Voice self-assessment in individuals with Parkinson's Disease as compared to general voice disorders.

BACKGROUND: Individuals with Parkinson's Disease (IwPD) often fail to adjust their voice in different situations, without awareness of this limitation. Clinicians use self-report questionnaires that are typically designed for individuals with General Voice Disorders (GVD) in the vocal assessment of IwPD. However, these instruments may not consider that IwPD have a reduced self-perception of their vocal deficits. This study aimed to compare self-reported vocal symptoms and voice loudness between IwPD and GVD. METHODS: 28 IwPD and 26 with GVD completed the Voice Symptom Scale (VoiSS) questionnaire to evaluate their voice self-perception. Vocal loudness (dB) was also assessed. Univariate and multivariate analyses were used to compare the outcomes from these measures between the two groups. Principal Component Analysis and Hierarchical Clustering Analysis were applied to explore data patterns related to voice symptoms. RESULTS: IwPD reported significantly fewer vocal symptoms than those with GVD in all VoiSS questionnaire domains. Multivariate principal component analysis found no significant correlations between VoiSS scores and participant similarities in voice measures. Despite experiencing hypophonia, IwPD scored lower in all VoiSS domains but still fell in the healthy voice range. Hierarchical Clustering Analysis grouped participants into three distinct categories, primarily based on age, vocal loudness, and VoiSS domain scores, distinguishing between PD and GVD individuals. CONCLUSIONS: IwPD reported fewer vocal symptoms than GVD. The voice self-assessment seems to be unreliable to assess vocal symptoms in IwPD, at least regarding loudness. New self-report instruments tailored to PD individuals are needed due to their particular voice characteristics.

Using the recurrence plots as indicators for the recognition of Parkinson's disease through phonemes assessment.

Parkinson's disease (PD) is considered to be the second most common neurodegenerative disease which affects the patients' life throughout the years. As a consequence, its early diagnosis is of major importance for the improvement of life quality, implying that the severe symptoms can be delayed through appropriate clinical intervention and treatment. Among the most important premature symptoms of PD are the voice impairments of articulation, phonation and prosody. The objective of this study is to investigate whether the voice's dynamic behavior can be used as possible indicator for PD. Thus in this work, we employ the recurrence plots (RPs) which derive from the analysis of the three modulated vowels /a/, /e/ and /o/, which belong to the PC-GITA dataset, and are fed as input images to a 3-channel Convolutional Neural Network-based (CNN) architecture, which, finally, differentiates the 50 PD patients from 50 healthy subjects. The experimental results obtained provide evidence that the RP-based approach is a promising tool for the recognition of PD patients through the analysis of voice recordings, with a classification accuracy achieved equal to 87%.

[Advances in application research on assessment methods of vocal fatigue].

Vocal fatigue（VF） is the common clinical symptom of voice diseases. It can also be a separate symptom and is considered to be a signal for the body to rest and to avoid pathological damage to the vocal cords. Therefore, the early identification and evaluation of vocal fatigue is of great value to the early prevention and treatment of vocal diseases. In recent years, there are many researches on the evaluation methods of vocalization fatigue. We searched the relevant literature and summarized the application status of vocal fatigue assessment methods, in order to provide reference for the selection and development of vocal fatigue assessment tools in clinical practice.

Assessment of Subjective and Objective Voice Analysis According to Types of Sulcus Vocalis.

INTRODUCTION: Sulcus vocalis (SV) subtypes are difficult to diagnose. Non-invasive techniques are sometimes not feasible in the diagnosis. The study aims to demonstrate the effectiveness and applicability of objective and subjective voice analysis combined with videolaryngostroboscopic examination (VLS) in the diagnosis of SV types. MATERIAL AND METHODS: This is a retrospective study that includes patients who presented to Phoniatric outpatient clinic with complaints related to voice and diagnosed with SV on VLS examination between 2017-2020. The SV type was determined based on VLS findings and the patients were categorized into respective groups. Between- and within-group assessment of objective and subjective voice analysis of SV types was conducted. RESULTS: 47 patients were included in the study; Type I, Type II, Type III SV patients were 16, 17, and 14 in number, respectively. Fundamental frequency (F0) and Shimmer (%) values were significantly high in Type II and III SV cases, whereas the Maximum Phonation Time (MPT) was significantly low. GRBAS, Voice Handicap Index -10 (VHI-10), Reflux Symptom Index (RSI) scores were statistically significantly high in pathological SV and Voice Related Quality of Life (V-RQOL) scores were low. A moderate correlation between VHI-10 and V-RQOL and between RSI and V-RQOL was detected. CONCLUSIONS: Objective and subjective voice analysis in Type II and III SV show a significant difference compared to Type I SV. The use of objective and subjective voice analysis combined with VLS examination can be helpful in the diagnosis of SV types.

