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. 2023 Nov;133(11):3094-3099.
doi: 10.1002/lary.30750. Epub 2023 May 17.

Detecting Mild Phonotrauma in Daily Life

Jarrad H Van Stan  1   2   3 , James Burns  1   2 , Tiffiny Hron  1   2 , Steven Zeitels  1   2 , Bharat A Panuganti  4 , Phillip R Purnell  5 , Daryush D Mehta  1   2   3 , Robert E Hillman  1   2   3 , Hamzeh Ghasemzadeh  1   3
Affiliations

Detecting Mild Phonotrauma in Daily Life

Jarrad H Van Stan et al. Laryngoscope. 2023 Nov.

Abstract

Objective: The aim of this study was to gain quantitative insights into the role of daily voice use associated with mild phonotrauma via the Daily Phonotrauma Index (DPI), a measure derived from neck-surface acceleration magnitude (NSAM) and difference between the first two harmonic magnitudes (H1 - H2).

Methods: An ambulatory voice monitor recorded weeklong voice use for 151 female patients with phonotraumatic vocal hyperfunction (PVH) and 181 female vocally healthy controls. Three laryngologists rated phonotrauma severity from each patient's laryngoscopy. Mixed generalized linear models evaluated the accuracy, sensitivity, and specificity of the original DPI trained on all patients versus a mild DPI version trained on only patients rated with mild phonotrauma. Individual contribution of NSAM and H1 - H2 to each DPI model was also evaluated.

Results: Reliability across the laryngologists' phonotrauma ratings was moderate (Fleiss κ = 0.41). There were 70, 69, and 12 patients with mild, moderate, and severe phonotrauma, respectively. The mild DPI, compared to the original DPI, correctly classified more patients with mild phonotrauma (Cohen's d = 0.9) and less controls (d = -0.9) and did not change in overall accuracy. H1 - H2 contributed less to mild phonotrauma classification than NSAM for mild DPI.

Conclusions: Compared with the original DPI, the mild DPI exhibited higher sensitivity to mild phonotrauma and lower specificity to controls, but the same overall classification accuracy. These results support the mild DPI as a promising detector of early phonotrauma and that NSAM may be associated with early phonotrauma, and H1 - H2 may be a biomarker associated with vocal fold vibration in the presence of lesions.

Level of evidence: Level 4, case-control study Laryngoscope, 133:3094-3099, 2023.

Keywords: voice assessment measures; voice dysphonia.

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Conflict of interest statement

CONFLICT OF INTEREST: Drs. Robert Hillman and Daryush Mehta have a financial interest in Inno-Voyce LLC, a company focused on developing and commercializing technologies for the prevention, diagnosis and treatment of voice-related disorders. Drs. Hillman’s and Mehta’s interests were reviewed and are managed by Massachusetts General Hospital and Mass General Brigham in accordance with their conflict-of-interest policies.

Figures

Figure 1.
Figure 1.
Pictures of the patients’ vocal folds in abduction (left) and adduction (right) that served as anchors for the severity rating of (A) mild phonotrauma, (B) moderate phonotrauma, and (C) severe phonotrauma.
Figure 2.
Figure 2.
Scatterplot of H1–H2 standard deviation (H1–H2 SD) on the y-axis and neck-surface acceleration magnitude (NSAM) Skew on the x-axis. Patients with mild, moderate, and severe phonotraumatic vocal hyperfunction are pink, red, and black circles, respectively; vocally healthy subjects are gray circles. Each marker represents a single subject’s daily mean across approximately 7 days of monitoring. The original and mild-only logistic regression boundaries between patient and control classifications are represented as black and gray diagonal lines, respectively.
See this image and copyright information in PMC

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