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Our preliminary work contains encouraging outcome trends that may point to positive outcome longevity regarding voice quality in patients treated with serial PRP injections. Continued patient follow-up and enroll- ment will further elucidate the therapeutic role of PRP in laryngology. Determining the safety of PRP trea... |
The trial contains clear limitations. The subjective nature of patient-reported voice outcomes limits the scope of meaningful conclusions about the procedure’s long- term efficacy. To that end, patient experiences need to be correlated to objective anatomical changes and voice parameters. By the current trial design, p... |
CONCLUSION: The absence of any reported safety events during the application and follow-up period for 43 unilateral vocal fold injections using PRP indicates its safety for use in the ambulatory care setting. The standardized approach of PRP preparation and application to the vocal folds rep- resents a safe therapeutic... |
Title: A Machine-Learning Algorithm for the Automated Perceptual Evaluation of Dysphonia Severity |
Summary: Objectives. Auditory-perceptual assessments are the gold standard for assessing voice quality. |
This project aims to develop a machine-learning model for measuring perceptual dysphonia severity of audio samples consistent with assessments by expert raters. |
Methods. The Perceptual Voice Qualities Database samples were used, including sustained vowel and Consensus Auditory-Perceptual Evaluation of Voice sentences, which were previously expertly rated on a 0–100 scale. The OpenSMILE (audEERING GmbH, Gilching, Germany) toolkit was used to extract acoustic (Mel-Frequency Ceps... |
Results. This algorithm has a high correlation (r = 0.847) with estimates of expert raters. The root mean square error was 13.36. Increasing signal complexity resulted in better estimation of dysphonia, whereby combining the features outperformed WA, S, and V sets individually. |
Conclusion. A novel machine-learning algorithm was able to perform perceptual estimates of dysphonia severity using standardized audio samples on a 100-point scale. This was highly correlated to expert raters. This suggests that ML algorithms could offer an objective method for evaluating voice samples for dysphonia se... |
Key Words: Machine learning–Voice evaluation–Perceptual voice evaluation–Automation–Artificial intelligence. |
BACKGROUND: Structured voice evaluation is a critical component of assessing patients with dysphonia. Comprehensive assessment typically includes both perceptual and instrumental assessments. Auditory-perceptual analysis represents the gold standard for the assessment of dysphonia severity. It is inexpensive and robust... |
METHODS This study was designed using a previously labeled data set to train a machine-learning model. The Perceptual Voice Qualities Database (PVQD) includes audio samples (n = 295) which were professionally captured at participating voice centers. These samples include sustained vowels and connected speech (CAPE-V se... |
RESULTS: The algorithm developed for this study was found to have a high correlation (r = 0.847) with estimates of expert raters when combining features of the three audio sets as shown in Table 1. The model showed enhanced performance when exposed to the augmented dataset that is comprised of combined features from (S... |
DISCUSSION: Voice evaluations are a crucial part of evaluating laryngology patients. The current gold standard for voice evaluation is through auditory-perceptual assessments performed on recorded audio samples collected during the process of in-person office visits. Furthermore, expert voice raters are required for pe... |
In this study, the authors have sought to develop an algorithm for automating portions of the auditory-perceptual evaluation of voice, namely Overall Severity. The high correlation coefficient and intra-class correlation with expert raters in the voice samples of the PVQD database indicate this algorithm is able to acc... |
As far as the selection of the features and data sets, this was determined during the training of the model. The 5-fold cross-validation process revealed that the combined audio set was the most highly correlated and had the lowest RMSE of the group (WA, V, and S). In more detail, after performing feature selection on ... |
An area in that we saw the model stray from the experts was with the normal and severe ranges of the CAPE-V system. These edge cases were more likely to be classified as mildly or moderately dysphonic instead of normal and severe respectively. Further study of normal and severely dysphonic samples would be important to... |
This study is limited by the development of this algorithm using the high-quality, professionally captured audio samples of the PVQD. This data set is small (n = 295), which represents one limitation of the study’s generalizability and future studies should include a higher number of samples for assessment of the model... |
CONCLUSIONS: This study represents a significant step toward the automation of dysphonia severity evaluations. The machine learning algorithm developed in this study has shown remarkable consistency with expert raters in evaluating the overall severity of dysphonia. The high correlation coefficient (r = 0.847), intra-c... |
This algorithm was trained on a dataset consisting of previously rated voice samples of the CAPE-V sentences and sustained vowels from the PVQD. Although the results are encouraging, more work is necessary to confirm these findings in a larger clinical population. In particular, future studies should assess the repeata... |
The developed algorithm has the potential to automate remote evaluations of dysphonia, which can be particularly useful in areas where access to clinical experts is limited. Furthermore, the algorithm provides an objective estimation of dysphonia severity, which can aid in developing treatment plans and evaluating the ... |
In conclusion, this study has demonstrated that automated perceptual evaluations of dysphonia severity are possible using current computing power and machine learning techniques. With further development and validation, this algorithm has the potential to become an important tool for clinical evaluations of dysphonia.
