1
|
Chiang YN, Chan RW, Hsieh LC. Vocal Range Variations Elicited With a Standard Mandarin Reading Passage in Individuals With Voice Disorders. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1283-1300. [PMID: 38483199 DOI: 10.1044/2024_ajslp-23-00333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
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.
Collapse
Affiliation(s)
- Yu-Ning Chiang
- Department of Physical Medicine and Rehabilitation, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Roger W Chan
- Geriatric Care Research Center, Xiamen Medical College, Xiamen, Fujian, China
| | - Li-Chun Hsieh
- Otolaryngology Head and Neck Surgery, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City, Taiwan
| |
Collapse
|
2
|
Andersen HS, Egsgaard MH, Ringsted HR, Grøntved ÅM, Godballe C, Printz T. Normative Voice Range Profile of the Young Female Voice. J Voice 2023; 37:546-552. [PMID: 34049760 DOI: 10.1016/j.jvoice.2021.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Normative data are important in the clinical setting of Speech and Language Pathology. The purpose of this study was to develop a normative reference dataset of voice range profiles from young females. STUDY DESIGN Descriptive study including a prospective collection of voice range profile data. METHODS Voice range profile recordings from 39 females with healthy voices aged 18 to 28 years were conducted. Seven voice range profile variables were analyzed: minimum and maximum fundamental frequency and intensity, semitone and intensity ranges, and voice range profile area. Descriptive statistical methods were applied. RESULTS An age-specific voice range profile normative dataset was established. The mean values and standard deviations were as follows: semitone range 34.7 ± 3.9 ST, minimum fundamental frequency 143.6 ± 21.7 hertz, maximum fundamental frequency 1063.5 ± 160 hertz, intensity range 65.6 ± 5.0 dB, minimum intensity 43.2 ± 2.5 dB SPL, maximum SPL 108.9 ± 5.1 dB SPL, and voice range profile area 1346 ± 222 cells. CONCLUSION A normative dataset usable for optimization of future voice assessments has been established. It may especially benefit evaluation and treatment planning for younger females suffering from vocal fold nodules.
Collapse
Affiliation(s)
| | | | - Helena Rask Ringsted
- Department of ORL Head & Neck Surgery, Odense University Hospital, Odense C, Denmark
| | - Ågot Møller Grøntved
- Department of ORL Head & Neck Surgery, Odense University Hospital, Odense C, Denmark
| | - Christian Godballe
- Department of ORL Head & Neck Surgery, Odense University Hospital, Odense C, Denmark
| | - Trine Printz
- Department of ORL Head & Neck Surgery, Odense University Hospital, Odense C, Denmark
| |
Collapse
|
3
|
McGlashan J, Aaen M, White A, Sadolin C. A mixed-method feasibility study of the use of the Complete Vocal Technique (CVT), a pedagogic method to improve the voice and vocal function in singers and actors, in the treatment of patients with muscle tension dysphonia: a study protocol. Pilot Feasibility Stud 2023; 9:88. [PMID: 37226281 DOI: 10.1186/s40814-023-01317-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 05/02/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Muscle tension dysphonia (MTD) results from inefficient or ineffective voice production and is the cause of voice and throat complaints in up to 40% of patients presenting with hoarseness. Standard treatment is voice therapy (SLT-VT) delivered by specialist speech therapists in voice disorders (SLT-V). The Complete Vocal Technique (CVT) is a structured, pedagogic method which helps healthy singers and other performers optimise their vocal function enabling them to produce any sound required. The aim of this feasibility study is to investigate whether CVT administered by a trained, non-clinical CVT practitioner (CVT-P) can be applied to patients with MTD before progressing to a pilot randomised control study of CVT voice therapy (CVT-VT) versus SLT-VT. METHODS/DESIGN In this feasibility study, we use a mixed-method, single-arm, prospective cohort design. The primary aim is to demonstrate whether CVT-VT can improve the voice and vocal function in patients with MTD in a pilot study using multidimensional assessment methods. Secondary aims are to assess whether (1) a CVT-VT study is feasible to perform; (2) is