Presbylarynx: Is it Possible to Predict Glottal Gap by Cut-Off Points in Auto-Assessment Questionnaires?

PURPOSE: To determine cut-off points in auto-assessment questionnaires to predict the presence and extent of presbylarynx signs. METHOD: This case control, prospective, observational, and cross-sectional study was carried out on consecutive subjects observed by Otorhinolaryngology, in a tertiary center, in 2020. Each subject underwent fiberoptic videolaryngoscopy with stroboscopy, and presbylarynx was considered when it was identified two or more of the following endoscopic findings: vocal fold bowing, prominence of vocal processes in abduction, and a spindle-shaped glottal gap. Each subject completed three questionnaires: the Voice Handicap Index (VHI), with 30 and 10 questions, and the "Screening for voice disorders in older adults questionnaire" (RAVI). RESULTS: The studied population included 174 Caucasian subjects (60 males; 114 females), with a mean age of 73.99 years (standard deviation = 6.37; range 65-95 years). Presbylarynx was identified in 71 patients (41%). Among patients with presbylarynx, a glottal gap was identified in 22 patients (31%). The mean score of VHI-30 between "no presbylarynx" and "presbylarynx" groups was statistically different (P < 0.001), with a higher score for subjects with signs of presbylarynx. The presence of glottal gap was associated to a higher mean score of VHI-30 (41.64 ± 11.87) (P < 0.001). The mean score of VHI-10 between "no presbylarynx" and "presbylarynx" groups was statistically different (P < 0.001), with a higher score for subjects with signs of presbylarynx. Among patients with presbylarynx, the presence of glottal gap was associated to higher mean score of VHI-10 (14.04 ± 3.91) (P < 0.001). There was a strong positive correlation between VHI-30 and VHI-10 (rs = 0.969; P < 0.001). The mean score of RAVI between "no presbylarynx" and "presbylarynx" groups was statistically different (P < 0.001), with a higher score for subjects with signs of presbylarynx. Among patients with presbylarynx, the presence of glottal gap was associated to a higher mean score of RAVI (11.68 ± 1.61) (P < 0.001). There was a strong positive correlation not only between RAVI and VHI-30 (rs = 0.922; P < 0.001), but also between RAVI and VHI-10 (rs = 0.906; P < 0.001). The optimal cut-off points to discriminate "no presbylarynx" from "presbylarynx", obtained by the Youden' index, were 3.5 for RAVI, 4.5 for VHI-30 and 1.5 for VHI-10. RAVI had the highest sensitivity and specificity. The optimal cut-off points to predict glottal gap, obtained by the Youden' index, were 9.5 for RAVI, 21 for VHI-30 and 7.5 for VHI-10. CONCLUSION: The optimal cut-off points do discriminate "no presbylarynx" from "presbylarynx" were 3.5 for RAVI, 4.5 for VHI-30 and 1.5 for VHI-10. RAVI had the highest sensitivity and specificity, probably because it was designed specifically for vocal complaints of the elderly. Among patients with presbylarynx, cut-off points of 9.5 for RAVI, 21 for VHI-30 and 7.5 for VHI-10 were determined to predict patients with and without glottal gap. It was found a strong positive correlation between RAVI, VHI-30 and VHI-10. Thus, VHI-10 can be preferred to VHI-30 to assess voice impairment in clinical practice, because for elderly patients it is easier to answer. However, to predict endoscopic signs of presbylarynx, RAVI should be preferred.

Longitudinal Assessment of Singing Students.