... |
Title: Robot-Automated Cartilage Contouring for Complex Ear Reconstruction: A Cadaveric Study |
Abstract: Objectives/Hypothesis: Auricular reconstruction requiring manual contouring of costal cartilage is complex and time-consuming, which could be facilitated by a robot in a fast and precise manner. This feasibility study evaluates the accuracy and speed of robotic contouring of cadaver costal cartilage. |
Methods: An augmented robot with a spherical burr was used on cadaveric rib cartilage. Using a laser scanner, each rib section was converted to a three-dimensional model for preoperative planning. A model ear was also scanned to define a carving path for each piece of cartilage. After being contoured, each specimen was... |
Results: Scanning the cartilage sections took 24.8 ± 6.8 seconds. Preoperative processing took an additional 29.9 ± 8.9 seconds for the preparation of the contouring path. Once the path was prepared, the robot contoured the specimens with a root mean square error of 0.54 mm and a mean absolute deviation of 0.40 mm. The... |
Conclusions: The accuracy of the robotic system was high, with submillimeter deviations from the preoperative plan. The robot required <20% of the contouring time compared to the experienced surgeon. This represents a fast and accurate alternative to hand-contouring costal cartilage grafts for auricular reconstruction. |
Key Words: Auricular reconstruction, robot, ear, cartilage, costal cartilage graft. |
BACKGROUND: Auricular reconstruction is a complex procedure due to intricate topographic features of the cartilage. Previous research has indicated negative effects on psychological health secondary to inadequate reconstruction, and symmetry of the ears has important cosmetic implications, contributing to self-image an... |
When reconstructing auricular defects, there are two major components: the hairless skin envelope and the cartilaginous framework. The complex shape of the ear from the cartilaginous framework has been reconstructed in many ways including alloplastic implants, homologous cartilage, and autologous cartilage. Several com... |
For these reasons, autologous cartilage has become the standard choice for auricular framework reconstruction. This is most commonly performed via composite reconstruction using costal cartilage harvested from the sixth to ninth ribs. Once harvested, the autologous cartilage is contoured into the intended shape, often ... |
The process of contouring the harvested cartilage is the rate-limiting step of the procedure. It necessitates contouring of the intricate topographic features of the contralateral ear, adding length to the surgical procedure. Previous studies have shown that prolonged operative time adds risk (e.g., venous thromboembol... |
MATERIALS AND METHODS: Materials: A cadaveric feasibility study was performed to test the accuracy (primary outcome) and timing (secondary outcome) of a robot-automated contouring process. Five ribs were harvested from fresh-frozen cadaveric specimens, and costal cartilage sections were excised, marked, and divided int... |
Robot Methodology: The cartilage contouring was completed using a 4-mm spherical burr mounted on a six-axis custom Stewart Platform robot, designed with high stiffness and compact size, ideal in an operating room setting. This configuration is from a class of robots known as hexapods, having six servo-actuated struts, ... |
Surgeon Methodology: All charts from surgical cases with a similarly sized defect at London Health Sciences Centre from 2006 to 2017 were reviewed. During these cases, after the harvest of an adequately sized cartilaginous graft for the treated defect, a 15 blade was used to manually shape the graft for inset. To creat... |
Data Analysis: Each cartilage piece prepared by the robot was laser scanned, and a new 3D model was created for comparison with the original ear scan by superimposing the two 3D models. A global coregistration function was used to minimize misalignment errors. Following alignment, a surface deviation map was generated ... |
RESULTS: Primary Outcome: Accuracy |
For all (n = 11) specimens, the RMS error was 0.54 ± 0.05 mm. The mean absolute deviation was 0.40 ± 0.05 mm (Fig. 5). The lowest mean absolute devia- tion was 0.28 mm and the highest mean absolute devia- tion was 0.47 mm. The maximum error tended to occur at the auricular tubercle, possibly due to the thicker skin of ... |