acceptable to patients, the CVT-P and SLT-VTs; and (3) whether CVT-VT differs from existing SLT-VT techniques. A minimum of 10 consecutive patients with a clinical diagnosis of primary MTD (types I-III) will be recruited over a 6-month period. Up to 6 video sessions of CVT-VT will be delivered by a CVT-P using a video link. The primary outcome will be a change in pre-/post-therapy scores of a self-reported patient questionnaire (Voice Handicap Index (VHI)). Secondary outcomes include changes in throat symptoms (Vocal Tract Discomfort Scale), acoustic/electroglottographic and auditory-perceptual measures of voice. Acceptability of the CVT-VT will be assessed prospectively, concurrently and retrospectively both quantitatively and qualitatively. Differences from SLT-VT will be assessed by performing a deductive thematic analysis of CVT-P transcripts of therapy sessions. CONCLUSION This feasibility study will provide important data to support whether to proceed with a randomised controlled pilot study focusing on the effectiveness of the intervention compared to standard SLT-VT. Progression criteria will be based on demonstrating a positive outcome in treatment, successful delivery of the pilot study protocol, acceptability to all stakeholders and satisfactory recruitment rates. TRIAL REGISTRATION ClinicalTrials.gov website ( NCT05365126 Unique Protocol ID: 19ET004). Registered on 06 May 2022.
Collapse
Affiliation(s)
- Julian McGlashan
- Ear, Nose and Throat Department, Queen's Medical Centre Campus, Nottingham University Hospitals, Nottingham, NG7 2UH, UK.
| | - Mathias Aaen
- Complete Vocal Institute, Kompagnistraede 32A, 1208, Copenhagen K, Denmark
- Honorary Researcher, Ear, Nose and Throat Department, Queen's Medical Centre Campus, Nottingham University Hospitals, Nottingham, NG7 2UH, UK
| | - Anna White
- Ear, Nose and Throat Department, Queen's Medical Centre Campus, Nottingham University Hospitals, Nottingham, NG7 2UH, UK
| | - Cathrine Sadolin
- Complete Vocal Institute, Kompagnistraede 32A, 1208, Copenhagen K, Denmark
- Honorary Researcher, Ear, Nose and Throat Department, Queen's Medical Centre Campus, Nottingham University Hospitals, Nottingham, NG7 2UH, UK
| |
Collapse
|
4
|
Ostermann TA, Fuchs M, Hinz A, Engel C, Berger T. Associations of Personality, Physical and Mental Health with Voice Range Profiles. J Voice 2023:S0892-1997(22)00377-0. [PMID: 36599716 DOI: 10.1016/j.jvoice.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES There is evidence in the literature that voice characteristics are linked to mental and physical health. The aim of this explorative study was to determine associations between voice parameters measured by a voice range profile (VRP) and personality, mental and physical health. STUDY DESIGN Cross-sectional population-based study. METHODS As part of the LIFE-Adult-Study, 2639 individuals aged 18-80 years, randomly sampled from the general population, completed both speaking and singing voice tasks and answered questionnaires on depression, anxiety, life satisfaction, personality and quality of life. The voice parameters used were fundamental frequency, sound pressure level, their ranges and maximum phonation time. The associations were examined with the help of correlation and regression analyses. RESULTS Wider ranges between the lowest and highest frequency, between the lowest and highest sound pressure level and longer maximum phonation time were significantly correlated with extraversion and quality of life in both sexes, as well as openness and agreeableness in women. Smaller ranges and shorter maximum phonation time were significantly correlated with depression. Neuroticism in men was inversely correlated with the maximum phonation time. In the speaking VRP, the associations for sound pressure level were more pronounced than for the fundamental frequency. The same was true in reverse for the singing VRP. Few associations were found for anxiety, life satisfaction and conscientiousness. CONCLUSIONS Weak associations between voice parameters derived from the VRP and mental and physical health, as well as personality were seen in this exploratory study. The results indicate that the VRP measurements in a clinical context are not significantly affected by these parameters and thus are a robust measurement method for voice parameters.