INTRODUCTION: Singers have unique vocal demands, and if the voice is impaired there can be a negative impact on their quality of life. While a variety of options exist to assess vocal health, the utilization of cepstral peak prominence (CPP) has increased due to his reliability in some situations. However, it has not been utilized commonly in the singing population. This study sought to assess vocal health in singing students using noninvasive measures such as singing voice handicap index (SVHI) and consensus auditory perceptual evaluation of voice (CAPE-V) as well as CPP to provide preliminary information on this measure. METHODS: A prospective longitudinal study of singing students independent of year of training enrolled in a 2-credit voice lesson at an undergraduate School of Music was conducted. Non-invasive measures were used to evaluate the voice. All participants recorded the same spoken sentence at four equally spaced intervals throughout the semester using a ZOOM H4n Pro (two cardioid input microphone, Hauppauge, New Year). Participants completed SVHI at the time of each recording, and CAPE-V conducted by two speech language pathologists trained in voice. CPP was determined using running speech samples. RESULTS: A total of 23 singers completed the study (11 male, 12 female). There was a significant difference in SVHI at the first recording compared to the final recording (10.6 ± 4.6 vs 9.3 ± 5.9, P= 0.008). Similarly, there was a significant difference in CPP at the first recording compared to the final recording (9 ± 3 vs 9.4 ± 1.1, P < 0.001). However, no significant difference was seen with CAPE-V. CONCLUSION: Our results are similar to previous studies. There was no evidence in decline in objective and subjective vocal quality utilizing the measure included in our study.

Effect of Pompage on Teachers Self-Assessment-Clinical Trial.

OBJECTIVE: To verify the results of self-assessments of teachers with vocal and musculoskeletal complaints and with the normal larynx, after myofascial release using pompage. METHODS: Double-blind, controlled, and randomized clinical trial including 28 teachers in the study group and 28 teachers in the control group, totaling 56 participants. Anamnesis, video laryngoscopy, hearing screening, clinical and photogrammetric postural assessment, pain threshold in cervical muscles, sound pressure and maximum phonation time measurements, and manovacuometry were performed. Protocols for vocal self-assessment, neck pain, anxiety and depression, and musculoskeletal pain were filled out. Pompage therapy consisted of a total of 24 sessions (8 weeks) of 40 minutes each, three times a week. Afterward, the groups were reassessed. RESULTS: In the study group, there was a significant improvement in the results of the following instruments: Hospital Anxiety and Depression Scale, Vocal Tract Discomfort Scale, Voice Symptoms Scale, Vocal Activity and Participation Profile, Vocal Handicap Index, Voice-Related Quality of Life, and Nordic Musculoskeletal Questionnaire. CONCLUSIONS: After myofascial release using pompage in teachers, there was an improvement in the self-assessed aspects regarding characteristics and quality of life related to the voice, social participation related to the voice, anxiety and depression, and musculoskeletal symptoms.

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.

Considerations and demands in the voice care of contemporary commercial singers in occupational health and safety aspects.

Singers, classified as "vocal performers" are at an increased risk of developing voice disorders. The area of contemporary commercial singing has not been studied as extensively as classical singing. Non-classical singing is generally considered detrimental to vocal health and thus the information on challenges contemporary commercial singers (CCS) pose to otolaryngologists and other healthcare professionals is scarce. The authors present an overview of contemporary commercial singing styles in comparison to classical singing, discuss the notion of non-classical style being harmful to vocal health, present major risk factors associated with developing voice disorders in contemporary commercial singers, and outline the diagnostic process of vocal health assessment in this group of occupational voice users. Given that contemporary commercial singers constitute a unique and vast group of elite vocal performers, the authors stress the importance of raising awareness among healthcare professionals of the fact that these patients require special considerations for voice evaluation and treatment in the occupational health and safety framework. Med Pr. 2022;73(1):33-41.

Respiratory Particle Emission During Voice Assessment and Therapy Tasks in a Single Subject.

INTRODUCTION: SARS-CoV-2 is transmitted via respiratory particles. Respiratory particle emission is impacted by manner of breathing and voicing, as well as intersubject variability. Assessment and treatment of voice disorders may include tasks that increase respiratory particle emission beyond typical breathing and speaking. This could increase the risk of disease transmission via respiratory particles. METHODS: Respiratory particle emission was measured during a single-subject, repeated measures clinical simulation of acoustic and aerodynamic assessment and voice therapy tasks. An optical particle sizer was used to measure particle count (1-10 µm in diameter). Assessment and therapy tasks were completed in three conditions: (1) 15 cm from the device, (2) 1 m from the device, and (3) 1 m from the device with the subject wearing a surgical mask. RESULTS: Condition 1 generated the highest particle count, with a median of 5.1 (13) additional particles above baseline, which was statistically significant (U = 381.5, P= 0.002). In condition 1, therapy and acoustic tasks combined produced more particles compared to the baseline and speech tasks, with a median difference of 6.5 additional particles per time point (U = 309.0, P= 0.002). This difference was not significant for conditions 2 and 3. Peak particle generation occurred in specific phonatory tasks, which was most pronounced in condition 1. Voice therapy tasks during condition 1 generated the highest peaks of normalized total particles with classical singing and expiratory muscle strength training. There was a significant difference in the amount of particle generation between condition 1 and 2, with a median difference of 5.2 particles (U = 461.0, P= 0.002). The particle count difference between conditions 2 and 3 was 2.1 (U = 282.0, P= 0.292), and this difference was not significant. The normalized total particles were assessed over time for each condition. For all conditions, there was no significant accumulation of particles. CONCLUSIONS: For a single subject, production of voice assessment and therapy tasks combined resulted in an increased number of respiratory particles compared to speech and baseline (1-10 µm). EMST and classical singing generated the greatest concentration of particles. Respiratory particle counts were higher at 15 cm from the particle sizer compared to 1 m from the particle sizer, suggesting that physical distancing may reduce immediate clinician exposure to respiratory particles. Particle concentration did not accumulate over time.

