Pitch abnormalities are a common manifestation of various voice disorders, with complex pathophysiological mechanisms involving changes in vocal fold tension, mass, and neuromuscular dysfunction of the larynx. This study aims to investigate the underlying physiological mechanisms of pitch-related disorders and explore diagnostic and therapeutic approaches, providing insights for clinical management.
Humans ; Voice Disorders/therapy* ; Vocal Cords/physiopathology*

Objective:To explore the factors influencing adherence to voice therapy among patients with voice disorders in China. Methods:Patients with voice disorders who visited the Voice Therapy Center at Sun Yat-sen Memorial Hospital, Sun Yat-sen University, from February to May 2022 were enrolled in the study. Adherence was assessed using the URICA-Voice scale, while influencing factors were assessed through the Voice Handicap Index（VHI） scale and a general information questionnaire. Correlation analysis was conducted using univariate and multivariate logistic regression analysis. Results:A total of 247 patients were included in the study, comprising 57 males（23.08%） and 190 females（76.92%）. The results revealed that: ①Female patients demonstrated higher likelihood of being in the contemplation stage（OR=0.22） compared to males. ②Patients with a monthly family income per capita>6 000 yuan were more likely to be in the contemplation stage than those with<3 000 yuan with an OR = 13.94. ③High vocal-demand occupations increased contemplation stage probability（OR=7.70） compared to moderate-demand occupations. ④Residence within 30-minute commute predicted action/maintenance stages（OR=7.14） versus≥60-minute commute. ⑤Patients whose occupations had high voice demands were more likely to be in the action and maintenance stages than those with average voice demands, with an OR of 16.20. Conclusion:Gender, monthly family income per capita, occupational voice demands, and distance to the hospital significantly impact the URICA-Voice compliance stages of patients. Patients who are female, have higher family income, have occupations with high voice demands, and live closer to the hospital exhibit higher compliance with voice training.
Humans ; Male ; Female ; Voice Disorders/therapy* ; Patient Compliance ; Voice Training ; Surveys and Questionnaires ; China ; Middle Aged ; Adult ; Voice Quality ; Logistic Models ; Aged

Parkinson’s disease (PD) is a chronic, neurodegenerative condition resulting in various motor impairments, including speech disorders. However, at the height of the coronavirus disease 2019 pandemic, a patient with PD could not access traditional in-person neurorehabilitation care. This case report highlights the feasibility of telerehabilitation to deliver speech therapy over a distance using available resources in a developing country. We describe a Filipino elderly woman, public speaker, and marriage counselor, seeking teleconsultation for her voice problems (slow and soft) attributed to PD. At that time, most center-based outpatient rehabilitation centers in Manila were closed due to the pandemic, and the patient preferred to stay at home for safety reasons. Hence, she was evaluated and managed remotely by an interdisciplinary team (neurologist, physiatrist, speech-language pathologist) through video calls. Since the ideal rehabilitation set up (in-person evaluation and therapy; use of Lee Silverman Voice Therapy) could not be done, the clinicians had to find practical alternatives, such as remotely administering subjective perceptual voice assessments, objective speech analysis using the Praat™ computer application, and speech teletherapy through synchronous (videocalls, phone calls) and asynchronous (e-mails, text messages, pre-recorded exercise videos) techniques. Notable speech improvements were observed by the clinicians, patient, and patient’s frequent communicative partners after at least four teletherapy sessions. However, the carry-over of the improvements was affected by the patient’s lack of compliance with the prescribed home exercise program. Telerehabilitation using synchronous and asynchronous techniques for speech disorders due to PD was found feasible, beneficial, safe, and practical amid social distancing and low resources in a developing country
Speech Therapy ; Telerehabilitation ; Parkinson Disease ; Voice Disorders ; COVID-19