Secondary Outcome: Speed |
For the purposes of this study, the contouring pro- cess consisted of multiple stages that were each timed. The surface scanning time for each cartilage specimen was 24.8 ± 6.8 seconds, and the 3D-model generation time was 29.9 ± 8.9 seconds. The robot contouring process had a mean time of 13 ± 2 minutes (Fig. 6). Thir... |
DISCUSSION: Composite auricular reconstruction is a challenging reconstructive problem that commonly relies on autologous cartilage grafting. Harvested costal cartilage is manually contoured to create symmetry with the contralateral ear. This graft forms the basis of the cartilaginous framework, which recreates the top... |
Outside of the medical field, robot-automated contouring systems have become increasingly available and have been successfully implemented in other surgical fields. This study evaluates the feasibility of robot-automated carving of cartilaginous grafts for auricular framework reconstruction with outcome metrics includi... |
On average, the robotic carving process was over five times faster than the reviewed surgical cases, while maintaining submillimeter accuracy, thus achieving both the desired primary and secondary outcomes. The time saved on surgical carving alone represents a significant potential benefit from utilizing this existing ... |
Handheld laser/optical scanners have been employed for creating anatomical 3D models in many studies, with fast and accurate results. For the present study, both a model ear (i.e., desired geometry) and the harvested cartilage were surface scanned. Collecting the scans and generating 3D models required less than 60 sec... |
Patient and operator safety are important concerns with any autonomous robot, especially one with a rotating burr. The design presented here avoids patient safety matters by performing the cartilage contouring process on the benchtop away from the patient. The robot has a very small range of motion, only slightly large... |
A limitation of this study was that a true operative experience was not reproduced, and so logistics of bringing the robot into the operating room were not evaluated. Notwithstanding this limitation, practical logistics would likely be mitigated by the design of the robot, which is a small portable device made to funct... |
CONCLUSION: The accuracy and speed of robot-automated contouring for auricular reconstruction observed in this study indicate an opportunity to improve surgical times and clinical outcomes. The complex shapes of the auricular framework are challenging and time-consuming to recreate by hand, but by using a surface scann... |
TITLE: Evaluation of Acoustic Analyses of Voice in Nonoptimized Conditions |
ABSTRACT: Objectives: This study aimed to evaluate the fidelity and accuracy of a smartphone microphone and recording environment on acoustic measurements of voice. Method: A prospective cohort proof-of-concept study was conducted using two sets of prerecorded samples: (a) sustained vowels (/a/) and (b) Rainbow Passage... |
INTRODUCTION: Acoustic analysis plays a pivotal role in the clinical assessment of voice disorders, offering baseline and diagnostic information along with objective measures for evaluating treatment outcomes. It serves as a noninvasive, objective method to detect vibratory abnormalities in voice production and to meas... |
MATERIALS AND METHODS: Participants: High-quality prerecorded audio samples were utilized to assess the impact of microphone and recording environment on acoustic measurements. For vowel analysis, 20 sustained vowel samples (/a/) included both normal (n=10) and dysphonic (n=10) voices, with dysphonic samples ranging fr... |
Procedure: Two microphones were used: (a) an iPhone 7 Plus internal microphone and (b) a Blue Yeti Ultimate USB Microphone, recording in mono. The iPhone microphone, an omnidirectional transducer with a 44,100 Hz sampling rate, and the Blue Yeti, recording at 48,000 Hz with a cardioid pattern, were chosen for their qua... |
Data and Statistical Analysis: A power calculation determined 17 recordings per group were required. Recordings were time-windowed for consistent analysis. Praat software calculated fundamental frequency (fo), jitter, shimmer, harmonic-to-noise ratio (HNR), and cepstral peak prominence (CPP). HNR and CPP were analyzed ... |
