Journal of Voice最新文献

{"title":"Perception of Vocal Tremor After Deep Brain Stimulation in Varying Speech Contexts.","authors":"Michael A Belsky, Yifei Ma, Casey H Halpern, Elizabeth Erickson-DiRenzo","doi":"10.1016/j.jvoice.2025.09.026","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.09.026","url":null,"abstract":"<p><strong>Objectives/hypothesis: </strong>Vocal tremor (VT) is a difficult to treat voice problem characterized by periodic modulations of fundamental frequency and vocal intensity. VT is easier to perceive during sustained phonation as compared to connected speech. Previous studies have demonstrated improvements in perception of VT during sustained phonation after undergoing deep brain stimulation (DBS) for treatment of essential tremor. However, few studies have investigated perception of VT in connected speech contexts. The purpose of this preliminary study was to examine differences in perception of VT severity before and after thalamic DBS across sustained phonation and connected speech contexts.</p><p><strong>Study design: </strong>Single arm, pre-post design.</p><p><strong>Methods: </strong>Nine adult participants diagnosed with VT undergoing thalamic DBS for treatment of essential tremor participated in this investigation. Perceptual voice evaluation of sustained vowel phonation and two connected speech samples, one loaded with primarily voiceless and the other with voiced speech sounds, were conducted preDBS and postDBS treatment by four expert listeners. Overall severity of the dysphonia and the \"unsteadiness\" of the voice were evaluated using visual analog scales. Paired t tests were employed for statistical comparisons.</p><p><strong>Results: </strong>There was good to excellent intra- and inter-rater reliability between expert listeners. We observed a significant interaction for speech context (sustained, voiced, voiceless) and time (preDBS, postDBS) for perceptual ratings of overall severity and unsteadiness. Tests revealed significant reductions in overall severity and unsteadiness postDBS treatment in the sustained vowel and voiced sentence contexts.</p><p><strong>Conclusions: </strong>Reductions in VT severity after DBS are most evident in sustained vowel analysis but also can be detected in connected speech. Future research on VT and its treatments, including DBS, should carefully consider the choice of speech contexts, as these can influence the perceived effectiveness of therapy. Overall, our findings also add to the growing evidence that DBS may be a valuable treatment for VT.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing Botulinum Toxin A Dosing for Laryngeal Dystonia.","authors":"Pelin Yuksel, Katherine D Mullen, Kathryn A Mozzochi, Robert T Sataloff","doi":"10.1016/j.jvoice.2025.09.025","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.09.025","url":null,"abstract":"<p><strong>Background/objectives: </strong>Laryneal dystonia (LD), also called spasmodic dysphonia, is a chronic focal dystonia that can profoundly affect communication-related quality of life. The standard of care for management of LD is repeated injection of botulinum neurotoxin (BTX) into the intrinsic laryngeal muscles. However, effects may vary based the patient and/or type of dystonia. The majority of the literature on LD focuses on the adductor subtype, which involves hyperadduction of the vocal folds, rather than abductor LD, which involves hyper abduction of the vocal folds, or the mixed subtype. Mean reported doses for adductor LD range from 1.5 to 7.5 units. The goal of this study was to evaluate presentation and treatment in a diverse group of LD patients.</p><p><strong>Methods: </strong>A retrospective chart review of 31 adult SD patients who received at least 10 BTX injections was conducted. Demographics and primary medical history were recorded, and information on units of BTX A injected, days of breathiness post-injection, and days between injections was analyzed within LD subtypes.</p><p><strong>Results: </strong>Mean BTX doses were 10.2 units and 15.1 units for the adductor and abductor/mixed groups, respectively. The average dose interval was 174 days and mean post-injection breathiness interval was 21 days for the adductor group and 27 days for the abductor/mixed group.</p><p><strong>Conclusion: </strong>LD patients who required high doses of BTX highlighted the differences in treatment among various LD subtypes and suggested that dose variability may occur in patients who do not respond to low-dose BTX. These results stress the importance of individualized treatment options for LD patients.