Citations

AbstractFor children with voice disorders, access to care has long been a challenge. Reasons for this include the challenge of qualifying children with isolated voice disorders for services within the public-school system as well as a family's geographic proximity to experienced clinicians who are in the healthcare system. Over the past decade, there have been both formal and informal investigations into the use of telepractice to deliver services to communicatively disordered children and adults, including those with voice disorders. Although barriers and obstacles existed, use of telepractice to deliver such services demonstrated both feasibility and, in some studies, effective outcomes. However, prior to spring of 2020, use of telepractice to deliver speech pathology services was not mainstream. This changed when the nation was forced to shut down many of its in-person healthcare and educational delivery due to the COVID-19 pandemic. This article summarizes select relevant literature pertaining to the use of telepractice in speech language pathology over the past decade and provides a case-based discussion of how it was and is currently being used to deliver pediatric voice care.

Investigating the phonatory processes in connected speech from high-speed videoendoscopy (HSV) demands the accurate detection of the vocal fold edges during vibration. The present paper proposes a new spatio-temporal technique to automatically segment vocal fold edges in HSV data during running speech. The HSV data were recorded from a vocally normal adult during a reading of the “Rainbow Passage.” The introduced technique was based on an unsupervised machine-learning (ML) approach combined with an active contour modeling (ACM) technique (also known as a hybrid approach). The hybrid method was implemented to capture the edges of vocal folds on different HSV kymograms, extracted at various cross-sections of vocal folds during vibration. The k-means clustering method, an ML approach, was first applied to cluster the kymograms to identify the clustered glottal area and consequently provided an initialized contour for the ACM. The ACM algorithm was then used to precisely detect the glottal edges of the vibrating vocal folds. The developed algorithm was able to accurately track the vocal fold edges across frames with low computational cost and high robustness against image noise. This algorithm offers a fully automated tool for analyzing the vibratory features of vocal folds in connected speech.

Objectives/HypothesisThe male singing voice through puberty undergoes many changes that present challenges for the singer and choral director. The purpose of this study was to discuss the endoscopic findings seen in prepubescent choir singers.Study DesignSingle‐institution prospective study.MethodsSubjects were recruited from the Cincinnati Boychoir and were described as Cooksey stage unchanged or mid‐voice I, as described by the Boychoir artistic director. Vocal history was obtained via questionnaire at the initial visit. Subjects with known laryngeal pathologies were excluded. Endoscopic laryngeal examinations were performed using videoendoscopy. During examination, each subject sang four discrete frequencies. Findings of the endoscopic exam were judged by a board‐certified pediatric otolaryngologist specializing in pediatric voice.ResultsWe evaluated 28 subjects prior to vocal maturation. Their age range was 8 to 13 years old (mean = 10.2 ± 1.2 years). The singing voice category of all 28 subjects was described as soprano vocal range by the Boychoir artistic director. The subjects had a mean of 1.7 ± 1.1 years in the Boychoir (0–5 years). None reported history of vocal issues or voice problems in the past; seven (25%) subjects had vocal fold lesions seen at one or more frequencies; 24 (85%) subjects had a posterior gap seen at one or more frequencies. Two subjects (7%) had a posterior gap at one frequency, C3 and G3, respectively. Five subjects (18%) had a posterior gap at two frequencies, seven subjects (25%) at three frequencies, and 10 subjects (36%) in all four frequencies.ConclusionsOur study aimed to describe the laryngeal examination of dedicated Boychoir singers prior to undergoing pubertal development and vocal maturation. In elite pediatric singers we found that vocal nodules are common (25%) and are not correlated with vocal symptoms. These findings may suggest that asymptomatic lesions may be more prevalent than previously thought. In these individuals, posterior glottic gap is common and can be considered a normal glottal configuration.Level of Evidence4 Laryngoscope, 131:592–597, 2021

