• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.26 no.2
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• pp.122-126
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• 2015

Background and Objective : Laryngeal microscopic surgery (LMS) is popular method to treat for vocal polyp. There is not always the improvement of the voice after operation. Many methods have been developed for better outcome of the surgery. The purpose of this study is to investigate the effect of the triamcinolone injection at vocal cord during LMS. Materials and Methods : The medical records of 28 patients, received LMS under diagnosis of vocal polyp, were retrospectively reviewed. The patients were divided into two groups depending on whether triamcinolone injected or not (case group : Triamcinolone-injected group, control group : Triamcinolone-not injected group). The quality of voice was evaluated by GRBAS scale, fundamental frequency (Fo), jitter, shimmer and NHR (Noise to harmonic ratio) at previous operation, 4 weeks after operation, 8 weeks after operation. Each voice analysis factor was compared between case group and control group by Independent t-test. Results : The mean differences of each voice analysis factor. The mean difference of Jitter, Shimmer, NHR in case group were lower than in control group, and mean difference of GRBAS scale in case group were higher than in control group. These differences were not significant (p>0.05). Conclusion : Though there was a tendency of better voice outcome in patients of triamcinolone-injection, it may not be concluded that the triamcinolone injection is helpful for better voice outcome in surgery of vocal polyp due to statistical insignificance.

• Phonetics and Speech Sciences
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• v.1 no.2
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• pp.37-42
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• 2009

The purpose of the present study was to determine the effect of the management program known as vocal function exercise (VFE) on voice quality. Typical VFE was modified and applied to patients with vocal nodules by controlling intensity of voice and relieving the vocal fold to solve hyperfunctional problems in VFE. Eight female subjects aged between 28 and 54 who had been diagnosed with vocal nodules took part in the study. The patients performed VFEs once a week for eight weeks. Vocal function exercises consist of voice hygiene, respiratory training, phonation training, and glide training. The subjects' voices were analyzed pre and post therapy on the aspects of acoustics, maximum phonation time (MPT), GRBAS, and voice handicap index (VHI). As a result, it was found that fundamental frequency ($F_o$) was significant increased, shimmer decreased remarkably and that noise to harmonic ratio (NHR) lowered obviously in the acoustic parameter. In addition, MPT was increased significantly. The scale of GRBAS indicated significant improvement in grade, roughness, and strained voice. VHI indicated significant improvement in an emotional part. In conclusion, VFE was effective in improving voice quality for patients with vocal nodules.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.15 no.2
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• pp.92-97
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• 2004

Background and Objectives : The purpose of this study was to examine objectively pre and post operative voice quality evaluation and intelligibility of alaryngeal voice using speech recognition program, HUVOIS. Materials and Methods : 2 laryngologists and 1 speech pathologist were evaluated 'G', 'R', 'B' in the GRBAS sclae and speech intelligibility using NTID rating scale from standard paragraph. And also acoustic estimates such as jitter, shimmer, HNR were obtained from Lx Speech Studio. Results : Speech recognition rate was not significantly different between pre and post operation for pathological vocie samples though voice quality(G, B) and acoustic values(Jitter, HNR) were significantly improved after post operation. In Alaryngeal voices, reed type electrolarynx 'Moksori' was the highest both speech intelligibility and speech recognition rate, whereas esophageal speech was the lowest. Coefficient correlation of speech intelligibility and speech recognition rate was found in alaryngeal voices, but not in pathological voices. Conclusion : Current study was not proved speech recognition program, HUVOIS during telephone program was not objective and efficient method for assisting subjective GRBAS scale.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.20 no.1
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• pp.52-56
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• 2009