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Vocal Exercises in Singers: A Scoping Review.","authors":"Cristóbal Riquelme-Muñoz, Antonia Labarca-Farías, Constanza Contreras-Arancibia, Sergio V Flores","doi":"10.1016/j.jvoice.2025.09.029","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.09.029","url":null,"abstract":"<p><strong>Introduction: </strong>This scoping review aimed to evaluate the effectiveness of vocal exercises-especially semi-occluded vocal tract exercises (SOVTE), vocal function exercises (VFE), and structured warm-ups-on acoustic, perceptual, and physiological outcomes in trained singers.</p><p><strong>Methods: </strong>We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and conducted a comprehensive search in Scopus, WOS, and PubMed for studies published in the last 10 years. Inclusion criteria were quantitative outcomes, formal vocal training, and use of SOVTE, VFE, or structured warm-ups. Two reviewers independently screened titles, abstracts, and full texts. Twenty studies were included. Data were synthesized thematically across four dimensions: acoustic/aerodynamic effects, perceptual/physiological benefits, training protocol effectiveness, and application in singing contexts.</p><p><strong>Results: </strong>The most consistent benefits included improvements in jitter, shimmer, vocal resonance, vocal comfort, phonation time, and flexibility. Structured protocols demonstrated adaptability across singing styles.</p><p><strong>Conclusion: </strong>Evidence-based vocal exercises enhance vocal health and performance in trained singers. Standardized methodologies and broader sampling are needed to strengthen future research. No protocol registration was conducted.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-Validation of the Acoustic Roughness Index in German.","authors":"Itsuki Kitayama, Kiyohito Hosokawa, Bernhard Lehnert, Kenji Aruga, Hidenori Inohara, Ben Barsties V Latoszek","doi":"10.1016/j.jvoice.2025.09.030","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.09.030","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to validate the Acoustic Roughness Index (ARI) for German-speaking participants by examining its correlation with perceived vocal roughness and its diagnostic accuracy in distinguishing rough from non-rough voices.</p><p><strong>Methods: </strong>Voice samples from 218 adult speakers (175 with dysphonia and 43 vocally healthy controls) were recorded using a sustained vowel /a:/ and a standardized 27-syllable passage of continuous speech (approximately 3 seconds) concatenated into a single sample per participant. Three experienced raters judged the roughness severity of each sample using the R-parameter from the Grade, Roughness, Breathiness, Asthenia, Strain scale (ranging from normal to severe). Intra- and inter-rater reliability were assessed with Cohen's kappa and Fleiss' kappa, respectively. Acoustic analysis was performed using the ARI algorithm implemented in the software Praat. Concurrent validity was evaluated by Spearman rank correlation (r_s) between ARI scores and perceptual roughness. Diagnostic validity was assessed via receiver operating characteristic (ROC) analysis determining the optimal ARI threshold for identifying rough voices.</p><p><strong>Results: </strong>Intra-rater reliability for roughness was moderate (mean Cohen's κ = 0.45) and inter-rater agreement was fair (Fleiss' κ = 0.35) indicating the inherent variability of perceptual roughness judgments. ARI scores demonstrated a sufficiently high correlation with perceived roughness (r_s = 0.726, P < 0.001, 95% confidence interval [CI] = 0.654-0.785). The area under the ROC curve was 0.824 reflecting good diagnostic accuracy. The (Youden-) optimal ARI threshold was 2.00 yielding 71.8% sensitivity and 79.3% specificity.</p><p><strong>Conclusion: </strong>ARI appears to offer a potentially useful acoustic measure for assessing vocal roughness, though its robustness may be limited. Further research is necessary to improve the accuracy and reliability of the voice quality evaluation of roughness.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence to Detect Voice Disorders: An AI-Supported Systematic Review of Accuracy Outcomes.","authors":"Charles J Nudelman, Virginia Tardini, Pasquale Bottalico","doi":"10.1016/j.jvoice.2025.09.021","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.09.021","url":null,"abstract":"<p><strong>Background: </strong>The objective of the present systematic review is to identify which artificial intelligence (AI) approaches have been used to successfully detect voice disorders. The review examines studies involving patients with non-neurological voice disorders and controls, where AI was applied to detect voice disorders. The primary outcome of interest is the accuracy of these AI models. Additionally, this review demonstrates how the procedures of conducting a systematic review can be supported by AI.