Assessment of Voice Quality and Vocal Cord Paralysis After Endarterectomy.

Introduction: Recurrent laryngeal nerve palsy is a rare but important complication after endarterectomy (CEA). The impact on voice quality after this procedure is also important. The aim of the study was to assess voice quality and vocal cord function after CEA. Material and Methods: 200 patients were enrolled in the study. Inclusion criteria were indications for CEA and patient consent to the procedure. Endoscopic examination of the larynx was performed before the procedure, immediately after the procedure, on the 2nd day after the procedure, then 3 month and 6 months after the procedure. Voice was assessed by maximum phonation time (MPT), GRBAS scale, Voice Handicap Index (VHI) and the Voice-Related Quality of Life (V-RQOL) questionnaire. Results: In the study group, the results on the GRBAS scale were significantly worse and the average MPT was shorter compared to the control group. In the V-RQOL assessment, patients rated their voice as fair or good, significantly more often noticed that they had difficulty speaking loudly and being heard, and that they felt short of air when speaking. In VHI-30, the total score was significantly higher in the study group compared to the control group. Voice disorders after the procedure were reported by 68 patients, while a disorder of the recurrent laryngeal nerve was observed immediately after the procedure in 32 patients. Most vocal cord disorders were transient. Ultimately, 3% of patients were diagnosed with vocal cord paralysis. Conclusion: Cranial nerves paralysis, including the recurrent laryngeal nerve, are a common complication after CEA. Majority the paralysis is transient, but requires appropriate diagnostic and therapeutic procedures. Vocal cord evaluation is a non-invasive and widely available examination and should be performed pre- and postoperatively after all neck surgeries. The incidence of voice disorders after CEA significantly affects the quality of life of patients and requires voice rehabilitation and patient care with psychological support.

Asymmetric triangular body-cover model of the vocal folds with bilateral intrinsic muscle activation.

Many voice disorders are linked to imbalanced muscle activity and known to exhibit asymmetric vocal fold vibration. However, the relation between imbalanced muscle activation and asymmetric vocal fold vibration is not well understood. This study introduces an asymmetric triangular body-cover model of the vocal folds, controlled by the activation of bilateral intrinsic laryngeal muscles, to investigate the effects of muscle imbalance on vocal fold oscillation. Various scenarios were considered, encompassing imbalance in individual muscles and muscle pairs, as well as accounting for asymmetry in lumped element parameters. Measurements of amplitude and phase asymmetries were employed to match the oscillatory behavior of two pathological cases: unilateral paralysis and muscle tension dysphonia. The resulting simulations exhibit muscle imbalance consistent with expectations in the composition of these voice disorders, yielding asymmetries exceeding 30% for paralysis and below 5% for dysphonia. This underscores the relevance of muscle imbalance in representing phonatory scenarios and its potential for characterizing asymmetry in vocal fold vibration.

Synthetic, self-oscillating vocal fold models for voice production researcha).

Sound for the human voice is produced by vocal fold flow-induced vibration and involves a complex coupling between flow dynamics, tissue motion, and acoustics. Over the past three decades, synthetic, self-oscillating vocal fold models have played an increasingly important role in the study of these complex physical interactions. In particular, two types of models have been established: "membranous" vocal fold models, such as a water-filled latex tube, and "elastic solid" models, such as ultrasoft silicone formed into a vocal fold-like shape and in some cases with multiple layers of differing stiffness to mimic the human vocal fold tissue structure. In this review, the designs, capabilities, and limitations of these two types of models are presented. Considerations unique to the implementation of elastic solid models, including fabrication processes and materials, are discussed. Applications in which these models have been used to study the underlying mechanical principles that govern phonation are surveyed, and experimental techniques and configurations are reviewed. Finally, recommendations for continued development of these models for even more lifelike response and clinical relevance are summarized.

Perception and imitation of period-doubled phonation: Pitch and voice qualitya).

