Partial Horizontal Supracricoid Laryngectomy: Which Factors Impact on Post-decannulation Swallowing Outcomes? A Prospective Single-Center Experience.

Early decannulation, performed within the first ten days after supracricoid partial laryngectomy, can result in a more rapid recovery of swallowing function with a semisolid bolus in the short term, about 30 days. We selected 20 patients with squamous cell carcinoma of larynx, who underwent supracricoid laryngectomies: 10 cricohyoidopexy (CHP) and 10 cricohyoidoepiglottopexy (CHEP). Staging was pT2 (10 pts), and pT3 (10 pts). Fiberoptic endoscopic evaluation of swallowing was used to assess postoperative swallowing function after a mean of 12 and 22 days from surgery. A modified PAS score (penetration-aspiration scale) was assigned for subtotal laryngectomies. Decannulation occurred after 6.7 ± 2.1 days. Univariate analysis showed that the type of surgery (CHP or CHEP), pT, resection of one arytenoid, and decannulation time are significantly associated with the 12-day PAS score. The 22-day PAS score is significantly associated with only 3 variables: type of surgery, pT, and resection of one arytenoid. From the data presented, the factors that most delay an effective recovery of swallowing are T3 and the resection of one arytenoid. Early decannulation has been shown statistically to improve PAS score in the short term, but not in the long term.

Acoustic analysis in stuttering: a machine-learning study.

Background: Stuttering is a childhood-onset neurodevelopmental disorder affecting speech fluency. The diagnosis and clinical management of stuttering is currently based on perceptual examination and clinical scales. Standardized techniques for acoustic analysis have prompted promising results for the objective assessment of dysfluency in people with stuttering (PWS). Objective: We assessed objectively and automatically voice in stuttering, through artificial intelligence (i.e., the support vector machine - SVM classifier). We also investigated the age-related changes affecting voice in stutterers, and verified the relevance of specific speech tasks for the objective and automatic assessment of stuttering. Methods: Fifty-three PWS (20 children, 33 younger adults) and 71 age-/gender-matched controls (31 children, 40 younger adults) were recruited. Clinical data were assessed through clinical scales. The voluntary and sustained emission of a vowel and two sentences were recorded through smartphones. Audio samples were analyzed using a dedicated machine-learning algorithm, the SVM to compare PWS and controls, both children and younger adults. The receiver operating characteristic (ROC) curves were calculated for a description of the accuracy, for all comparisons. The likelihood ratio (LR), was calculated for each PWS during all speech tasks, for clinical-instrumental correlations, by using an artificial neural network (ANN). Results: Acoustic analysis based on machine-learning algorithm objectively and automatically discriminated between the overall cohort of PWS and controls with high accuracy (88%). Also, physiologic ageing crucially influenced stuttering as demonstrated by the high accuracy (92%) of machine-learning analysis when classifying children and younger adults PWS. The diagnostic accuracies achieved by machine-learning analysis were comparable for each speech task. The significant clinical-instrumental correlations between LRs and clinical scales supported the biological plausibility of our findings. Conclusion: Acoustic analysis based on artificial intelligence (SVM) represents a reliable tool for the objective and automatic recognition of stuttering and its relationship with physiologic ageing. The accuracy of the automatic classification is high and independent of the speech task. Machine-learning analysis would help clinicians in the objective diagnosis and clinical management of stuttering. The digital collection of audio samples here achieved through smartphones would promote the future application of the technique in a telemedicine context (home environment).

Vocal singing skills by cochlear implanted children without formal musical training: Familiar versus unfamiliar songs.

OBJECTIVES: Vocal singing skills in pediatric CI users are not much known due to the limited number of studies. The principal aim of the present study was to evaluate vocal singing skills in Italian pediatric CI users. A further aim was to investigate factors that may significantly influence their performance. METHODS: The participants were twenty-two implanted children and twenty-two hearing peers. Their vocal singing skills for familiar ("Happy Birthday to You") and unfamiliar songs ("Baton Twirler" from Pam Pam 2- Tribute to Gordon) were evaluated in relation to their music perception (the Gordon test). Acoustic analysis was performed using Praat and MATLAB software. Nonparametric statistical tests and principal component analysis (PCA) were used to analyze the data. RESULTS: Hearing children outperformed implanted peers in both music perception and vocal singing tasks (all measures regarding intonation, vocal range, melody, and memory for the familiar song versus measures regarding intonation and overall melody production for the unfamiliar song). Music perception and vocal singing performances revealed strong correlations. For the familiar and unfamiliar songs, age-appropriate vocal singing was observed in 27.3% versus 45.4% of children, all implanted within 24 months of age. Age at implantation and duration of CI experience were moderately correlated with the total score obtained from the Gordon test. CONCLUSION: Implanted children show limited vocal singing skills in comparison to their hearing peers. However, some children implanted within 24 months of age seem to achieve vocal singing skills as good as their hearing peers. Future research could be useful to better understand the role of brain plasticity to implement specific training programs for both music perception and vocal singing.

