Relationships Across Clinical Measures of Vocal Quality and Functioning and Their Relationship With Patient Perception.

Purpose The purpose of this study was to investigate the relationships among subjective auditory-perceptual ratings of vocal quality, objective acoustic and aerodynamic measures of vocal function, and patient-perceived severity of their vocal complaint. Method This study was a retrospective chart review of adult patients evaluated at a single outpatient center over a 1.5-year time period.

The Effects of Menopause on Neuromuscular Parameters of the Rat Vocal Folds.

Objectives/hypothesis: Menopause adversely affecs power and endurance of the limb muscles. However, despite clinical observations that menopause corresponds to negative changes of the voice, the direct effects of estrogen deprivation on the thyroarytenoid muscles are unknown. The purpose of this study was to investigate the effects of estrogen deprivation via ovariectomy on three neuromuscular parameters of the thyroarytenoid muscles using a rat model.

Autologous fibroblasts for vocal scars and age-related atrophy: A randomized clinical trial.

Objectives/hypothesis: To assess the safety and efficacy of autologous cultured fibroblasts (ACFs) to treat dysphonia related to vocal fold scar and age-related vocal atrophy (ARVA).

Study Design: Randomized, double-blinded, placebo-controlled, multi-institutional, phase II trial.

Methods: ACFs were expanded from punch biopsies of the postauricular skin in each subject; randomization was 2:1 (treatment vs.

Comparative Treatment Outcomes for Patients With Idiopathic Subglottic Stenosis.

Importance: Surgical treatment comparisons in rare diseases are difficult secondary to the geographic distribution of patients. Fortunately, emerging technologies offer promise to reduce these barriers for research.

Objective: To prospectively compare the outcomes of the 3 most common surgical approaches for idiopathic subglottic stenosis (iSGS), a rare airway disease.

Exercise Science and the Vocalist.

The application of exercise science training knowledge has been of growing interest to voice professionals. This tutorial, derived from the authors' invited presentations from the "Exercise and the Voice" Special Session at the 2018 Voice Foundation Symposium, proposes a foundational theoretical structure based in exercise science, clarifies the wide range of variables that may influence voice training, and summarizes our present understanding of voice physiology from the perspective of muscle training. The body of literature on voice exercise was then analyzed from the perspective of this framework, identifying what we currently know and what we still have yet to learn.

Laryngeal distribution of adult-onset recurrent respiratory papillomatosis: A longitudinal study.

Objectives/hypothesis: To describe recurrence patterns in patients with recurrent respiratory papillomatosis (RRP) following surgical intervention.

Study Design: Single-center, retrospective, longitudinal case series.

Methods: Initial and follow-up laryngoscopic examinations of seven previously untreated adult-onset RRP patients were reviewed.

A Tutorial of the Effects of Sex Hormones on Laryngeal Senescence and Neuromuscular Response to Exercise.

Purpose The purpose of this tutorial is to summarize how sex hormones affect both laryngeal senescence and neuromuscular response to exercise, highlighting the importance of considering sex differences in developing treatment for the senescent voice. Conclusion Men and women's voices are sexually dimorphic throughout the life span, including during the laryngeal adaptations observed during senescence. Therefore, presbyphonia (age-related dysphonia) likely clinically manifests differently for men and women due to differences in how the male and the female larynx change in response to aging.

Automated Indentation Mapping of Vocal Fold Structure and Cover Properties Across Species.

Objectives/hypothesis: Various animal models have been employed to investigate vocal fold (VF) and phonatory function. However, biomechanical testing techniques to characterize vocal fold structural properties vary and have not compared critical properties across species. We adapted a nondestructive, automated indentation mapping technique to simultaneously quantify VF structural properties (VF cover layer and intact VF) in commonly used species based on the hypothesis that VF biomechanical properties are largely preserved across species.

The effects of cytosporone-B, a novel antifibrotic agent, on vocal fold fibroblasts.

Objectives/hypothesis: Our laboratory recently described NR4A1 as an endogenous inhibitor of TGF-β-induced vocal fold (VF) fibrosis. Our prior report described the temporal expression of NR4A1 during VF healing in vivo and the effects of NR4A1 knockdown on fibroplastic cell activities in vitro. Based on these findings, we hypothesized that cytosporone-B (Csn-B), an NR4A1 agonist, may hold significant therapeutic potential.

NR4A1 is an endogenous inhibitor of vocal fold fibrosis.

Objectives/hypothesis: NR4A1 was recently identified as an endogenous inhibitor of transforming growth factor (TGF)-β-induced fibrosis, and the role of this nuclear receptor has not been elucidated in tissue health or the response to injury in the vocal folds. Given the clinical implications of vocal fold fibrosis, we investigated NR4A1 expression during vocal fold wound healing in vivo and the regulatory roles of NR4A1 on vocal fold fibroblasts (VFFs) in vitro with the ultimate goal of developing targeted therapies for this challenging patient population.