Collapse
Affiliation(s)
- Thomas A Ostermann
- Phoniatrics and Audiology, Department of Otorhinolaryngology, University of Leipzig, Leipzig, Germany; LIFE Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany; Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Michael Fuchs
- Phoniatrics and Audiology, Department of Otorhinolaryngology, University of Leipzig, Leipzig, Germany; LIFE Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Andreas Hinz
- LIFE Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany; Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Christoph Engel
- LIFE Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany; Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Thomas Berger
- Phoniatrics and Audiology, Department of Otorhinolaryngology, University of Leipzig, Leipzig, Germany; LIFE Leipzig Research Centre for Civilization Diseases, University of Leipzig, Leipzig, Germany.
| |
Collapse
|
5
|
Yamauchi A, Imagawa H, Yokonishi H, Sakakibara KI, Tayama N. Sex and Age Stratified Voice Data in Japanese Vocally Healthy Individuals: Vocal Capacity. J Voice 2022:S0892-1997(22)00103-5. [PMID: 35513937 DOI: 10.1016/j.jvoice.2022.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE There is no normative voice dataset regarding the vocal capacity of Japanese speakers in the English literature. We collected age- and sex-stratified data on the vocal capacity of vocally healthy Japanese speakers. METHODS In total, 111 vocally healthy Japanese speakers (42 men and 69 women) were divided into the young (13 men and 30 women), middle-aged (18 men and 27 women), and elderly (11 men and 12 women) groups. Participants underwent duration-, intensity-, and pitch-related vocal capacity tests using either a conventional method or an aerodynamic method or both. The data obtained were statistically analyzed in terms of age and sex. RESULTS Overall, the duration- and pitch-related parameters measured by the conventional method were generally comparable to the previous results in the literature, while duration-, pitch-, and intensity-related parameters measured by the aerodynamic method differed significantly from them. Significant sex differences were noted in all parameters in the duration-, intensity-, and pitch-related vocal capacity tests. Furthermore, significant age-related changes were observed in all parameters, except for the mean flow rate and highest pitch measured by the aerodynamic method. CONCLUSION This study is the first to provide a sex- and age-stratified database of the normative vocal capacity data of Japanese speakers. However, further improvements will be needed in the assessment protocols, conditions, or devices used for the duration-, intensity-, and pitch-related vocal capacity tests in the aerodynamic method.
Collapse
Affiliation(s)
- Akihito Yamauchi
- Department of Otolaryngology, The University of Tokyo Hospital, Tokyo, Japan.
| | - Hiroshi Imagawa
- Department of Otolaryngology, The University of Tokyo Hospital, Tokyo, Japan
| | - Hisayuki Yokonishi
- Department of Otolaryngology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Ken-Ichi Sakakibara
- Department of Communication Disorders, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Niro Tayama
- Department of Otolaryngology and Tracheo-Esophagology, National Center for Global Health and Medicine, Tokyo, Japan
| |
Collapse
|
6
|
Yen YZ, Wu CH, Chan RW. A Mandarin Chinese Reading Passage for Eliciting Significant Vocal Range Variations. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:1117-1135. [PMID: 33820432 DOI: 10.1044/2020_jslhr-20-00424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose There is a lack of standardized Mandarin reading text material that could potentially elicit significant variations in fundamental frequency (F0) and in vocal intensity for clinical voice evaluation. In this study, a phonetically balanced "Three Bears Passage" was developed based on the classical "Goldilocks" story for this purpose. The hypothesis was that the vocal range (F0 range and Intensity range) elicited while reading aloud the passage could be similar to that of the voice range profile (VRP) obtained with sustained vowel production and significantly different from that while reading an existing standard Mandarin passage. Method One hundred twenty young adults (60 men and 60 women, aged 25.22 ± 3.74 years) without vocal pathologies and vocal training participated in the study. Vocal range data, including F0-related measures and intensity-related measures, were obtained with Praat in order to construct VRPs for the sustained /a/ and to construct speech range profiles for passage reading. Results F0 range and intensity range for the new passage were significantly larger than those for the existing Mandarin passage for both male and female participants. In particular, the F0 range for the passage was not significantly different from that of the VRP for male participants. Conclusions These findings suggested that the new passage could allow individuals without vocal training to demonstrate a large vocal range in both F0 and vocal intensity, in a passage reading setting in a relatively short time. Further studies should be pursued with the passage to investigate the vocal range and vocal potential of individuals with voice disorders.
