patients with vocal fold nodules should be evaluated more extensively using psychological assessment scales, such as the BSI, and a psychiatric consultation should be added in cases of abnormal findings.

VOICE CONDITION FOLLOWING SHORT-TERM ENDOTRACHEAL INTUBATION IN HEAD AND NECK SURGERY: STUDY PROTOCOL FOR CLINICAL TRIAL.

Endotracheal intubation is an airway management procedure commonly performed under general anesthesia. It is linked with postoperative voice changes. The incidence and reasons of hoarseness and vocal cord injury are not very well investigated, especially after short-term anesthesia and intubation in head and neck surgery. The aim of the study is to identify the causes of voice changes after short endotracheal anesthesia in head and neck surgery. The study will include patients scheduled for head and neck surgery under general anesthesia with endotracheal intubation up to 3 hours. There will be 3 groups of patients, as follows: thyroid surgery, non-thyroid surgery, and control group undergoing surgery outside head and neck. Videostroboscopy will be recorded before and after surgery. Further diagnostic workup will include voice status; subjective voice self-analysis; perceptive and objective acoustic voice analysis at 4 time points (preoperatively, postoperative day 2, 2 weeks and 1 month after surgery). Endotracheal intubation is a safe method of airway management although it can temporarily alter a patient's voice quality. It is not known how much of this is the result of anesthesia, general condition of the patient, or surgery. This trial is expected to shed some light on this issue.

Sinais e sintomas vocais em professores universitários durante a pandemia da COVID-19 / Vocal signs and symptoms in university professors during the COVID-19 pandemic / Signos y síntomas vocales en profesores universitarios durante la pandemia del COVID-19

Introdução: Os professores utilizam a voz como instrumento de trabalho. Neste momento de pandemia da COVID-19, aumentaram os desafios das demandas vocais. Objetivo: Analisar os sinais e os sintomas vocais presentes em professores universitários durante o período da pandemia da COVID-19, o qual exigiu a realização de aulas e reuniões online. Método: A amostra foi composta por 664 professores universitários, de todas as áreas de conhecimento, sendo 366 do sexo feminino e 298 do masculino. Foi aplicado um formulário online que incluiu o Questionário de Sinais e Sintomas Vocais e o preenchimento de dados relativos a sexo biológico, universidade e departamento ao qual está vinculado. Foi realizada a associação de sinais e sintomas por meio de análise fatorial e foram comparados os sintomas vocais às variáveis sexo e área de conhecimento por meio do teste qui-quadrado. Resultados: Os sinais e os sintomas mais frequentes foram garganta seca, dificuldade para cantar agudo e cansaço vocal. 29,1% dos docentes apresentaram no mínimo 5 sintomas vocais. Houve significância estatística na relação de sexo com os sintomas de dificuldade para cantar agudo, garganta seca e dor na garganta. O sintoma de cansaço vocal foi significativamente correlacionado com as áreas de conhecimento Ciências da Saúde e Ciências Biológicas. Conclusão: Os professores universitários autorreferiram sintomas vocais físicos e funcionais durante o período da pandemia da COVID-19, havendo uma prevalência na sensação de garganta seca e dificuldade para cantar agudo.

Introduction: Teachers use their voice as a work tool. At this time of the COVID-19 pandemic, the challenges of vocal demands have increased. Objective: To analyze the vocal signs and symptoms present in university professors during the COVID-19 pandemic period, which required online classes and meetings. Method: The sample consisted of 664 university professors, from all areas of knowledge, 366 of whom were female and 298 of whom were male. An online form was applied that included the Questionnaire of Vocal Signs and Symptoms and the filling in of data related to biological sex, university, and department to which each subject is linked. The association of signs and symptoms was carried out through factor analysis and the vocal symptoms were compared to the variables gender and area of knowledge using the chi-square test. Results: The most frequent signs and symptoms were dry throat, difficulty in high-pitched singing, and vocal tiredness. 29.1% of the teachers had at least 5 vocal symptoms. There was statistical significance with sex in relation to the symptoms of difficulty in high-pitched singing, dry throat, and sore throat. The symptom of vocal tiredness was significantly correlated with the areas of knowledge Health Sciences and Biological Sciences. Conclusion: University professors self-reported physical and functional vocal symptoms during the COVID-19 pandemic period, with a prevalence of dry throat sensation and difficulty in high-pitched singing.

Introducción: Los profesores utilizan la voz como instrumento de trabajo. En estos momentos de pandemia por el COVID-19, aumentaron los desafíos y las demandas vocales. Objetivo: Analizar los signos y síntomas vocales presentes en profesores universitarios durante el período de la pandemia COVID-19, que requirieron hacer clases y reuniones virtuales. Método: La muestra fue compuesta por 664 profesores de todas las áreas de conocimiento, siendo 366 del género femenino y 298 del masculino. Fue aplicado una encuesta virtual que incluyó el Examen de Signos y Síntomas Vocales, así como también datos relacionados con el sexo biológico, universidad y programa académico vinculado. La asociación de signos y síntomas se realizó mediante análisis factorial y los síntomas vocales se compararon con las variables de género y área de conocimiento mediante la prueba de chi-cuadrado. Resultados: Los signos y síntomas más frecuentes fueros garganta seca, dificultad para cantar agudos y fatiga vocal. 29,1% de los profesores presentaron por lo menos 5 síntomas vocales. Hubo significancia estadística en la relación entre el sexo y los síntomas de dificultad para cantar agudos, garganta seca y dolor de garganta. El síntoma de fatiga vocal tuvo correlación significativa con las áreas de conocimiento de Ciencias de la Salud y Ciencias Biológicas. Conclusión: Los profesores universitarios auto relataron síntomas vocales físicos y funcionales durante el período de la pandemia del COVID-19, siendo predominante la sensación de garganta seca y la dificultad para cantar agudos.