</p><p><strong>Methods: </strong>Studies were eligible for inclusion if they implemented an AI approach to detect non-neurological voice disorders from healthy voice samples. A comprehensive search was conducted using PubMed/MEDLINE, Science Direct, Web of Science, EBSCO, and Scopus databases. Risk of bias was assessed via the Quality Assessment Tool for Diagnostic Accuracy Studies. The occurrences of the most common AI techniques utilized in the literature are presented, and a summary of their abilities to accurately detect a voice disorder is reported.</p><p><strong>Results: </strong>In total, 79 publications met the inclusion criteria. These studies included patient recordings from a variety of voice databases. The most common AI techniques implemented were Support Vector Machines (SVMs) (n = 28) and Convolutional Neural Networks (CNNs) (n = 22). The mean accuracy of the models in detecting voice disorders was 92% across all studies. Nine studies reported 100% accuracy, and 32 studies reported between 95% and 99%.</p><p><strong>Discussion: </strong>Strengths of the evidence include high accuracies across diverse models and datasets. Limitations include a limited variety of datasets and a trend of hyperoptimization without sufficient external validation. Clinicians and researchers should recognize that while current AI models show promise, future studies should prioritize robust external validation and more representative datasets.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Belting by Trained Singers Compared With Shouting by Untrained Nonsingers: How Do They Differ?","authors":"Tero Ikävalko, Anne-Maria Laukkanen","doi":"10.1016/j.jvoice.2025.09.011","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.09.011","url":null,"abstract":"<p><strong>Objective: </strong>This exploratory study investigated differences between belting (\"yell-like\" singing) by trained singers and shouting by untrained participants. Special interest was in parameters estimating vocal efficiency and economy.</p><p><strong>Methods: </strong>Ten trained singers with expertise in belting and 10 vocally untrained individuals (males and females) produced moderately loud and very loud syllable repetitions of /pe/ at three pitches (males: C#4, D#4, and F4 and females: F4, G4, and A4). Oral air pressure, flow, electroglottographic (EGG), and acoustic signals were recorded. Thirteen parameters were calculated, including subglottal pressure (P_sub), average air flow (Q), estimate of glottal resistance (GR), contact quotient (CQ), alpha ratio, level difference between the first and second harmonic (H1-H2), spectral center of gravity (CG), and sound pressure level (SPL). Twelve parameters estimating vocal efficiency and economy were calculated, including efficiency (VE), SPL/P_sub, SPL/CQ, and quasi-output-cost ratio (QOCR). Group differences between belters and shouters were explored separately for the males and females.</p><p><strong>Results: </strong>Eighteen parameters in males and nine in females differed significantly (P < 0.05) between the groups. VE in dB (re 1 W) was higher in belting in both sexes. Male belters also showed lower Q, subglottal power (P_sub * Q), H1-H2, SPL/P_sub, and QOCR, as well as higher GR, CQ, and SPL/Q, than shouters. Female belters demonstrated lower P_sub and CQ, and higher CG, SPL/P_sub, QOCR, and SPL/CQ than shouters.</p><p><strong>Conclusions: </strong>Trained belters demonstrated greater efficiency, producing similar acoustic output to the shouters, but with less subglottal power. This result may reflect differences in vocal skill. Somewhat counterintuitively, some economy estimates were lower in male belters than in shouters. This was due to the trained males' significantly higher P_sub and CQ. It is questionable whether the economy estimates approximating vocal fold impact stress based on CQ and P_sub perform well in high-intensity phonation.