The Significant Influence of Hoarseness Levels in Connected Speech on the Voice-Related Disability Evaluated Using Voice Handicap Index-10.

OBJECTIVES: This retrospective study examines the influence of voice quality in connected speech (CS) and sustained vowels (SV) on the voice-related disability in patients' daily living documented by Voice Handicap Index-10 (VHI-10). METHODS: A total of 500 voice recordings of CS and SV samples from 338 patients with voice disturbances were included, along with the patients' age, diagnoses, maximum phonation time, and VHI-10. Dataset-1 comprised of 338 untreated patients, whereas Dataset-2 included 162 patients before and after phonosurgeries. As a preliminary study, the concurrent and diagnostic validities based on auditory-perceptual judgments were examined for cepstral peak prominence (CPP) and CPP smoothed (CPPS) for CS and SV tasks. Next, simple correlations and multivariate regression analyses (MRA) were performed to identify which of the acoustic measures for the CS or SV tasks significantly influenced the total score or improvement of VHI-10. RESULTS: The preliminary study confirmed high correlations with hoarseness levels as well as the excellent diagnostic accuracy of CPP and CPPS for both CS and SV tasks. In Dataset-1, the simple correlations and MRA results showed that cepstral measures in both tasks demonstrated moderate correlations with, and significant contribution to the total score of VHI-10, respectively. However, in Dataset-2, the changes of cepstral measures, as well as the median pitch after phonosurgeries in the CS tasks only, showed significant contributions to the improvement of VHI-10. CONCLUSION: The study demonstrated that the hoarseness levels in both the CS and SV tasks equivalently influenced the VHI-10 scores, and that the post-surgical change of voice quality only in the CS tasks influenced the improvement of voice-related disability in daily living.

Intertext Variability of Smoothed Cepstral Peak Prominence, Methods to Control It, and Its Diagnostic Properties.

OBJECTIVES: This study aimed to estimate the intertext variability of smoothed cepstral peak prominence (CPPS), examine whether sound-processing techniques improved its variability and diagnostic capability, and evaluate the degree of intertext variability in detail with reference to the CPPS variabilities in sustained vowels. STUDY DESIGN: This was a retrospective study. METHODS: Text readings of 58 Japanese syllables were recorded from 210 speakers with different diagnoses and varying degrees of dysphonia, and were divided into six passages. Applying the sound-processing techniques to those passages, we prepared three sample types: (1) nonprocessed, (2) only-loud, and (3) only-voiced samples. The intertext CPPS variability and diagnostic properties were compared across the passages and sample types. For detailed analysis, we subsequently extracted 63 normophonic speakers who maintained constant quality in their vowel utterances to evaluate the degree of intertext CPPS variability in relation to the variabilities between repeated identical vowels and across different vowels. RESULTS: Although several combinations of passages showed moderate-to-large CPPS variabilities, those variabilities were decreased by either technique, especially the deletion of silent segments, which resulted in the best diagnostic accuracy. The degree of intertext CPPS variability for the only-voiced samples was comparable to that of the CPPS variabilities in sustained vowels. CONCLUSIONS: The sound-processing technique removing silent segments should be applied to enhance the diagnostic properties of CPPS. The additional technique of deleting unvoiced segments is worth adopting if clinicians and researchers seek to attenuate the influence of text differences in calculating CPPS values.

Acoustic Breathiness Index for the Japanese-Speaking Population: Validation Study and Exploration of Affecting Factors.

Objectives The purposes of this study were to validate the Acoustic Breathiness Index (ABI) for the Japanese-speaking population and to determine whether it is independent of factors such as sex, age, and perceptual ratings of roughness. Method First, the concurrent validity of the ABI for perceptual breathiness was evaluated on the concatenations of continuous speech and sustained vowels from 288 patients with varying degrees of dysphonia. The diagnostic accuracy was examined on 343 samples with 55 additional normophonic speakers. Second, the validity related to responsiveness-to-change was estimated on 222 samples obtained before and after interventions for 111 voice-disordered patients. Third, the relationships between the ABI and other variables (i.e., perceptual hoarseness/breathiness/roughness, sex, and age) were explored using bivariate and multivariate analyses for the 288 patients. Results First, the concurrent validity and the responsiveness-to-change validity were confirmed by strong correlation coefficients of .890 and .878, respectively. Second, the receiver operating characteristic analysis showed the area under the curve to be 0.939, indicating excellent accuracy. The ABI of 3.44 exhibited a sensitivity of 76.3% and a specificity of 94.1%. Third, although bivariate analyses revealed a weak relationship between ABI and roughness and an ABI difference by age, multiple regression analyses showed a strong relation between only ABI and breathiness, without a meaningful contribution from roughness, sex, and age factors. Conclusion The study confirmed that the ABI is an accurate and specific tool to estimate breathiness levels in the Japanese-speaking population and neither roughness, sex, nor age significantly affects the ABI.