Background and Objectives : Vocal nodule is common inflammatory vocal cord lesion which could be improved by voice rest or voice therapy. But some patients, who do not have any improvement after voice therapy, should take laryngomicorsurgery or additional long-term voice therapy. So we try to find prognostic factors which affect the results of voice therapy. Materials and Methods: There are 36 patients (response group) whose symptoms improved after initial voice therapy and 16 patients (no response group) whose symptoms did not improve at all. We compared clinical features (durations of symptoms, voice abuse, laryngopharyngeal reflux), GRBAS scale, acoustic analysis, aerodynamic analysis and voice handicap index between the two groups from January, 2006 to June, 2008. Results: Response group underwent voice therapy 4.5 times (ave.) and no response group underwent 6.7 times (ave.). No response group has longer duration of symptoms, higher GRBAS scale score, higher NIH ratio, and higher MFR than those of response group. Conclusion : This study found that the prognosis of voice therapy in patients who have longer duration of symptoms, high NIH ratio, and bad perceptional test result is not likely to be good. In those cases, we should recommend earlier surgery, voice therapy after surgery, and inform about the necessity of long-term voice rehabilitation or voice therapy in order to get favorable compliance.

• Phonetics and Speech Sciences
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• v.15 no.4
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• pp.81-90
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• 2023

Auditory perceptual assessment and acoustic analysis are commonly used in clinical practice for voice evaluation. This study aims to explore the effects of speech task context on auditory perceptual assessment and acoustic measures in patients with voice disorders. Sustained vowel phonations (/a/, /e/, /i/, /o/, /u/, /ɯ/, /ʌ/) and connected speech (a standardized paragraph 'kaeul' and nine sub-sentences) were obtained from a total of 22 patients with voice disorders. GRBAS ('G', 'R', 'B', 'A', 'S') and CAPE-V ('OS', 'R', 'B', 'S', 'P', 'L') auditory-perceptual assessment were evaluated by two certified speech language pathologists specializing in voice disorders using blind and random voice samples. Additionally, spectral and cepstral measures were analyzed using the analysis of dysphonia in speech and voice model (ADSV).When assessing voice quality with the GRBAS scale, it was not significantly affected by the vowel type except for 'B', while the 'OS', 'R' and 'B' in CAPE-V were affected by the vowel type (p<.05). In addition, measurements of CPP and L/H ratio were influenced by vowel types and sentence positions. CPP values in the standard paragraph showed significant negative correlations with all vowels, with the highest correlation observed for /e/ vowel (r=-.739). The CPP of the second sentence had the strongest correlation with all vowels. Depending on the speech stimulus, CAPE-V may have a greater impact on auditory-perceptual assessment than GRBAS, vowel types and sentence position with consonants influenced the 'B' scale, CPP, and L/H ratio. When using vowels in the voice assessment of patients with voice disorders, it would be beneficial to use not only /a/, but also the vowel /i/, which is acoustically highly correlated with 'breathy'. In addition, the /e/ vowel was highly correlated acoustically with the standardized passage and sub-sentences. Furthermore, given that most dysphonic signals are aperiodic, 2nd sentence of the 'kaeul' passage, which is the most acoustically correlated with all vowels, can be used with CPP. These results provide clinical evidence of the impact of speech tasks on auditory perceptual and acoustic measures, which may help to provide guidelines for voice evaluation in patients with voice disorders.

• Proceedings of the KSPS conference
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• 2007.05a
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• pp.292-294
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• 2007

This study was designed to compare the translated patient's subjective rating scales for voice evaluation (Voice Handicap Index; VHI, Voice-Related Quality of Life; V-RQOL, Voice Rating Score; VRS) into Korean, taken from 24 professional voice users diagnosed with organic voice disorders. First, the correlation amongh those scales were observed. Second, the correlation between the patient's subjective rating scales and acoustic measures (Jitter%, Shimmer%, NHR) were examined. Third, those scales were compared by clinician's objective scale (G in GRBAS scale). Results indicated that significant correlations among the patients' subjective rating scales and significant correlations of clinician's rating scale with jitter% and Shimmer%, but not with NHR were observed. In addition, there were significant correlations of G with VHI and VHI-P (one of subscale of VHI). However, none of acoustic measures were correlated with the patient's subjective rating scales.