RESULTS: The analysis presented in the tables outlined the mean, median, standard deviation, and standard error for each acoustic measure across four different recording conditions. The repeated-measures ANOVA showed that there were no significant differences in the fundamental frequency (fo) across conditions, indicat... |
However, jitter measures were significantly affected by microphone type but not by the acoustic environment, with iPhone recordings showing higher jitter values than Yeti recordings in both settings. Both shimmer and harmonic-to-noise ratio (HNR) measures showed significant differences based on both the microphone type... |
For HNR derived from sentences and cepstral peak prominence (CPP) from both vowels and sentences, significant differences were noted for the main effects of both environment and microphone, highlighting better performance in sound booth conditions and with Yeti microphones. Scatter plots with linear regression fits vis... |
DISCUSSION: This study investigated the impact of smartphone microphones and recording environments on voice sample collection, revealing statistically significant differences for most acoustic measurements between microphone types and recording environments. However, the absolute differences were generally small, sugg... |
The fundamental frequency (fo) was consistent across recording conditions, indicating fo estimation is robust, with deviations primarily from a single outlier in severely disordered samples. This aligns with literature suggesting fo estimation is reliable across different acoustic analysis systems for voices that are n... |
Jitter differences between microphone types were statistically significant but minor in magnitude. Even with these differences, jitter values remained within published normative ranges, suggesting these variations might not impact clinical interpretations significantly. |
Shimmer and harmonic-to-noise ratio (HNR) measures were affected by both the microphone type and the recording environment. Despite statistical significance, only the shimmer data from iPhone recordings in a nonsoundproof environment notably exceeded normative thresholds. This indicates that, while statistically signif... |
The cepstral peak prominence (CPP) measures, which are increasingly considered important in dysphonia evaluation, showed differences that were within the range of clinical insignificance. This is encouraging, demonstrating the potential reliability of smartphone microphones for collecting voice samples outside of tradi... |
The cardioid pattern of the Yeti microphone seemed to mitigate environmental noise impacts, highlighting the importance of microphone selection in achieving reliable voice recordings. However, caution is advised due to potential proximity effects, which were minimized in this study by maintaining an appropriate distanc... |
In summary, while microphone type and recording environment influenced acoustic voice measures, the clinical significance of these differences is limited for many measures. This suggests that smartphone microphones, even in less controlled environments, can provide viable options for voice sample collection, expanding ... |
CONCLUSIONS: This study found statistically significant differences when using smartphone microphones and nonsound controlled environments for voice sample collection in acoustic voice analysis. However, the examination of these differences indicates a limited overall impact on certain acoustic measures, suggesting the... |
Despite potential concerns about the validity of data obtained from less controlled environments and with consumer-grade technology, the findings suggest that the advantages of increasing accessibility to acoustic voice analysis may outweigh the minimal loss of accuracy in most clinical or monitoring scenarios. Notably... |
The study supports the feasibility of using smartphones as a reliable tool for voice sample collection, paving the way for their use in the assessment and ongoing monitoring of voice disorders. This aligns with the broader goals of mobile health (mHealth) applications in providing accessible, efficient, and patient-cen... |
TITLE: Parapharyngeal abscess following use of a laryngeal mask airway during open revision septorhinoplasty |