Automatic Segmentation of the Paranasal Sinus from Computer Tomography Images Using a Probabilistic Atlas and a Fully Convolutional Network.

In this paper, we present an automatic approach to paranasal sinus segmentation in computed tomography (CT) images. The proposed method combines a probabilistic atlas and a fully convolutional network (FCN). The probabilistic atlas was used to automatically localize the paranasal sinus and determine its bounding box. The FCN was then used to automatically segment the paranasal sinus in the bounding box. Comparing our proposed method with the conventional FCN (without probabilistic atlas) and the state-of-the-art method using active contour with group similarity, the proposed method demonstrated an improvement in the paranasal sinus segmentation. The segmentation accuracy (Dice coefficient) was about 0.83 even for the case with unclear boundary.

The Acoustic Voice Quality Index Version 03.01 for the Japanese-speaking Population.

OBJECTIVES: We aimed to determine the most appropriate syllable number for analyzing the Acoustic Voice Quality Index for the Japanese-speaking population (AVQIv3-JP) and to validate AVQIv3-JP using the determined syllable number. METHODS: First, we counted how many syllables should be included in each continuous speech (CS) sample to achieve time-balanced analysis between CS and sustained vowel samples using our previous dataset including 336 CS samples with 58 syllables. From the descriptive statistics of the counted syllable numbers, the most appropriate syllable number was identified. Subsequently, we performed validation procedures of AVQIv3-JP using our latest dataset including 455 recordings. RESULTS: Thirty Japanese syllables were judged to be the most appropriate syllable number. The concurrent validity of the AVQIv3-JP using 30 syllables was confirmed by Spearman's rho of 0.873. Subsequently, the receiver operating characteristic analysis demonstrated the excellent discriminative capability of AVQIv3-JP, showing the area under the curve of 0.915. The AVQIv3's original threshold of 2.43 in the Dutch language corresponded to sensitivity and specificity of 64.6% and 97.3%, respectively. In the present study, a threshold of 1.41 achieved the best accuracy with balanced sensitivity and specificity of 84.4% and 85.6%, respectively. Furthermore, the 95th percentile of the control participants exhibited a threshold of 2.06, showing sensitivity and specificity of 72.1% and 93.8%, respectively, as well as reasonable positive and negative likelihood ratios of 11.7 and 0.298, respectively. CONCLUSION: The AVQIv3 using 30 Japanese syllables is a reliable measurement tool for estimating the severity of voice quality and detecting abnormal voices.

Design of Soft Robotic Actuation for Supporting Eyelid Closure Movement.

We have been developing a facial wearable robot to support the eyelid movements of patients with facial paralysis, especially on one side of the face [1]. This robot has a mechanism for supporting eyelid movements, made from a soft material, which is called the eyelid gating mechanism (ELGM). The ELGM deforms by simple rotational actuation inputs and its deformation is customized to the eyelid movements. Therefore, this robot can provide non-invasive and gentle support for eyelid movements. We herein describe the design rule of the ELGM, and based on this, we conducted a deformation analysis with a non-linear finite element method. We verified the deformation trend from the results, and developed three prototypes based on this trend. Using these prototypes, we conducted a clinical study with facial paralysis patients to evaluate if the ELGM is capable of assisting in closing the eyelid.

Validation of the Acoustic Voice Quality Index in the Japanese Language.

OBJECTIVES: The Acoustic Voice Quality Index (AVQI) is a multivariate construct for quantification of overall voice quality based on the analysis of continuous speech and sustained vowel. The stability and validity of the AVQI is well established in several language families. However, the Japanese language has distinct characteristics with respect to several parameters of articulatory and phonatory physiology. The aim of the study was to confirm the criterion-related concurrent validity of AVQI, as well as its responsiveness to change and diagnostic accuracy for voice assessment in the Japanese-speaking population. STUDY DESIGN: This is a retrospective study. METHODS: A total of 336 voice recordings, which included 69 pairs of voice recordings (before and after therapeutic interventions), were eligible for the study. The auditory-perceptual judgment of overall voice quality was evaluated by five experienced raters. The concurrent validity, responsiveness to change, and diagnostic accuracy of the AVQI were estimated. RESULTS: The concurrent validity and responsiveness to change based on the overall voice quality was indicated by high correlation coefficients 0.828 and 0.767, respectively. Receiver operating characteristic analysis revealed an excellent diagnostic accuracy for discrimination between dysphonic and normophonic voices (area under the curve: 0.905). The best threshold level for the AVQI of 3.15 corresponded with a sensitivity of 72.5% and specificity of 95.2%, with the positive and negative likelihood ratios of 15.1 and 0.29, respectively. CONCLUSIONS: We demonstrated the validity of the AVQI as a tool for assessment of overall voice quality and that of voice therapy outcomes in the Japanese-speaking population.