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Voice as a Marker of Professional Identity: Exploring Occupational Voice Use by Fitness Professionals.","authors":"Victoria Reynolds, Ashley FitzSimmons-Olsen, Noël Nocciolo, Cynthia Lopez, Dominic Reynolds","doi":"10.1016/j.jvoice.2025.09.022","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.09.022","url":null,"abstract":"<p><strong>Introduction: </strong>Fitness instructors (FIs) are professional voice users of the instructor type. They are required to use their voices to coach, motivate, and acknowledge the clientele while leading their classes or sessions. FIs are expected to recruit and retain clients to their sessions, and in order to do so, create themselves as a brand within the marketplace. FIs are at increased risk of developing dysphonia, yet few of them report concerns about this occupational risk factor. In order to devise risk mitigation plans and policies, it is essential to understand how these professionals use their voices in the workplace. This study aimed to explore the phenomenology of occupational voice use in FIs.</p><p><strong>Method: </strong>A semistructured interview was used to explore the thoughts, attitudes, and beliefs toward occupational voice use in seven FIs. A thematic approach was applied to analyzing the data.</p><p><strong>Results: </strong>Four major themes emerged from the data: voice as a marker of professional identity, industrial and organizational issues, knowledge of voice and voice use at work, and scientific thinking within the profession.</p><p><strong>Discussion: </strong>FIs relied on their voices in numerous ways: to coach their clients, but also to recruit and retain them, to motivate them, and to encourage them on their fitness journeys. Voice was considered to be an integral part of the work identity of FIs in this study. Participants focused largely on the need to project their voices to be understood by clients in different instructing scenarios, yet, alternative ways of using voice to achieve these ends were discussed. FIs could be considered a unique type of professional voice user, in that as well as instruction, there is a performance aspect to their work, as they seek to both teach and entertain, their clientele.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Laryngopharyngeal Reflux Disease in Laryngeal and Hypopharyngeal Squamous Cell Carcinoma: A Systematic Review.","authors":"Guangjin Chen, Jérôme R Lechien","doi":"10.1016/j.jvoice.2025.09.019","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.09.019","url":null,"abstract":"<p><strong>Background: </strong>Laryngeal and hypopharyngeal squamous cell carcinomas (L/HSCC) are common head and neck cancers with rising incidence globally. Laryngopharyngeal reflux disease (LPRD) is suspected to play a role in carcinogenesis through unknown mechanisms. The aim of this review was to summarize the literature findings about the potential carcinogenesis mechanisms associated with LPRD in L/HSCC.</p><p><strong>Methods: </strong>A PubMed, Embase, and Web of Science database search was carried out by two independent investigators for studies investigating laryngeal and hypopharyngeal mucosa injuries and premalignancy modifications related to LPRD refluxate. The authors considered clinical and experimental studies using human biopsies, animal models, and cell lines that investigated potential mechanistic associations between LPRD and L/HSCC progression. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements were followed.</p><p><strong>Results: </strong>Of the 689 identified papers, 34 studies were included. There were human tumor tissue studies (n = 8), human cell line studies (n = 19), and animal models (n = 12). Across methodologies, consistent evidence supported reflux-induced NF-κB pathway activation, oncogenic miRNA dysregulation, epithelial-mesenchymal transition, abnormal cell proliferation and differentiation, increased DNA damage, imbalance in the expression of tumor-promoting and tumor-suppressing genes, and altered cellular stress responses. Both pepsin and bile acids demonstrated carcinogenic potential through multiple molecular pathways, despite significant methodological heterogeneity across studies.</p><p><strong>Conclusion: </strong>LPRD-refluxed pepsin and bile acids may substantially contribute to the carcinogenesis of laryngeal and hypopharyngeal cells through several pathways. Future translational studies documenting refluxed gastroduodenal enzymes in tumor samples are needed to better determine their role in the development of L/HSCC through understanding the underlying biomolecular cellular mechanisms.