• Speech Sciences
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• v.10 no.4
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• pp.201-219
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• 2003

Background: The perceptual assessment is generally performed by the voice specialist. The objective evaluation is performed in a voice laboratory. Research in voice laboratories has generated a variety of different objective tests and parameters. The perceptual evaluation is one of the most controversial topics in voice research. Review of literature reveals a wide variety of rating scales and reliability data fluctuating from study to study. Unfortunately, there is no widely accepted valid method for classifying voice disorders and assessing outcome after voice treatment. Objectives: The goals of this research were to identify important objective acoustic parameters of vocal quality, and to establish an objective and quantitative correlate of the perceived vocal quality. Materials and Methods : We evaluated the voice analyzed data from 122 dysphonic patients and 20 normal volunteers. A computerized speech lab. 4300B(CSL) was used to carry out the analysis of each voice sample. Results: Three dysphonia severity indices(DSI) were created using discriminant analysis. DSI is based on the weighted combination of the following selected set of acoustic parameters: absolute jitter(Jita in us), smoothed pitch period perturbation (sPPQ in %), amplitude perturbation quotient(APQ in %), soft phonation index(SPI), average fundamental frequency(Fo in Hz), lowest fundamental frequency(Flo in Hz), and smoothed amplitude perturbation quotient(sAPQ in %). The DSI, being the discriminating rule calculated by the logistic regression, consists of three equation based on statistically significant acoustic parameters. Three DSI were created to reflects best the degree of hoarseness as expressed by G from the GRBAS scale. The more positive this DSI is for a patient, the worse the vocal quality. The more it is negative, the better it is. The effect of sex is included implicitly in the DSI-1 and DSI-2, so that a separate DSI-1 and DSI-2 for males and females need not be used. The DSI is objective because no perceptual input is required for its calculation. Conculsion : This research demonstrates that the voice function values calculated from three different multivariate objective dysphonia severity indices are significantly associated with subjective voice assessments. These multivariate objective dysphonia severity indices may be appropriate for use in clinical trials and outcomes research on treatment effectiveness for voice disorders.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.14 no.2
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• pp.117-122
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• 2003

Background and Objectives : $VoCoM^{\circledR}$ is a commercialized set composed of prefabricated hydroxylapatite implants and shims of various sizes which are specially designed for the type I thyroplasty. Even though a previously published preliminary report showed that $VoCoM^{\circledR}$ is a convenient and safe product for the type I thyroplasty, further investigations or experiences are yet to be reported. Authors aimed to evaluate the efficacy of $VoCoM^{\circledR}$type I thyroplasty, and its advantage and/or disadvantage. Materials and Method : Twenty three consecutive patients with unilateral vocal cord palsy enrolled for the study, who received type I thyroplasty with $VoCoM^{\circledR}$ between July 2001 and June 2003. Acoustic, aerodynamic and stoboscopic analyses were performed prior to surgery and 1 to 3 months after surgery. Speech language pathologists evaluated their voice quality by GRBAS scale, and patients themselves reported subjective changes of their voice by visual analog scale. Results : The average time for the operation was 80 min, which is about 30 min less than other methods. Preoperative jitter was 3.25$\pm$1.65% and improved to 1.94$\pm$1.79% postoperatively (p<0.05). Preoperative shimmer was 9.72$\pm$6.56% and improved to 5.61 $\pm$3.76% (p<0.05), Maximal phonation time increased from 4.41$\pm$2.99 to 7.98$\pm$4.35 sec (p<0.05) The postoperative stroboscopy revealed an effective medialization in 91.3% of the patients. The subjective phonetic improvements were reported in 21 out of 23 patients. GRBAS scale improved from 2.71$\pm$0.46 to 1.47$\pm$1.12(p<0.05). Additional medialization with $Gore-Tex^{\circledR}$ was easily performed in two revision cases. Previously inserted $VoCoM^{\circledR}$ implant was hard to remove because of the tight integration of soft tissues around the implant. Side effects such as extrusion or foreign body reaction are not observed. $VoCoM^{\circledR}$ was relatively expensive and costed more than 10 times of $Gore-Tex^{\circledR}$. Conclusion : Prefabricated hydroxylapatitie implant($VoCoM^{\circledR}$) provides a convenient, safe and efficient way of vocal fold medialization. However it is relatively expensive and hard to remove.