The influence of auditory selective attention on linguistic outcomes in deaf and hard of hearing children with cochlear implants.

PURPOSE: Auditory selective attention (ASA) is crucial to focus on significant auditory stimuli without being distracted by irrelevant auditory signals and plays an important role in language development. The present study aimed to investigate the unique contribution of ASA to the linguistic levels achieved by a group of cochlear implanted (CI) children. METHODS: Thirty-four CI children with a median age of 10.05 years were tested using both the "Batteria per la Valutazione dell'Attenzione Uditiva e della Memoria di Lavoro Fonologica nell'età evolutiva-VAUM-ELF" to assess their ASA skills, and two Italian standardized tests to measure lexical and morphosyntactic skills. A regression analysis, including demographic and audiological variables, was conducted to assess the unique contribution of ASA to language skills. RESULTS: The percentages of CI children with adequate ASA performances ranged from 50 to 29.4%. Bilateral CI children performed better than their monolateral peers. ASA skills contributed significantly to linguistic skills, accounting alone for the 25% of the observed variance. CONCLUSIONS: The present findings are clinically relevant as they highlight the importance to assess ASA skills as early as possible, reflecting their important role in language development. Using simple clinical tools, ASA skills could be studied at early developmental stages. This may provide additional information to outcomes from traditional auditory tests and may allow us to implement specific training programs that could positively contribute to the development of neural mechanisms of ASA and, consequently, induce improvements in language skills.

Resuming Swallowing and Oral Feeding in Tracheostomized COVID-19 Patients: Experience of a Swiss COVID-Center and Narrative Literature Review.

During the COVID-19 pandemic, percutaneous tracheostomy proved to be an effective option in the management of patients with prolonged periods of intubation. In fact, among other things, it allowed early discharge from ICUs and contributed to reducing overcrowding in intensive care settings, a central and critical point in the COVID pandemic. As a direct consequence, the management and the weaning of frail, tracheostomized and ventilated patients was diverted to sub-intensive or normal hospitalization wards. One central challenge in this setting is the resumption of swallowing and oral feeding, which require interdisciplinary management involving a phoniatrician, ENT, pneumologist, and speech therapist. With this article, we aim to share the experience of a Swiss COVID-19 Center and to draw up a narrative review on the issues concerning the management of the tracheostomy cannula during swallowing resumption, integrating the most recent evidence from the literature with the clinical experiences of the professionals directly involved in the management of tracheostomized COVID-19 patients. In view of the heterogeneity of COVID-19 patients, we believe that the procedures described in the article are applicable to a larger population of patients undergoing tracheostomy weaning.

Accuracy of Dysphagia Standard Assessment (DSA®) bedside screening test: a flowchart for patient eligibility.

BACKGROUND: Oropharyngeal dysphagia (OD) screening tests have improved patient management; however, the complex applicability and high percentage of false negatives do not allow these tests to be considered completely reliable if not supported by an instrumental investigation. The aim of the present study is to evaluate an OD screening test, the Dysphagia Standard Assessment (DSA®) with different volumes and viscosities. MATERIALS AND METHODS: Prospective study of 72 patients evaluated for suspected OD through a double-blind methodology conducted by two operators. All patients underwent fiberoptic endoscopic evaluation of swallowing (FEES) as a reference test and a separate DSA® test. DSA® was performed by administering boluses with different viscosities, with the signal of interruption of the test being: onset of the cough reflex, wet voice after swallowing, and/or desaturation of O2 ≥ 5%. The Penetration-Aspiration Scale (PAS) was evaluated by FEES. The cut-off identified to diagnose OD was PAS ≥ 3. RESULTS: The test showed an accuracy of 82%, a sensitivity of 0.93 (95% C.I. 0.84-0.97), and a specificity of 0.78 (95% C.I. 0.67-0.87); positive predictive value 0.55 (95% C.I. 0.43-0.67); negative predictive value 0.97 (95% C.I. 0.90-0.99), positive likelihood ratio 4.37 (95% C.I. 3.6-5.2); likelihood negative ratio 0.08 (95% C.I. 0.06-0.09). CONCLUSIONS: According to the preliminary results, the test showed good outcomes in determining the presence or absence of OD with a wide spectrum of applicability with some limitations that could be overcome by the selection of a target population. For this reason, a flowchart to address patient eligibility was developed.