ABSTRACT: The laryngeal mask airway (LMA) is a widely used device to maintain the airway in patients undergoing surgery with general anesthesia, known for its safety and low complication rate. This report presents a rare case of a 50-year-old female who developed a parapharyngeal neck abscess after an uneventful septor... |
INTRODUCTION: The Laryngeal Mask Airway (LMA) is recognized for its efficacy in providing a secure artificial airway for both controlled and spontaneous ventilation by forming a low-pressure seal around the glottis. With a success rate of insertion at 99.81% among 11,910 patients and a critical incident rate of only 0.... |
CASE PRESENTATION: A 50-year-old female experienced right neck pain and odynophagia following an open revision septorhinoplasty, where a Number 4 LMA Classic™ laryngeal mask airway was employed for airway management. The procedure and LMA insertion were uneventful, completed within two hours by an experienced anestheti... |
Persisting swallowing difficulties and insufficient pain relief from oxycodone led her to present to the emergency room five days post-surgery. Initial treatment included IV ceftriaxone, and imaging identified a significant abscess in the right neck. A CT scan detailed a loculated fluid and air collection extending fro... |
Surgical intervention at a community hospital involved incision and drainage of the abscess, confirmed by laryngoscopy, and a nasogastric tube placement for nutrition. Cultures identified multiple organisms, including Streptococcus anginosus group, anaerobic gram-positive cocci, and Prevotella species. Following transf... |
This case underscores the rarity yet potential severity of complications associated with LMA use, such as parapharyngeal abscess, which demands prompt recognition and intervention to prevent more serious outcomes. The patient's recovery highlights the importance of multidisciplinary management in addressing complex pos... |
DISCUSSION: This case report illuminates a rare instance of parapharyngeal abscess following the use of a Laryngeal Mask Airway (LMA) in a surgical procedure. It's suspected that over-inflation of the LMA cuff led to soft tissue necrosis, forming a pathway for infection into the deep neck spaces, ultimately resulting i... |
CONCLUSION: Laryngeal mask airway-related injuries, while rare, can lead to severe complications, such as parapharyngeal abscesses. This report highlights the critical need for early detection and intervention to prevent complications from escalating to more serious conditions like retropharyngeal abscesses and airway ... |
TITLE:Sialocutaneous fistula to the external auditory canal repaired with superficial parotidectomy and temporoparietal flap: A case report |
ABSTRACT: This case report details the surgical management of a late-evolving sialocutaneous fistula to the external auditory canal, manifesting 27 years after the initial operation and 19 years following the onset of mild symptoms. The patient presented with left-sided clear otorrhea that was gustatory in nature, expe... |
Keywords: auditory canal atresia, canaloplasty, external auditory canal, salivary fistula, sialocutaneous fistula |
INTRODUCTION: Sialocutaneous fistula, characterized by an abnormal connection between the salivary gland ducts and the skin, is an infrequent medical condition. While congenital instances have been documented, the majority of cases are attributed to facial trauma. The spectrum of management strategies ranges from non-i... |
CASE REPORT: |
2.1. Patient Information: This case involves a 41-year-old female with an 18-year history of gustatory, left-sided clear otorrhea, which had significantly increased in volume over the last 8 months, causing social discomfort. She had a history of bilateral canaloplasty for congenital auditory canal atresia and had been... |
2.2. Physical Examination: The examination showed canals within normal limits following previous canaloplasty, intact tympanic membranes bilaterally, fluid presence in the left external canal, and a small punctum in the anteroinferior portion of her left external canal. |
2.3. Diagnostic Assessment: Salivary amylase testing of the otorrhea returned a highly positive result (>33,000 u/L), suggesting a salivary origin. However, magnetic resonance imaging of the neck found no evidence of a parotid/EAC fistula or other abnormalities. An MR sialogram, which could have definitively identified... |