Period-doubled phonation, henceforth, period doubling, characterized by voicing periods that alternate in amplitudes and/or frequencies, is often perceived rough and with an indeterminate pitch. Lower pitch percept has been suggested by past studies when the degree of amplitude or frequency modulation increases. However, how listeners use period doubling when identifying linguistic tones remains unclear. The current study uses tasks of categorization with training, followed by imitation of tones manipulated with period doubling (with amplitude and frequency modulation, both separately and jointly) in a novel language. Native Mandarin and English speakers with different levels of music experience were tested. I show that period doubling leads to a low-tone bias in perception and imitation, especially as the modulation degree, particularly that of frequency, increases. Interestingly, interactions with stimulus f0 and modulation type show that in amplitude-modulated tokens, when compared to lower f0 (200 Hz), higher f0 (300 Hz) drives more low-tone responses. Period doubling is also imitated with lowered f0 and creaky quality. Language and music experience does not affect perceptual and imitative responses, suggesting that the perception of period doubling is not language-specific or conditioned by tonal knowledge. Period doubling likely signals low tones, even when the original f0 is high.

An investigation of acoustic cues to tonal registers and voicing in Donglei Kama).

The Kam language has experienced historical tonal splits, resulting in the development of a complex tonal system. However, there is still limited knowledge regarding the acoustic characteristics associated with aspiration-based tone splitting. This study aims to investigate the acoustic cues related to the tonal registers and laryngeal configurations in Donglei Kam, a dialect of Southern Kam. Sixteen native speakers of Donglei Kam participated, producing lexical tones. Statistical analyses were conducted to examine the acoustic distinctions between tonal registers, using measurements of voice onset time, spectral tilt, noise, and energy. The results indicated that Donglei Kam retained a two-way contrast of aspiration, albeit with a trend toward gradual loss. Additionally, a breathy voice was detected in the Ciyin tonal register, characterized by elevated spectral tilt values and spectral noise throughout the vowels. Moreover, machine learning classifiers effectively identified tonal registers using voice-quality data, suggesting that the phonation contrast between breathy and modal voice could contribute to the tonal split alongside pitch contrast. In summary, these findings enhance our understanding of the acoustic implementation of breathiness in Kam and offer valuable insights into the role of laryngeal contrast in tonal splits.

Principal dimensions of voice production and their role in vocal expression.

How we produce and perceive voice is constrained by laryngeal physiology and biomechanics. Such constraints may present themselves as principal dimensions in the voice outcome space that are shared among speakers. This study attempts to identify such principal dimensions in the voice outcome space and the underlying laryngeal control mechanisms in a three-dimensional computational model of voice production. A large-scale voice simulation was performed with parametric variations in vocal fold geometry and stiffness, glottal gap, vocal tract shape, and subglottal pressure. Principal component analysis was applied to data combining both the physiological control parameters and voice outcome measures. The results showed three dominant dimensions accounting for at least 50% of the total variance. The first two dimensions describe respiratory-laryngeal coordination in controlling the energy balance between low- and high-frequency harmonics in the produced voice, and the third dimension describes control of the fundamental frequency. The dominance of these three dimensions suggests that voice changes along these principal dimensions are likely to be more consistently produced and perceived by most speakers than other voice changes, and thus are more likely to have emerged during evolution and be used to convey important personal information, such as emotion and larynx size.

The breath shape controls intonation of mouse vocalizations.

Intonation in speech is the control of vocal pitch to layer expressive meaning to communication, like increasing pitch to indicate a question. Also, stereotyped patterns of pitch are used to create distinct sounds with different denotations, like in tonal languages and, perhaps, the 10 sounds in the murine lexicon. A basic tone is created by exhalation through a constricted laryngeal voice box, and it is thought that more complex utterances are produced solely by dynamic changes in laryngeal tension. But perhaps, the shifting pitch also results from altering the swiftness of exhalation. Consistent with the latter model, we describe that intonation in most vocalization types follows deviations in exhalation that appear to be generated by the re-activation of the cardinal breathing muscle for inspiration. We also show that the brainstem vocalization central pattern generator, the iRO, can create this breath pattern. Consequently, ectopic activation of the iRO not only induces phonation, but also the pitch patterns that compose most of the vocalizations in the murine lexicon. These results reveal a novel brainstem mechanism for intonation.