Collapse
Affiliation(s)
- You-Zhen Yen
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taiwan
| | - Chia-Hsin Wu
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taiwan
| | - Roger W Chan
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taiwan
| |
Collapse
|
7
|
Barsties v. Latoszek B, Auner M, Graf S. Cross-Cultural Adaption and Validation of the Vocal Fatigue Index in German. J Voice 2021; 35:161.e1-161.e13. [DOI: 10.1016/j.jvoice.2019.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/02/2019] [Accepted: 08/02/2019] [Indexed: 11/29/2022]
|
8
|
Cutchin GM, Plexico LW, Weaver AJ, Sandage MJ. Data Collection Methods for the Voice Range Profile: A Systematic Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1716-1734. [PMID: 32579858 DOI: 10.1044/2020_ajslp-20-00023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose To assess data collection variability in the voice range profile (VRP) across clinicians and researchers, a systematic review was conducted to evaluate the extent of variability of specific data collection points that affect the determination of frequency range and sound level and determine next steps in standardization of a VRP protocol. Method A systematic review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis checklist. Full-text journal articles were identified through PubMed, Web of Science, Psych Info, ProQuest Dissertations and Theses Global, Google Scholar, and hand searching of journals. Results A total of 1,134 articles were retrieved from the search; of these, 463 were duplicates. Titles and abstracts of 671 articles were screened, with 202 selected for full-text review. Fifty-four articles were considered eligible for inclusion. The information extracted from these articles revealed the methodology used to derive the VRP was extremely variable across the data points selected. Additionally, there were eight common acoustic measures used for statistical analysis described in included studies that were added as a data point. Conclusions The data collection methods for the VRP varied considerably. Standardization of procedures was recommended for clinicians and researchers.
Collapse
Affiliation(s)
| | - Laura W Plexico
- Department of Communication Disorders, Auburn University, AL
| | - Aurora J Weaver
- Department of Communication Disorders, Auburn University, AL
| | - Mary J Sandage
- Department of Communication Disorders, Auburn University, AL
| |
Collapse
|
9
|
Berger T, Fuchs M, Dippold S, Meuret S, Zebralla V, Yahiaoui-Doktor M, Wirkner K, Loeffler M, Engel C. Standardization and Feasibility of Voice Range Profile Measurements in Epidemiological Studies. J Voice 2020; 36:142.e9-142.e20. [PMID: 32402662 DOI: 10.1016/j.jvoice.2020.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The voice range profile (VRP) is composed of the speaking VRP (spVRP) and the singing VRP (siVRP). Different examination methods of VRP and effects of interobserver variability were evaluated to define a standard operating procedure (SOP) suitable for the specific use in epidemiological studies. Subsequently the feasibility of the SOP was investigated in a larger number of participants. STUDY DESIGN Cross-sectional study. METHODS In a first phase both the spVRP and the siVRP of 51 female students were measured by four differently experienced examiners. Using a cross-over study design the effects of two different recording methods (manual vs automatic) and three different types of instructions given by the examiner (none vs before vs during recording) were investigated. In a second phase, the SOP for VRP recording was tested in the framework of a feasibility study in 110 (55 female and 55 male) participants. RESULTS The average total investigation time was significantly (P = 0.001) higher for the manual recording method (6.1 minutes ± 1.0) in comparison to the automated (5.5 minutes ± 0.7) recording method. The manual recording method led to significantly lower values of minimum frequency (F0min) (P = 0.013) and minimum intensity (SPLmin) (P < 0.001) and higher values of the maximum frequency (F0max) (P = 0.005) of the siVRP. The maximum phonation time, F0max, SPLmax of the siVRP and the frequency and intensity of the shouting voice (Level IV) of the spVRP showed significantly (P < 0.001) higher values when the examiner was allowed to give instructions and advise during the recording. Voice parameters of the siVRP did not show significant associations with the experience of the examiner. CONCLUSIONS Standardization of VRP measurements is important to obtain correct and reproducible data in a reasonable examination time. The SOP proposed here proved to be feasible in the setting of an epidemiological study.
