Quantitative evaluation of the voice range profile in patients with voice disorder

Vocal Range Variations Elicited With a Standard Mandarin Reading Passage in Individuals With Voice Disorders

PURPOSE

This study examined whether the "Three Bears Passage" (TB), a standard Mandarin reading passage, could elicit significant vocal range variations in individuals with voice disorders. Relative sensitivity of TB versus another existing standard reading passage, "Passage in Mandarin" (PM), for differentiating between individuals with and without voice disorders was also evaluated.

METHOD

Forty-two individuals with normal voice and 30 individuals with voice disorders participated in the study. Maximum fundamental frequency (f0), minimum f0, mean f0, f0 range, maximum vocal intensity, minimum intensity, mean intensity, and intensity range of all participants reading aloud the two passages were measured with Praat to construct speech range profiles (SRPs).

RESULTS

Significantly larger vocal range was found for TB than for PM in individuals with voice disorders, including significantly higher maximum f0, mean f0, maximum intensity, mean intensity, and significantly larger f0 range and intensity range. Significantly more limited vocal range was observed in individuals with voice disorders than those without, with more obviously restricted SRPs while reading aloud TB compared to PM. Receiver operating characteristic analysis suggested that TB was more sensitive than PM in distinguishing between individuals with and without voice disorders.

CONCLUSIONS

Our findings supported the potential of TB as a standard clinical assessment tool for evaluating pathological changes in vocal range. Future studies should explore if therapeutic approaches based on the passage or variations of it could be developed for overcoming functional limitations and restrictions in vocal range for specific voice disorders.

Treatment Efficacy of Voice Therapy Following Injection Laryngoplasty for Unilateral Vocal Fold Paralysis

OBJECTIVES

Injection laryngoplasty (IL) is performed to reduce the gap between vocal folds induced by unilateral vocal fold paralysis (UVFP). Voice quality after IL may be different due to other factors that influence voice quality. Voice therapy has been reported to improve voice quality after IL in patients with UVFP. This study evaluated the efficacy of voice therapy combined with IL.

METHODS

Patients with UVFP who underwent IL as primary therapy from March 2017 to June 2019 were evaluated. The enrolled patients were divided into two groups, those who did and did not receive voice therapy after IL. Voice quality was evaluated using perceptual, acoustic, and aerodynamic parameters, and voice handicap index-30 scores one month after IL and after completing each treatment.

RESULTS

Of 261 patients who underwent IL during the study period, 40 were enrolled, including 21 who did and 19 who did not receive voice therapy. Voice parameters one month after IL did not differ between these two groups. Jitter, shimmer, noise-to-harmonic ratio, and mean flow rate decreased, while maximum phonation time increased after voice therapy (both P < 0.05). In the absence of voice therapy, improved voice parameters were maintained for six months after IL. Total voice handicap index-30 scores decreased, from 35.6 to 19.1 (P < 0.05), in patients who received voice therapy.

CONCLUSION

Voice therapy following IL is beneficial to patients with UVFP. Combined treatment can help to maintain improved voice quality more than six months after IL.

Does a Systematic Vocal Exercise Program Enhance the Physiologic Range of Voice Production in Classical Singing Graduate-Level Students?

Purpose The purpose of this study was to assess the effects of vocal function exercises (VFEs) on the physiologic range of the operatic voice. The primary outcome measure was total voice range profile (VRP) area. Method Forty graduate-level opera majors were randomly assigned to experimental (training with VFE + vocal hygiene) and control (vocal hygiene only) groups. All participants underwent an acoustic voice assessment (modified VRP) pre and post 10 weeks of the assigned intervention. VRP total area was calculated and compared between and within the two groups. The total VRP area was subsequently divided into three area thirds (low, medium, and high). Results A significant improvement (increase) was observed in the VFE group for the primary outcome measure of VRP area when pre- and postvoice conditions were compared for total area, upper third, and middle third. No significant improvement was found in the vocal hygiene-only group. Conclusion Vocal training with VFEs over a 10-week period demonstrated positive effects on physiologic voice range as evidenced by an increase in the total VRP area and therefore may enhance the potential of those who already have professional voice training.