Hearing attention and quality of listening in children with unilateral hearing loss with and without hearing aid.

Objective: To analyse hearing attention and quality of listening in a cohort of children affected by moderate to severe unilateral hearing loss, comparing a group of hearing aid users to children with no hearing aid. Methods: Twenty-four children (12 hearing aid users, and 12 without hearing rehabilitation) underwent audiological evaluation with speech audiometry in quiet and noise, hearing attention tests, and the speech, spatial and quality of hearing questionnaire in the version for parents. Results: Concerning speech audiometry in noise, in the most difficult condition no one in the unaided group achieved a normal speech recognition threshold score (0% vs 11.6 ± 2.7% in the aided group). The selective hearing attention and shifting tests showed fewer errors in the aided group vs. the non-aided group. The questionnaire showed a significant difference between the quality of listening perceived by the parents of the two groups. The mean total scores were 152.8 ± 2.7 in the aided group and 116.1 ± 2.6 in the non-aided group (p > 0.001). Conclusions: Children with unilateral hearing loss without hearing rehabilitation show a lower quality of hearing, especially with regards to divided auditory attention. Hearing rehabilitation should be proposed as soon as possible in children with moderate to severe unilateral hearing loss.

Listening comprehension in profoundly deaf children with cochlear implants: the role of auditory perception and foundational linguistic and cognitive skills.

PURPOSE: The aim of the study was to investigate the listening comprehension (LC) skills in deaf and hard of hearing children (DHH) using cochlear implants (CI). Besides, personal and audiological variables that could influence the levels of competence reached were analyzed. METHODS: Thirty-four children using CI were enrolled. LC skills were assessed through the standardized Italian test "Comprensione Orale-Test e Trattamento" (CO-TT). A univariate analysis was conducted to compare LC with gender, listening mode (unilateral or bilateral), maternal level of education and family income. A bivariate analysis was performed to search possible connections between children's performances and their individual characteristics, audiological conditions, and language levels. Finally, a multivariate analysis was performed using a stepwise hierarchical linear regression model which included all variables whose p value resulted ≤ 0.05. RESULTS: Twenty-one children using CI (61.8%) showed adequate performances in terms of chronological age, while 13 (38.2%) showed difficulties in LC. Maternal level of education, age at diagnosis and non-verbal cognitive level accounted for 43% of the observed variance. Auditory attention skills explained an additional 15% of variance. Morphosyntactic comprehension added a further 12% of variance. CONCLUSION: CI can really help many DHH children to reach adequate LC skills, but in some cases difficulties remain. Factors influencing LC need to be early investigated and considered when planning an appropriate rehabilitative intervention.

A multinational consensus on dysphagia in Parkinson's disease: screening, diagnosis and prognostic value.

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative disorder characterized by a combination of motor and non-motor dysfunction. Dysphagia is a common symptom in PD, though it is still too frequently underdiagnosed. Consensus is lacking on screening, diagnosis, and prognosis of dysphagia in PD. OBJECTIVE: To systematically review the literature and to define consensus statements on the screening and the diagnosis of dysphagia in PD, as well as on the impact of dysphagia on the prognosis and quality of life (QoL) of PD patients. METHODS: A multinational group of experts in the field of neurogenic dysphagia and/or PD conducted a systematic revision of the literature published since January 1990 to February 2021 and reported the results according to PRISMA guidelines. The output of the research was then analyzed and discussed in a consensus conference convened in Pavia, Italy, where the consensus statements were drafted. The final version of statements was subsequently achieved by e-mail consensus. RESULTS: Eighty-five papers were used to inform the Panel's statements even though most of them were of Class IV quality. The statements tackled four main areas: (1) screening of dysphagia: timing and tools; (2) diagnosis of dysphagia: clinical and instrumental detection, severity assessment; (3) dysphagia and QoL: impact and assessment; (4) prognostic value of dysphagia; impact on the outcome and role of associated conditions. CONCLUSIONS: The statements elaborated by the Consensus Panel provide a framework to guide the neurologist in the timely detection and accurate diagnosis of dysphagia in PD.