Collapse
Affiliation(s)
- Thomas Berger
- Department of Otorhinolaryngology, Section of Phoniatrics and Audiology, University of Leipzig, Leipzig, Germany; LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany.
| | - Michael Fuchs
- Department of Otorhinolaryngology, Section of Phoniatrics and Audiology, University of Leipzig, Leipzig, Germany; LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Sebastian Dippold
- Department of Otorhinolaryngology, Section of Phoniatrics and Audiology, University of Leipzig, Leipzig, Germany
| | - Sylvia Meuret
- Department of Otorhinolaryngology, Section of Phoniatrics and Audiology, University of Leipzig, Leipzig, Germany
| | - Veit Zebralla
- Department of Otorhinolaryngology, Section of Phoniatrics and Audiology, University of Leipzig, Leipzig, Germany
| | - Maryam Yahiaoui-Doktor
- Institute for Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Leipzig, Germany; LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Kerstin Wirkner
- Institute for Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Leipzig, Germany; LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Leipzig, Germany; LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Leipzig, Germany; LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| |
Collapse
|
10
|
On the design of automatic voice condition analysis systems. Part I: Review of concepts and an insight to the state of the art. Biomed Signal Process Control 2019. [DOI: 10.1016/j.bspc.2018.12.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
11
|
Barrett EA, Lam W, Yiu EML. Elicitation of Minimum and Maximum Fundamental Frequency and Vocal Intensity: Discrete Half Steps Versus Glissando. J Voice 2018; 34:179-196. [PMID: 30385012 DOI: 10.1016/j.jvoice.2018.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/27/2018] [Accepted: 09/27/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To investigate the effect of elicitation method, either discrete half steps or glissando, on the minimum fundamental frequency, maximum fundamental frequency, minimum vocal intensity, and maximum vocal intensity. METHOD Fifty-six healthy-voice participants (28 males and 28 females) ranging from 18 to 25 years of age participated in the study. Each participant performed both the discrete half steps and the glissando procedure. The minimum frequency, maximum frequency, minimum intensity, and maximum intensity values elicited by each task were analyzed. A portion of participants (five males and five females) returned within 3 weeks to repeat the whole procedure to determine test-retest reliability. RESULT The results of Pearson's correlation demonstrated all measures were positively significantly correlated. However, the results of paired t tests showed significant difference between elicitation methods, where discrete half steps could elicit maximal vocal performance better than glissando in terms of minimum frequency, maximum frequency, and minimum intensity. Discrete half steps could elicit higher maximum intensity than glissando in males to a greater extent than in females. CONCLUSION The difference in performance elicited by the two procedures may be considered acceptable under some situations (eg, time constraint, patient fatigue). In the clinical setting, the clinician should select the appropriate procedure with the consideration of time and assessment purpose.