Ramsay hunt syndrome in a patient with rheumatoid arthritis after treatment with infliximab.

A 39-year-old female patient with rheumatoid arthritis developed Ramsay Hunt syndrome after infliximab treatment. This condition is caused by the reactivation of varicella zoster virus infection in the geniculate ganglion of facial nerve in the host's immunosuppression. She was treated immediately with valaciclovir and hydrocortisone, and the complete recovery was achieved at 6 months after the onset. This is the first report of Ramsay Hunt syndrome as an adverse effect of infliximab in rheumatoid arthritis.

[A case of advanced adenocarcinoma of the ethmoid sinus treated by chemoradiation with S-1].

We report a case of advanced adenocarcinoma in the left ethmoid sinus invading the frontal sinus, the frontal skull base and the orbits(T4bN0M0 and Stage IVB). With the goal of functional preservation, we carried out radiation therapy with total 60 Gy irradiation and chemotherapy with S-1 80 mg/body/day before a radical operation. The tumor clinically disappeared without surgical treatment, and there was no sign of recurrence for 2.5 years. When we decide the treatment policy for advanced adenocarcinoma of the ethmoid sinus, chemoradiotherapy wit S-1 might be one of the effective treatments before radical operation to control the disease with preservation of functions.

Ménière's disease is associated with single nucleotide polymorphisms in the human potassium channel genes, KCNE1 and KCNE3.

Although the bases for both the sporadic and inherited forms of Ménière's disease (MD) remain undefined, it is likely to be multifactorial, one of the factors being a genetic predisposition. Recently, genetic association studies on complex diseases have become very popular and most of them are case-control studies using single nucleotide polymorphisms (SNPs) as markers. Mutations/polymorphisms in KCNE potassium channel genes might play a causative role in MD, because KCNE potassium channels have been suggested to be present and active in transmembrane ion and water transports in the inner ear. In the present study, to identify MD susceptibility genes, we have conducted a genetic association study with optimized sampling, optimized phenotyping/genotyping, and a selection of KCNE genes as the candidate genes. The SNPs analyses identified 112G/A SNP in the KCNE1 gene and 198T/C SNP in the KCNE3 gene in 63 definite MD cases as well as 205 and 237 non-MD control subjects. For both KCNE1 and KCNE3 genes, a significant difference in frequency of each SNP was confirmed between MD cases and non-MD control subjects. The result indicates that 112G/A SNP in the KCNE1 gene and 198T/C SNP in the KCNE3 gene could determine an increased susceptibility to develop MD.

[Audiological effect of bone-anchored hearing aid].

The bone-anchored hearing aid (BAHA) has proved to be a valuable alternative to conventional air and bone conduction hearing aids for patients suffering from chronic otitis media or bilateral aural atresia. The BAHA gave better sound quality and greater comfort than conventional hearing aids (HAs), but only 1 study has been done in Japan. We implanted BAHAs in 6 hard-of-hearing patients in the last 2 years. One patient suffered skin problems around the abutment and used the BAHA only briefly. Free-field audiometry, the speech discrimination test (SDT), and the speech recognition test (SRT) were conducted in all subjects. They were evaluated either with the HA or BAHA. The SDT and SRT showed better hearing results in quiet for the BAHA than the conventional HA, but there was a minimum difference in SDT and SRT in noise. Subjects assessed the HA and BAHA using questionnaires. Subjects reported that the BAHA offers a number of important advantages, including greater cosmetic acceptability, improved speech intelligibility, and better sound quality.

Comparison of speech perception between monaural and binaural hearing in cochlear implant patients.

OBJECTIVE: To assess the advantages of binaural hearing for cochlear implant (CI) users using a hearing aid (HA) for the contralateral ear. MATERIAL AND METHODS: The subjects comprised 3 males and 3 females (age range 48-84 years). All of them had been using a CI and HA for > 6 months. Their speech perception was examined in quiet using monosyllables and Japanese Hearing in Noise Test (J-HINT) sentences. Speech perception in noise was examined using J-HINT sentences. Late cortical waves were measured while subjects listened to 1 kHz frequent and 2 kHz target tone stimuli. The latency of the event-related potential (P300) wave was compared for monaural and binaural hearing conditions. RESULTS: Three subjects showed significantly better results for binaural than monaural (CI alone) hearing for monosyllables and HINT sentences (p < 0.05; paired t-test). Subjects with better speech perception had been using an HA for longer than those with poor performance (18.3 vs 4.0 years). The overall average score was better for binaural than monaural hearing in the speech perception test under quiet and noisy conditions. Comparison of the latency of the P300 wave under monaural and binaural hearing conditions showed a significantly shorter latency for the latter (p = 0.02; paired t-test). CONCLUSIONS: Although the use of an HA alone showed marginal benefit for CI users, binaural hearing (CI+HA) resulted in a significant improvement in speech perception under various circumstances.

