• 대한후두음성언어의학회지
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• 제21권1호
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• pp.37-41
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• 2010

Background and Objectives : Transient minor voice changes after thyroidectomy are not infrequent complaints even in cases without any evidence of recurrent laryngeal nerve damage. However, clinical course, diagnosis and management of such voice changes are not fully understood. This study aimed to evaluate the clinical characteristics of minor voice changes after thyroidectomy. We also tried to assess the significance and feasibility of superior laryngeal nerve monitoring and to find out the optimal evaluation tools for such voice changes after thyroidectomy. Materials and Method : Nine adult patients who received total thyroidectomy without evidence of recurrent laryngeal nerve injury were enrolled for this prospective study. Voice evaluations were performed preoperatively and 3 months postoperatively ; acoustic analyses including voice range profile, aerodynamic study, stroboscopic evaluation and subjective voice assessment with questionnaires. The external branch of superior laryngeal nerve was monitored by nerve stimulator after ligation of superior thyroidal vessels. Results: Four of nine patients complained their voice change at 3 months after the surgery. Three of them reported complete recovery of their voice at 6 months after the surgery. Acoustic analysis revealed significant decrease in their phonatory range especially with high tone loss. Questionnaires related to singing was more sensitive than previously well-known "voice handicap index". Stimulation of the superior laryngeal nerve was feasible in most of the cases (94.4%), but it failed to show any correlation with minor voice changes after thyroidectomy. Conclusion : Minor voice changes were not rare events during the first 6 month after thyroidectomy. Decrease in phonatory range with high tone loss and therefore, discomfort in singing was the most common finding. Superior laryngeal monitoring was feasible but it was not a sensitive tool for the prediction of minor voice change after thyroidectomy.

• 대한후두음성언어의학회지
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• 제29권1호
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• pp.24-29
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• 2018

Background and Objectives : The purpose of this study was to evaluate the impact of surgical extent on voice using acoustic and aerodynamic measurements in a serially followed thyroidectomy patients. Materials and Method : From October 2015 to January 2017, 108 patients who had undergone thyroid surgery and voice test for preoperative, 2, 3, and 6 months postoperatively were classified into five operative types. The radiological stage preoperatively and histopathological stage postoperatively were classified according to the invasion of thyroid capsule and surrounding tissue. For each classification, the results of the voice analysis according to the period were compared and analyzed. Results : The difference of voice according to surgical extent, radiological stage, and histopathologic stage showed significant difference only with Maximal phonation time (MPT) over time. However, in the analysis of interaction between each classification and period, Phonation threshold pressure (PTP) only showed significant results. Conclusion : Differences in imaging and histopathologic stages have no significant effect on recovery of voice symptoms after thyroid surgery. As the extent of operation increases, the pressure to start vocalization is relatively higher, which also varies with time after surgery.

• 대한후두음성언어의학회지
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• 제18권2호
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• pp.134-137
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• 2007

Background and Objectives: The goals of laryngeal reconstruction have been prevention of aspiration, production of a functional voice, and maintenance of an adequate airway for decannulation. It is generally believed that the reconstruction of the glottic region after vertical partial laryngectomy (VPL) can improve laryngeal function. The objective of this study is to evaluate of voice function after VPL with mucosal flap and fat graft reconstruction. Materials and Methods: From 1994 to 2006, 13 patients, who had been treated with VPL with mucosal flap and fat graft reconstruction. The voice characteristics, acoustic, aerodynamic parameter were measured in 13 patients after vertical partial laryngectomy with mucosal flap and fat graft reconstruction. Acoustic analysis was carried out using Computerized Speech Lab (CSL) and aerodynamic analysis were carried out using Aerophon II,3 months and 12 months after surgery. Results: The GRBAS scale, jitter, shimmer, NHR were improved as time goes on after surgery. But, maximum phonation time was shortened after surgery and there is no significant differences between before and after surgery in mean flow rate. Conclusion: The voice function of the mucosal flap and fat graft reconstruction after VPL were satisfactory. This can be an excellent reconstruction method after vertical partial laryngectomy.