Biomechanics of sound production in high-pitched classical singing.

Voice production of humans and most mammals is governed by the MyoElastic-AeroDynamic (MEAD) principle, where an air stream is modulated by self-sustained vocal fold oscillation to generate audible air pressure fluctuations. An alternative mechanism is found in ultrasonic vocalizations of rodents, which are established by an aeroacoustic (AA) phenomenon without vibration of laryngeal tissue. Previously, some authors argued that high-pitched human vocalization is also produced by the AA principle. Here, we investigate the so-called "whistle register" voice production in nine professional female operatic sopranos singing a scale from C6 (≈ 1047 Hz) to G6 (≈ 1568 Hz). Super-high-speed videolaryngoscopy revealed vocal fold collision in all participants, with closed quotients from 30 to 73%. Computational modeling showed that the biomechanical requirements to produce such high-pitched voice would be an increased contraction of the cricothyroid muscle, vocal fold strain of about 50%, and high subglottal pressure. Our data suggest that high-pitched operatic soprano singing uses the MEAD mechanism. Consequently, the commonly used term "whistle register" does not reflect the physical principle of a whistle with regard to voice generation in high pitched classical singing.

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

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

Consistency of the Signature of Phonotraumatic Vocal Hyperfunction Across Different Ambulatory Voice Measures.

PURPOSE: Although different factors and voice measures have been associated with phonotraumatic vocal hyperfunction (PVH), it is unclear what percentage of individuals with PVH exhibit such differences during their daily lives. This study used a machine learning approach to quantify the consistency with which PVH manifests according to ambulatory voice measures. Analyses included acoustic parameters of phonation as well as temporal aspects of phonation and rest, with the goal of determining optimally consistent signatures of PVH. METHOD: Ambulatory neck-surface acceleration signals were recorded over 1 week from 116 female participants diagnosed with PVH and age-, sex-, and occupation-matched vocally healthy controls. The consistency of the manifestation of PVH was defined as the percentage of participants in each group that exhibited an atypical signature based on a target voice measure. Evaluation of each machine learning model used nested 10-fold cross-validation to improve the generalizability of findings. In Experiment 1, we trained separate logistic regression models based on the distributional characteristics of 14 voice measures and durations of voicing and resting segments. In Experiments 2 and 3, features of voicing and resting duration augmented the existing distributional characteristics to examine whether more consistent signatures would result. RESULTS: Experiment 1 showed that the difference in the magnitude of the first two harmonics (H1-H2) exhibited the most consistent signature (69.4% of participants with PVH and 20.4% of controls had an atypical H1-H2 signature), followed by spectral tilt over eight harmonics (73.6% participants with PVH and 32.1% of controls had an atypical spectral tilt signature) and estimated sound pressure level (SPL; 66.9% participants with PVH and 27.6% of controls had an atypical SPL signature). Additionally, 77.6% of participants with PVH had atypical resting duration, with 68.9% exhibiting atypical voicing duration. Experiments 2 and 3 showed that augmenting the best-performing voice measures with univariate features of voicing or resting durations yielded only incremental improvement in the classifier's performance. CONCLUSIONS: Females with PVH were more likely to use more abrupt vocal fold closure (lower H1-H2), phonate louder (higher SPL), and take shorter vocal rests. They were also less likely to use higher fundamental frequency during their daily activities. The difference in the voicing duration signature between participants with PVH and controls had a large effect size, providing strong empirical evidence regarding the role of voice use in the development of PVH.

Effects of Speech Characteristics on Electroglottographic and Instrumental Acoustic Voice Analysis Metrics in Women With Structural Dysphonia Before and After Treatment.