[Four cases of hypopharyngeal cancer treated with docetaxel, cisplatin, and 5-FU followed by radiotherapy and/or neck dissection].

We treated 4 patients with hypopharyngeal cancer, each of whom had a complete response after 2 cycles of chemotherapy with docetaxel, cisplatin, and 5-FU followed by radiation and/or neck dissection. Twenty-one months to 2 years after this therapy, 3 patients had no recurrence and no metastasis with their laryngeal framework and function preserved. Chemotherapy including docetaxel, cisplatin, and 5-FU is a useful treatment for early head and neck cancer.

Evidence of a founder effect for the 235delC mutation of GJB2 (connexin 26) in east Asians.

Mutations in the GJB2 gene encoding connexin 26 (Cx26) are a major cause of autosomal recessive and sporadic cases of congenital deafness in most populations. The 235delC mutation of GJB2 is the most frequent known mutation in some east Asian populations, with a carrier frequency of approximately 1%. In order to study the origin of 235delC among east Asians, we analyzed single-nucleotide polymorphisms (SNPs) within the coding region of GJB2 and flanking the 235delC mutation. We observed significant linkage disequilibrium between 235delC and five linked polymorphic markers, suggesting that 235delC arose from a common founder. The detection of 235delC only in east Asians, but not in Caucasians, and the small chromosomal interval of the shared haplotype suggest that 235delC is an ancient mutation that arose after the divergence of Mongoloids and Caucasians. Similarly, the finding that this mutation appears on a single haplotype provides no support for the possibility that recurrent mutation is the explanation for the high frequency of the allele.

[Binaural advantage on usage of hearing aid together with cochlear implant--examination on speech perception (Japanese monosyllable word list 67-S and Japanese HINT)].

Six cochlear implant recipients with hearing aids in the opposite ear were studied to survey binaural advantage. They were examined in separate tests by using a hearing aid alone, cochlear implant alone, and by using both devices (bimodal condition). Test items used were the Japanese monosyllable word list 67--S and Japanese HINT. Statistically significantly results were obtained in the bimodal condition, three out of six subjects were successful in the monosyllable word test and all successful in the Japanese HINT. We conclude that all subjects enjoyed binaural advantage in speech perception in bimodal condition with no conflict at the recognition level; even when different sounds from cochlear implant and contralateral hearing aid were received. The plasticity of the brain is thought to be of importance in the bimodal condition.

Successful cochlear implantation in prelingual profound deafness resulting from the common 233delC mutation of the GJB2 gene in the Japanese.

OBJECTIVES: Recently, we identified three novel mutations of the GJB2 gene in Japanese families with autosomal-recessive non-syndromic deafness.1 Seven of 11 mutated chromosomes (63.6%) contained a 233delC allele, suggesting that the 233delC mutation is the most common mutation of the GJB2 gene in the Japanese population. After it was recognized that cochlear implantation (CI) is of benefit to children with prelingual deafness, we have had a number of prelingual pediatric CI patients. Because children carrying the homozygous 233delC mutation show bilateral prelingual profound deafness, they could be enrolled in the CI program at Osaka University Graduate School of Medicine. The purposes of this study were 1) to analyze the occurrence of the GJB2 mutations in our 15 prelingual pediatric CI patients in whom the cause of non-syndromic deafness was unknown, and 2) to evaluate the auditory function and postoperative speech perception with CI of those GJB2-related deaf subjects. STUDY DESIGN: Retrospective analysis. METHODS: Mutation analysis of the GJB2 gene by direct sequencing was performed with genomic DNA from 15 children born profoundly deaf as a result of unknown causes and implanted with CI. Intraoperative electrically evoked auditory brainstem response (EABR) and intra-/postoperative EAP were measured. The speech perception was evaluated with Infants and Toddlers Meaningful Auditory Integration Scale (IT-MAIS). RESULTS AND CONCLUSIONS: We identified 4 CI patients (26.7%) out of 15 children carrying the homozygous 233delC mutation. Intra- and postoperative evaluation of the auditory system revealed almost intact cochlear and retrocochlear auditory function in these 4 patients. Postoperative auditory testing indicates that their speech perception had become significantly higher in comparison with that of other prelingual CI patients. These results suggest that prelingual deaf children carrying the homozygous 233delC mutation of the GJB2 gene can benefit from CI.