Voice Range Change After Injection Laryngoplasty for Unilateral Vocal Fold Paralysis

OBJECTIVES

Patients with unilateral vocal fold paralysis (UVFP) caused by nerve injury manifest with voice changes. This study investigated vocal performance measured by voice range profile (VRP) in patients with UVFP and changes in VRP in response to intracordal hyaluronate injection.

METHODS

Eighty-five patients with UVFP were enrolled prospectively, among whom 68 received intracordal hyaluronate injections. The outcome measurements included VRP, acoustic and aerodynamic analyses, peak turn frequency of thyroarytenoid-lateral cricoarytenoid muscle complex (TA-LCA) measured by laryngeal electromyography, and normalized glottal gap area by videolaryngostroboscopy.

RESULTS

The peak turn frequency of the paralyzed TA-LCA showed a modest correlation with max fundamental frequency (F0) and F0 range. Closed-phase normalized glottal gap area showed modest negative correlations with max F0 and F0 semitone range. Regarding conventional acoustic and aerodynamic analyses, the paralyzed TA-LCA peak turn frequency was only correlated with maximal phonation time. Intracordal hyaluronate injection improved VRP performance by increasing max F0, decreasing min F0, increasing F0 range, and increasing semitone range (all P <0.01) with small or medium strength of effect size (Cohen d, 0.39-0.76).

CONCLUSIONS

Change in voice pitch in patients with UVFP can partly predict impairment of neuromuscular functions and glottal gap. VRP provides a more sensitive reflection of the severity of neuromuscular impairment, compared with conventional voice analysis. The validity of VRP is further supported by a robust response to voice improvements following injection laryngoplasty.

Características da fonetografia em indivíduos com equilíbrio dentofacial pós-muda vocal

OBJETIVO: caracterizar, por meio de fonetografia, o perfil da extensão vocal em indivíduos sem alterações pós-muda vocal e equilíbrio dentofacial. MÉTODO: participaram deste estudo 15 homens com idades entre 14 e 35 anos com pós-muda vocal. Eles responderam a um questionário específico, e também foram submetidos a uma avaliação antropométrica da face, a avaliação dento-oclusal, o exame fonetografia e também a uma análise da frequência fundamental habitual da voz. RESULTADOS: frequência fundamental mínima: 89Hz ± 3Hz ou 29st ±14st; Frequência fundamental máxima: 665Hz±179Hz ou 63st±5st; Extensão Vocal: 34st±6st; Intensidade mínima: 66 dB ± 3dB; Intensidade máxima: 114dB ± 5dB; Extensão Dinâmica Máxima: 42dB ± 4dB, Área do Fonetograma: 936,4 dB.st ± 258,8 dB.st ou 42,1 cm² ± 11,6 cm²; Frequência Fundamental Habitual para a vogal "a": 111,26 Hz ± 15,24 Hz. CONCLUSÃO: apesar de os estudos nacionais e internacionais apresentados neste trabalho não considerarem a condição dentofacial dos indivíduos, os resultados foram semelhantes.

Feasibility of measurement of a voice range profile with a semi-occluded vocal tract

Semi-occlusion of the vocal tract may provide a new method for assessing ranges of F(0) and a physiological correlate of vocal intensity. Signals can be obtained without concern about room noise, steadiness in mouth-to-microphone distance, and possibly without vocal injury caused by excessive loudness produced. Nine volunteers participated. Steady and acoustic pressures behind the lips were measured. Traditional voice range profiles were obtained on the vowels /α/ and /u/ for comparison. Range of F(0) was not limited in most subjects with the semi-occlusion but may be restricted in some subjects. In the lower portion of the F(0) range, the highest and lowest steady pressures at the semi-occlusion constitute an oral pressure range profile.

