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The Application of Dynamic CT Scan in Evaluating the Dynamic Changes of Laryngeal Morphology...

The Application of Dynamic CT Scan in Evaluating the Dynamic Changes of Laryngeal Morphology during Inspiration and Pronunciation

Yanli Ma MD, Jie Cai MD, Yongjing You MD, Zheyi Zhang MD, Jinan ...Wang MD, Peiyun Zhuang MD

Objective: To explore the dynamic changes of three-dimensional morphology of laryngeal soft tissue and its application value in the unilateral vocal fold paralysis (UVFP) patients with dynamic CT scanning during inspiration and phonation.
Methods: 18 patients with UVFP and 10 normal subjects were studied. The cine mode of laryngeal dynamic computed tomography (CT) was performed to obtain 10 dynamic sequence images of movement of vocal fold in the process from inspiration to phonation. Based on the dynamic changes of glottal area and the displacement of cricoid cartilage, 10 phases were classified as inspiratory phase and phonation phase, open phase and closed phase. The soft tissue parameters including length, width, thickness and subglottal convergence angle（SGCA）of vocal fold during 10 phases were measured respectively and tested by independent-sample t test between UVFP group and control group.
Results: In normal group, the morphology of vocal fold was relatively stable in inspiratory phase and closed phase during phonation. When open phase and closed phase of phonation were switching, the morphology of vocal fold changed obviously. The length of vocal fold became longer, the range of change was 1.19±0.10mm. The width became wider, the range of change was 2.19±0.17mm. The thickness became thinner, the range of change was 2.66±0.56mm. The SGCA decreased, the range of change was 31.45±4.78 degrees. Compared with the normal group, in the open phase, the thickness and width of the vocal fold affected side in the UVFP group were thinner (t=10.25, P＜0.01) and wider (t=5.25, P＜0.01), while in the closed phase, the SGCA was larger (t=4.41, P＜0.01). The width of the vocal fold healthy side in the UVFP group was wider (t=2.54, P＜0.05) than those in the normal group.
Conclusion: Dynamic CT scanning of larynx provides a simple and non-invasive method for the objective and quantitative measurement of the dynamic changes of laryngeal morphology from inspiration to phonation. The dynamic changes of SGCA and thickness may be used in the differential diagnose of patients with UVFP. The width of the vocal fold healthy side in UVFP group could be used to assess its compensatory function.
Key words: Dynamic CT, Cine film mode, Vocal fold paralysis,Subglottal convergence angle

Yanli Ma MD1, Jie Cai MD2, Yongjing You MD3, Zheyi Zhang MD4, Jinan Wang MD4, Peiyun Zhuang MD1#
1.Department of ENT, Xiamen University Zhongshan Hospital, Xiamen, Fujian, China;
2.School of Medicine, Xiamen University, Xiamen, Fujian, China;
3.Fujian Medical University, Xiamen, Fujian, China;
4.Radiology Department, Xiamen University Zhongshan Hospital, Xiamen, Fujian, China[+] Show More

The Application of Dynamic CT Scan in Evaluating the Dynamic Changes of Laryngeal Morphology...

The Application of Dynamic CT Scan in Evaluating the Dynamic Changes ...

Automatic Evaluation of Voice Severity using Deep Neural Network

Shunsuke Hidaka Ph.D. Student Graduate School of Design, Kyushu ...

Shunsuke Hidaka
Ph.D. Student
Graduate School of Design, Kyushu University
[email protected]

Yogaku Lee
M.D.
Department of Otorhinolaryngology, Faculty of Medicine, Kyushu University
[email protected]

Kohei Wakamiya
Assistant professor
Faculty of Design, Kyushu University
[email protected]

Takashi Nakagawa
Professor
Department of Otorhinolaryngology, Faculty of Medicine, Kyushu University
[email protected]

Tokihiko ...Kaburaki
Professor
Faculty of Design, Kyushu University
[email protected]