Collapse
Affiliation(s)
- Elizabeth Ann Barrett
- Voice Research Laboratory, Division of Speech and Hearing Sciences, The University of Hong Kong, Pokfulam, Hong Kong.
| | - Wency Lam
- Voice Research Laboratory, Division of Speech and Hearing Sciences, The University of Hong Kong, Pokfulam, Hong Kong
| | - Edwin M L Yiu
- Voice Research Laboratory, Division of Speech and Hearing Sciences, The University of Hong Kong, Pokfulam, Hong Kong
| |
Collapse
|
12
|
|
13
|
Pei YC, Chuang HF, Chang CF, Chang TL, Chiang HC, Fang TJ. Voice Range Change After Injection Laryngoplasty for Unilateral Vocal Fold Paralysis. J Voice 2017; 32:625-632. [PMID: 29248388 DOI: 10.1016/j.jvoice.2017.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/23/2017] [Accepted: 07/25/2017] [Indexed: 10/18/2022]
Abstract
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.
Collapse
Affiliation(s)
- Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Center of Vascularized Tissue Allograft, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Feng Chuang
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chia-Fen Chang
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Tzu-Ling Chang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Hui-Chen Chiang
- Graduate School of Management, Ming Chung University, Taipei, Taiwan
| | - Tuan-Jen Fang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
| |
Collapse
|
14
|
Lewandowski A, Gillespie AI, Kridgen S, Jeong K, Yu L, Gartner-Schmidt J. Adult normative data for phonatory aerodynamics in connected speech. Laryngoscope 2017; 128:909-914. [DOI: 10.1002/lary.26922] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 08/14/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Ali Lewandowski
- University of Pittsburgh Voice Center, Department of Otolaryngology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Amanda I. Gillespie
- University of Pittsburgh Voice Center, Department of Otolaryngology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Samantha Kridgen
- Department of Music, Wake Forest University; Winston-Salem North Carolina
| | - Kwonho Jeong
- University of Pittsburgh Center for Research on Health Care Data Center; Pittsburgh Pennsylvania U.S.A
| | - Lan Yu
- University of Pittsburgh Center for Research on Health Care Data Center; Pittsburgh Pennsylvania U.S.A
| | - Jackie Gartner-Schmidt
- University of Pittsburgh Voice Center, Department of Otolaryngology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| |
Collapse
|
15
|
Ma EPM, Li TKY. Effects of Coaching and Repeated Trials on Maximum Phonational Frequency Range in Children. J Voice 2017; 31:243.e1-243.e8. [DOI: 10.1016/j.jvoice.2016.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 05/16/2016] [Indexed: 11/24/2022]
|
16
|
Yiu EML, Chan KMK, Kwong E, Li NYK, Ma EPM, Tse FW, Lin Z, Verdolini Abbott K, Tsang R. Is Acupuncture Efficacious for Treating Phonotraumatic Vocal Pathologies? A Randomized Control Trial. J Voice 2016; 30:611-20. [PMID: 26298839 PMCID: PMC4548836 DOI: 10.1016/j.jvoice.2015.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 07/14/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the effectiveness of acupuncture in treating phonotraumatic vocal fold lesions. STUDY DESIGN/METHODS A total of 123 dysphonic individuals with benign vocal pathologies were recruited. They were given either genuine acupuncture (n = 40), sham acupuncture (n = 44), or no treatment (n = 39) for 6 weeks (two 30-minute sessions/wk). The genuine acupuncture group received needles puncturing nine voice-related acupoints for 30 minutes, two times a week for 6 weeks, whereas the sham acupuncture group received blunted needles stimulating the skin surface of the nine acupoints for the same frequency and duration. The no-treatment group did not receive any intervention but attended just the assessment sessions. One-hundred seventeen subjects completed the study (genuine acupuncture = 40; sham acupuncture = 43; and no treatment = 34), but only 84 of them had a complete set of vocal functions and quality of life measures (genuine acupuncture = 29; sham acupuncture = 33; and no-treatment = 22) and 42 of them with a complete set of endoscopic data (genuine acupuncture = 16; sham acupuncture = 15; and no treatment = 11). RESULTS Significant improvement in vocal function, as indicated by the maximum fundamental frequency produced, and also perceived quality of life, were found in both the genuine and sham acupuncture groups, but not in the no-treatment group. Structural (morphological) improvements were, however, only noticed in the genuine acupuncture group, which demonstrated a significant reduction in the size of the vocal fold lesions. CONCLUSIONS The findings showed that acupuncture of voice-related acupoints could bring about improvement in vocal function and healing of vocal fold lesions.
