Comparison of Voice Outcomes Between Minimally Invasive Open Hemithyroidectomy and Conventional Hemithyroidectomy

Background and Objectives@#Voice change after thyroidectomy is a common complication that affects a patient’s quality of life. In this study, we aimed to compare voice outcomes between minimally invasive open hemithyroidectomy (MIOT) and conventional hemithyroidectomy.Materials and Method We enrolled 215 patients who underwent hemithyroidectomy performed by an experienced surgeon at our institute between June 2017 and December 2021. All patients underwent voice evaluations, including subjective and objective assessments, preoperatively and 2 weeks and 2 months postoperatively. @*Results@#Sixty-one patients underwent MIOT (M group) and 154 patients underwent conventional hemithyroidectomy (C group). There were 50 female (82.0%) and 11 male (18.0%) in the M group, and 129 female (83.8%) and 25 male (16.2%) in the C group. In both groups, the thyroidectomy-related voice questionnaire score increased at 2 weeks and 2 months postoperatively. However, no statistically significant differences were observed between the two groups. Voice parameters were analyzed according to sex. There were some changes in the parameters in both groups. However, no statistically significant differences were observed between the two groups. @*Conclusion@#Our study showed no differences in the acoustic results between MIOT and conventional hemithyroidectomy.

Effect of Voiced Segment Extraction on Voice of Vocal Cord Paralysis: Focused on Cepstral Analysis / 대한이비인후과학회지

Background and Objectives@#The purpose of this study was to investigate the effect of unvoiced segments on the cepstral analysis in patients with vocal cord paralysis (VCP).Subjects and Method A total 302 subjects (173 subjects with VCP and 129 normal voice subjects) participated in this study. The sustained vowel /a/ 2 seconds and one sentence of ‘Sanchaek’ were edited, and analyzed by Praat script. The cepstral analyses were performed using sustained vowel (SV), continuous speech (CS), and extracted continuous speech (EXT) samples. The auditory-perceptual (AP) rating was also completed by three raters. @*Results@#First, there were significant differences in all variables except low-to high spectral ratio(L/H ratio)_EXT between two groups. Second, cepstral peak prominence (CPP), smoothed cepstral peak prominence (CPPS), and L/H ratio showed significant differences in SV, CS, and EXT samples. Third, cepstral measurements were highly correlated with the AP ratings. Finally, the level of discrimination of dysphonia estimated from CPP and CPPS gotten from SV and CS values was more than area under the curve (AUC) of 0.941. AUC of 0.880 or more was also found in EXT. @*Conclusion@#In this study, we confirmed that both CS and EXT are highly predictive of pathologic speeches. Further study will also need to be validated for a more diverse group of voice disorders.

Effects of Injection Laryngoplasty with Hyaluronic Acid in Patients with Vocal Fold Paralysis

OBJECTIVES: The purpose of this study was to explore the effects of injection laryngoplasty (IL) with hyaluronic acid in patients with vocal fold paralysis (VFP). METHODS: A total of 50 patients with VFP participated in this study. Pre- and post-IL assessments were performed, which included analyzing the sustained vowel /a/ phonation, and the patient reading 1 Korean sentence from the “Walk” passage that comprised 25 syllables in 10 words. To investigate the effect of IL on vocal fold function, acoustic analysis (acoustic voice quality index, cepstral peak prominence, maximum phonation time, speaking fundamental frequency) was conducted and auditory-perceptual (grade and overall severity), visual judgment (gap), and self-questionnaire (voice handicap index-10) assessments were performed. RESULTS: The patients with VFP showed statistically significant differences between pre-and post-IL assessments for acoustic and auditory-perception, visual judgment, and self-questionnaire assessments. CONCLUSION: The patients with VFP showed positive change in vocal fold function between pre- and post-IL measurements. The findings showed that IL with hyaluronic acid is an effective method to improve vocal fold function in patients with VFP.