Treatment Outcomes for Professional Voice Users

Professional voice users comprise 25% to 35% of the U.S. working population. Their voice problems may interfere with job performance and impact costs for both employers and employees. The purpose of this study was to examine treatment outcomes of two specific rehabilitation programs for a group of professional voice users. Eighteen professional voice users participated in this study; half had complaints of throat pain or vocal fatigue (Dysphonia Group), and half were found to have benign vocal fold lesions (Lesion Group). One group received 5 weeks of expiratory muscle strength training followed by six sessions of traditional voice therapy. Treatment order was reversed for the second group. The study was designed as a repeated measures study with independent variables of treatment order, laryngeal diagnosis (lesion vs non-lesion), gender, and time. Dependent variables included maximum expiratory pressure (MEP), Voice Handicap Index (VHI) score, Vocal Rating Scale (VRS) score, Voice Effort Scale score, phonetogram measures, subglottal pressures, and acoustic and perceptual measures. Results showed significant improvements in MEP, VHI scores, and VRS scores, subglottal pressure for loud intensity, phonetogram area, and dynamic range. No significant difference was found between laryngeal diagnosis groups. A significant difference was not observed for treatment order. It was concluded that the combined treatment was responsible for the improvements observed. The results indicate that a combined modality treatment may be successful in the remediation of vocal problems for professional voice users.

Nonlinear acoustics in the pant hoots of common chimpanzees (Pan troglodytes): vocalizing at the edge

Common chimpanzee (Pan troglodytes) "pant hoots" are multi-call events that build from quiet, consistently harmonic introductory sounds to loud, screamlike "climax" calls with acoustic irregularities known as "nonlinear phenomena" (NLP). Two possible functions of NLP in climax calls are to increase direct auditory impact on listeners and to signal physical condition. These possibilities were addressed by comparing climax calls from 12 wild chimpanzee males with "screams" and pant hoot "introduction" calls from the same individuals. Climax calls that included NLP were found to have higher fundamental frequencies (F0s) than introduction or climax calls that were purely harmonic. NLP onsets within climax calls were also specifically associated with local F0 maxima, suggesting vocalizers are vibrating their vocal folds at the upper limits of stability. Furthermore, climax calls showed far fewer NLP than did screams recorded from the same individuals, while showing equivalent or higher F0 values. Overall, the results are consistent with the hypothesis that the relative prevalence of NLP is a signal of physical condition, with callers "vocalizing at the edge" of regular, stable production while producing few NLP. The results are discussed in light of the initial hypotheses.

Multidimensional Voice Evaluation in Pretreatment Glottic Carcinoma

It is generally accepted that, in glottic carcinoma, the voice will deteriorate, even in the early stages. This paper reports the degree of hoarseness and multidimensional vocal evaluation of glottic carcinoma patients. Forty-seven male glottic carcinoma patients and a control group of 13 normal subjects were included in this study involving psychoacoustic evaluation by doctors, acoustic analysis, phonogram, maximum phonation time and stroboscopy before treatment. A normal voice or mild hoarseness by psychoacoustic evaluation was found in 35% of cases with T1 and T2 glottic carcinoma. Patients with psychoacoustically inferior vocalization had high scores on acoustic analysis, small phonogram areas, and short maximum phonation time. Stroboscopy revealed attenuation or disappearance of the mucosal wave on the tumor side in all cases, whether the acoustic analysis data were within or beyond the normal limits. We identified two conditions offering superior vocalization in glottic carcinoma patients: (1) the lesion should be unilateral, and (2) the lesion should be flat with no protrusion. We should evaluate patients with glottic carcinoma not only with vocal examination but also using stroboscopy before biopsy.

Effects of voice therapy on the voice range profiles of dysphonic patients

In a group of chronically dysphonic patients, a voice range profile, or phonetogram, was recorded before and after receiving voice therapy and again 3 months later. The voice range profiles took a wide variety of shapes. Therefore, only measures that did not depend on a smooth contour could be used to describe changes before and after therapy. The main effect of voice therapy was an enlargement on the side of low frequency and low intensity.