Assessment of Dysphonia Using the Japanese Version of the Voice Handicap Index and Determination of Cutoff Points for Screening.

INTRODUCTION: The Voice Handicap Index (VHI) is recognized as a useful subjective assessment method for dysphonia. The original VHI has been translated into numerous other languages, including Japanese (J-VHI). Although the reliability and validity of the J-VHI have already been established, the cutoff point has not been determined. The aims of this study were to investigate the relationship between the J-VHI and other voice laboratory measurements, and determine the cutoff point. METHOD: This study included 167 dysphonic patients and 55 healthy volunteers. All patients and volunteers completed the J-VHI at the initial visit, and the following outcomes were determined: VHI scores of patients with dysphonia and healthy volunteers, VHI scores according to disease, cutoff point, and correlations between VHI scores and other voice laboratory measurements. RESULTS: Both the total VHI (VHI-T) and individual domain (functional domain [VHI-F], emotional domain [VHI-E], physical domain [VHI-P]) scores were significantly higher in the dysphonia group compared to the healthy volunteer group. VHI-T, VHI-F, and VHI-E scores were significantly lower in the benign mucosal lesion subgroup, compared to the other disease subgroups. The G scale and B scale of the grade-roughness-breathiness-asthenia-strain scale showed a significant association with VHI-T, VHI-F, and VHI-P scores. Similarly, the A scale showed a significant association with VHI-T, VHI-F, and VHI-E scores. The cutoff point (12) for VHI-T was chosen from the receiver operating characteristic curve to maximize sensitivity and specificity. Similarly, the cutoff points for VHI-F (5), VHI-P (5), and VHI-E (3) were also obtained. Significant differences in maximum phonation time, pitch range, G scale, and B scale were observed between the VHI-T negative (VHI ≤ 12) and positive (VHI-T > 13) groups. CONCLUSION: These findings suggest that self-evaluation using the VHI could serve as an independent assessment and screening tool for patients with dysphonia.

Percepção de queixa vocal e autoavaliação do impacto de um problema de voz em atores profissionais de teatro / Perceived vocal complaint and self- assessment of the vocal problem impact in professional theater actors

RESUMO Objetivo investigar a ocorrência de queixa vocal autorreferida no uso profissional da voz em atores profissionais de teatro; correlacionar presença de queixa vocal com três protocolos de autoavaliação do impacto de uma alteração vocal: Escala de Sintomas Vocais (ESV), Escala de Desconforto do Trato Vocal (EDTV) e Índice de Desvantagem Vocal -10 (IDV-10); verificar quais protocolos são mais robustos à detecção do impacto de possível disfonia nessa população. Métodos Participaram 75 atores profissionais de teatro, ambos os gêneros, 18 a 64 anos. Os atores informaram a presença ou ausência de queixa vocal e responderam a três protocolos de autoavaliação: Escala de Sintomas Vocais (ESV), Escala de Desconforto do Trato Vocal (EDTV) e Índice de Desvantagem Vocal-10 (IDV-10). Resultados constatou-se que 25% dos atores apresentaram queixa vocal. O grupo com queixa (GCQ) apresentou maior número de sintomas vocais e maior frequência e intensidade de desconforto de trato vocal, quando comparado ao grupo sem queixa (GSQ). IDV-10 não identificou desvantagem vocal nos grupos. No GCQ, houve correlação forte entre ESV e IDV-10 e correlação muito forte entre os escores de frequência e intensidade da EDTV. No GSQ, houve correlação moderada entre ESV e EDTV, ESV e IDV-10 e correlação muito forte entre os escores de frequência e intensidade da EDTV. Conclusão neste estudo, 25% dos atores profissionais de teatro apresentaram queixa vocal. A correlação entre a queixa vocal e os protocolos foi positiva e variou de moderada à forte. No GCQ, a ESV e a EDTV foram instrumentos mais robustos na detecção do impacto de uma possível disfonia.

