• 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.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.27 no.2
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• pp.102-107
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• 2016

Background and Objectives : Vocal polyps are caused by inflammation induced by stress or irritation. Many patients with vocal polyps complain voice discomfort. For vocal polyps, surgery such as laryngeal microsurgery has been the mainstay of management. We analyzed the clinical features of vocal polyps, and how the size and location of vocal polyps affect the outcomes of surgery. Methods : We retrospectively reviewed 42 patients from March 2014 to December 2015, who were diagnosed as unilateral single vocal polyp. When we operated on a vocal polyp with laryngeal microscopy, we measured their size and location. The quality of voice was evaluated by GRABS scale, jitter, shimmer, NHR (noise to harmonic ratio), MPT (maximum phonation time), and VHI (voice handicap index) before operation and 4 weeks after operation. Results : When we divided the patients into large-sized vocal polyp group (the longest length >3 mm) and small-sized vocal polyp group (the longest length ${\leq}3mm$), all parameter differences tend to be greater at large sized vocal polyp. However, these differences were not statistically significant (p>0.05). When we divided into two groups depending on the volume of vocal polyp, no distinct tendency was found. When we compared the location (anterior, mid and posterior) of vocal polyp with the improvement of voice quality, more change was found at mid portion vocal polyp, except the difference of VHI. However, these differences were also not statistically significant (p>0.05). Conclusion : All parameter differences tend to be greater at large vocal polyp and polyp of the mid location.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.20 no.1
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• pp.63-67
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• 2009

Background and Objectives: In patients with asthma, increased obstruction and resistance of airway result in impairment in the generation of voice. Allergy and nasal polyposis, which are frequently observed in patients with asthma, are other factors that affect the vocal performance. Bronchodilators and steroids are commonly used in the treatment of asthma, and these agents also have been reported to be associated with voice changes. The aim of this study is to evaluate the voice quality in patients with mild to-moderate asthma by subjective and objective methods. Materials and Methods: A total of 36 patients with asthma established in the Department of Respiratory Medicine were included in this study. 23 were women and 13 were men, with a mean age of 51.7 years. The average duration of asthma was 77.0 months. All patients had mild-to moderate asthma. Acoustic and aerodynamic analyses were performed and the movements of the vocal cords were examined by videolaryngostroboscopy (VLS). Voice Handicap Index (VHI) and GRABS scales were used for subjective evaluations. Results: 50% of patients suffered from dysphonia and FO was 119.3${\pm}$23.7 Hz in male and 198.2${\pm}$18.4 Hz in female patients. There were no significant differences in average shimmer and NHR between females (4.90${\pm}$2.95% ; 0.1O${\pm}$0.04 dB) and males (4.64${\pm}$2.45% ; 0.20${\pm}$0.15 dB). However, the value of jitter was greater for females (2.60${\pm}$1.92%) than for males (1.21${\pm}$0.84%). The VHI score was above the normal limit in 35%, and VLS findings were shown diverse abnormality in 89% asthmatics from mucosal change to hyperfunction of supragottis and contact granuloma. But duration of illness and steroid dose did not correlate with these findings. Conclusion: Subjective and objective abnormality was shown in more than 50% of asthmatic patients. We suggest that persons who suffer from asthma should be examined for possible voice disorders by laryngologist. Additionally, appropriate medical care and voice therapy should be provided for those who have voice disorders associated with asthma.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.26 no.2
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• pp.117-121
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• 2015

Background : Cepstral analysis which is obtained from Fourier transformation of spectrum has been known to be effective indicator to analyze the voice disorder. To evaluate the voice disorder, phonation of sustained vowel /a/ sound or continuous speech have been used but the former was limited to capture hoarseness properly. This study is aimed to compare the effectiveness in analysis of cepstrum between the sustained vowel /a/ sound and continuous speech. Methods : From March 2012 to December 2014, total 72 patients was enrolled in this study, including 24 unilateral vocal cord palsy, vocal nodule and vocal polyp patients, respectively. The entire patient evaluated their voice quality by VHI (Voice Handicap Index) before and after treatment. Phonation of sustained vowel /a/ sample and continuous speech using the first sentence of autumn paragraph was subjected by cepstral analysis and compare the pre-treatment group and post-treatment group. Results : The measured values of pre and post treatment in CPP-a (cepstral peak prominence in /a/ vowel sound) was 13.80, 13.91 in vocal cord palsy, 16.62, 17.99 in vocal cord nodule, 14.19, 18.50 in vocal cord polyp respectively. Values of CPP-s (cepstral peak prominence in text-based speech) in pre and post treatment was 11.11, 12.09 in vocal cord palsy, 12.11, 14.09 in vocal cord nodule, 12.63, 14.17 in vocal cord polyp. All 72 patients showed subjective improvement in VHI after treatment. CPP-a showed statistical improvement only in vocal polyp group, but CPP-s showed statistical improvement in all three groups (p<0.05). Conclusion : In analysis of cepstrum, text-based analysis is more representative in voice disorder than vowel sound speech. So when the acoustic analysis of voice by cepstrum, both phonation of sustained vowel /a/ sound and text based speech should be performed to obtain more accurate result.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.33 no.3
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• pp.166-171
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• 2022