Collapse
Affiliation(s)
- Edwin M L Yiu
- Division of Speech and Hearing Sciences, The University of Hong Kong, Pokfulam, Hong Kong, China.
| | - Karen M K Chan
- Division of Speech and Hearing Sciences, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Elaine Kwong
- Division of Speech and Hearing Sciences, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Nicole Y K Li
- School of Communication Sciences and Disorders, McGill University, Montreal, Canada
| | - Estella P M Ma
- Division of Speech and Hearing Sciences, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Fred W Tse
- Fred TSE's CM Clinic, Causeway Bay, Hong Kong, China
| | - Zhixiu Lin
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | | | - Raymond Tsang
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong, China
| |
Collapse
|
17
|
Davies S, Papp VG, Antoni C. Voice and Communication Change for Gender Nonconforming Individuals: Giving Voice to the Person Inside. Int J Transgend 2015. [DOI: 10.1080/15532739.2015.1075931] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
18
|
Šrámková H, Granqvist S, Herbst CT, Švec JG. The softest sound levels of the human voice in normal subjects. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2015; 137:407-418. [PMID: 25618070 DOI: 10.1121/1.4904538] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Accurate measurement of the softest sound levels of phonation presents technical and methodological challenges. This study aimed at (1) reliably obtaining normative data on sustained softest sound levels for the vowel [a:] at comfortable pitch; (2) comparing the results for different frequency and time weighting methods; and (3) refining the Union of European Phoniatricians' recommendation on allowed background noise levels for scientific and equipment manufacturers' purposes. Eighty healthy untrained participants (40 females, 40 males) were investigated in quiet rooms using a head-mounted microphone and a sound level meter at 30 cm distance. The one-second-equivalent sound levels were more stable and more representative for evaluating the softest sustained phonations than the fast-time-weighted levels. At 30 cm, these levels were in the range of 48-61 dB(C)/41-53 dB(A) for females and 49 - 64 dB(C)/35-53 dB(A) for males (5% to 95% quantile range). These ranges may serve as reference data in evaluating vocal normality. In order to reach a signal-to-noise ratio of at least 10 dB for more than 95% of the normal population, the background noise should be below 25 dB(A) and 38 dB(C), respectively, for the softest phonation measurements at 30 cm distance. For the A-weighting, this is 15 dB lower than the previously recommended value.
Collapse
Affiliation(s)
- Hana Šrámková
- Voice Research Lab, Department of Biophysics, Faculty of Science, Palacký University Olomouc, 17. listopadu 12, 771 46 Olomouc, Czech Republic
| | - Svante Granqvist
- Department of Basic Science and Biomedicine, School of Technology and Health (STH), Campus Haninge, Royal Institute of Technology (KTH), Mariens väg 30, SE-136 40 Handen, Sweden
| | - Christian T Herbst
- Voice Research Lab, Department of Biophysics, Faculty of Science, Palacký University Olomouc, 17. listopadu 12, 771 46 Olomouc, Czech Republic
| | - Jan G Švec
- Voice Research Lab, Department of Biophysics, Faculty of Science, Palacký University Olomouc, 17. listopadu 12, 771 46 Olomouc, Czech Republic
| |
Collapse
|
19
|
Roy N, Barkmeier-Kraemer J, Eadie T, Sivasankar MP, Mehta D, Paul D, Hillman R. Evidence-based clinical voice assessment: a systematic review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2013. [PMID: 23184134 DOI: 10.1044/1058-0360(2012/12-0014)] [Citation(s) in RCA: 203] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE To determine what research evidence exists to support the use of voice measures in the clinical assessment of patients with voice disorders. METHOD The American Speech-Language-Hearing Association (ASHA) National Center for Evidence-Based Practice in Communication Disorders staff searched 29 databases for peer-reviewed English-language articles between January 1930 and April 2009 that included key words pertaining to objective and subjective voice measures, voice disorders, and diagnostic accuracy. The identified articles were systematically assessed by an ASHA-appointed committee employing a modification of the critical appraisal of diagnostic evidence rating system. RESULTS One hundred articles met the search criteria. The majority of studies investigated acoustic measures (60%) and focused on how well a test method identified the presence or absence of a voice disorder (78%). Only 17 of the 100 articles were judged to contain adequate evidence for the measures studied to be formally considered for inclusion in clinical voice assessment. CONCLUSION Results provide evidence for selected acoustic, laryngeal imaging-based, auditory-perceptual, functional, and aerodynamic measures to be used as effective components in a clinical voice evaluation. However, there is clearly a pressing need for further high-quality research to produce sufficient evidence on which to recommend a comprehensive set of methods for a standard clinical voice evaluation.