Introduction: Perceptual evaluation of voice quality (e.g., the GRBAS scale or CAPE-V) is used widely in laryngological practice. However, this method suffers from the lack of reproducibility caused by inter- and intra-rater variability. To date, it has been a topic of discussion among clinicians how to improve the reliability of judgement. Objective: The purpose of this study was to solve the inevitable problem of perceptual evaluation by building an automatic evaluation system. Understandably, automatic evaluation is surely reproducible (i.e., reliable). Moreover, the system was required to output meaningful judgements (i.e., to be valid). Methods: We constructed a deep neural network (DNN) that estimated all the scores of the GRBAS scale. DNN was composed of Bidirectional GRUs and fully connected layers. As the acoustic feature, we compared spectrogram and mel-spectrogram of speech samples obtained using sustained vowel /a/. The dataset for supervised learning was composed of 3118 samples. All true labels were given by an otolaryngologist. Results: The performance of the system was measured in terms of accuracy and statistical agreement index Cohen’s linearly weighted Kappa. Five-fold cross validation showed the accuracy of 60% on average. The Kappa scores of GBAS were “moderate” and that of R was “fair.” For all the GRBAS, the performance was higher when using mel-spectrogram. Conclusions: Our study showed the feasibility of automatic evaluation. In order to indicate how valid the system performance is, future studies could investigate inter- and intra-rater variability for our dataset.[+] Show More

Comparative Study of Acoustic Analysis, Electroglotographic and Aerodynamic Measures of Singers

Comparative Study of Acoustic Analysis, Electroglotographic and ...

Comparative Study of Acoustic Analysis, Electroglotographic and Aerodynamic Measures of Tenors and Sopranos Classical and Non-Classical

Carlos Manzano, MD, Phoniatrician, MS,
Hospital Médica Sur, Hospital Centro médico ABC, Ciudad de ...México, [email protected]

María de la Luz Arenas, MD,PhD, Instituto Nacional de Rehabilitación, Ciudad de México, [email protected]

Rafael Alarcón, PhD, Instituto Nacional de Antropología e Historia, Ciudad de México, [email protected]

Marco Guzman, PhD, Universidad de los Andes, Santiago de Chile, [email protected]

Antonio Ysunza, MD, Phoniatrician, PhD, Oakland University William Beaumont School of Medicine, Detroit, Michigan, [email protected]

Miguel Angel Villasís, MD, PhD Instituto Mexicano del Seguro Social, Ciudad de México, [email protected]

Wendy Castro, MD, Hospital Médica Sur, Ciudad de México, [email protected]

Objective: Establish normal acoustic, electroglotogic and aerodynamic values in tenors and sopranos of classical and non-classic singers. Establish differences in acoustic, electroglotographic and aerodynamic values in tenors and sopranos (classical singers, non-classical singers, singers with tension muscle dysphonia and non-singers).
Methods: Observational, cross-sectional, descriptive and comparative study. Normalized study through the composition of 4 groups: classical singers, non-classical singers, singers with tension muscle dysphonia and non-singers. Singers from 22 to 50 years old and vocal training of at least 5 years with without any history of vocal pathology. Analyze voice samples with the voice analysis program -Multidimensional Voice Program (MDVP), KayPentax computerized speech laboratory (model CSL 4500), EGG Kay Pentax Electrophotograph (model 6103), Kay Pentax Aerodynamic Phonatory System and The Analysis of Dysphonia in Speech and Voice (ADSV).
Results: Preliminary findings suggest:
Tenors: Comfortable sustain phonation with EGG
Classic Tenors: Maximum spl: 79.68 dB, minium spl 73.45 dB, mean spl 77 dB, spl range 6.25 dB, mean pitch 127.39 Hz, phonation time 3.17 sec, peak expiratory airflow 0.3 lit/sec, mean expiratory airflow 0.22 lit/sec, expiratory volume 0.77 liters, mean egg quotient 49.93 %, EGG quotient std dev2.25 %, EGG quotient range 10.71 %.
Non Classic Tenors: Maximum spl: 83.96 dB, minium spl 78.91 dB, mean spl 80.82 dB, spl range 5.05 dB, mean pitch 146.46 Hz, phonation time 3.12 sec, peak expiratory airflow 0.1825 lit/sec, mean expiratory airflow 0.13 lit/sec, expiratory volume 0.37 liters, mean egg quotient 63.71 %, EGG quotient std dev 1.2 %, EGG quotient range 5.27 %.
Sopranos: Comfortable sustain phonation with EGG
Classic Sopranos: Maximum spl: 79.97 dB, minium spl 66.72 dB, mean spl 77.54 dB, spl range 13.26 dB, mean pitch 254.24 Hz, phonation time 3.47 sec, peak expiratory airflow 0.27 lit/sec, mean expiratory airflow 0.21 lit/sec, expiratory volume 0.79 liters, mean egg quotient 43.7%, EGG quotient std dev 2.36 %, EGG quotient range 11.41 %.
Non Classical Sopranos: Maximum spl: 78.45 dB, minium spl 74.1 dB, mean spl 75.97 dB, spl range 4.34 dB, mean pitch 194.43 Hz, phonation time 2.45 sec, peak expiratory airflow 0.23 lit/sec, mean expiratory airflow 0.17 lit/sec, expiratory volume 0.44 liters, mean egg quotient 52.99%, EGG quotient std dev 1.26%, EGG quotient range 55.71 %.
Additional data collection and analyses are ongoing.
Conclusions: So far with the data collected; the acoustic, electroglotographic and aerodynamic values in classical tenors and sopranos are different from popular tenors and sopranos because of their vocal technique.[+] Show More

Diagnosing Laryngopharyngeal Reflux: A Comparison between Impedance Testing and Restech

Dylan Vance, B.S. Medical Student Drexel University College of ...