Background and Objectives Vocal fold (VF) scar is known to be the most common cause of dysphonia after laryngeal microsurgery (LMS). Steroids reduce postoperative scar formation by inhibiting inflammation and collagen deposition. However, the clinical evidence of whether steroids are helpful in reducing VF scar formation after LMS is still lacking. The purpose of this study is to determine whether intralesional VF steroid injection after LMS helps to reduce postoperative scar formation and voice quality. Materials and Method This study was conducted on 80 patients who underwent LMS for VF polyp, Reinke's edema, and leukoplakia. Among them, 40 patients who underwent VF steroid injection after LMS were set as the injection group, and patients who had similar sex, age, and lesion size and who underwent LMS alone were set as the control group. In each group, stroboscopy, multi-dimensional voice program, Aerophone II, and voice handicap index (VHI) were performed before and 1 month after surgery, and the results were statistically analyzed. Results There were no statistically significant differences in the distribution of sex, age, symptom duration, occupation and smoking status between each group. Both groups consisted of VF polyp (n=21), Reinke's edema (n=11), and leukoplakia (n=9). On stroboscopy, the lesion disappeared after surgery, and the amplitude and mucosal wave were symmetrical on both sides of the VFs in all patients. Acoustic parameters and VHI significantly improved after surgery in all patients. However, there was no significant difference between the injection and control group in most of the results. Conclusion There was no significant difference in the results of stroboscopy, acoustic, aerodynamic, and subjective evaluation before and after surgery in the injection group and the control group.

• Journal of Korean Medical Ki-Gong Academy
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• v.23 no.1
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• pp.10-29
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• 2024

Objective : The purpose of this study is to determine whether An's breathing meditation qigong therapy (ABMQT) delivers bioenergy to the frontal lobe, prefrontal lobe, the olfactory tract in the mesolimbic pathway, olfactory bulb, CV22, CV21, olfactory area and vocal-related areas in Parkinson's disease (PD) patients to help improve olfactory disorders (anosmia) and vocal functions. Methods : The subjects of this study were 4 patients with idiopathic PD (3 males/1 female, 65.0±NA/68.7±10.2 years old). ABMQT was applied once a week, 120 minutes per session for 12 weeks in a non-invasive and noncontact manner, and the test before and after ABMQT application included olfactory impairment test the Korean version of Sniffin' stick test (KVSS), voice acoustic test, aerodynamic test, vocal handicap index (VHI-30), and auditory perception scale test tools. The results before and after the experiment were analyzed assuming a normal distribution, and a chi-square test was performed using a continuity correction, and the significance level was set to p<0.05. And the medical diagnosis and findings of the examiner (doctor in charge) before and after the experiment were described. Results : KVSS was significant as 0.2±0.5 and 9.0±0.0 before and after the experiment. There was no significant difference between the voice acoustic test FO and Jitter, the vocal aerodynamic test MPT, SP, AE, the vocal disorder index test, and the auditory perception test. However, the medical diagnosis findings of four study subjects showed that olfactory disorders, voice disorders, and laryngeal function were improved before and after the application of ABMQT. Conclusions : The breathing meditation qigong program showed significant effects on improving the olfactory disorders (anosmia) and speech function of each study subject. However, to produce meaningful results, it is thought that experiments involving a larger number of research participants are necessary, and additional blood and FMRI tests are conducted to verify metabolic activities and the olfactory neuron signal transmission system.

