METHODS: The study included 382 participants (252 normal voices and 130 dysphonic voices) in the proposed database MVPD. Complete data were obtained for both groups, including voice samples, laryngostroboscopy videos, and acoustic analysis. The diagnoses of patients with dysphonia were obtained. Each voice sample was anonymized using a code that was specific to each individual and stored in the MVPD. These voice samples were used to train and test the proposed OSELM algorithm. The performance of OSELM was evaluated and compared with other classifiers in terms of the accuracy, sensitivity, and specificity of detecting and differentiating dysphonic voices.
RESULTS: The accuracy, sensitivity, and specificity of OSELM in detecting normal and dysphonic voices were 90%, 98%, and 73%, respectively. The classifier differentiated between structural and non-structural vocal fold pathology with accuracy, sensitivity, and specificity of 84%, 89%, and 88%, respectively, while it differentiated between malignant and benign lesions with an accuracy, sensitivity, and specificity of 92%, 100%, and 58%, respectively. Compared to other classifiers, OSELM showed superior accuracy and sensitivity in detecting dysphonic voices, differentiating structural versus non-structural vocal fold pathology, and between malignant and benign voice pathology.
CONCLUSION: The OSELM algorithm exhibited the highest accuracy and sensitivity compared to other classifiers in detecting voice pathology, classifying between malignant and benign lesions, and differentiating between structural and non-structural vocal pathology. Hence, it is a promising artificial intelligence that supports an online application to be used as a screening tool to encourage people to seek medical consultation early for a definitive diagnosis of voice pathology.
METHODS: The study population consisted of 53 participants, 23 patients with BVFI after endolaryngeal laser posterior cordectomy and 30 healthy volunteers. All of them had body plethysmography (airway resistance, Raw), spirometry (ratio of forced expiratory flow at 50% to forced inspiratory flow at 50%, FEF50/FIF50 and peak inspiratory flow, PIF), 6 min-walking-test (6MWT) and Medical Research Council (MRC) dyspnea scale measurements. The tests were repeated and reliability was evaluated using intraclass correlation (ICC) and Spearman correlation.
RESULTS: The reliability of Raw was high with ICC of 0.92, comparable to the spirometry measurements: FEF50/FIF50(ICC = 0.72) and PIF (ICC = 0.97). The mean of Raw was significantly higher in patient group. A strong significant correlation between Raw and MRC dyspnea scale (r = 0.79; p<0.05) and a moderate negative correlation between Raw and 6MWT (r = 0.4; p<0.05) was demonstrated.
CONCLUSION: Body plethysmography (Raw) is a reliable tool in objective measurement of upper airway resistance that reflects the patient's perception of breathlessness. A larger number of participants are necessary to confirm this finding.
Methods: 383 snores from 40 participants who complained of snoring were digitally recorded during natural and induced sleep using a level III polysomnography monitor with a built-in microphone. During drug-induced sleep endoscopy (DISE), the real-time site of upper airway obstruction was assessed, and the sound frequency of snoring was recorded synchronously.
Results: The mean peak of snoring frequency for unilevel palatal, oropharynx and epiglottis obstruction were 522.5, 482.4 and 300.0 Hz, respectively. Most participants showed multilevel obstruction at the palate and oropharynx, in which the mean for bi-peak snoring frequency were 402.90 Hz and 1086.96 Hz, respectively. Severity of OSA was significantly associated with multilevel obstruction.
Conclusions: There was a significant association between the snoring sound frequency and site of unilevel obstruction. Palatal or oropharyngeal obstruction produced sound at mid-frequency range, while the epiglottis produced a low frequency range. Multilevel obstruction documented a bi-peak snoring frequency.
MATERIALS AND METHODS: This cross-sectional study was carried out in the Otorhinolaryngology, Head and Neck Surgery Department of Universiti Kebangsaan Malaysia Medical Centre (UKMMC) from June 2015 to May 2016. The mVHI-10 was produced following a rigorous forward and backward translation. One hundred participants, including 50 healthy volunteers (17 male, 33 female) and 50 patients with voice disorders (26 male, 24 female), were recruited to complete the mVHI-10 before flexible laryngoscopic examinations and acoustic analysis. The mVHI-10 was repeated in 2 weeks via telephone interview or clinic visit. Its reliability and validity were assessed using interclass correlation.
RESULTS: The test-retest reliability for total mVHI-10 and each item score was high, with the Cronbach alpha of >0.90. The total mVHI-10 score and domain scores were significantly higher (P
OBJECTIVES: This study aimed to translate and validate a Bahasa Malaysia version of SECEL (mSECEL) using a validated framework of transcultural adaptation.
METHODS: This cross-sectional study was conducted in the Otorhinolaryngology, Department of Universiti Kebangsaan Malaysia Medical Centre from February 2019 to May 2020. The mSECEL was produced following a rigorous forward and backward translation. Eighty-three laryngectomees (78 male, five female) using various methods of alaryngeal communication (47 voice prosthesis, 29 electrolarynx, three esophageal speech and four pen and paper), completed the mSECEL and mVHI-10 before head and neck and flexible laryngoscopic examinations. The mSECEL was repeated in 2 weeks via telephone interview or clinic visit. Its reliability was assessed using intraclass correlation. The Pearson product-moment correlation test was used to analyze correlation between the mSECEL and mVHI-10.