Dylan Vance, B.S.
Medical Student
Drexel University College of Medicine

Jin Park, B.S.
Medical Student
Drexel University College of Medicine

Ghiath Alnouri, M.D.
Laryngology Fellow
Department of Otolaryngology - Head and Neck Surgery
Drexel University ...College of Medicine

Srihari Daggumati, M.D.
Resident
Department of Otolaryngology – Head and Neck Surgery
Virginia Commonwealth University

Ashley P. O’Connell Ferster, M.D.
Laryngology Fellow
Department of Otolaryngology – Head & Neck Surgery
Vanderbilt University Medical Center

Karen Lyons, M.D.
Clinical Professor
Department of Otolaryngology - Head and Neck Surgery
Drexel University College of Medicine

Justin Ross, D.O.
Resident
Department of Otolaryngology - Head and Neck Surgery
Philadelphia College of Osteopathic Medicine

Robert T. Sataloff, M.D., D.M.A., F.A.C.S.
Professor and Chair
Department of Otolaryngology - Head and Neck Surgery
Senior Associate Dean for Clinical Academic Specialties
Drexel University College of Medicine

Objective: The purpose of this study was to compare the diagnostic utility of pH monitoring via 24-hour esophageal pH-Impedance testing versus pharyngeal pH (Restech) testing. (Respiratory Technology Corporation, Houston, Texas)
Methods: A retrospective review of patients who had completed a Reflux Symptom Index (RSI) survey and stroboscopy within 60 days before or after undergoing simultaneously double probe esophageal pH-Impedance monitoring and Restech testing within 60 days. Reflux Finding Score (RFS) was determined by 4 blinded observers. Pearson correlation coefficients were calculated to assess relationships among RSI, RFS, and test results from 24-hour esophageal pH-Impedance and Restech tests.
Results: Eighty-seven patients were included in the analysis. The inter-rater reliability of the RFS determination was 74.57% and the intra-rater reliability was 67.00%. Restech RYAN score has a significant correlation with RFS (r of 0.222 and p-value of 0.0492). There was no correlation between RFS and number or percent time of reflux events, longest event, total number of events, or percent of time at alkaline pH for either 24-hour pH-impedance and Restech tests. RSI correlated better with 24-hour pH-Impedance test than Restech for percent time spent in both upright (r of 0.226 and p-value of 0.029) and supine position (r of 0.261 and a p-value of 0.032). Restech correlated better with total patient symptom scores including cough, heartburn, burping, and clearing throat with a r of 0.242 and a p-value of 0.048. Restech detected more percent time in reflux for total reflux, supine reflux, and upright reflux (p-value less than 0.0001). Restech also detected longer event times than Impedance (p-value of less than 0.0001). Restech RYAN score correlated with total patient symptom score (r of 0.265 and a p-value of 0.013). Seventy-four patients had a Wu score determined. Thirty-seven of these patients had a positive Wu Score. There was a statistically significant positive correlation between Wu Score and upright RYAN score (Figure 12). There was also a statistically significant positive correlation between Wu score and percent of time in total reflux, upright reflux, or supine reflux, and longest time spent in reflux at pH less than 6.5, 6, 5.5, and 5 (Figure 13-29).
Conclusion: Restech RYAN score has a significant correlation with RFS, no other parameter has a significant correlation with RFS. Total number of symptoms in Restech had a better correlation than 24-hour Impedance with RSI. 24-hour Impedance percent time spent in reflux for both upright and supine reflux had a significant correlation with RSI.
Key Words: Reflux, GERD, Gastroesophageal Reflux, Laryngopharyngeal Reflux, LPR, 24-hour pH monitoring, 24-hour pH-Impedance Test, Pharyngeal Reflux Monitoring, Restech, Reflux Symptom Index, Reflux Finding Score[+] Show More

Diagnostic Value of Acoustic and Aerodynamic Measurements and their Correlation with LEMG and VHI

Ghiath Alnouri, MD William Valentino, M.D. Jin Park, B.S. Dylan Vance, ...

