Relation between Orotracheal Intubation, Inflammatory Markers, Breathing and Voice in Post-COVID-19.

INTRODUCTION: COVID-19, an infectious disease with a wide spectrum of clinical manifestations and intensities in the human body, it can cause respiratory and vocal disorders, with fatigue. OBJECTIVE: To verify the relation between biological Inflammatory markers D-dimers and C-Reactive Protein, Forced Vital Capacity, Maximum Phonation Time, vocal performance and fatigue, length of hospitalization period and gender of people affected by COVID-19 who were hospitalized, but did not use orotracheal intubation and compare with a group of post-COVID-19 patients with orotracheal intubation. METHODS: Data on D-dimers and C-Reactive Protein, spirometry, Maximum Phonation Time, performance and vocal fatigue were collected. The study included 42 adult people affected by COVID-19 who were hospitalized, 22 (52.4%) female and 20 (47.6%) male; 23 (54.8%) critical cases composing the group with orotracheal intubation (average age 48.9 years old) and 19 (45.24%) severe cases in the group without orotracheal intubation (average age 49.9 years old). RESULTS: hospital length of stay was significantly longer for the group with orotracheal intubation; D-dimers were significantly altered in all groups; correlations between maximum phonation times were positive and significant; correlations between maximum phonation times, vocal performance and fatigue were both negative and significant. CONCLUSION: Patients with orotracheal intubation had longer hospital internment and increased D-dimers and were amazed that, whenever maximum phonation times decreased performance and vocal fatigue increased.

Emission rates, size distributions, and generation mechanism of oral respiratory droplets

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has brought renewed attention to respiratory aerosol and droplet generation. While many studies have robustly quantified aerosol (<10 µm diameter) number and mass exhalation rates, fewer studies have explored larger droplet generation. This study quantifies respiratory droplets (>20 µm diameter) generated by a cohort of 76 adults and children using a water-sensitive paper droplet deposition approach. Unvoiced and voiced activities spanning different levels of loudness, different lengths of sustained phonation, and a specific manner of articulation in isolation were investigated. We find that oral articulation drives >20 µm droplet generation, with breathing generating virtually no droplets and speaking and singing generating on the order of 250 droplets min−1. Lip trilling, which requires extensive oral articulation, generated the most droplets, whereas shouting "Hey,” which requires minimal oral articulation, generated relatively few droplets. Droplet size distributions were all broadly consistent, and no significant differences between the children and adult cohorts were identified. By comparing the aerosol and droplet emissions for the same participants, the full size distribution of respiratory aerosol (0.5–1000 µm) is reported. Although <10 µm aerosol dominates the number concentration, >20 µm droplets dominate the mass concentration. Accurate quantification of aerosol concentrations in the 10–70 μm size range remains very challenging;more robust aerosol analysis approaches are needed to characterize this size range.

Effect of FFP2/3 Masks on Voice Range Profile Measurement and Voice Acoustics in Routine Voice Diagnostics.

INTRODUCTION: Voice diagnostics including voice range profile (VRP) measurement and acoustic voice analysis is essential in laryngology and phoniatrics. Due to COVID-19 pandemic, wearing of 2 or 3 filtering face piece (FFP2/3) masks is recommended when high-risk aerosol-generating procedures like singing and speaking are being performed. Goal of this study was to compare VRP parameters when performed without and with FFP2/3 masks. Further, formant analysis for sustained vowels, singer's formant, and analysis of reading standard text samples were performed without/with FFP2/3 masks. METHODS: Twenty subjects (6 males and 14 females) were enrolled in this study with an average age of 36 ± 16 years (mean ± SD). Fourteen patients were rated as euphonic/not hoarse and 6 patients as mildly hoarse. All subjects underwent the VRP measurements, vowel, and text recordings without/with FFP2/3 mask using the software DiVAS by XION medical (Berlin, Germany). Voice range of singing voice, equivalent of voice extension measure (eVEM), fundamental frequency (F0), sound pressure level (SPL) of soft speaking and shouting were calculated and analyzed. Maximum phonation time (MPT) and jitter-% were included for Dysphonia Severity Index (DSI) measurement. Analyses of singer's formant were performed. Spectral analyses of sustained vowels /a:/, /i:/, and /u:/ (first = F1 and second = F2 formants), intensity of long-term average spectrum, and alpha-ratio were calculated using the freeware praat. RESULTS: For all subjects, the mean values of routine voice parameters without/with mask were analyzed: no significant differences were found in results of singing voice range, eVEM, SPL, and frequency of soft speaking/shouting, except significantly lower mean SPL of shouting with FFP2/3 mask, in particular that of the female subjects (p = 0.002). Results of MPT, jitter, and DSI without/with FFP2/3 mask showed no significant differences. Further mean values analyzed without/with mask were ratio singer's formant/loud singing, with lower ratio with FFP2/3 mask (p = 0.001), and F1 and F2 of /a:/, /i:/, /u:/, with no significant differences of the results, with the exception of F2 of /i:/ with lower value with FFP2/3 mask (p = 0.005). With the exceptions mentioned, the t test revealed no significant differences for each of the routine parameters tested in the recordings without and with wearing a FFP2/3 mask. CONCLUSION: It can be concluded that VRP measurements including DSI performed with FFP2/3 masks provide reliable data in clinical routine with respect to voice condition/constitution. Spectral analyses of sustained vowel, text, and singer's formant will be affected by wearing FFP2/3 masks.