PURPOSE: The purpose of this study was to compare the clinical and functional outcomes in patients with primary base of tongue (BOT) cancer who received definitive radiotherapy (RT) or surgery followed by radiotherapy (SRT). MATERIALS AND METHODS: Between January 2002 and December 2016, 102 patients with stage I-IVB primary BOT cancer underwent either definitive RT (n=46) or SRT (n=56), and treatment outcomes were compared between two groups. The expression of p16 was also analyzed. RESULTS: The RT group had more patients with advanced T stage (T3-4) disease (58.7% vs. 35.7%, p=0.021) and who received chemotherapy (91.3% vs. 37.5%, p < 0.001) than the SRT group. At a median follow up of 36.9 months (range, 3.3 to 181.5 months), the 5-year overall survival (OS) and disease-free survival (DFS) were 75.5% and 68.7%, respectively. With respect to treatment group, the 5-year OS and DFS in the RT and SRT groups did not differ significantly (OS, 68.7% vs. 80.5%, p=0.601; DFS, 63.1% vs. 73.1%, p=0.653). In multivariate analysis, OS differed significantly according to p16 expression (p16-negative vs. p16-positive; hazard ratio [HR], 0.145; 95% confidence interval [CI], 0.025 to 0.853; p=0.033). Regarding DFS, p16 expression (p16-negative vs. p16-positive; HR, 0.164; 95% CI, 0.045 to 0.598; p=0.006) showed a significant effect in multivariate analysis. Functional defects (late grade ≥ 3 dysphagia or voice alteration) were more frequently reported in the SRT than in the RT group (16.1% vs. 2.2%, p=0.021). CONCLUSION: Despite advanced disease, patients in the RT group showed comparable survival outcomes and better functional preservation than those in the SRT group.
Chemoradiotherapy* ; Deglutition Disorders ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Organ Preservation ; Radiotherapy ; Radiotherapy, Adjuvant* ; Tongue Neoplasms* ; Tongue* ; Treatment Outcome ; Voice

OBJECTIVE: To identify the relationship between maximum phonation time (MPT) and swallowing function, as well as the elements of swallowing, in order to provide a rationale for speech therapy in patients with Parkinsonism manifesting dysphagia. METHODS: Thirty patients with Parkinsonism who underwent speech evaluation and videofluoroscopic swallowing study (VFSS) were recruited. The MPT, the longest periods of sustained pronunciation of /aa/, was evaluated. The VFSS was evaluated using Penetration Aspiration Scale (PAS), National Institutes of Health-Swallowing Safety Scale (NIH-SSS), and Videofluoroscopic Dysphagia Scale (VDS). The relationship between dysphagia scales and MPT was analyzed using Pearson correlation. The difference in VDS variables between subgroups (Parkinson disease or Parkinsonian syndrome, independent or dependent ambulation, and normal or abnormal MPT) and the difference in MPT between subgroups based on the VDS variables were analyzed using the independent t-test. RESULTS: Bolus formation and laryngeal elevation functions were significantly higher in the normal MPT group compared with the impaired group. In the VDS variables, patients with intact bolus formation, oral transit time, pharyngeal swallow triggering, and laryngeal elevation showed significantly longer MPTs compared with the impaired groups. In addition, MPT was significantly correlated with the VDS and modestly correlated with the NIH-SSS, but not the PAS, suggesting that phonatory function is related to the oropharyngeal swallowing function, but not directly to the aspiration itself. CONCLUSION: The correlation between MPT and several swallowing-related elements was identified, indicating an interactive correlation between swallowing and phonation. This result justifies voice therapy as a treatment for dysphagia in patients with Parkinsonism.
Academies and Institutes ; Deglutition Disorders ; Deglutition* ; Dependent Ambulation ; Humans ; Parkinson Disease ; Parkinsonian Disorders* ; Phonation* ; Speech Therapy ; Voice ; Weights and Measures