Does the Reflux Symptom Index Predict Proximal Reflux Events on HEMII-pH Testing?

Elliana Kirsh DeVore, MD, Walter W. Chan, MD, MPH, Jennifer J. Shin MD ...

The Effects of Menopause on Voice Metrics: A Systematic Review and Meta-Analysis

Filipa M.B. Lã, PhD, Diego Ardura, PhD ABSTRACT Objectives: To ...

Filipa M.B. Lã, PhD, Diego Ardura, PhD

ABSTRACT
Objectives: To investigate which voice metrics change during menopause and clarify on the magnitude of those changes.
Methods: Five major scientific databases were searched: ...PubMed, Web of Science, Academic Search Complete, Scopus and Scielo. Combinations of the following key words were used, without language restriction: voice at menopause, voice and climaterium, fundamental frequency and menopause, acoustic voice characteristics and menopause, vocal quality and menopause. Original articles were included if: written in English, have been published as a full article or an abstract with sufficient detail to extract the main attributes of the study published in peer-reviewed; be cross-sectional studies on voice characteristics during the menopause. Heterogeneity among size effects was tested using the Cochran’s Q statistic and quantified through the I index. Statistical analyses were carried out using the metaphor package in R.
Results: A total of 8 studies were considered for a meta-analysis on 6 comparable voice-related acoustical and phonatory metrics: speaking fundamental frequency, mean fundamental frequency for the vowel /a/, jitter, shimmer, noise-to-harmonics ration, and maximum phonation time. The great heterogeneity of primary cross-sectional studies as to what concerned their methods of data collection and analysis, and the lack of more than 3 studies presenting analysis on the same voice-related parameter prevented the inclusion of more studies and parameters. Fundamental frequency is lower after menopause, although falling below the 2ST just noticeable interval difference and well above the cutting point for distinguishing female from male voice (165 Hz). No effects were found for the remaining voice metrics.
Conclusions: There is a need to change the research paradigm on the effects of the menopause on voice so that the heterogeneity of previous studies as to what concerns data collection and analysis is reduced and their results become comparable. Given the dependency of fundamental frequency on age, the inclusion of a clinical assessment of menopause as a criteria to choose pre- and post-menopausal groups with restricted age range seems more appropriate.

Filipa M.B. Lã, PhD, Faculty of Education, Department of Didactics, School Organization and Special Didactics, National University of Distance Learning (UNED), [email protected]

Diego Ardura, PhD, Faculty of Education, Department of Research Methods and Diagnoses in Education I, National Distance Education University (UNED)
[email protected][+] Show More

$Efficacy of Nissen Fundoplication for Management of Refractory Laryngopharyngeal Reflux$

Efficacy of Nissen Fundoplication for Management of Refractory Laryngopharyngeal Reflux

Clara Grayhack, MD; Ashley P. O’Connell Ferster, MD; Robert Kucejko, ...

Food Sensitivity and Laryngopharyngeal Reflux: Preliminary Observations

Anish Vora, Dylan Vance, Ghiath Alnouri, MD, Robert T. Sataloff, M.D., ...

Handheld Bioprinting Platform for Voice Surgery

Presenting Author: Name: Amir K. Miri Degree: Ph.D. Job Title: ...

Presenting Author:
Name: Amir K. Miri
Degree: Ph.D.
Job Title: Assistant Professor
Affiliation: Department of Mechanical Engineering and Biomedical Engineering, Rowan University
Website: http://akmiri.com/

Co-Author 1:
Name: Matthew Malpica
Degree: B.Sc.
Job Title: Graduate Research Assistant
Affiliation: Department of ...Mechanical Engineering, Rowan University

Co-Author 2:

Name: Robert T. Sataloff
Degree: M.D., D.M.A., F.A.C.S.
Job Title: Professor and Chairman
Affiliation: Department of Otolaryngology-Head & Neck Surgery, Drexel University College of Medicine

Objective: Vocal fold (VF) augmentation which involves delivery of biomaterials to supplement VF tissue, suffers from inconsistent clinical outcomes, and no biomaterial-based intervention exists that can adequately and permanently restore native VF tissue. Biomaterial injection from a needle remains inadequate for large voids, such as surgically-resected cancer regions. To overcome such limitations, highly controlled deposition of tissue-adhesive VF implant is necessary to rebuild the resected portion of VF tissue. For the first time, we designed a customizable handheld bioprinter, which allows for the in situ deposition of hydrogels for VF dressing.