Progression of Oropharyngeal Dysphagia in Amyotrophic Lateral Sclerosis: A Retrospective Cohort Study.

Little is known regarding the optimal timing of dysphagia assessment and PEG indication in amyotrophic lateral sclerosis (ALS). The study aims to investigate the progression of dysphagia in a cohort of ALS patients and to analyse whether there are variables linked to a faster progression of dysphagia and faster indication of PEG placement. A retrospective cohort study in 108 individuals with ALS. Fiberoptic endoscopic evaluation of swallowing was performed 6 monthly until PEG indication or death. Dysphagia severity and PEG indication were assessed using Penetration Aspiration Scale. Progression Index (PI) analysed the risk of disease progression (fast/slow) in relation to dysphagia onset and PEG indication. Patients were grouped based on ALS onset and PI. Person-time incidence rates were computed considering dysphagia onset and PEG indication from ALS symptoms during the entire observation period and have been reported as monthly and 6-month rates. Cox regression survival analysis assessed dysphagia and PEG risk factors depending on onset. Person-time incidence rates of dysphagia progression and PEG risk were increased based on type of ALS onset and PI. Patients with a fast progressing disease and with bulbar onset (BO) show statistically significant increased risk of dysphagia (BO 178.10% hazard ratio (HR) = 2.781 P < 0.01; fast 181.10% HR 2.811 P < 0.01). Regarding PEG risk, fast patients and patients with BO had a statistically significant increased risk (fast 147.40% HR 2.474 P < 0.01, BO 165.40% HR 2.654 P < 0.01). Fast PI predicts the likelihood of faster progression of dysphagia and PEG indication and should be included in multidisciplinary assessments and considered in the design of future guidelines regarding dysphagia management in ALS patients.Level of Evidence Level IV.

Benefits of Parent Training in the Rehabilitation of Deaf or Hard of Hearing Children of Hearing Parents: A Systematic Review.

The present study is a systematic review on the effectiveness of Parent Training (PT) and coaching in deaf and hard of hearing (DHH) rehabilitation programs which reviews and synthesizes the existing body of evidence to assess the benefits of these programs in enhancing parents' sensitivity, responsivity and promoting language development in DHH children during the first years after HA fitting or CI activation. Five published studies met the Population, Intervention, Comparison and Outcomes (PICO) inclusion criteria and were eligible to be included, but heterogeneity in terms of the study design, interventions and outcomes did not allow for performing a meta-analysis. All included studies shared the view that a parent's learning is a circular (rather than frontal) process, and the results appear promising in terms of enhancing parents' responsiveness and promoting DHH child language development. Nevertheless, the available evidence was judged to not be robust enough due to limitations in the studies' designs. Further high-quality evidence is needed to evaluate the true degree of clinical value and the cost effectiveness of PT programs aimed at increasing parents' responsiveness to their DHH children.

Consensus on the treatment of dysphagia in Parkinson's disease.

BACKGROUND: Dysphagia is common in Parkinson's disease (PD). The effects of antiparkinsonian drugs on dysphagia are controversial. Several treatments for dysphagia are available but there is no consensus on their efficacy in PD. OBJECTIVE: To conduct a systematic review of the literature and to define consensus statements on the treatment of dysphagia in PD and related nutritional management. METHODS: A multinational group of experts in the field of neurogenic dysphagia and/or Parkinson's disease conducted a systematic evaluation of the literature and reported the results according to PRISMA guidelines. The evidence from the retrieved studies was analyzed and discussed in a consensus conference organized in Pavia, Italy, and the consensus statements were drafted. The final version of statements was subsequently achieved by e-mail consensus. RESULTS: The literature review retrieved 64 papers on treatment and nutrition of patients with PD and dysphagia, mainly of Class IV quality. Based on the literature and expert opinion in cases where the evidence was limited or lacking, 26 statements were developed. CONCLUSIONS: The statements developed by the Consensus panel provide a guidance for a multi-disciplinary treatment of dysphagia in patients with PD, involving neurologists, otorhinolaryngologists, gastroenterologists, phoniatricians, speech-language pathologists, dieticians, and clinical nutritionists.