ABSTRACT Purpose To investigate the occurrence of self-reported vocal complaints in the professional use of the voice in professional theater actors; analyze the correlation between the presence of vocal complaint and three self-assessment protocols of the vocal problem impact; The Voice Symptom Scale (VoiSS), the Vocal Tract Discomfort (VTD) scale and the Voice Handicap Index -10 (VHI -10); verify the most robust protocols to identify dysphonia in this population. Methods The participants were 75 professional theater actors, men and women, between 18 and 64 years old. They answered to a questioner informing presence or absence of vocal complaint and to three self-assessment protocols: VoiSS, VTD and VHI-10. Results 25% of the actors presented vocal complaints. The group with vocal complaint (GwVC) had more voice symptoms and higher frequency and intensity of vocal tract discomfort than the group with no vocal complaint (GnVC). No group presented voice handicap considering the VHI-10 and a very high correlation between the VTD frequency and intensity scores. The GnVC presented moderate correlation between the VoiSS and the VTD, moderate correlation between the VoiSS and the VHI-10 and, a very high correlation between the VTD frequency and intensity scores. Conclusion In this study, 25% of professional theater actors presented vocal complaints. The correlation between vocal complaints and protocols was positive and ranged from moderate to strong. The VoiSS and the VTD were more robust identify dysphonia in the GwVC.

Speech and language therapy assessment of patients on the 2-week wait head and neck cancer referral pathway: evidence and opinion following a pilot study.

PURPOSE OF REVIEW: Spiralling numbers of patients are being referred on the two-week wait (2WW) head and neck cancer referral pathway. Only a small proportion are found to have cancer. There is a call for change in the management of these referrals, particularly following coronavirus. Allied health professionals (AHPs) are being encouraged by the NHS to extend their clinical practice to address increased demand. Speech and Language Therapists (SLTs) may offer a solution to some of the 2WW pathway's challenges. RECENT FINDINGS: Recent evidence highlights problems with the pathway and reasons for change. Hoarse voice is consistently found to be the most common presenting symptom. Emerging evidence suggests SLTs can extend their scope of practice to manage new hoarse voice referrals. A pilot project is described. Outcomes from this and other ongoing studies explore efficacy and investment required to make this proposal an achievable prospect for the future. SUMMARY: The management of 2WW referrals on the head and neck cancer pathway needs to change. Preliminary findings suggest SLTs working within the context of the multidisciplinary team can safely extended their role to improve management of these patients. Professional role outline, recognition, guidance, and training framework are needed.

Functional Voice Assessment and Therapy Methods Supported by Telepractice, VoiceEvalU8, and Estill Voice Training.

Functional assessment and therapy methods are necessary for a client-centered approach that addresses the client's vocal needs across all environments. The purpose of this article is to present the approach with the intent to encourage discussion and implementation among educators, clinicians, researchers, and students. The functional approach is defined and its importance is described within the context of the World Health Organization's International Classification of Functioning, Disability, and Health with support provided by synchronous and asynchronous telepractice, the VoiceEvalU8 app, server, and web portal, and a framework that defines voice qualities (e.g., resonance, twang, loud, and others) by the anatomy and physiology of the voice production system (i.e., Estill Figures for Voice). Case scenarios are presented to highlight application of the functional voice approach.

Acoustic Assessment.

In the setting of a voice clinic, the voice may be assessed in a number of different ways. As a bare minimum, assessment should include stroboscopic examination, patient self-reported questionnaires, and clinician-reported perceptual evaluation. In addition, recordings of the voice may be analyzed using computer software: several different measures exist, but the most widely used are jitter, shimmer, and noise-to-harmonic ratio. There are, however, significant limitations of these measures, including access to the equipment, inter-test reliability of the measurements, and a lack of correlation with clinical improvement. Other mathematical techniques (nonlinear algorithms) may provide more robust measurements. A pragmatic approach to assessment in the voice clinic suggests that stroboscopic examination should be accompanied by patient-reported questionnaires and clinician-rated voice assessments.

Multiparametric laryngeal assessment of the effect of thalamic deep brain stimulation on essential vocal tremor.