• 대한후두음성언어의학회지
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• 제23권2호
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• pp.119-123
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• 2012

Background and Objectives : Sulcus vocalis could be classified into type I, type IIa, and type IIb. There have been a little reports about voice quality and treatment results related with types of sulcus vocalis. The authors conducted an analysis of voice and treatment according to different types of sulcus vocalis. Materials and Methods : This study was based on a retrospective chart review. The sulcus types were classified into type I and type II. Objective and subjective voice assessments were analyzed. Patients were treated individually with voice therapy, percutaneous steroid injection, and injection laryngoplasty. Comparison was performed on the voice difference between type I group and type II group, and between pre-treatment and post-treatment of each types. Results : One hundred and one patients were enrolled into this study, and 49 patients were type I and 52 patients were type II. Type I group showed longer mean maximal phonation time (MPT) than type II group, although other voice parameters didn't show any difference between two groups. Even after the management, almost all of the voice parameters didn't show improvement except MPT of type II group. Conclusion：Although the type I sulcus has been known as a non-pathologic lesion, it can result in some degree of voice change and discomfort, and thus need an active management. In this study, voice therapy, percutaneous steroid injection, and injection laryngoplasty showed limited effect to the both types of sulcus vocalis. Further studies for management of sulcus vocalis were needed.

• 대한후두음성언어의학회지
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• 제26권2호
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• pp.97-100
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• 2015

Benign vocal fold lesions, such as vocal nodules, polyps and Reinke's edema, usually result from chronic voice overuse. Conservative management such as voice therapy and pharmacotherapy are used as the primary treatment techniques. The main purpose of voice therapy is to identify and reduce voice misuse to achieve the optimal voice. But complete resolution may not be possible in all patients after voice therapy. Furthermore, some patients with voice-related occupations, voice rest and voice therapy are sometimes difficult, which makes it hard to carry out the treatment. When conservative therapy is ineffective, laryngeal microsurgery can be performed under general anesthesia. However, potential complications following laryngeal suspension and violation of the layered structure of the vocal fold during surgery should be considered before surgery. In recent decades, emerging literatures have demonstrated the potential usefulness of vocal fold steroid injection as an alternative treatment option for benign vocal fold lesions. The most advantageous feature of vocal fold steroid injection is the maintenance of regional anti-inflammatory effects while preventing the potential systemic adverse effects of the steroid. Many non-surgical treatment methods can be conducted using different approaches in the office setting. It can be applied as an alternative treatment modality for the management of various benign vocal fold lesions.

• 대한후두음성언어의학회지
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• 제27권2호
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• pp.108-113
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• 2016

Background and Objectives : After thyroidectomy, many patients experience problems report such things as reduced voice range and vocal fatigue, swallowing problems without superior and recurrent laryngeal nerve injury. The purpose of this study was to evaluate voice and swallowing problems before and after thyroid surgery without laryngeal nerve injury. Materials and Methods : Ninety-three patients who underwent thyroidectomy without laryngeal nerve injury and completed the follow-up evaluations were studied between June 2013 and December 2015. Each evaluation was performed preoperatively, as well as 1 week, 1 month postoperatively. Analysis was performed including voice handicap index (VHI), dysphagia handicap index (DHI), and acoustic voice analysis. Results : Patients show significant variation of parameters in the fundamental frequency (F), maximal phonation time (MPT), shimmer, jitter and soft phonation index (SPI) early after operation, and most of them showed recovery of parameters after 1month of operation. Perceptive complaint of voice and swallowing also showed significant decreased after operation (p<0.005). After 1month of operation, MPT, highest frequency and frequency ranges still showed significant decreased parameters. Comparing acoustic and perceptive parameters of total thyroidectomy and lobectomy, there was no significant changes between them except highest frequency (p=0.042). Conclusion : The results from both subjective and objective evaluations show voice and swallowing disturbance after thyroidectomy even in the absence of laryngeal nerve and provide patients information about the recovery process after surgery. Highest frequency parameter showed most significant changes after operation.

• 임상이비인후과
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• 제29권2호
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• pp.229-234
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• 2018

Background and Objectives : Vocal nodules occur with a 12-22% prevalence in pediatric populations. Most otolaryngologists recommend voice therapy as the primary treatment. The aim of this study is to evaluate patient compliance with voice therapy and its effect on vocal nodules in children. Materials and Methods : We retrospectively reviewed 44 pediatric patients between 3 and 11 years old diagnosed with vocal nodules between March 2015 and December 2017. We evaluated the treatment adoption rate, dropout rate during voice therapy, and reasons for dropout. For patients who completed voice therapy, we measured the changes in nodule size, perceptual parameters, and acoustic parameters. We evaluated patient satisfaction using the pediatric voice handicap index (P-VHI). Results : Of the 44 pediatric patients diagnosed with vocal nodules, 22 (50%) agreed to voice therapy. Of the 22 patients who started voice therapy, 5 (22.7%) dropped out during therapy because they were unsatisfied with their treatment. Another 4 patients discontinued therapy for reasons unrelated to treatment effectiveness. Vocal nodule disappeared or decreased in all 13 patients who completed voice therapy. All voice parameters were improved and statistically significant changes were observed in perceptual, acoustic, and P-VHI parameters. Conclusions : Although compliance to voice therapy among the pediatric patients with vocal nodules was low, there were significant improvements in voice parameters for those who completed voice therapy. A change toward a positive perception of voice therapy is necessary and a multidisciplinary approach is needed to improve the effect of voice therapy on pediatric patients with vocal nodules.