PURPOSE: Literature suggests a dependency of the acoustic metrics, smoothed cepstral peak prominence (CPPS) and harmonics-to-noise ratio (HNR), on human voice loudness and fundamental frequency (F0). Even though this has been explained with different oscillatory patterns of the vocal folds, so far, it has not been specifically investigated. In the present work, the influence of three elicitation levels, calibrated sound pressure level (SPL), F0 and vowel on the electroglottographic (EGG) and time-differentiated EGG (dEGG) metrics hybrid open quotient (OQ), dEGG OQ and peak dEGG, as well as on the acoustic metrics CPPS and HNR, was examined, and their suitability for voice assessment was evaluated. METHOD: In a retrospective study, 29 women with a mean age of 25 years (± 8.9, range: 18-53) diagnosed with structural vocal fold pathologies were examined before and after voice therapy or phonosurgery. Both acoustic and EGG signals were recorded simultaneously during the phonation of the sustained vowels /ɑ/, /i/, and /u/ at three elicited levels of loudness (soft/comfortable/loud) and unconstrained F0 conditions. RESULTS: A linear mixed-model analysis showed a significant effect of elicitation effort levels on peak dEGG, HNR, and CPPS (all p < .01). Calibrated SPL significantly influenced HNR and CPPS (both p < .01). Furthermore, F0 had a significant effect on peak dEGG and CPPS (p < .0001). All metrics showed significant changes with regard to vowel (all p < .05). However, the treatment had no effect on the examined metrics, regardless of the treatment type (surgery vs. voice therapy). CONCLUSIONS: The value of the investigated metrics for voice assessment purposes when sampled without sufficient control of SPL and F0 is limited, in that they are significantly influenced by the phonatory context, be it speech or elicited sustained vowels. Future studies should explore the diagnostic value of new data collation approaches such as voice mapping, which take SPL and F0 effects into account.

Immediate Ansa cervicalis-to-recurrent laryngeal nerve low-tension anastomosis: A new technique for phonation recovery and bilateral anastomoses to avoid tracheotomy.

OBJECTIVE: This case series study investigated the outcomes of an innovative approach, ansa cervicalis nerve (ACN)-to-recurrent laryngeal nerve (RLN) low-tension anastomosis. METHODS: Patients who received laryngeal nerve anastomosis between May 2015 and September 2021 at the facility were enrolled. The inclusion criteria were patients with RLN dissection and anastomosis immediately during thyroid surgery. Exclusion criteria were cases with anastomosis other than cervical loop-RLN anastomosis or pronunciation recovery time > 6 months. Patients admitted before January 2020 were assigned to group A which underwent the conventional tension-free anastomosis, and patients admitted after January 2020 were group B and underwent the innovative low-tension anastomosis (Dong's method). RESULTS: A total of 13 patients were included, 11 patients received unilateral surgery, and 2 underwent bilateral surgery. For patients who underwent unilateral anastomosis, group B had a significantly higher percentage of normal pronunciation via GRBAS scale (83.3 % vs. 0 %, p = 0.015) and voice handicap index (66.7 % vs. 0 %, p = 0.002), and shorter recovery time in pronunciation (median: 1-day vs. 4 months, p = 0.001) than those in group A after surgery. CONCLUSIONS: ACNs-to-RLN low-tension anastomosis with a laryngeal segment ≤1 cm (Dong's method) significantly improves postoperative pronunciation and recovery time. The results provide clinicians with a new strategy for ACN -to-RLN anastomosis during thyroid surgery.

Outcomes of laryngeal framework surgeries for unilateral vocal cord paralysis in the elderly patients.