Objectives/HypothesisDescribe the preoperative evaluation of patients with glottic diastasis who are candidates for endoscopic posterior cricoid reduction (EPCR) and their perioperative and postoperative surgical and voice outcomes, and validate the aerodynamic benefit of EPCR using computation fluid dynamics (CFD)‐based modeling from computed tomography (CT) scans.Study DesignRetrospective case series.MethodsThirteen patients who underwent EPCR were followed from 2013 to 2017. They received a preoperative voice evaluation, microlaryngoscopy and bronchoscopy, dynamic voice CT (performed on patients seen from 2014 to study completion), and postoperative voice evaluation (n = 12). Postoperative inpatient days, complications, and postoperative endoscopic intervention were collected. To validate the aerodynamic benefit of EPCR, CFD modeling was carried out on one patient.ResultsThirteen patients (nine females, nine with intubation injury, and four with post–airway reconstruction dysphonia) underwent EPCR at a mean age of 11.0 years. The mean preoperative and postoperative Pediatric Voice handicap Index scores were 53.8 and 33.8, respectively (P = .006). Mean maximum phonation time preoperatively and postoperatively was 5.3 and 6.7, respectively (P = .04). Of eight patients who underwent preoperative CT imaging, all demonstrated a posterior gap. Modeling demonstrated a change in flow and pressure. The mean hospital stay was 2.4 days. Nine patients underwent postoperative endoscopic intervention, and one experienced a complication that resolved with intervention.ConclusionsPatients who underwent EPCR for dysphonia following intubation or airway reconstruction showed improvements in vocal efficiency, loudness, and perceived voice handicapping. Their hospital stay was brief, with few complications. CFD modeling corroborated these clinical findings. EPCR thus warrants consideration in the management of patients with posterior glottic diastasis.Level of Evidence4 Laryngoscope, 129:S1–S9, 2019

Studying voice production during running speech can provide new knowledge about the mechanisms of voice production with and without disorder. Laryngeal high-speed videoendoscopy (HSV) systems are powerful tools for studying laryngeal function and, if coupled with flexible fiberoptic endoscopes, they can provide unique possibilities to measure vocal fold vibration with high temporal resolution during connected speech. Hence, we can measure the non-stationary behaviors of the vocal folds, such as the glottal attack and offset times in running speech. In this study, a custom-built flexible fiberoptic HSV system was used to record a “Rainbow Passage” production from a vocally normal female. Automated temporal and spatial segmentation algorithms were developed to determine the time stamps of the vibrating vocal folds and the edges of the vocal folds during phonation. The glottal attack time and offset times were then measured from the temporally and spatially segmented HSV images. The amplification ratio was computed during the phonation onset and the damping ratio was calculated at the offset of sustained portion of phonation. These measures can be used to describe the laryngeal mechanisms of voice production in connected speech.

Purpose: This article describes the design and implementation of a web-based portal developed to provide supported home practice between weekly voice therapy sessions delivered through telehealth to children with voice disorders. This in-between care consisted of supported home practice that was remotely monitored by speech-language pathologists (SLPs). Methods: A web-based voice therapy portal (VTP) was developed as a platform so participants could complete voice therapy home practice by an interdisciplinary team of SLPs (specialized in pediatric voice therapy), telehealth specialists, biomedical informaticians, and interface designers. The VTP was subsequently field tested in a group of children with voice disorders, participating in a larger telehealth study. Results: Building the VTP for supported home practice for pediatric voice therapy was challenging, but successful. Key interactive features of the final site included 11 vocal hygiene questions, traditional voice therapy exercises grouped into levels, audio/visual voice therapy demonstrations, a store-and-retrieval system for voice samples, message/chat function, written guidelines for weekly therapy exercises, and questionnaires for parents to complete after each therapy session. Ten participants (9–14 years of age) diagnosed with a voice disorder were enrolled for eight weekly telehealth voice therapy sessions with follow-up in-between care provided using the VTP. Conclusion: The development and implementation of the VTP as a novel platform for the delivery of voice therapy home practice sessions were effective. We found that a versatile individual, who can work with all project staff (speak the language of both SLPs and information technologists), is essential to the development process. Once the website was established, participants and SLPs effectively utilized the web-based VTP. They found it feasible and useful for needed in-between care and reinforcement of therapeutic exercises.