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fusing Time-Frequency Heterogeneous Features With Cross-Attention Mechanism for Pathological Voice Detection.","authors":"Zhang Jiaqing, Wu Yaqin, Zhang Tao","doi":"10.1016/j.jvoice.2025.09.017","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.09.017","url":null,"abstract":"<p><p>To address the critical challenges of data scarcity, feature homogenization, and limited model generalization in current pathological voice diagnosis systems, a novel algorithm was developed to integrate time-frequency heterogeneous acoustic features for multi-class pathological voice detection. The Wav2vec2-XLSR model pretrained through self-supervised learning was first employed to extract deep contextual features from time-domain voice signals. Mel-Frequency Cepstral Coefficients (MFCC) features from the frequency domain were subsequently integrated to construct a heterogeneous vocal feature space. A cross-attention mechanism from the Transformer architecture was innovatively applied to achieve dynamic spatiotemporal alignment and semantic interaction within the heterogeneous feature space, enabling complementary feature enhancement. A dual-granularity joint analysis framework encompassing vowel and sentence hierarchies was ultimately established for efficient multi-type pathological voice detection. Experimental results demonstrated that the proposed algorithm achieved 95.1% accuracy, 100% recall, 0.92 F1-score, and 0.97 area under the ROC curve (AUC) value on sentence-level Saarbruecken Voice Database (SVD) dataset. For vowel-level classification tasks, classification accuracies of 100% and 99.6% were obtained on the Massachusetts Eye and Ear Infirmary (MEEI) and SVD datasets, respectively. Multi-corpus evaluation experiments confirm the algorithm's robustness and generalization capability across different data distributions.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modulation of Brainstem-Cortical Pathways by Injection Laryngoplasty in Unilateral Vocal Fold Paralysis: A Longitudinal Diffusion MRI Case Study.","authors":"Marie Dedry, Nicolas Delinte, Quentin Dessain, Arnaud Szmalec, Youri Maryn, Laurence Dricot, Gauthier Desuter","doi":"10.1016/j.jvoice.2025.09.013","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.09.013","url":null,"abstract":"<p><strong>Objective: </strong>This study investigates the potential role of injection laryngoplasty with hyaluronic acid in supporting spontaneous reinnervation and the recovery of vocal fold mobility, following unilateral vocal fold paralysis (UVFP). Building on previous findings suggesting functional activation of the brainstem during a sustained vowel task before vocal fold mobility recovery (Dedry, Dricot, Van Parys, Boucquey, Delinte, van Lith-Bijl, Szmalec Maryn & Desuter, 2022), this study aims to explore the neural plasticity in response to this peripheral intervention. Specifically, we hypothesize that this intervention may not only activate brainstem regions of interest (ROIs) but also induce changes in the motor and sensory pathways associated with phonation.</p><p><strong>Methods: </strong>A longitudinal single-case study was conducted on a 54-year-old woman (P3) with right-sided UVFP. P3 received a hyaluronic acid injection laryngoplasty into the paralyzed vocal fold, along with a sham behavioral voice therapy. Assessment sessions, including MRI scans (structural, functional, and diffusion), were conducted at four time points to examine potential neural changes. Diffusion MRI and tractography were used to assess microstructural changes in brainstem-to-cortex motor and sensory pathways. The same assessment protocol was followed by a matched healthy control participant for comparison. Diffusion data were preprocessed and modeled using the DIAMOND model, focusing on the corticobulbar and medial lemniscal tracts.</p><p><strong>Results: </strong>A marked increase in weighted fractional anisotropy (wFA) was observed in left and right anterior motor tracts of interest (TOIs) between the first and second sessions, shortly after the hyaluronic acid injection. These values remained stable thereafter. In contrast, the posterior sensory tracts showed minimal change over time, with wFA values remaining lower than those of the control participant.</p><p><strong>Conclusion: </strong>Although limited to a single case, the bilateral improvements observed in motor tract integrity, reflected by increased FA shortly after the hyaluronic acid injection, suggest a possible neuroplastic response, particularly within the corticobulbar projections. These findings indicate that early injection laryngoplasty may promote adaptive structural changes in motor pathways involved in phonation, potentially supporting reinnervation following UVFP.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}