OBJECTIVE: Laryngeal framework surgery is a widely accepted treatment for unilateral vocal fold paralysis with good functional outcomes. Recently, with the aging of the population, opportunities to perform this procedure in elderly patients have increased; however, the safety and efficacy of this procedure in elderly patients has not been established. Therefore, this study aimed to investigate the safety and functional outcomes of laryngeal framework surgery in elderly patients. METHODS: Between January 2008 and December 2017, 97 patients with unilateral vocal fold paralysis underwent laryngeal framework surgery, and 71 among them completed pre- and post-operative voice function evaluations. The clinical course of these 71 patients were retrospectively reviewed. RESULTS: Out of 71 patients, 35 were assigned to the younger group (< 65 years) and 36 to the elderly group (≥ 65 years). Complications included post-operative edema and submucosal hematoma that were safely managed in all cases, and no differences were identified between the groups. Significant improvements were observed in maximum phonation time (MPT), mean flow rate, alternating current/direct current ratio, pitch perturbation quotient, amplitude perturbation quotient, and noise-to-harmonic ratio in both groups, and multivariate analysis of variance revealed greater improvement in the younger group in MPT. CONCLUSION: Laryngeal framework surgeries for unilateral vocal fold paralysis are safe and effective, regardless of age. Better improvement was observed in the younger group in the MPT suggesting that the effects of laryngeal framework surgeries is more likely to be present in the younger group than in the elderly.

"Lombard Effect" and Voice Changes in Adductor Laryngeal Dystonia: A Pilot Study.

OBJECTIVES: The aim was to describe the acoustic, auditory-perceptive, and subjective voice changes under the Lombard effect (LE) in adductor laryngeal dystonia (AdLD) patients. METHODS: Subjective perception of vocal effort (OMNI Vocal Effort Scale OMNI-VES), Maximum Phonation Time (MPT), and the perceptual severity of dysphonia (GRBAS scale) were assessed in condition of stillness and under LE in 10 AdLD patients and in 10 patients with typical voice. Speakers were asked to produce the sustained vowel /a/ and to read a phonetically balanced text aloud. Using the PRAAT software, the following acoustic parameters were analyzed: Mean Pitch (Hz), Minimum and Maximum Intensity (dB), the Fraction of Locally Unvoiced Frames, the Number of Voice Breaks, the Degree of Voice Breaks (%), the Cepstral Peak Prominence-Smoothed (CPPS) (dB). RESULTS: Under LE, the AdLD group showed a decrease of both G and S parameters of GRBAS and subjective effort, mean MPT increased significantly; in the controls there were no significant changes. In both groups under LE, pitch and intensity of the sustained vowel /a/ significantly increased consistently with LE. In the AdLD group the mean gain of OMNI-VES score and the mean gain of each parameter of the speech analysis were significantly greater than the controls' ones. CONCLUSION: Auditory feedback deprivation obtained under LE improves subjective, perceptual-auditory, and acoustics parameters of AdLD patients. These findings encourage further research to provide new knowledge into the role of the auditory system in the pathogenesis of AdLD and to develop new therapeutic strategies. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:3754-3760, 2024.

Changes in and clinical utility of maximum phonation time and repetitive saliva swallowing test scores after esophagectomy.

BACKGROUND: Postoperative pneumonia in patients with esophageal cancer occurs due to swallowing dysfunction and aspiration. Recently, maximum phonation time (MPT) assessment and repetitive saliva swallowing test (RSST) have been focused on as swallowing function assessment methods that can identify patients as high risk for pneumonia. We aimed to evaluate the clinical utility of MPT assessment and RSST in patients undergoing oncological esophagectomy. METHODS: In total, 47 consecutive patients who underwent esophagectomy for esophageal cancer between August 2020 and July 2023 were eligible. The perioperative changes in MPTs and RSST scores were examined. In addition, univariate and multivariate analyses were performed to identify the predictive factors of postoperative pneumonia. RESULTS: The median MPTs before surgery and on postoperative days (PODs) 3, 6, and 10 were 18.4, 7.2, 10.6, and 12.4 s, respectively; postoperative MPTs were significantly lower than preoperative MPT. In addition, the MPT of POD 6 was significantly longer than that of POD 3 (P < 0.05). Meanwhile, there were no significant changes in perioperative RSST scores. Overall, 8 of 47 patients (17.0%) developed pneumonia postoperatively. A short MPT on POD 6 was one of the independent predictive factors for the incidence of postoperative pneumonia (odds ratio: 12.6, 95% confidence interval: 1.29-123, P = 0.03) in the multivariate analysis. CONCLUSIONS: The MPT significantly decreased after esophagectomy. However, the RSST score did not. The MPT on POD6 can be a predictor of postoperative pneumonia.