PURPOSE: This study evaluates the long-term results of definitive radiotherapy (RT) for early glottic cancer. Clinical and treatment factors related to local control and patterns of failure are analyzed. MATERIALS AND METHODS: We retrospectively reviewed 222 patients with T1-2N0 squamous cell carcinoma of the glottic larynx treated with definitive RT from 1981 to 2010. None of the patients received elective nodal RT or combined chemotherapy. The median total RT dose was 66 Gy. The daily fraction size was < 2.5 Gy in 69% and 2.5 Gy in 31% of patients. The RT field extended from the hyoid bone to the cricoid cartilage. RESULTS: The median age was 60 years, and 155 patients (70%) had T1 disease. The 5-year rates of local recurrence-free survival (LRFS) and ultimate LRFS with voice preservation were 87.8% and 90.3%, respectively. T2 (hazard ratio [HR], 2.30; 95% confidence interval [CI], 1.08 to 4.94) and anterior commissural involvement (HR, 3.37; 95% CI, 1.62 to 7.02) were significant prognostic factors for LRFS. In 34 patients with local recurrence, tumors recurred in the ipsilateral vocal cord in 28 patients. There were no contralateral vocal cord recurrences. Most acute complications included grade 1-2 dysphagia and/or hoarseness. There was no grade 3 or greater chronic toxicity. CONCLUSION: Definitive RT achieved a high cure rate, voice preservation, and tolerable toxicity in early glottic cancer. T2 stage and anterior commissural involvement were prognostic factors for local control. Further optimization of the RT method is needed to reduce the risk of ipsilateral tumor recurrence.
Carcinoma, Squamous Cell ; Cricoid Cartilage ; Deglutition Disorders ; Drug Therapy ; Glottis ; Hoarseness ; Humans ; Hyoid Bone ; Laryngeal Neoplasms ; Larynx ; Neoplasm Recurrence, Local ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Risk Factors ; Vocal Cords ; Voice

Tic disorder is a childhood neuropsychological disorder which has the characteristics of abrupt, involuntary, and repetitive stereotyped muscle movement or voice. Tourette's disorder shows a chronic prognosis, and can last for life if no medical treatment is applied. Though the tic disorder has been known for a long time, the underlying cause is still not well known. Psychotropic drugs have long been used for the tic disorder or Tourette's disorder, but few clinical studies were carried out. However, the European Society for the Study of Tourette's syndrome recently reported the clinical guideline of Tourette's syndrome and other tic disorders based on the research findings obtained so far. Also, the guideline for the evidence-based treatment was reported in Canada, and North America. By synthesizing the newly reported foreign guidelines for treatment and review articles, this study aims to investigate the psychotropic drug therapy used for the tic disorder or Tourette's disorder.
Canada ; Drug Therapy* ; Muscles ; North America ; Prognosis ; Psychotropic Drugs ; Tic Disorders ; Tourette Syndrome* ; Voice

OBJECTIVES: Cognitive behavioral therapy for treatment of schizophrenia was designed as a psychological therapy for treatment of drug resistant patients with schizophrenia. This therapy is currently being widely applied from early psychosis to chronic condition. The aim of this article is to review the main results of research articles on cognitive behavioral therapy of schizophrenia and prompt practicing the therapy in Korean mental health services. METHODS: The important original and review articles were referred in order to understand the main results of research from published international books, and the English website Pubmed was searched in order to update recent findings. This article reviewed the results of four areas of different phases and types of cognitive behavioral therapy for treatment of schizophrenia: drug resistant chronic patients, acute psychotic state, prodromal phase, and group cognitive behavioral therapy. RESULTS: Cognitive behavioral therapy for treatment of drug resistant patients with schizophrenia can attenuate the positive and general symptoms more than that for patients who receive supportive psychotherapy or treatment as usual. However, the effect appears to be less than previously expected, small to moderate. Cognitive behavioral therapy for patients of acute psychotic state can reduce the time of recovery from acute psychotic symptoms by approximately 25%. The result of cognitive behavioral therapy for patients of prodromal phase shows that the therapy can reduce the rate of transition to schizophrenia by up to one third. Group behavioral therapy has recently been tested. Group therapists have suggested that the therapy should be applied through the way of groups with relatively homogenous symptoms. However, whether the therapy can reduce the severity of hallucination in the voice hearer group is inconclusive. CONCLUSION: Alongside pharmacotherapy for treatment of schizophrenia, cognitive behavioral therapy is a distinct psychological therapy for attenuation of psychotic symptoms. The effect of cognitive behavioral therapy appears to last for one year and requires additional therapeutic sessions after one year. The effect is not still clear in group cognitive behavioral therapy for treatment of schizophrenia. Cognitive behavioral therapy for treatment of schizophrenia should be practiced widely in the Korean mental health system.
Cognitive Therapy ; Hallucinations ; Humans ; Mental Health ; Prodromal Symptoms ; Psychotherapy ; Psychotic Disorders ; Schizophrenia ; Voice