• Journal of Pharmacopuncture
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• v.17 no.3
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• pp.57-61
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• 2014

Objectives: When a person speaks, voice problems usually include pain or discomfort and/or difficulties in terms of the pitch, the loudness and the quality of the voice. When patients with voice problems induced by stroke, Parkinson's disease, and systemic diseases involving the voice are examined, generally, of the Four Diagnoses (四診), a Diagnosis of Hearing can be used in current Korean medicine. The effects of acupuncture and herb medicine on voice problems have been reported for over 20 years. However, when it comes to improvements, objective and subjective evaluation methods need to be explained. Methods: Subjective methods for evaluating voice were studied through a literature search of old medicinal books containing Korean medicine diagnostics, and an objective evaluation method using Praat software is presented. Results: Korean medicine doctors analyze the patient's voice in clinical settings unconsciously on a daily basis. However, most voice diagnoses depend on the doctor's subjective evaluation. Voice qualities can be evaluated by using the Eight Principles (八綱), including Yin-Yang; the Five Elements (Phases); the Grade, Roughness, Breathy, Asthenic, Strained (GRBAS) score, and the Visual Analogue Scale (VAS) as subjective methods, and an acoustic analysis using the Praat program can be used as an objective method. Conclusion: A more complete voice examination can be achieved by using subjective and objective methods at the same time. For an objective explanation and management of patient's voice problems or systemic disorders, an objective method should be used in Korean medicine, which already has many subjective diagnostic methods. More research needs to be conducted, and more clinical evidence needs to be collected in the future.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.29 no.1
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• pp.30-36
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• 2018

Background and Objectives : The effect of palliative injection laryngoplasty in cancer-related unilateral vocal cord paralysis patients on voice and swallowing function is uncertain and there are few previous studies of its suitability, benefits as a palliative treatment option. The purpose of this study is to confirm the objective results of voice and swallowing function after palliative office-based hyaluronic acid injection laryngoplasty in cancer-related unilateral vocal cord paralysis patients. Materials and Method : 36 patients who had unilateral vocal cord paralysis from non-thyroidal, extralaryngeal neoplasms were included in this study. To evaluate the clinical outcome, we analyzed perceptual GRBAS grading, acoustic analysis, aerodynamic study, Electroglottography (EGG), Voice Handicap Index (VHI-30) about voice function and disability rating scale (DRS), gastric tube dependency, aspiration pneumonia about swallowing function and 36-Item Short Form Survey version 2 (SF-36v2) about quality of life. Results : In GRBAS scale, G (p<0.001), R (p=0.004), B (p=0.001), A (p=0.011), and S (p=0.007) showed significant improvement. Jitter, shimmer, speaking fundamental frequency, maximal phonation time, VHI-30, DRS score, gastric tube dependency, aspiration pneumonia, and SF-36v2 were significantly improved after injection (p=0.016, p=0.011, p=0.045, p=0.005, p<0.001, p<0.001 p=0.003, p<0.001, and p<0.001 respectively). Conclusion : From this study we concluded office-based hyaluronic acid injection can be used as a useful palliative treatment option in cancer-related ill patients with unilateral vocal cord paralysis. Palliative hyaluronic acid injection laryngoplasty avoids the need for tube feeding, thus reducing the risk of aspiration pneumonia. These outcomes are accompanied by significant improvement in voice quality.