• Phonetics and Speech Sciences
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• v.10 no.3
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• pp.49-59
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• 2018

The purpose of this study was to investigate vocal hygiene habits and Korean Voice-Related Quality of Life (K-VRQOL) among classical singers. A total of 128 classical singers filled an online voice and K-VRQOL questionnaire, and the results were analyzed. In order to investigate the characteristics of K-VRQOL according to age groups, and the presence or absence of a history of voice problems, we conducted a two-way ANOVA. The results are as follows. Of the 128 classical singers, 28 (21.9%) with a history of voice problems said that excessive conversation, singing practice, and yelling were the causes of their voice problems. The symptoms of voice problems were fatigue, loss of range, hoarseness, and breathiness. In addition, classical singers were less likely to smoke, or to drink alcohol or caffeine. The K-VRQOL was highly correlated with all sub-domains. There was a statistically significant difference according to age groups (p<.05) and history of voice problems (p<.01). There was no correlation between age groups and history of voice problems. Voice management is important because classical singers can ruin their voice by speaking, and the risk of voice disorder is high. Voice problems affect quality of life. In future studies, it is necessary to obtain information on the subjective voice characteristics of classical singers by examining the relationship between their voice hygiene habits and VHI, SVHI, and K-VRQOL.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.30 no.2
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• pp.87-94
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• 2019

The purpose of this study was to investigate the speech characteristics and speech therapy of Parkinson disease (PD). This study selected 28 papers published in Korea from 1998 to 2018 after searching the terms 'Parkinson voice' and 'Parkinson speech therapy.' Literature review had been conducted in the two aspects of speech characteristics and speech therapy. The speech characteristics were divided into respiration, phonation, articulation, prosody, vowel production, and voice questionnaire. Speech therapy was divided into Lee Sliverman voice treatment (LSVT) and other voice therapy. PD patients did not differ in respiration function compared to normal elderly people, but their speech and articulation function were poorer. There was also a difference in the speech rate, frequency of pause, and accuracy of vowel production compared with normal elderly people. PD had a lower VHI score and their voice related quality of life was a little poorer. The LSVT was typically used in speech therapy for PD. The methods of speech therapy for PD have been shown to improve respiration and phonation. It is necessary to establish voice norms in PD patients and develop effective speech therapy in the following study.

• Phonetics and Speech Sciences
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• v.9 no.4
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• pp.99-106
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• 2017

Clinical data about vocal nodules have seldom been reported, even though vocal nodules are commonly diagnosed in outpatient speech and voice clinic. This study aims to investigate clinical characteristics of the patients who are diagnosed with vocal nodules. This study analyzed the data for 10 years from the 319 patients diagnosed with vocal nodules (45 males and 274 females with the mean age of 39.4 ranging from 2 to 83) in terms of gender, age, occupation, voice change initiation pattern, change with time, throat clearing, smoking history, type of voice abuse, acoustic analysis, maximum phonation time, GRBAS, and VHI. Thirteen patients (4.08%) had unilateral vocal nodule and 306 patients (95.9%) had bilateral vocal nodule, the majority of which had a pattern of asymmetry (73.9%). The glottal closure pattern was hourglass in 72.1% of patients, posterior chink in 17.9% of patients, and irregular in 7.9% of patients. The most common occupational category was professional voice users (43.4%). The voice abuse pattern included excessive talking in 96 patients (76.8%), loud voice in 78 (62.4%) patients, and excessive singing in 17 patients (21.6%). The patients showed worse scores in G, B, and S than in R and A for the GRBAS evaluation. The most recommended treatment for vocal nodules was voice therapy. The current clinical data will be helpful for treatment planning for the patients of vocal nodule.

• Phonetics and Speech Sciences
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• v.8 no.2
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• pp.57-63
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• 2016

Recently, the Lax Vox voice therapy has been used as one of the SOVTE(Semi-Occluded Vocal Tracts Exercise). The purpose of this study was to explore the effect of Lax Vox voice therapy for a patient with Spasmodic dysphonia on voice improvement. One female spasmodic dysphonia patient(age=27) who had been diagnosed by a laryngologist received Lax Vox voice therapy. The Lax Vox protocol was configured as 5 steps (1 warm-up and 4 steps : bubbling without / with phonation/ gliding with phonation/ generalization) in this study. A total of 11 sessions were performed by a certified speech language pathologist. The present study evaluated the acoustic, aerodynamic, auditory perceptual, and patient's self-rating between pre-, mid-, and post- voice therapy. All objective and subjective parameters were improved after voice therapy; Reduced frequency variation, increased maximum phonation time, enlarged voice range, improved 'G' and 'S' in GRBAS & USDRS, and reduced VHI were observed. Especially, decreased $f_0$ and remarkably reduced voice tremor were also demonstrated following Lax Vox voice therapy. Accordingly, Lax Vox voice therapy technique can be useful for improving voice and quality of life in patients with spasmodic dysphonia.