Barbed suture Extrusion and Exposure in palatoplasty for OSA: What does it mean?

PURPOSE: Analyze Extrusion&Exposion (E&E), its implications in the functional, anatomical results and subjective discomfort in OSA patients treated with Barbed Reposition Pharyngoplasty (BRP). MATERIALS AND METHODS: 488 patients treated with BRP or multilevel TORS. Stratafix wire was used in 230 patients, V-Loc in 258. E&E, timing and localization evaluated at follow-up. Polygraphy used to assess the impact of E&E on functional results, PPOPS questionnaire used for subjective discomfort. RESULTS: E&E in the entire group was 18,4%, with significant difference between Stratafix and V-Loc wire (p = 0,002), but not between BRP alone and multilevel surgery (p = 0,68). 28,9% of extrusion happened within the first seven days, 76,7% between seven days and two months, 5,5% after two months. Symptomatic clinical profile has been seen in 62,2%, asymptomatic one in 37,8% of patients. 35,5% of E&E were localized in tonsillar bed, 46,7% in soft palate and 20% in other sites. Mean delta-AHI of E&E patients was -15,87 ± 16.82 compared with one of those who did not have E&E was -16.34 ± 22,77 (p = 0,38). Mean PPOPS of 183 patients analyzed was 12,32 ± 4,96. Mean PPOPS of extruded group was 12,94 ± 4,68 and 11,92 ± 5,11 in not extruded one (p = 0,166). CONCLUSIONS: E&E are suture-type sensitive (V-Loc > Stratafix), reported more frequent when BRP is performed alone than BRP-TORS with no statistical significance. 76,7% of the E&E occur after patient discharge and within 2 months. About half of the E&E were localized in soft palate. There is no need to fear Extrusion&Exposition because it does not affect in a negative way subjective and PSG outcome.

Voice Analysis with Machine Learning: One Step Closer to an Objective Diagnosis of Essential Tremor.

BACKGROUND: Patients with essential tremor have upper limb postural and action tremor often associated with voice tremor. The objective of this study was to objectively examine voice tremor and its response to symptomatic pharmacological treatment in patients with essential tremor using voice analysis consisting of power spectral analysis and machine learning. METHODS: We investigated 58 patients (24 men; mean age ± SD, 71.7 ± 9.2 years; range, 38-85 years) and 74 age- and sex-matched healthy subjects (20 men; mean age ± SD, 71.0 ± 12.4 years; range, 43-95 years). We recorded voice samples during sustained vowel emission using a high-definition audio recorder. Voice samples underwent sound signal analysis, including power spectral analysis and support vector machine classification. We compared voice recordings in patients with essential tremor who did and did not manifest clinically overt voice tremor and in patients who were and were not under the symptomatic effect of the best medical treatment. RESULTS: Power spectral analysis demonstrated a prominent oscillatory activity peak at 2-6 Hz in patients who manifested a clinically overt voice tremor. Voice analysis with support vector machine classifier objectively discriminated with high accuracy between controls and patients who did and did not manifest clinically overt voice tremor and between patients who were and were not under the symptomatic effect of the best medical treatment. CONCLUSIONS: In patients with essential tremor, voice tremor is characterized by abnormal oscillatory activity at 2-6 Hz. Voice analysis, including power spectral analysis and support vector machine classification, objectively detected voice tremor and its response to symptomatic pharmacological treatment in patients with essential tremor. © 2021 International Parkinson and Movement Disorder Society.

State of the evidence about rehabilitation interventions in patients with dysphagia.