RESULTS: The mSECEL questionnaire showed strong internal consistency with the Cronbach alpha of >0.90 for total score, Environmental and Attitude subscale. The test-retest reliability for total mSECEL score was high with the intraclass correlation of 0.97. There was a highly significant positive correlation between the mSECEL total score and mVHI-10 (P < 0.001). Items in the General subscale showed poorer internal consistency with Cronbach alpha ranging 0.55-0.46 and poor correlation with mVHI-10.
CONCLUSIONS: The Bahasa Malaysia version of the SECEL measure is a valid and reliable instrument to evaluate communication perception after laryngectomy. Future studies should consider subscale validation and further abbreviation of its items to make this measure clinically relevant.
DESIGN: Cross sectional reliability study.
SETTING: University teaching hospital.
METHODS: Fifty healthy volunteers and 50 voice disorder patients had supervised recordings in a quiet room using OperaVOX by the iPod's internal microphone with sampling rate of 45 kHz. A five-seconds recording of vowel/a/was used to measure fundamental frequency (F0), jitter, shimmer and noise-to-harmonic ratio (NHR). All healthy volunteers and 21 patients had a second recording. The recorded voices were also analysed using the MDVP. The inter- and intrasoftware reliability was analysed using intraclass correlation (ICC) test and Bland-Altman (BA) method. Mann-Whitney test was used to compare the acoustic parameters between healthy volunteers and patients.
RESULTS: Nine of 50 patients had severe aperiodic voice. The ICC was high with a confidence interval of >0.75 for the inter- and intrasoftware reliability except for the NHR. For the intersoftware BA analysis, excluding the severe aperiodic voice data sets, the bias (95% LOA) of F0, jitter, shimmer and NHR was 0.81 (11.32, -9.71); -0.13 (1.26, -1.52); -0.52 (1.68, -2.72); and 0.08 (0.27, -0.10). For the intrasoftware reliability, it was -1.48 (18.43, -21.39); 0.05 (1.31, -1.21); -0.01 (2.87, -2.89); and 0.005 (0.20, -0.18), respectively. Normative data from the healthy volunteers were obtained. There was a significant difference in all acoustic parameters between volunteers and patients measured by the Opera-VOX (P
METHODS: Two middle-aged women with vagal paraganglioma undergoing an excision operation underwent immediate selective laryngeal reinnervation using the phrenic nerve and ansa cervicalis as the donor nerve. Multidimensional outcome measures were employed pre-operatively, and at 1, 6 and 12 months post-operatively.
RESULTS: The voice handicap index-10 score improved from 23 (patient 1) and 18 (patient 2) at 1 month post-operation, to 5 (patient 1) and 1 (patient 2) at 12 months. The Eating Assessment Tool 10 score improved from 20 (patient 1) and 24 (patient 2) at 1 month post-operation, to 3 (patient 1) and 1 (patient 2) at 12 months. There was slight vocal fold abduction observed in patient one and no obvious abduction in patient two.
CONCLUSION: Selective reinnervation is safe to perform following vagal paraganglioma excision conducted on the same side. Voice and swallowing improvements were demonstrated, but no significant vocal fold abduction was achieved.
METHODS: This is a cross-sectional study that included 66 subjects: 46 symptomatic and 20 asymptomatic of suspected LPR based on the reflux symptom index (RSI). Subjects underwent flexible video laryngoscopic evaluation of the larynx utilising both WLE and i-scan during one continuous exam. Subjects also underwent 24-hour oropharyngeal pH-monitoring (Dx-pH). Two laryngologists and two general otolaryngologists evaluated the anonymized videos independently using RFS. Dx-pH results were interpreted using the pH graph, report and RYAN score. Subjects were then designated into one of three groups: no reflux, acid reflux and alkaline reflux.
RESULTS: For the symptomatic group, no mucosal irregularities or early mucosal lesions were observed except in one subject who had granulation tissue. The mean RFS using WLE and i-scan were, respectively: 11.8 (SD 6.1) and 11.3 (SD 5.6) in symptomatic and 7.3 (SD 5.7) and 7.3 (SD 5.2) in asymptomatic group. The inter-rater agreement of RFS using WLE and i-scan for both groups were good with intraclass correlation, ICC of 0.84 and 0.88 (laryngologists); and 0.85 and 0.81 (ORL). The intra-rater agreement among all four raters were good to excellent and similar for both WLE and i-scan (ICC of 0.80 to 0.99). 47 of 66 subjects had evidence of LPR on Dx-pH results which more specifically showed 39 subjects had "acid reflux" and 8 had "alkaline reflux". Sixteen subjects demonstrated a positive RYAN score but showed none were significantly correlated with their RFS.
CONCLUSIONS: This study reports the first utilization of real-time video chromoendoscopy with i-scan technology through high-definition flexible endoscopes to attempt to characterize laryngopharyngeal findings in patients suspected of having LPR. Both general otolaryngologists and laryngologists were equally capable of reliably calculating the RFS using both WLE and i-scan, however no significant improvement in agreement or change in RFS was found when i-scan technology was employed.
LEVEL OF EVIDENCE: Level 2.