Acoustic and Auditory-Perceptual Evaluation as Predictor of Voice Recovery after Laryngeal Microsurgery in Patients with Vocal Polyp / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to investigate acoustic (acoustic voice quality index, AVQI) and auditory-perceptual evaluation (grade, rough, breathy, asthenic, strained; GRBAS and consensus auditory-perceptual evaluation of voice; CAPE-V) as a predictor of voice recovery after laryngeal microsurgery (LMS) in patients with vocal polyp. SUBJECTS AND METHODS: A total of 68 patients with vocal polyp participated in this study. Voice samples were analyzed for AVQI by Praat and auditory-perceptual ratings were performed by three speech language pathologists. Voice handicap index-10 (VHI-10) was evaluated by patients themselves. RESULTS: Decreased AVQI, VHI-10, overall severity (OS), and increased smoothed cepstral peak prominence (CPPS) values were measured and statistically significant changes were noted after LMS. The ratio of Grade 0 and Grade 1 was increased. AVQI was correlated with CPPS, Grade, and OS, but not with VHI-10. The voice recovery of pedunculated polyp appeared in all vocal polyp sizes after LMS, but statistically significant differences were found only in small and medium sizes. After LMS of sessile polyps, AVQI, VHI-10, and OS decreased whereas CPPS increased; however, statistically significant difference was confirmed only in VHI-10 and OS. The receiver operating characteristic curve analysis showed the following results: AVQI [cutoff=5.5, sensitivity=61.8%, specificity=76.5%, area under the curve (AUC)=0.712], CPPS (cutoff=5.0, sensitivity=89.7%, specificity=48.5%, AUC=0.743), VHI-10 (cutoff=13.0, sensitivity=77.9%, specificity=89.7%, AUC=0.893), Grade (cutoff=2.0, sensitivity=70.6%, specificity=69.1%, AUC=0.728), and OS (cutoff=51.0, sensitivity=86.8%, specificity=66.2%, AUC=0.833). CONCLUSION: Acoustic and auditory-perceptual variables showed significant positive changes and predicted recovery of voice. In this study, we believe that the acoustic and auditory-perceptual evaluations.

Post-Processing of High-Speed Video-Laryngoscopic Images to Two-Dimensional Scanning Digital Kymographic Images

BACKGROUND AND OBJECTIVES: High-speed videolaryngoscopy (HSV) is the only technique that captures the true intra-cycle vibratory behavior of the vocal folds by capturing full images of the vocal folds. However, it has problems of no immediate feedback during examination, considerable waiting time for digital kymography (DKG), recording duration limited to a few seconds, and extreme demands for storage space. Herein, we demonstrate a new post-processing method that converts HSV images to two-dimensional digital kymography (2D-DKG) images, which adopts the algorithm of 2D videokymography (2D VKG). MATERIALS AND METHODS: HSV system was used to capture images of vocal folds. HSV images were post-processed in Kay image-process software (KIPS), and conventional DKG images were retrieved. Custom-made post-processing system was used to convert HSV images to 2D-DKG images. The quantitative parameters of the post-processed 2D-DKG images was validated by comparing these parameters with those of the DKG images. RESULTS: Serial HSV images for all phases of vocal fold vibratory movement are included. The images were converted by the scanning method using U-medical image-process software. Similar to conventional DKG, post-processed 2D DKG image from the HSV image can provide quantitative information on vocal fold mucosa vibration, including the various vibratory phases. Differences in amplitude symmetry index, phase symmetry index, open quotient, and close quotient between 2D-DKG and DKG were analyzed. There were no statistical differences between the quantitative parameters of vocal fold vibratory movement in 2D-DKG and DKG. CONCLUSION: The post-processing method of converting HSV images to 2D DKG images could provide clinical information and storage economy.

Auditory-Perceptual and Acoustic Evaluation in Measuring Dysphonia Severity of Vocal Cord Paralysis

BACKGROUND AND OBJECTIVES: The purpose of this study was to investigate the criterion-related concurrent validity of two standardized auditory-perceptual assessments and the Acoustic Voice Quality Index (AVQI) for measuring dysphonia severity in patients with vocal cord paralysis (VCP). MATERIALS AND METHODS: Total 210 patients with VCP and 236 normal voice subjects were asked to sustain the vowel [a:] and to read aloud the Korean text “Walk”. A 2 second mid-vowel portion of the sustained vowel and two sentences (with 26 syllables) were recorded. And then voice samples were edited, concatenated, and analyzed according to Praat script. Two standardized auditory-perceptual assessment (GRBAS and CAPE-V) were performed by three raters. RESULTS: The VCP group showed higher AVQI, Grade (G) and Overall Severity (OS) values than normal voice group. And the correlation among AVQI, G, and OS ranged from 0.904 to 0.926. In ROC curve analysis, cutoff values of AVQI, G, and OS were < 3.79, < 0.00, and < 30.00, respectively, and the AUC of each analysis was over .89. CONCLUSION: AVQI and auditory evaluation can improve the early screening ability of VCP voice and help to establish effective diagnosis and treatment plan for VCP-related dysphonia.