Immediate effect of inspiratory exercise with exerciser and respiratory encourager in women without vocal complaints. / Efeito imediato de exercício inspiratório com exercitador e incentivador respiratório em mulheres sem queixas vocais.

PURPOSE: To evaluate the immediate effect of the inspiratory exercise with a booster and a respiratory exerciser on the voice of women without vocal complaints. METHODS: 25 women with no vocal complaints, between 18 and 34 years old, with a score of 1 on the Vocal Disorder Screening Index (ITDV) participated. Data collection was performed before and after performing the inspiratory exercise and consisted of recording the sustained vowel /a/, connected speech and maximum phonatory times (MPT) of vowels, fricative phonemes and counting numbers. In the auditory-perceptual judgment, the Vocal Deviation Scale (VSD) was used to verify the general degree of vocal deviation. Acoustic evaluation was performed using the PRAAT software and the parameters fundamental frequency (f0), jitter, shimmer, harmonium-to-noise ratio (HNR), Cepstral Peak Prominence Smoothed (CPPS), Acoustic Voice Quality Index (AVQI) and Acoustic Breathiness Index (ABI). To measure the aerodynamic measurements, the time of each emission was extracted in the Audacity program. Data were statistically analyzed using the Statistica for Windows software and normality was tested using the Shapiro-Wilk test. To compare the results, Student's and Wilcoxon's t tests were applied, adopting a significance level of 5%. RESULTS: There were no significant differences between the results of the JPA and the acoustic measures, in the pre and post inspiratory exercise moments. As for the aerodynamic measures, it was possible to observe a significant increase in the value of the TMF /s/ (p=0.008). CONCLUSION: There was no change in vocal quality after the inspiratory exercise with stimulator and respiratory exerciser, but an increase in the MPT of the phoneme /s/ was observed after the exercise.

OBJETIVO: Avaliar o efeito imediato do exercício inspiratório com incentivador e exercitador respiratório na voz de mulheres sem queixas vocais. MÉTODO: Participaram 25 mulheres sem queixas vocais, entre 18 e 34 anos, com pontuação 1 no Índice de Triagem para Distúrbio Vocal (ITDV). A coleta de dados foi realizada nos momentos antes e após realização de exercício inspiratório e consistiu na gravação de vogal sustentada /a/, fala encadeada e tempos máximos fonatórios (TMF) de vogais, fonemas fricativos e contagem de números. No julgamento perceptivo-auditivo foi utilizada a Escala de Desvio Vocal (EDV) para verificar o grau geral do desvio vocal. Avaliação acústica foi feita no software PRAAT e foram extraídos os parâmetros frequência fundamental (f0), jitter, shimmer, proporção harmônico -ruído (HNR), Cepstral Peak Prominence Smoothed (CPPS), Acoustic Voice Quality Index (AVQI) e Acoustic Breathiness Index (ABI). Para mensuração das medidas aerodinâmicas, o tempo de emissão foi extraído no programa Audacity. Para comparar os resultados utilizou-se o teste paramétrico t de Student para amostras dependentes na análise das variáveis com distribuição normal e o teste de Wilcoxon para variáveis com distribuição não normal. RESULTADOS: Não houve diferenças entre os resultados do JPA e das medidas acústicas, nos momentos pré e pós exercício inspiratório. Quanto às medidas aerodinâmicas foi possível observar aumento significativo no valor do TMF /s/ (p=0,008). CONCLUSÃO: Não houve modificação na qualidade vocal após o exercício inspiratório com incentivador e exercitador respiratório, porém foi observado aumento do TMF do fonema /s/ após a realização do exercício.