• 대한두경부종양학회지
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• 제32권1호
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• pp.7-11
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• 2016

Background and Objectives: Quality of voice may be deteriorated after thyroidectomy without any injury to recurrent laryngeal nerve. While there have been several studies showing the change of acoustic parameters after thyroidectomy, factors related to deteriorated voice quality have been rarely studies. In this study, we sought to analyze the factors associated to deteriorated voice quality after thyroidectomy. Materials and Methods: We made a retrospective review of 35 patients who underwent thyroidectomy for papillary thyroid carcinoma. Voice analysis including acoustic analysis, voice handicap index 10 (VHI-10), and GRBAS score was conducted before and 3 months after surgery. Patients were grouped according to the amount of increase in VHI-10 after surgery ; group A (${\Delta}VHI<7$) and group B (${\Delta}VHI{\geq}7$). Clinicopathologic factors associated to patients of group B were analyzed and changes of parameters from acoustic analysis in each group were evaluated. Results : Patients of group B were associated with age ${\geq}45$ years (p=0.025) and showed borderline association to total thyroidectomy (p=0.075) and tumor size ${\geq}1cm$ (p=0.086). Multivariate analysis demonstrated that those with age ${\geq}45$ years were independently associated to deteriorated quality of voice (p=0.014, HR=18.38). Patients of group B were also associated to significant deterioration of high pitch (p<0.001) and Grade score with borderline significance (p=0.054). Conclusion: Patients older than 45 years may have higher risk of deterioration of quality of voice after thyroidectomy based on increase of VHI-10 score (${\Delta}VHI{\geq}7$). Association with deterioration of high pitch should also be considered in these patients.

• 대한후두음성언어의학회지
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• 제29권1호
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• pp.37-40
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• 2018

Background and Objectives : This study aimed to evaluate patients' subjective and objective outcomes after laryngeal microsurgery for benign vocal fold (VF) lesions, and to identify usefulness of surgical treatment. Materials and Methods : The authors reviewed the 102 patients medical records, retrospectively who received laryngeal microsurgery for benign VF lesions from January 2013 to August 2017. Subjective voice were measured using the Voice Handicap Index (VHI). Objective voice were recorded with Multi-Dimensional Voice Program (MDVP) just before surgery, and after at least 3 months of surgery. Results : Benign VF lesions were categorized as VF nodule (n=34, 33%), VF Polyp (n=47, 26%), Intracordal cyst (n=15, 15%), Reinke's edema (n=6, 6%), and VF Papilloma (n=2, 2%). Post-operative voice assessment at VHI scores showed statistically significant reductions in all of functional, physical and emotional parts (p<0.001). MDVP were showed significant improvement of Jitter (P=0.001), Shimmer (p<0.001) and Noise to Harmonic Ratio (NHR) (p=0.001). Conclusion : Laryngeal microsurgery for benign vocal fold lesions is effective treatment with statistically significant improvement at subjective and objective vocal quality assessment.

• 대한후두음성언어의학회지
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• 제32권2호
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• pp.87-93
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• 2021

There are a number of voice analysis programs around the world. Domestic voice analysis is performed by relying heavily on specific commercial program. We intend to develop coding for voice analysis using Praat and apply it to clinical practice. This study consisted of Experiment 1 and Experiment 2. Experiment 1 was the development of automated voice analysis coding based on Praat. The coding was largely divided into a recording, an analysis, and a storage section. Experiment 2 was applied to the voice analysis of 2 male patients pre- and post-operation with this coding. The analysis parameters of this coding provided 26 parameters for vowel /a/, nine parameters for sentence analysis, and a total of 4 parameters for voice range profile analysis. In two male patients, the pitch and the intensity increased, the voice quality improved, and the sentence length decreased after surgery. The coding was well made, so the output was good in real time. The code is automated as much as possible to block manual errors and increases convenience and efficiency by generating the result sheet in real time.