Vocal Improvement After Voice Therapy in Unilateral Vocal Fold Paralysis

Unilateral vocal fold paralysis (UVFP) is associated with changes in acoustic and aerodynamic voice measurements and can have a significant impact on a patient's quality of life. Few objective data regarding the efficacy of voice therapy for UVFP exist. The aim of this study was to retrospectively analyze voice modifications in a group of patients with UVFP before and after voice therapy. Forty patients with UVFP of different etiology were included in the study. Each subject had voice therapy with an experienced speech/language pathologist twice a week; the mean number of sessions was 12.6. A multidimensional assessment protocol was used; it included videoendoscopy, the maximum phonation time (MPT), the GIRBAS scale, spectrograms and a perturbation analysis, and the Voice Handicap Index (VHI). Pre- and posttreatment data were compared by means of the Wilcoxon and Student's t tests. A complete glottal closure was seen in 8 patients before voice therapy and in 14 afterward. Mean MPT increased significantly. In the perceptual assessment, the difference was significant for five out of six parameters. A significant improvement was found on spectrographic analysis; as for perturbation analysis, the differences in jitter, shimmer, and noise-to-harmonic ratio values were significant. VHI values showed a clear and significant improvement. A significant improvement of voice quality and quality of life after voice therapy is an often reached and reasonable goal in patients with UVFP.     

Validation of the Numen Field by the Energy Conditions in the Early Universe

The energy conditions in general relativity are introduced to establish powerful theorems without having to restrict their applicability to specific choices of the stress-energy tensor. They are famously invoked, e.g., to prove the singularity theorems of Penrose and Hawking, but have also been applied elsewhere, including various tests of certain cosmological theories. These conditions have become somewhat controversial, however, because they appear to be violated by commonly accepted scenarios, such as inflation shortly after the Big Bang and late-time acceleration of the cosmic expansion. But accommodating these processes by abandoning all of the energy conditions will promote other disquieting possibilities, including the breakdown of causality with traversable wormholes and closed timeloops. This paper advocates for the opposite viewpoint, demonstrating that the ‘numen’ scalar field, derived from the zero active mass condition in general relativity, satisfies all of the energy conditions in the early Universe. This unique feature among scalar fields adds to its success in accounting for the observed properties of the cosmic microwave background better than its inflationary counterpart. Specifically, numen's complete consistency with all of the energy conditions, and inflation's violation of at least one of them, provides additional justification for theoretically favoring the former over the latter.