Methods: The design considerations included (i) the weight of the device, (ii) the ease of handling by surgeons/laryngologists, (iii) adaptability to current laryngoscopes and endoscopes, and (iv) potential fit to surgical robotic arms for future developments. We built a prototype using engineering methods and we assessed the device by commonly-used hydrogels: gelatin/alginate hydrogel system. We optimized our bioink formulation by varying mass concentrations of gelatin, alginate, and crosslinking agent (calcium) in the solutions, and tested the gelatin hydrogel for mapping the printability versus different viscosities. Excised-larynx experiment was then used to test our bioprinter. Porcine larynx was used and the bioprinter was tested for different conditions of biomaterial delivery.

Results/Conclusions: Excised larynx experiments provided design feedback for the handheld bioprinter. The delivery of hydrogels was also optimized and compared to in vitro experiments where no geometrical constraints were imposed. We showed that rapidly crosslinkable biomaterials can be delivered with tunable mechanics through our platform. While it offers precise control over the bioprinted constructs, it can also fit the endoscopes required for voice surgery.[+] Show More

Impact of Respiratory Function on Voice in Patients with Presbyphonia

Maude Desjardins, PhD, Post-doctoral Researcher, Department of ...

Maude Desjardins, PhD, Post-doctoral Researcher, Department of Communication Sciences and Disorders, University of Delaware, 100 Discovery Boulevard, Newark, DE, 19713, (302) 831-7104, [email protected]

Lucinda Halstead, MD, Associate Professor, Medical Director, Evelyn ...Trammell Institute for Voice & Swallowing, Dept. of Otolaryngology HNS, Medical University of South Carolina

Annie Simpson, PhD, Associate Professor, Department of Healthcare Leadership and Management - College of Health Professions; Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina,

Patrick Flume, MD, Professor, Pulmonary and Critical Care Division - College of Medicine, Medical University of South Carolina

Heather Bonilha, PhD, Associate Professor, Department of Health Sciences and Research - College of Health Professions; Evelyn Trammel Institute for Voice and Swallowing, Medical University of South Carolina

Background and Objective: Presbyphonia is an age-related voice disorder characterized by vocal fold atrophy and incomplete glottal closure during phonation. The extent to which the effects of presbyphonia may be compounded by age-related declines in the respiratory system and further impact communication and quality of life remains unknown. Therefore, the objective of this study was to determine how variations in respiratory function impact vocal function in a sample of participants with presbyphonia. Methods/Design: This was a prospective observational cohort study. Twenty-one participants with presbyphonia underwent respiratory assessments (spirometry and respiratory muscle strength testing) and voice assessments (videostroboscopy, acoustic analysis, auditory-perceptual ratings, aerodynamic assessment, and self-assessments). Factor and cluster analyses were conducted to extract voice and respiratory parameters and to identify groups of participants with similar profiles. Additionally, correlations and regression analyses were conducted to better understand the relationships between voice and respiratory function. Results: Respiratory function was found to impact voice via two main pathways: through its physiological effect on voice and through its impact on general health and impairment. A lower respiratory function was associated with a lower vocal fold pliability and regularity of vibration and with an elevated aerodynamic resistance accompanied by laryngeal hyperfunction. Standardized measures of respiratory function had a direct impact on perceived voice-related handicap. Respiratory function did not have an impact on voice quality, which was mostly influenced by the severity of vocal fold atrophy. Conclusion: Poor respiratory health exacerbates the burden of vocal fold atrophy and, therefore, implementation of respiratory screening prior to starting voice therapy may significantly affect the treatment plan and outcomes of voice therapy in this patient population.[+] Show More

Incidence and Treatment in Singers of Diagnosed LPR and GERD: Survey Results

Kathleen Bell, DMA, Adjunct Assistant Professor of Voice, Shenandoah ...

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The Application of Dynamic CT Scan in Evaluating the Dynamic Changes of Laryngeal Morphology...

Questions?

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JOURNAL OF VOICE

About JOVJournal HomeJOV Annual Best Papers

DOWNLOADS

2022 Symp Program2019 AbstractsPrograms and Abstracts

PARTNERSHIPS

Exhibitor ProspectusMarketingLeading Roles

Advancing Understanding of the Voice
Through Interdisciplinary Research & Education

About JOV
Journal Home
JOV Annual Best Papers

2022 Symp Program
2019 Abstracts
Programs and Abstracts

Exhibitor Prospectus
Marketing
Leading Roles