Comparison of the Variability of Acoustic Measures of Speech using Different Recording Devices in Individuals with Parkinson's Disease

Objective: To compare the variability of acoustic measures of speech presencial and remote recording during the assessment of individuals with Parkinson's Disease (PD). Background: The Covid-19 pandemic scenario has restricted inperson speech recordings. Thus, telephone recording has become an option as it is simple to drive, reduces time and investment, and can be done remotely from the owners' home. Methods: This study was approved by the Ethics Committee and all participants signed an informed consent form. The in-person evaluation was carried out in a silent environment, whose maximum noise level did not exceed 40 dB, using the Karsect HT2® microphone earphone placed five centimeters from the participant's mouth and connected to a recorder. The remote data were collected using a phone and a call recording application. Each individual was recorded only once, performing three speech tasks that involved: sustained production of the vowel / a /, diadochokinesis of the syllabic set / PA-TA-KA /, and a 60-s monologue. The acoustic characteristics analyzed using the PRAAT® software were: vocal profile and articulation. Results: 10 patients with PD were included, aged 57.7 years (± 9.4), disease duration of 14.9 years (± 4.45), 60% (6) men and 40% (4) women. The difference between in-person and remote recording was observed in the acoustic analysis of the minimum fundamental frequency (F0) (p = 0.001) and the harmonic-noise level (HNR) (p = 00.005). No important differences were found in the variables of articulation of diadochokinesia and monologue, respectively: the number of syllables (p = 0.661;p = 0.861), number of pauses (p = 1,000;p = 0.702), duration (p = 0.491;p = 0.814), phonation time (p = 0.443;p = 0.904), speech rate (p = 0.929;p = 0.300), articulation rate (p = 0.823;p = 0.611) and average syllable duration (ASD) (p = 0.255;p = 0.750). Conclusion: A comparison between remote speech recording and in-person evidence that the statistically significant differences are related only to the noise variables, which is not enough to interfere in the patient's final diagnosis. Thus, remote recording can be a promising option for acoustic analysis of speech.

Association between obesity and chronic laryngitis in women and their effects on phonation

Introduction: 'Phonation' is the physical process by which the vocal folds produce certain sounds. According to laryngology, there are different factors that can affect our larynx (voice box) negatively, such as: Obesity, benign vocal cord lesions, sex hormones, head and neck surgeries and patients who are suffering from health complications recovered from COVID-19 after a prolonged intubation. These factors could show difficulties in voice, airway, and swallowing. Aim: This study aimed to investigate the relationship between obesity and chronic laryngitis in which this inflammation hinders phonation and voice/sound output. This investigation in South Korea using data from Korea National Health and Nutrition Examination Survey (KNHANES) collected during 2008 - 2010. Method: (KNHANES) was a cross-sectional survey of the civilian, noninstitutionalized population of South Korea (n=13,819) aged 19 years or older. Obesity status was measured by using BMI and waist circumference. Conclusions: Obese women in Korea have an elevated risk for developing chronic laryngitis. Chronic laryngitis itself is a misfortune. Chronic laryngitis (CL) causes excess mucus, a sore throat, a persistent dry cough, loss of voice and phonation and difficulty swallowing. Moreover, obese women will suffer from hormonal imbalances that show changes in their voice tones. Elevated estrogen levels cause gastric acid secretion and GERD in women. To help those patients, it is better to shift into a healthy lifestyle, manage their weight by healthy diet and exercises. In this way, a lot of complications will be lessened such as: GERD that is responsible for benign vocal cord lesions possibility. Some women who suffer from chronic laryngitis and turns into cancer decide to do neck surgery. Otolaryngologists stated common side effects from head and neck surgery include temporary or permanent loss of normal voice, impaired speech, and hearing loss.

Does the wearing of masks change voice and speech parameters?

PURPOSE: The authors aim to review available reports on the potential effects of masks on voice and speech parameters. METHODS: A literature search was conducted using MEDLINE and Google Scholar databases through July 2021. Several targeted populations, mask scenarios and methodologies were approached. The assessed voice parameters were divided into self-reported, acoustic and aerodynamic. RESULTS: It was observed that the wearing of a face mask has been shown to induce several changes in voice parameters: (1) self-reported-significantly increased vocal effort and fatigue, increased vocal tract discomfort and increased values of voice handicap index (VHI) were observed; (2) acoustics-increased voice intensity, altered formants frequency (F2 and F3) with no changes in fundamental frequency, increased harmonics-to-noise ratio (HNR) and increased mean spectral values in high-frequency levels (1000-8000 Hz), especially with KN95 mask; (3) aerodynamics-maximum phonatory time was assessed in only two reports, and showed no alterations. CONCLUSION: Despite the different populations, mask-type scenarios and methodologies described by each study, the results of this review outline the significant changes in voice characteristics with the use of face masks. Wearing a mask shows to increase the perception of vocal effort and an alteration of the vocal tract length and speech articulatory movements, leading to spectral sound changes, impaired communication and perception. Studies analyzing the effect of masks on voice aerodynamics are lacking. Further research is required to study the long-term effects of face masks on the potential development of voice pathology.