2.4. Interventions: Initially considered as a potential case of Frey Syndrome in the EAC and treated with Botox injections without improvement, the patient was eventually referred for surgical treatment. Opting for a definitive solution, she underwent a superficial parotidectomy with a temporoparietal flap, chosen over... |
2.5. Follow-up and Outcomes: Postoperatively, the patient reported cessation of otorrhea, with no facial weakness, First Bite syndrome, or Frey syndrome symptoms. The surgical incision healed well, with no hair loss, and the fistula tract site remained visible but dry. |
This case underscores the challenges in diagnosing and managing late-presenting, evolving sialocutaneous fistulas, particularly when initial conservative treatments fail. Surgical intervention, tailored to the patient's specific condition and history, proved effective in resolving the symptoms and improving the patient... |
DISCUSSION: |
Sialocutaneous fistula to the external auditory canal (EAC) presents a diagnostic challenge due to its rarity, leading to potential misdiagnosis and inadequate treatment. The origins of such fistulas can be congenital or acquired, with the Foramen of Huschke and the Fissures of Santorini being potential congenital path... |
The reported incidence of sialocutaneous fistula to the EAC following surgical repair for congenital aural atresia is notably low, at 0.4%. The case presented here is distinguished by its delayed onset, with the patient initially experiencing mild symptoms that were not reported until 19 years post canaloplasty. The si... |
Conservative treatments such as observation, sclerosing agents, and anticholinergics (e.g., Botox or glycopyrrolate) have been mentioned in literature, along with pressure dressings and surgical options like fistula tract obliteration, direct fascial closure, and parotidectomy. The decision to pursue a more aggressive ... |
The chosen surgical approach of superficial parotidectomy combined with temporoparietal flap aimed to not only address the fistula but also to prevent future salivary leakage by removing adjacent salivary tissue and creating a barrier. This method has proven to be a viable solution for resolving severe or refractory ca... |
CONCLUSION: Sialocutaneous fistula to the external auditory canal (EAC) represents a rare and challenging condition, with the case discussed herein exemplifying an unusually late manifestation following canaloplasty—a scenario that extends well beyond typical postoperative complication timeframes. Highlighting the comp... |
TITLE: Cricothyroid Muscle Botulinum Toxin Chemodenervation to Treat Recalcitrant High-Pitched Functional Dysphonia in an Adult Male |
ABSTRACT: Summary: Introduction: Functional dysphonia, characterized by voice disorders such as aphonia or inappropriate vocal pitch without any structural or neurologic abnormalities in the larynx, primarily receives voice therapy as the initial treatment modality. However, options for cases unresponsive to voice ther... |
Methods: This study involves a retrospective review of medical records alongside a detailed case report. |
Results: We present a distinctive case of an adult male suffering from persistent high-pitched functional dysphonia, diagnosed in adulthood, who experienced significant improvement following a single botulinum toxin (Botox) chemodenervation injection into the cricothyroid muscle. |
Conclusion: Cricothyroid muscle botulinum toxin chemodenervation emerges as a viable therapeutic option for treating stubborn cases of functional dysphonia, offering a potential avenue for patients who do not respond to conventional voice therapy. |
Key Words: High-pitched functional dysphonia, Puberphonia, Dysphonia, Botulinum toxin injection, Cricothyroid muscle. |
INTRODUCTION: Functional dysphonia is a voice disorder occurring without structural or neurological laryngeal abnormalities, often resulting from inappropriate laryngeal muscle tension during phonation. Various factors, including infections, intubation, or trauma, have been suggested as potential triggers, yet the prec... |
The primary management strategy for functional dysphonia involves specialized voice therapy conducted by skilled speech-language pathologists (SLPs), focusing on techniques like manual laryngeal manipulation to alleviate symptoms. Despite the general effectiveness of voice therapy, literature on alternative treatments ... |
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