Patient Self-Assessment and Acoustic Voice Analysis in Screening of Postoperative Vocal Fold Paresis and Paralysis

Background and Aims: The aim of this study was to evaluate the utility of two items in vocal fold paresis and paralysis screening after thyroid and parathyroid surgery: patient self-assessment of voice using the Voice Handicap Index and computer-based acoustic voice analysis using the Multi-Dimensional Voice Program. Materials and Methods: This was a prospective study of 181 patients who underwent thyroid or parathyroid surgery over a 1-year study period (2017). Preoperatively, all patients underwent laryngoscopic vocal fold inspection and acoustic voice analysis, and they completed the Voice Handicap Index questionnaire. Postoperatively, all patients underwent laryngoscopy prior to hospital discharge; 2 weeks after the surgery, they completed the Voice Handicap Index questionnaire a second time. Two weeks postoperatively, patients with vocal fold paresis or paralysis and 20 randomly selected controls without vocal fold paresis or paralysis underwent a follow-up acoustic voice analysis. Results: Fourteen patients had a new postoperative vocal fold paresis or paralysis. Postoperatively, the total Voice Handicap Index score was significantly higher (p = 0.040) and the change between preoperative and postoperative scores was greater (p = 0.028) in vocal fold paresis or paralysis patients. A total postoperative Voice Handicap Index score > 30 had 55% sensitivity, and 90% specificity, for vocal fold paresis or paralysis. In the postoperative Multi-Dimensional Voice Program analysis, vocal fold paresis or paralysis patients had significantly more jitter (p = 0.044). Postoperative jitter > 1.33 corresponded to 55% sensitivity, and 95% specificity, for vocal fold paresis or paralysis. Conclusion: In identifying postoperative vocal fold paresis or paralysis, patient self-assessment and jitter in acoustic voice analysis have high specificity but poor sensitivity. Without routine laryngoscopy, approximately half of the patients with postoperative vocal fold paresis or paralysis could be overlooked. However, if the patient has no complaints of voice disturbance 2 weeks after thyroid or parathyroid surgery, the likelihood of vocal fold paresis or paralysis is low.

Perceptual Assessment and Acoustic Voice Analysis as Screening Tests for Vocal Fold Paresis After Thyroid or Parathyroid Surgery

Background The aim of this study was to evaluate the reliability of clinician-based perceptual assessment of voice and computerized acoustic voice analysis as screening tests for vocal fold paresis or paralysis (VFP) after thyroid and parathyroid surgery. Methods This was a prospective study of 181 patients undergoing thyroid or parathyroid procedure with pre and postoperative laryngoscopic vocal fold inspection, perceptual voice assessment using grade, roughness, breathiness, asthenia, and strain (GRBAS) scale and acoustic voice analysis using the multi-dimensional voice program (MDVP). Patients were divided into 2 groups for comparison; those with new postoperative VFP and those without. Potential screening tools were evaluated using the receiving operating characteristic (ROC) analysis. Results Fourteen (6.6%) patients had a new postoperative VFP. Postoperative GRBAS scores were significantly (P < 0.05) higher in patients with VFP compared to those without. However, there were no statistically significant differences in MDVP values between the groups. Postoperative GRBAS grade score (cut off > 0) had the best sensitivity, 93%, for predicting VFP, but the specificity was only 50%. Postoperative jitter (cut off > 1.60) in MDVP had a good specificity, 90%, but only 50% sensitivity. Combining all the GRBAS and MDVP variables with P < 0.05 in the ROC analysis yielded a test with 100% sensitivity and 55% specificity. Conclusions Physician-based perceptual voice assessment has a high sensitivity for detecting postoperative VFP, but the specificity is poor. The risk of VFP is low in patients with completely normal voice at discharge. However, routine laryngoscopy after thyroid and parathyroid surgery is still the most reliable exam for VFP screening.

ACOUSTIC VOICE ANALYSIS IN TYPICAL MALAYALAM SPEAKING MENOPAUSAL INDIVIDUAL

Voice is that the sound produced during a person’s larynx and uttered through the mouth, as speech or song. Voice is generated by airflow from the lungs because the vocal folds are brought approximately. When air is pushed past the vocal folds with sufficient pressure vocal folds vibrate and make sound. Menopause is defined because the purpose at the time when the cycle permanently ceases because of natural depletion of ovarian oocytes from aging. PRAAT could also be a really flexible tool to undertake to do speech analysis. The PRAAT software is made by Boersma and Weeniak from university of Amsterdam [1992]. The aim of the study was to live and describe the changes and acoustic voice analysis in typical Malayalam speaking menopause individual within the age range between 50 to 70 years using PRAAT software. The subjects were seated and therefore the recordings were made employing a microphone attached to a Del laptop in a quiet noise free illuminated environment. The microphone was placed at a distance of 8-10cm from the subject mouth. Subjects were asked to take a deep breath and phonate /a/, /i/, /u/ as long as possible at a comfortable pitch level. This was demonstrated by examiner for all subjects. The result shows that the highest mean pitch for vowel /u/. The highest mean minimum pitch for menopausal female observed for vowel /u/. The highest mean maximum pitch for menopausal female was observed for vowel /u/. The highest mean jitter and shimmer value for menopausal female was observed for vowel /u/. The highest mean NHR value of menopausal female was observed for vowel /u/. But the highest mean HNR value of menopausal female was observed for value /i/.In conclusion, the acoustic parameter tested that is [mean pitch, minimum pitch, maximum pitch, jitter, shimmer, NHR] the highest mean value of menopause female was observed for vowel /u/ but in HNR the highest mean value was observed for vowel /i/. And the lowest mean value for all the parameter [mean pitch, minimum pitch, maximum pitch, jitter, shimmer, HNR] except NHR was observed for vowel /a/ in menopausal female. For NHR the lowest mean value was observed for vowel /i/.