INTRODUCTION: Rather than a separate nosological entity, dysphagia must be considered as a symptom of other pathological conditions, which afflicts patients admitted to numerous medical departments (rehabilitation, neurology, geriatrics, internal medicine, etc.) These disorders share the need for timely access to quality care and multidisciplinary treatment, including rehabilitation. The purpose of this study was to conduct a review of the current guidelines' recommendations in the literature and provide recommendations on the rehabilitative management of the patient with dysphagia. EVIDENCE ACQUISITION: The search was carried out through the main databases (Medline, Pedro, Cochrane Database and Google Scholar). All the articles concerning rehabilitation management of dysphagia, published in the last 10 years, have been included. EVIDENCE SYNTHESIS: Bibliographic research has provided thirteen guidelines. The literature analysed focuses mainly on the screening, the evaluation and the planning of multidisciplinary treatment. The literature agrees in recommending as cornerstones in the treatment of the dysphagic patient dietary changes, rehabilitation training (particularly muscle strengthening exercises and coordination) and early use of alternative nutrition in patients severely compromised. CONCLUSIONS: The dysphagic patient requires the deployment of a range of skills by a multi-professional and multi-disciplinary team. Speech and language pathologists in cooperation with specialists of rehabilitation have the task of managing the various stages, ranging from the early identification of the symptom to the setting of the treatment plan. Due to the lack of standardized protocols, it is necessary to implement the research path, especially regarding rehabilitation intervention.

Variables influencing executive functioning in preschool hearing-impaired children implanted within 24 months of age: an observational cohort study.

PURPOSE: Executive Functions (EFs) are fundamental to every aspect of life. The present study was implemented to evaluate factors influencing their development in a group of preschools orally educated profoundly deaf children of hearing parents, who received CI within 2 years of age. METHODS: Twenty-five preschool CI children were tested using the Battery for Assessment of Executive Functions (BAFE) to assess their flexibility, inhibition, and non-verbal visuo-spatial working memory skills. The percentage of children performing in normal range was reported for each of the EF subtests. Mann-Whitney and Kruskal-Wallis were performed to assess differences between gender, listening mode, and degree of parents' education subgroups. The Spearman Rank Correlation Coefficient was calculated to investigate the relationship between EF scores of audiological and linguistic variables. RESULTS: Percentages ranging from 76 to 92% of the children reached adequate EF scores at BAFE. Significant relations (p < 0.05) were found between EFs and early intervention, listening, and linguistic skills. Furthermore, CI children from families with higher education level performed better at the response shifting, inhibitory control, and attention flexibility tasks. Economic income correlated significantly with flexibility and inhibitory skills. Females performed better than males only in the attention flexibility task. CONCLUSIONS: The present study is one of the first to focus attention on the development of EFs in preschool CI children, providing an initial understanding of the characteristics of EFs at the age when these skills emerge. Clinical practice must pay increasing attention to these aspects which are becoming the new emerging challenge of rehabilitation programs.

Machine-Learning Analysis of Voice Samples Recorded through Smartphones: The Combined Effect of Ageing and Gender.

BACKGROUND: Experimental studies using qualitative or quantitative analysis have demonstrated that the human voice progressively worsens with ageing. These studies, however, have mostly focused on specific voice features without examining their dynamic interaction. To examine the complexity of age-related changes in voice, more advanced techniques based on machine learning have been recently applied to voice recordings but only in a laboratory setting. We here recorded voice samples in a large sample of healthy subjects. To improve the ecological value of our analysis, we collected voice samples directly at home using smartphones. METHODS: 138 younger adults (65 males and 73 females, age range: 15-30) and 123 older adults (47 males and 76 females, age range: 40-85) produced a sustained emission of a vowel and a sentence. The recorded voice samples underwent a machine learning analysis through a support vector machine algorithm. RESULTS: The machine learning analysis of voice samples from both speech tasks discriminated between younger and older adults, and between males and females, with high statistical accuracy. CONCLUSIONS: By recording voice samples through smartphones in an ecological setting, we demonstrated the combined effect of age and gender on voice. Our machine learning analysis demonstrates the effect of ageing on voice.

Multiple Sclerosis: Impact on Oral Hygiene, Dysphagia, and Quality of Life.