Modification of velopharyngeal closure pressures during phonation by neuromuscular electrical stimulation in healthy individuals.

Introduction: Rhinophonia aperta may result from velopharyngeal insufficiency. Neuromuscular electrical stimulation (NMES) has been discussed in the context of muscle strengthening. The aim of this study was to evaluate in healthy subjects whether NMES can change the velopharyngeal closure pattern during phonation and increase muscle strength. Method: Eleven healthy adult volunteers (21-57 years) were included. Pressure profiles were measured by high resolution manometry (HRM): isolated sustained articulation of /a/ over 5 s (protocol 1), isolated NMES applied to soft palate above motor threshold (protocol 2) and combined articulation with NMES (protocol 3). Mean activation pressures (MeanAct), maximum pressures (Max), Area under curve (AUC) and type of velum reactions were compared. A statistical comparison of mean values of protocol 1 versus protocol 3 was carried out using the Wilcoxon signed rank test. Ordinally scaled parameters were analyzed by cross table. Results: MeanAct values measured: 17.15±20.69 mmHg (protocol 1), 34.59±25.75 mmHg (protocol 3) on average, Max: 37.86±49.17 mmHg (protocol 1), 87.24±59.53 mmHg (protocol 3) and AUC: 17.06±20.70 mmHg.s (protocol 1), 33.76±23.81 mmHg.s (protocol 3). Protocol 2 produced velum reactions on 32 occasions. These presented with MeanAct values of 13.58±12.40 mmHg, Max values of 56.14±53.14 mmHg and AUC values of 13.84±12.78 mmHg.s on average. Statistical analysis comparing protocol 1 and 3 showed more positive ranks for MeanAct, Max and AUC. This difference reached statistical significance (p=0.026) for maximum pressure values. Conclusions: NMES in combination with articulation results in a change of the velopharyngeal closure pattern with a pressure increase of around 200% in healthy individuals. This might be of therapeutic benefit for patients with velopharyngeal insufficiency.

Effect of physical frailty on maximum phonation time in community-dwelling older individuals who visited a neurology outpatient clinic.

BACKGROUND: Maximum phonation time (MPT) is used to assess speech and other oral rehabilitation-related issues. Various factors contribute to MPT decline in older individuals. Although the impact of physical frailty on MPT has been suggested, this has not been conclusively determined. OBJECTIVE: To examine the relationship between MPT and physical frailty in community-dwelling individuals aged ≥60 years who were independently mobile. MPT-associated factors were investigated. METHODS: This cross-sectional study analysed the clinical data of 122 patients (age [interquartile range]: 80.0 [74.0-83.0] years) without dementia who visited a neurology department between 1 February 2021 and 31 January 2023. Investigated factors included age, sex, weight, height, body mass index, smoking history, grip strength, functional independence measure, vital capacity, oral diadochokinesis, MPT and the Japanese Cardiovascular Health Study score. Physical frailty was assessed based on the total score from five items (weight loss, weakness, exhaustion, slowness and low physical activity). The relationship between MPT and physical frailty was examined using Spearman's rank correlation coefficient and hierarchical multiple regression analysis. RESULTS: The MPT was negatively correlated with age (r = -0.347, p < .01) and physical frailty (r = -0.681, p < .01) and positively correlated with vital capacity (r = 0.474, p < .01) and height (r = 0.248, p < .01). The hierarchical multiple regression analysis, conducted with MPT as the dependent variable, demonstrated that physical frailty (ß = -.59, 95% confidence interval: -0.74 to 0.43, p < .001) had a strong influence on MPT. CONCLUSION: In older individuals, MPT is associated with physical frailty. When assessing MPT in clinical settings, it is advisable to perform a concurrent assessment of physical frailty.

Extrinsic Laryngeal Muscle Activity With Different Diameters and Water Depths in a Semi-Occluded Vocal Tract Exercise.

