Analysis of Speech Fundamental Frequencies for Different Tasks in Japanese.

PURPOSE: Speech fundamental frequency (SFF) assessment is essential for all dysphonia patients to effectively evaluate the therapeutic effects of voice therapy, especially in patients with disturbances in their voice pitch due to mutational dysphonia, Reinke's edema, or as side effects of hormone therapy. A standard method of SFF measurement remains unknown. Speech tasks such as sustained vowel phonation, counting, reading passage, and spontaneous speech have generally been used for SFF measurements. Ideally, spontaneous speech best reflects SFF; however, this task has not yet been clearly defined and is limited with regard to its adaptation to a clinical setting. A reliable task for SFF measurement in Japanese, which corresponds to a speech task that most closely reflects the value that would be observed with typical spontaneous speech, has not been investigated. This study aimed to identify a reliable speech task by measuring the SFF values elicited by different widely used speech tasks in Japanese, and assess its reliability and coefficient of determination (R2). METHODS: Sixty healthy volunteers (30 men and 30 women; aged 19-30 years; mean age 22.5 years) were enrolled. All experimental procedures were performed in Japanese. The SFF values for the speech tasks were determined through the voice samples recorded using a Pulse Code Modulation (PCM) recorder. Each task, except spontaneous speech, was repeated five times, and the average fundamental frequency in each task was determined as the SFF. To assess the reliability of the SFF values across daily variations within individual speakers, the SFF measurements were repeated on two different days, separated by at least 1 week. RESULTS: The SFF values of sustained /a/ phonation, sustained vowel-average, counting, reading passage, and spontaneous speech had excellent reliability, in terms of their reproduction based on intraclass correlation. Significantly high SFF values were observed, in decreasing order, for sustained vowels-average, counting, reading passage, and spontaneous speech in both males and females. The highest R2 for spontaneous speech was that of reading passage in both males (R2 = 0.771) and females (R2 = 0.806) (P < 0.01). CONCLUSION: When spontaneous speech was presented as a task most reflective of daily conversation, reading passage was determined to be the reliable task to assess the therapeutic effect of voice therapy in Japanese.

Intracordal injection therapy for vocal fold scarring: Steroid versus basic fibroblast growth factor.

Objectives: Vocal fold scarring is caused by replacement of vocal fold mucosa with fibrous tissue due to repeated inflammation or trauma. It can lead to severe dysphonia. It is currently treated conservatively and with phonosurgery and intracordal injections. Intracordal injection of steroid or basic fibroblast growth factor (bFGF) has been recently found to be useful for treating vocal fold scarring that does not respond to voice therapy. Methods: This retrospective study involved the administration of steroid injection and bFGF injection bilaterally under local anesthesia in 16 patients each. Laboratory measurements of voice parameters were performed before and 3-6 months after injection. Results: In the steroid injection group, the Voice Handicap Index (VHI) score significantly improved from 57.1 to 40.5, total Grade, Roughness, Breathiness, Asthenia, Strain (tGRBAS) score significantly improved from 4.2 to 2.6, and mean speech fundamental frequency (SFF) increased from 192.5 to 211.4 dB, but there was no improvement in maximum phonation time (MPT) and mean airflow rate (MFR). In the bFGF injection group, significant improvements in the VHI score (from 53.3 to 35.7), MPT (from 16.9 to 21.8 s) and MFR (from 314.6 to 210.5 ml/s) were seen; however, the tGRBAS score did not improve. In addition, the SFF significantly decreased from 178.1 to 160.5 Hz. Conclusion: These results suggest that both steroid and bFGF injections are effective for treating vocal fold scarring, with steroids improving voice quality and bFGF improving glottic closure, thereby contributing to improvements in VHI scores. Level of Evidence: 4.

Long-term results and safety of fibroblast growth factor injection for unilateral vocal fold paralysis.

Objectives: Treatments for unilateral vocal fold paralysis (UVFP) include conservative voice rehabilitation, vocal fold injection, and laryngeal framework surgery. We proposed basic fibroblast growth factor (bFGF) injection as a potential novel treatment for UVFP and have reported the short-term results. In this study, we present the long-term results and safety of vocal fold bFGF injection as a treatment for UVFP. Methods: This retrospective study included 42 patients (25 males and 17 females) with UVFP who were administered a local injection of bFGF. The injection regimen involved injecting FGF (0.5 µg/ml in 0.5 ml per side) into the bilateral vocal folds using a 23-gauge injection needle. Phonological outcomes were evaluated 6 months and 12 months after the injection. Results: Overall, 26 patients received a single injection of bFGF, six patients received an additional injection, and 10 patients received the additional framework surgery. Maximum phonation time, mean flow rate, pitch range, jitter and shimmer percentages, the total GRBAS (grade, roughness, breathiness, asthenia, strain) score, and voice handicap index scores improved significantly in the long term. In patients who received the additional injection or framework surgery, the effects of bFGF injection were temporary, but did not interfere with the performance of the framework surgery. Conclusion: In total, 42 patients who underwent vocal fold bFGF injections were reviewed. The bFGF injections were effective and safe in the long-term results for UVFP in the selected cases. Some patients with severe symptoms benefited from the additional framework surgery but not the additional bFGF injection.

Comparison of therapeutic effects of steroid injection by benign vocal fold lesion type.

BACKGROUND: Benign vocal fold lesions (BVFLs) can cause voice changes, including reduced loudness and pitch range. In recent times, with progression in endoscopic technology, office-based vocal fold steroid injection (VFSI) has been used as an alternative therapy for BVFLs. AIMS/OBJECTIVES: In this study, we analyzed the efficacy and safety of VFSI to investigate the mechanism underlying its therapeutic effects and determine the conditions in which VFSI will be most effective. MATERIALS AND METHODS: In this retrospective cohort study, we included 40 condition-matched patients (8 patients per lesion) with chorditis, vocal nodules, vocal polyps, Reinke's edema (RE), or vocal scars who received similar regimens of steroid injection using a commercial preparation of triamcinolone acetonide. Their phonological outcomes were evaluated 2 or 3 months after the injection. RESULTS: Significant improvements were observed in Voice Handicap Index scores, results of laboratory voice evaluation, and voice quality measured using the Grade, Roughness, Breathiness, Asthenia, Strain scale in all participants. In subgroup analysis, VFSI was highly effective against chorditis and vocal nodules, but less effective against RE and vocal scars. CONCLUSIONS: Single-dose VFSI is valuable as an alternative to voice rehabilitation and laryngo-microsurgery, but higher concentrations or repeated injections are required for intractable lesions.