Multiple sclerosis (MS) is an autoimmune disease in which the immune system reacts by damaging the central nervous system, specifically myelin and oligodendrocytes. It is the most debilitating neurological disease among young adults, causing personal, familiar, social, and professional limitations. Multiple sclerosis can cause disturbances in the orofacial district, due to a demyelination process on the nerves of the head and neck district. The aim of this study was to evaluate the oral health status, dysphagia, and quality of life of patients affected by MS. For this study, 101 patients aged between 12 and 70 (47 males, 54 females) affected by MS were selected, and three questionnaires were handed out and anonymously filled in by them: An oral hygiene test, DYMUS (DYsphagia in MUltiple Sclerosis), and IOHIP-14 (Italian version Oral Health Impact Profile). Through the analysis of the questionnaires it was possible to observe pathological conditions, such as gingival inflammation, xerostomia, dysphagia, neuralgia, and dysarthria. Through the analysis it was possible to outline how the roles of a medical team, composed of a dentist, otolaryngologist, and dental hygienist, are fundamental in coping with other medical figures, during the whole development of the diseases, as well as to prevent possible complications.

Voice analysis in adductor spasmodic dysphonia: Objective diagnosis and response to botulinum toxin.

INTRODUCTION: Adductor-type spasmodic dysphonia is a task-specific focal dystonia characterized by involuntary laryngeal muscle spasms. Due to the lack of quantitative instrumental tools, voice assessment in patients with adductor-type spasmodic dysphonia is mainly based on qualitative neurologic examination. We evaluated patients with cepstral analysis and specific machine-learning algorithms and compared the results with those collected in healthy subjects. In patients, we also used cepstral analysis and machine-learning algorithms to investigate the effect of botulinum neurotoxin type A. METHODS: We investigated 60 patients affected by adductor-type spasmodic dysphonia before botulinum neurotoxin type A therapy and 60 age and gender-matched healthy subjects. A subgroup of 35 patients was also evaluated after botulinum neurotoxin type A therapy. We recorded the sustained emission of a vowel and a sentence by means of a high-definition audio recorder. Voice samples underwent cepstral analysis as well as machine-learning algorithm classification techniques. RESULTS: Cepstral analysis was able to differentiate between healthy subjects and patients, but receiver operating characteristic curve analysis demonstrated that machine-learning algorithms achieved better results than cepstral analysis in differentiating healthy subjects and patients affected by adductor-type spasmodic dysphonia. Similar results were obtained when differentiating patients before and after botulinum neurotoxin type A therapy. Cepstral analysis and machine-learning measures correlated with the severity of voice impairment in patients before and after botulinum neurotoxin type A therapy. CONCLUSIONS: Cepstral analysis and machine-learning algorithms are new tools that offer meaningful support to clinicians in the diagnosis and treatment of adductor-type spasmodic dysphonia.

Voice Parameter Changes in Professional Musician-Singers Singing with and without an Instrument: The Effect of Body Posture.

BACKGROUND AND AIM: The impact of body posture on vocal emission is well known. Postural changes may increase muscular resistance in tracts of the phono-articulatory apparatus and lead to voice disorders. This work aimed to assess whether and to which extent body posture during singing and playing a musical instrument impacts voice performance in professional musicians. SUBJECTS AND METHODS: Voice signals were recorded from 17 professional musicians (pianists and guitarists) while they were singing and while they were singing and playing a musical instrument simultaneously. Metrics were extracted from their voice spectrogram using the Multi-Dimensional Voice Program (MDVP) and included jitter, shift in fundamental voice frequency (sF0), shimmer, change in peak amplitude, noise to harmonic ratio, Voice Turbulence Index, Soft Phonation Index (SPI), Frequency Tremor Intensity Index, Amplitude Tremor Intensity Index, and maximum phonatory time (MPT). Statistical analysis was performed using two-tailed t tests, one-way ANOVA, and χ2 tests. Subjects' body posture was visually assessed following the recommendations of the Italian Society of Audiology and Phoniatrics. Thirty-seven voice signals were collected, 17 during singing and 20 during singing and playing a musical instrument. RESULTS: Data showed that playing an instrument while singing led to an impairment of the "singer formant" and to a decrease in jitter, sF0, shimmer, SPI, and MPT. However, statistical analysis showed that none of the MDVP metrics changed significantly when subjects played an instrument compared to when they did not. Shoulder and back position affected voice features as measured by the MDVP metrics, while head and neck position did not. In particular, playing the guitar decreased the amplitude of the "singer formant" and increased noise, causing a typical "raucous rock voice." CONCLUSIONS: Voice features may be affected by the use of the instrument the musicians play while they sing. Body posture selected by the musician while playing the instrument may affect expiration and phonation.