Study Design: In vivo and in vitro.

Automated acoustic analysis of 50-kHz ultrasonic vocalizations using template matching and contour analysis.

Ultrasonic vocalizations are a useful tool for inferring affective states in the rat and have been incorporated in research paradigms modeling important human conditions. While the majority of studies report the quantity or rate of observed ultrasonic vocalizations, growing evidence suggests that critical data may be contained in the acoustic features of individual vocalizations. Thus, the goal of the present study was to develop and validate a method for measuring acoustic parameters of ultrasonic vocalizations that were collected using automatic template detection.

Backstage at Broadway: a demographic study.

Objectives/hypothesis: To provide insight into the demographics and vocal habits of current Broadway musical theater performers.

Study Design: Prospective, Questionnaire.

Methods: Adult musical theater performers in Broadway Productions as defined by the League of American Theater Producers and the Actors' Equity Association were asked to complete a survey collecting demographic information, vocal health and habits, alcohol, tobacco, and drug use and information regarding their level of vocal comfort and threshold to miss performances based on their voice.

Incidence of underlying laryngeal pathology in patients initially diagnosed with laryngopharyngeal reflux.

Objectives/hypothesis: To characterize the videoendoscopic laryngeal findings in patients with a prior established diagnosis of laryngopharyngeal reflux disease (LPR) as the sole etiology for their chief complaint of hoarseness. We hypothesized that many, if not all, of these patients would present with discrete laryngeal pathology, divergent from LPR.

Study Design: Prospective, nonintervention.

The utility of the potassium titanyl phosphate laser in modulating vocal fold scar in a rat model.

Objectives/hypothesis: We hypothesize that the KTP laser has the potential to augment wound healing in a rat model, and this modality may serve as a therapeutic tool for the management of vocal fold fibrosis.

Study Design: Prospective, laboratory animal study.

Methods: Rats were subjected to either vocal fold injury ± KTP laser treatment at low energy to simulate clinically relevant endpoints.

Dynamic magnetic resonance imaging of the pharynx during deglutition.

Objectives: We utilized dynamic magnetic resonance imaging to visualize the pharynx and upper esophageal segment in normal, healthy subjects.

Methods: A 3-T scanner with a 4-channel head coil and a dual-channel neck coil was used to obtain high-speed magnetic resonance images of subjects who were swallowing liquids and pudding. Ninety sequential images were acquired with a temporal resolution of 113 ms.

Morbidity and patient perception of flexible laryngoscopy.

Objectives: The recently published Clinical Practice Guideline: Hoarseness (Dysphonia) revealed major deficits in the literature regarding relatively routine clinical decision-making. One of the more controversial points in the Guideline regarded the utility and timing of laryngeal visualization via flexible laryngoscopy, potentially because of sparse literature regarding the risks and potential morbidity. We sought to prospectively address this issue in order to optimize evaluation protocols.

Diagnosis and management of new-onset hoarseness: a survey of the American Broncho-Esophagological Association.

Objectives: The recently published Clinical Practice Guideline raised issues related to the value and timing of laryngoscopy in patients with hoarseness. We sought to determine the extent to which these guidelines concur with clinical practice among members of the American Broncho-Esophagological Association (ABEA).

Methods: A web-based survey was distributed to ABEA members, composed of four sections: 1) background and demographics; 2) information regarding the appropriate length of time that new-onset dysphonia may be managed before laryngeal visualization, given particular comorbidities; 3) the frequency and risks of office-based flexible transnasal laryngoscopy; and 4) the overall value of laryngoscopy and stroboscopy.

3 Tesla turbo-FLASH magnetic resonance imaging of deglutition.

Objectives/hypothesis: In this article we describe a methodology for obtaining high-quality dynamic magnetic resonance imaging (MRI) sequences of the swallow sequence in healthy volunteers. The study includes comparison to previous work done in our lab using a 1.5 Tesla (T) magnet.

Hands-on training methods for vocal fold injection education.

Objectives: Vocal fold injection (VFI) in the office setting and in the operating room is becoming increasingly popular. Most training programs fail to educate residents in performing these injections. In this report, we describe novel and effective teaching tools that provide real-life simulation of VFI for the education of residents and otolaryngologists in practice.

Thyrohyoid approach for vocal fold augmentation.

Objectives: I performed a retrospective chart review to evaluate the patient tolerance and clinical results of a new technique for office-based vocal fold augmentation.

Methods: Ten patients undergoing the thyrohyoid approach for vocal fold augmentation were asked to rate their tolerance of the procedure using a 10-point rating scale (1 = "no problem" and 10 = "very uncomfortable"). The patients also filled out a quality-of-life survey (Voice Handicap Index-10) immediately before and 1 month after the procedure.