PURPOSE: Surface electromyography (sEMG) has been used to evaluate extrinsic laryngeal muscle activity during swallowing and phonation. In the current study, sEMG amplitudes were measured from the infrahyoid and suprahyoid muscles during phonation through a tube submerged in water. METHOD: The sEMG amplitude values measured from the extrinsic laryngeal muscles and the electroglottographic contact quotient (CQ) were obtained simultaneously from 62 healthy participants (31 men, 31 women) during phonation through a tube at six different depths (2, 4, 7, 10, 15, and 20 cm) while using two tubes with different diameters (1 and 0.5 cm). RESULTS: With increasing depth, the sEMG amplitude for the suprahyoid muscles increased in men and women. However, sEMG amplitudes for the infrahyoid muscles increased significantly only in men. Tube diameter had a significant effect on the suprahyoid sEMG amplitudes only for men, with higher sEMG amplitudes when phonating with a 1.0-cm tube. CQ values increased with submerged depth for both men and women. Tube diameter affected results such than CQ values were higher for men when using the wider tube and for women with the narrower tube. CONCLUSIONS: Vocal fold vibratory patterns changed with the depth of tube submersion in water for both men and women, but the patterns of muscle activation differed between the sexes. This suggests that men and women use different strategies when confronted with increased intraoral pressure during semi-occluded vocal tract exercises. In this study, sEMG provided insight into the mechanism for differences between vocally normal individuals and could help detect compensatory muscle activation during tube phonation in water for people with voice disorders.

The Thyrohyoid Muscle: A Crucial Player in Deglutition and Vocalization / El Músculo Tirohioideo: Un Actor Crucial en la Deglución y la Vocalización

SUMMARY: The thyrohyoid muscle is one of the four infrahyoid muscles. Its role in vocalization and deglutition could be often overlooked, despite its crucial participation in these processes. Unlike other infrahyoid muscles, the thyrohyoid muscle receives innervation from the first cervical spinal nerves which contributes to its unique function. Its primary action involves hyolaryngeal elevation during swallowing, contributing to the opening of the upper esophageal sphincter. In conjunction with other muscles, it also protects the airway and facilitates the passage of food into the esophagus. Variations in the muscle's thickness may exist, and its function can be influenced by chewing habits. Weakened muscles involved in swallowing are often associated with dysphagia, a common complication in stroke and brain-injured patients. Advanced imaging techniques and sleep studies have provided insights into the dynamics and frequency of swallowing. This review explores the anatomic structures, function in action, diagnosis and clinical implications of this muscle. Overall, understanding the significance of the thyrohyoid muscle enhances our comprehension of the intricate interplay of laryngeal muscles during vocalization and deglutition.

El músculo tirohioideo es uno de los cuatro músculos infrahioideos. A menudo podría pasarse por alto su papel en la vocalización y la deglución, a pesar de su participación crucial en estos procesos. A diferencia de otros músculos infrahioideos, el músculo tirohioideo recibe inervación de los primeros nervios espinales cervicales, lo que contribuye a su función única. Su acción principal implica la elevación hiolaríngea durante la deglución, contribuyendo a la apertura del esfínter esofágico superior. Junto con otros músculos, también protege las vías respiratorias y facilita el paso de los alimentos al esófago. Pueden existir variaciones en el grosor del músculo y su función puede verse influenciada por los hábitos de masticación. Los músculos debilitados involucrados en la deglución a menudo se asocian con disfagia, una complicación común en pacientes con accidente cerebrovascular y lesión cerebral. Las técnicas de imagen avanzadas y los estudios del sueño han proporcionado información sobre la dinámica y la frecuencia de la deglución. Esta revisión explora las estructuras anatómicas, la función en acción, el diagnóstico y las implicaciones clínicas de este músculo. En general, comprender la importancia del músculo tirohioideo mejora nuestra comprensión de la intrincada interacción de los músculos laríngeos durante la vocalización y la deglución.