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OBJECTIVES: The purpose of this study was to the usefulness of a five-variable model predicting perceived voice severity and incorporating acoustic analysis based on cepstral analysis and self-reported questionnaires, for measuring voice recovery after endolaryngeal phonomicrosurgery in patients with vocal fold polyps. METHODS: In this study, 72 patients with vocal fold polyps were included. Two voice evaluations, including acoustic analysis, self-reported questionnaires, and auditory perceptual assessments for each patient, were implemented before and after endolaryngeal phonomicrosurgery. Using these evaluations, we compared the mean values of the perceptual evaluation of voice, acoustic analysis parameters, self-reported questionnaires, and the five-variable model estimated severity pre- and post-endolaryngeal phonomicrosurgery. RESULTS: Various parameters related to acoustic analysis, self-reported questionnaires, and auditory perceptual assessments were useful for measuring voice recovery after endolaryngeal phonomicrosurgery. In particular, a five-variable model incorporating spectral/cepstral analyses and self-reported questionnaires was able to effectively track voice changes after endolaryngeal phonomicrosurgery. CONCLUSION: We verified that most of the variables and the five-variable model were useful for measuring voice recovery in patients with vocal polyps after endolaryngeal phonomicrosurgery.

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Aim: Examination of central compensatory mechanisms following peripheral vocal nerve injury and recovery is essential to build knowledge about plasticity of the neural network underlying phonation. The objective of this prospective multiple-cases longitudinal study is to describe brain activity in response to unilateral vocal fold paralysis (UVFP) management and to follow central nervous system adaptation over time in three patients with different nervous and vocal recovery profiles. Materials and methods: Participants were enrolled within 3 months of the onset of UVFP. Within 1 year of the injury, the first patient did not recover voice or vocal fold mobility despite voice therapy, the second patient recovered voice and mobility in absence of treatment and the third patient recovered voice and vocal fold mobility following an injection augmentation with hyaluronic acid in the paralyzed vocal fold. These different evolutions allowed comparison of individual outcomes according to nervous and vocal recovery. All three patients underwent functional magnetic resonance imaging (fMRI task and resting-state) scans at three (patient 1) or four (patients 2 and 3) time points. The fMRI task included three conditions: a condition of phonation and audition of the sustained [a:] vowel for 3 s, an audition condition of this vowel and a resting condition. Acoustic and aerodynamic measures as well as laryngostroboscopic images and laryngeal electromyographic data were collected. Results and conclusion: This study highlighted for the first time two key findings. First, hyperactivation during the fMRI phonation task was observed at the first time point following the onset of UVFP and this hyperactivation was related to an increase in resting-state connectivity between previoulsy described phonatory regions of interest. Second, for the patient who received an augmentation injection in the paralyzed vocal fold, we subsequently observed a bilateral activation of the voice-related nuclei in the brainstem. This new observation, along with the fact that for this patient the resting-state connectivity between the voice motor/sensory brainstem nuclei and other brain regions of interest correlated with an aerodynamic measure of voice, support the idea that there is a need to investigate whether the neural recovery process can be enhanced by promoting the restoration of proprioceptive feedback.

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Despite the lack of findings in laryngeal endoscopy, it is common for patients to undergo vocal problems after thyroid surgery. This study aimed to predict the recovery of the patient's voice after 3 months from preoperative and postoperative voice spectrograms. We retrospectively collected voice and the GRBAS score from 114 patients undergoing surgery with thyroid cancer. The data for each patient were taken from three points in time: preoperative, and 2 weeks and 3 months postoperative. Using the pretrained model to predict GRBAS as the backbone, the preoperative and 2-weeks-postoperative voice spectrogram were trained for the EfficientNet architecture deep-learning model with long short-term memory (LSTM) to predict the voice at 3 months postoperation. The correlation analysis of the predicted results for the grade, breathiness, and asthenia scores were 0.741, 0.766, and 0.433, respectively. Based on the scaled prediction results, the area under the receiver operating characteristic curve for the binarized grade, breathiness, and asthenia were 0.894, 0.918, and 0.735, respectively. In the follow-up test results for 12 patients after 6 months, the average of the AUC values for the five scores was 0.822. This study showed the feasibility of predicting vocal recovery after 3 months using the spectrogram. We expect this model could be used to relieve patients' psychological anxiety and encourage them to actively participate in speech rehabilitation.