OBJECTIVE: EVT is a refractory voice disorder that significantly affects quality of life. This work aims to conduct a multiparametric assessment of the effect of deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus (VIM) on essential vocal tremor (EVT) and investigate the relation between DBS lead location and EVT outcomes. METHODS: Nine participants underwent DBS for essential tremor and were diagnosed with co-occurring EVT in this prospective cohort study. Objective measurements including acoustic evaluation of vocal fundamental frequency (F0) and intensity modulation and subjective measurements including physiologic evaluation of the oscillatory movement of the laryngeal muscles and vocal tract and perceptual ratings of tremor severity were collected PRE and POST DBS. Finally, we investigated the relation between DBS lead location and EVT outcomes. RESULTS: Acoustic modulations of F0 and intensity were significantly improved POST DBS. Physiologic assessment showed a POST DBS reduction of oscillatory movement in the laryngeal muscles and vocal tract, but not significantly. Listener and participant perception, of EVT severity was also significantly reduced. Finally, our results indicate better EVT control with increased distance to midline of left VIM thalamic stimulation. CONCLUSIONS: By employing a battery of objective and subjective measures, our study supports the benefit of DBS for the treatment of EVT and specifies the acoustic and physiologic mechanisms that mediate its positive effect. We further provide preliminary results on the relation between lead location and EVT outcomes, laying the foundation for future studies to clarify the optimal DBS target for the treatment of EVT.

Self-assessment of voice outcomes after total thyroidectomy using the Voice Handicap Index questionnaire: Results of a prospective multicenter study.

BACKGROUND: Voice disorders are frequent after thyroidectomy. We report the long-term voice quality outcomes after thyroidectomy using the voice handicap index self-questionnaire. METHODS: Eight hundred patients who underwent total thyroidectomy between 2014 and 2017 in 7 French hospitals were prospectively included. All patients filled in voice handicap index questionnaires, preoperatively and 2 and 6 months after surgery. RESULTS: Median (range) voice handicap index scores were significantly increased at month 2 (4 [0; 108]) compared to preoperative values (2 [0; 76]) and were unchanged at month 6 (2 [2; 92]). Clinically significant voice impairment (voice handicap index score difference ≥18 points) was reported in 19.7% at month 2 and 13% at month 6. Thirty-seven (4.6%) had postoperative vocal cord palsy. In patients with vocal cord palsy compared to those without, median voice handicap index scores were increased at month 2 (14 [0; 107] vs 4 [0; 108]; P = .0039), but not at month 6 (5 [0; 92] vs 2 [0; 87]; P = .0702). Clinically significant impairment was reported in 38% vs 19% at month 2 (P = .010), and in 19% vs 13% at month 6 (P = .310). Thyroid weight, postoperative hypocalcemia, vocal cord palsy, and absence of intraoperative neuromonitoring utilization were associated with an increased risk of clinically significant self-perceived voice impairment at month 2. CONCLUSION: Thyroidectomy impairs patients' voice quality perception in patients with and without vocal cord palsy.

Resident Education in Laryngeal Stroboscopy and Perceptual Voice Evaluation: An Assessment.

OBJECTIVES: To evaluate otolaryngology residents' level of confidence and understanding in interpreting laryngeal stroboscopy. METHODS: Otolaryngology residents from three residency programs with fellowship-trained laryngologists on faculty were invited to participate. An assessment consisting of a survey and five stroboscopic exams was administered. Each exam consisted of questions on perceptual voice evaluation, laryngoscopic findings, and stroboscopic findings. Scores were compared to answers provided by three fellowship-trained laryngologists. RESULTS: Thirty-eight of 47 invited residents (80.8%) enrolled in the study. On a five-point likert scale, residents reported low confidence (median = 2, range = 1-4) in interpreting stroboscopy, regardless of training program (P = 0.81). Mean assessment scores were 56.5% ± 11.9, with scores in perceptual voice evaluation = 68.5% ± 10.6; laryngoscopy = 70.2% ± 12.8; and stroboscopy = 45.3% ± 17.8. Residents performed worse on stroboscopy questions compared to laryngoscopy questions (P < 0.0001). There was a significant difference in scores by postgraduate year (P = 0.03), but not by institution (P = 0.34). A moderately positive correlation between reported level of confidence and overall scores (ρ = .47, P = 0.003) was demonstrated. CONCLUSIONS: Despite didactic and clinical exposure, residents report low confidence in interpreting stroboscopy and scored lower on stroboscopy-specific questions compared to other assessment items. Additional resources and learning opportunities are needed to improve resident confidence and comprehension of stroboscopy.