Voice outcomes in patients with advanced laryngeal and hypopharyngeal cancer treated with chemo-radiotherapy.

Objective: Patients with locally advanced laryngeal and hypopharyngeal cancer (LHC) are often treated with chemo-radiotherapy to avoid total laryngectomy, although voice problems may occur even if not markedly manifest. We sought to evaluate the impact of chemoradiation on voice and quality of life. Methods: We studied 21 patients with locally advanced LHC with tumour control at least two years after chemo-radiotherapy. None manifested clinical symptoms related to the treatment and maintained an activity considered as within normal limits. All patients had a voice handicap index (VHI) of less than 15. Voice function was evaluated by perceptual vocal analysis (CAPE-V) and aerodynamic and acoustic study. Quality of life was assessed with the EORTC-H&N35 (voice items 46, 53 and 54). Results: Voice changes were frequent, with alterations in all CAPE-V attributes, and predominantly type II and III spectrograms in acoustic analysis (78%). The EORTC-H&N35 scale showed a reduction in scores in 10-40% of items related to voice. Conclusions: Subclinical voice disorders are common after chemo-radiotherapy. Although patients consider vocal impairment to be very minor and to not interfere with their daily life, it may contribute to a reduced quality of life.

Effects of Medical Masks on Voice Quality in Patients With Voice Disorders.

PURPOSE: The purpose of this study was to explore the effects of medical masks on the voice quality of patients with voice disorders. METHOD: We included 106 patients diagnosed with voice disorders. Among them, 59 were diagnosed with vocal-fold benign lesions, 27 with insufficient glottis closure, and 20 with precancerous lesions/early-stage glottic carcinoma. Perceptual parameters (GRBAS [grade, roughness, breathiness, asthenia, strain] scale), acoustic parameters (f o, sound pressure level [SPL], jitter, shimmer, noise-to-harmonic ratio [NHR], and cepstral peak prominence [CPP]), and maximum phonation time (MPT) without and with medical masks were analyzed. Changes in the GRBAS scale after wearing medical masks were also evaluated. RESULTS: With medical mask wearing, the G, R, and B scales in the vocal-fold benign lesion and insufficient glottic closure groups decreased, with a statistical significance seen in the G and R scales of the vocal-fold benign lesion group (G 1.07 ± 0.59, 0.95 ± 0.68, p < .01; R 1.07 ± 0.59, 0.95 ± 0.68, p < .01). The B scale in the precancerous lesions/early-stage glottic carcinoma (95%) and vocal-fold benign lesion groups (83%) and R scale in the insufficient glottic closure group (77.8%) were stable with mask wearing. f o and SPL in the vocal-fold benign lesion group and f o and jitter in the insufficient glottic closure group increased significantly with medical masks. The NHR and CPP in each group changed little, and all the parameters in the precancerous lesions/early-stage glottic carcinoma group showed no significant change. CONCLUSIONS: The effects of medical masks on the voice quality of patients with voice disorders were associated with the type of the disease, degree of hoarseness, and subjective scale influencing specific voice disorder. When wearing medical masks, the pitch and loudness of patients increased as compensation. Medical masks had the least impact on the precancerous lesions/early-stage glottic carcinoma group.

Schoolteachers with voice handicap are twice as likely to report depressive symptoms.

This study aimed to examine the association between voice disorder and depressive symptoms in schoolteachers. A cross-sectional survey was conducted with elementary and secondary schoolteachers. Voice disorders and depressive symptoms were assessed with the Voice Handicap Index-10 and the Beck Depression Inventory-II, respectively. Logistic and linear regressions models were adjusted for confounding variables. In the 389 schoolteachers studied, the prevalence of voice handicap and depressive symptoms was 18.8 and 38.8%, respectively. Voice handicap was associated with depressive symptoms on all models tested. The logistic regression showed an odds ratio of 2.21 (95% confidence interval: 1.19, 4.08; p value < 0.05), while in the linear regression each point increase on the voice disorder scale increased the Beck Depression Inventory-II score by 0.39 points (95% confidence interval: 0.26, 0.54; p value < 0.05). This study showed that teachers of public schools with voice handicap are twice as likely to report depressive symptoms.

The role of platelet-rich plasma in microlaryngeal surgery: a randomised, controlled trial.

OBJECTIVE: Platelet-rich plasma has gained interest over the two last decades, mainly because of its role in regenerative medicine. This work aimed to assess the role of intra-operative local application of platelet-rich plasma gel in the improvement of quality of voice after microlaryngeal surgery. METHOD: This was a prospective comparative study that included 40 patients undergoing microlaryngeal surgery for benign vocal fold lesions. There were two groups divided equally into study group A and control group B. The assessment of voice was performed by videostroboscopy and acoustic analysis pre-operatively and at two weeks and one and three months post-operatively. RESULTS: The data demonstrated that all the stroboscopic and acoustic parameters showed significant improvement in both groups. Group A showed significant improvement regarding acoustic parameters at the third post-operative follow up when compared with group B. CONCLUSION: Platelet-rich plasma has a beneficial effect on voice quality following microlaryngeal surgery based in particular on acoustic parameters.