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OBJECTIVES: Patients with vocal cord paralysis can experience feeding, respiratory, and vocal problems leading to disability and decreased quality of life. Current evidence suggests waiting a period of 12 months for spontaneous recovery before permanent interventions. This study aims to determine the time to recover spontaneously and vocal cord movement in a pediatric population and create a model for evidence-based patient counseling. STUDY DESIGN: Retrospective longitudinal cohort study. METHODS: The report is a single institution longitudinal study on vocal cord paralysis recovery. Patients were categorized based on spontaneous recovery with vocal cord movement or no recovery. Recovery rates were determined using the Kaplan-Meier method. RESULTS: Of 158 cases of vocal cord paralysis over a 4-year period, 36 had spontaneous recovery with symptom improvement and motion return. The average recovery was 8.8 months for those who recovered, and 78% recovered within 9 months. Two groups emerged from the data: an early recovery group with spontaneous recovery before 12 months and a late recovery group after 12 months. Children with dysphonia and paralysis due to cardiac surgery were less likely to recover, and children with aspiration were more likely to recover. Children with gastrointestinal comorbidities were less likely to recover; however, those who did recover were more likely to have recovered after 12 months. Based on our model, there is about a 3% chance of recovery between 9 and 12 months. CONCLUSIONS: Patients should be counseled about earlier interventions. Waiting the conventional 12 months for only a 3% chance of spontaneous recovery without intervention or laryngeal EMG may not be the preferred option for some patients and their families.

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Background: Closed reduction is an effective treatment for arytenoid dislocation. The treatment is usually given more than once to obtain normal voice. However, when to perform the next closed reduction remains controversial.Objective: This study aimed to observe the regularity of the voice recovery and the arytenoid motion in patients with arytenoid dislocation after closed reduction.Material and methods: Thirty-one patients were recruited from September 2017 to April 2019. Results of their clinical data were reviewed retrospectively.Results: Among the thirty-one patients, their VHI scores, F0, jitter%, shimmer%, glottal-to-noise excitation %(GNE), maximum phonation time (MPT) and GRBAS Scale (G, R, B, A) improved significantly (p < .05), but there was no statistically significant difference for GRBAS Scale (S) (p>.05). The duration between last closed reduction and the restoring normal voice ranged from 1-8 days, with a mean of 4.65 ± 0.57 days, at the same time the glottis was completely closed.Conclusions and significance: Closed reduction for patients with arytenoid dislocation is an effective procedure. A time window between 4.08th and 5.22th day (at a confidence level of 95%) after the last closed reduction was identified to be critical for voice recovery.

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Laryngeal cysts are rare lesions of the larynx that are often described on incidental discovery. We report an unusual presentation of a large ductal cyst located on the laryngeal surface of the epiglottis. The patient presented with a low tone voice while displaying bilateral normal appearing vocal cords with normal mobility. Computed tomography scans and flexible laryngoscopy showed a round supraglottic mass approximately 2 cm in diameter on the right lateral laryngeal surface of the epiglottis. The mass was removed surgically during microsuspension laryngoscopy with excision of the mucocele utilizing a gold laser. Postoperatively, the patient's voice returned to baseline with no complications.

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OBJECTIVES: Occupational voice users report higher instances of vocal health problems. Women, who are more likely than men to report voice problems, are the largest members of some occupational voice users, such as teachers. While a common complaint among this population is vocal fatigue, it has been difficult to quantify. Therefore, the goal of this study is to quantify vocal fatigue generally in school teachers and investigate any related gender differences. METHODS: Six hundred forty (518 female, 122 male) teachers were surveyed using an online questionnaire consisting in part of the Vocal Fatigue Index (VFI), an index specifically designed to quantify vocal fatigue. RESULTS: Compared to vocally healthy adults, the teachers surveyed were 3 times as likely to report vocal tiredness or vocal avoidance and over 3 times as likely to report physical voice discomfort. Additionally, female teachers were more likely to have scores approaching those with dysphonia. CONCLUSIONS: The VFI quantified elevated levels of vocal fatigue in teachers, with a significant prevalence of symptoms reported among females compared to males. Further, because the VFI indicated elevated complaints (between normal and dysphonic) in a population likely to be elevated, the VFI might be used to identify early indications of voice problems and/or track recovery.

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OBJECTIVE: Posterior glottal insufficiency manifests as a rough, breathy voice with poor vocal projection, air hunger, and decreased phonatory efficiency. There are limited medical and surgical therapies. This study reports the use of insetting a buccal mucosa graft into the posterior interarytenoid space to close the posterior glottic gap for phonatory rehabilitation. METHODS: Our study is a retrospective case series of 2 female patients undergoing buccal mucosa graft inset to repair acquired posterior glottic insufficiency as a result of prolonged intubation and laryngeal tuberculosis infection. Patients selected for this procedure had posterior glottal insufficiency due to erosion of posterior glottal tissue. They also had dysphonia refractory to voice therapy and injection augmentation. CONCLUSIONS: Interarytenoid buccal graft for posterior glottal insufficiency is effective with excellent vocal rehabilitation and minimal donor site morbidity.

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