BACKGROUND AND OBJECTIVES: We aimed to develop a Korean version of the velopharyngeal insufficiency (VPI) speech corpus system. SUBJECTS AND METHOD: After developing a 3-channel simultaneous speech recording device capable of recording nasal/oral and normal compound speech separately, voice data were collected from VPI patients aged more than 10 years with/without the history of operation or prior speech therapy. This was compared to a control group for which VPI was simulated by using a french-3 nelaton tube inserted via both nostril through nasopharynx and pulling the soft palate anteriorly in varying degrees. The study consisted of three transcriptors: a speech therapist transcribed the voice file into text, a second transcriptor graded speech intelligibility and severity and the third tagged the types and onset times of misarticulation. The database were composed of three main tables regarding (1) speaker's demographics, (2) condition of the recording system and (3) transcripts. All of these were interfaced with the Praat voice analysis program, which enables the user to extract exact transcribed phrases for analysis. RESULTS: In the simulated VPI group, the higher the severity of VPI, the higher the nasalance score was obtained. In addition, we could verify the vocal energy that characterizes hypernasality and compensation in nasal/oral and compound sounds spoken by VPI patients as opposed to that characgerizes the normal control group. CONCLUSION: With the Korean version of VPI speech corpus system, patients' common difficulties and speech tendencies in articulation can be objectively evaluated. Comparing these data with those of the normal voice, mispronunciation and dysarticulation of patients with VPI can be corrected.
Aged ; Articulation Disorders ; Cleft Palate ; Compensation and Redress ; Database Management Systems ; Demography ; Humans ; Nasopharynx ; Palate, Soft ; Speech Intelligibility ; Speech Therapy ; Velopharyngeal Insufficiency ; Voice

OBJECTIVE: To discuss the effect of cochlear implant and hearing aid to voice quality. METHOD: Four groups of randomly selected 73 subjects were compared. The groups comprised: cochlear implant children, children using hearing aids, normal hearing children and deaf children with no hearing instrumentation. The latter two groups were control groups. Each subject was required to phonate /ae/ about 3 s using 'voice assessment' to record the sound, and following voice acoustic variables were analysed: F0, SDF0, Jitter, Shimmer, NNE, HNR, SNR. RESULT: Voice F0 of children with cochlear implant was significantly lower that the other three groups (P<0.05); there were no significant difference between hearing aid group, normal hearing group, and deaf children group with no intervention (P>0. 05); SDF0 of cochlear implant group and hearing aids group were significantly larger than the normal hearing group and deaf children group with no intervention (P<0.05), and the interaction of two factors (hearing and sex) was close to the critical level of significance (P>0.05), which means that cochlear implant and hearing aid could have affected the SDF0 of female children more than those of male children. There were no significant difference among all the four groups about voice quality variables: Jitter, Shimmer, NNE, HNR, SNR. CONCLUSION Cochlear implant and hearing aid mainly change the voice F0 and/or SDF0, and have no effect on the voice quality variables.
Adolescent ; Child ; Child, Preschool ; Cochlear Implantation ; Cochlear Implants ; Female ; Hearing Aids ; Hearing Disorders ; therapy ; Humans ; Male ; Treatment Outcome ; Voice Quality