Collapse
Affiliation(s)
- Nelson Roy
- University of Utah, Salt Lake City, UT, USA.
| | | | | | | | | | | | | |
Collapse
|
20
|
Sanchez K, Oates J, Dacakis G, Holmberg EB. Speech and voice range profiles of adults with untrained normal voices: Methodological implications. LOGOP PHONIATR VOCO 2013; 39:62-71. [DOI: 10.3109/14015439.2013.777109] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
21
|
Mituuti CT, Santos CC, Teles LCDS, Berretin-Felix G. Características da fonetografia em indivíduos com equilíbrio dentofacial pós-muda vocal. REVISTA CEFAC 2012. [DOI: 10.1590/s1516-18462012005000101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
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.
Collapse
|
22
|
Tse ACY, Masters RSW, Whitehill TL, Ma EPM. The use of analogy in speech motor performance. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2012; 14:84-90. [PMID: 22070672 DOI: 10.3109/17549507.2011.616600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The acoustic correlates of pitch variation were examined in 40 participants who received analogy instructions or explicit instructions that required them to modulate their intonation during speech production. First, using focus group methodology, professional speech-language pathologists were asked to identify analogies that best described minimum pitch variation (monotone), moderate pitch variation (normal intonation), and maximum pitch variation (exaggerated intonation) in speech. The focus group established that an appropriate pitch variation metaphor may be related to imagery of "waves at sea", with minimum pitch variation represented by a flat calm sea, moderate pitch variation represented by a moderate sea, and maximum pitch variation represented by a choppy sea. Forty adult participants without speech impairments were asked to read aloud a standard paragraph using their habitual pitch variation (control condition). They were then allocated randomly to an analogy or an explicit instruction group and were asked to read aloud different paragraphs with minimum, moderate, or maximum pitch variations. Results revealed that acoustic correlates of pitch variation (standard deviation of fundamental frequency, SDF0) were not different for the control condition, or moderate and maximum pitch variation conditions in the two groups. However, the analogy instruction was significantly more effective than the explicit instruction for inducing minimum pitch variation. Analysis of participants in each group who showed higher than normal pitch variation in the control condition (>.5 SD above the group SDF0) revealed that the analogy instruction was more effective than the explicit instruction in the minimum variation condition. It was concluded that analogy instructions may be a useful tool in speech rehabilitation.
Collapse
Affiliation(s)
- Andy C Y Tse
- Institute of Human Performance, The University of Hong Kong, Hong Kong, SAR, PR China.
| | | | | | | |
Collapse
|
23
|
Cielo CA, Gonçalves BFDT, Lima JPDM, Christmann MK. Afecções laríngeas, tempos máximos de fonação e capacidade vital em mulheres com disfonia organofuncional. REVISTA CEFAC 2011. [DOI: 10.1590/s1516-18462011005000126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: verificar e correlacionar os tempos máximos de fonação (TMF) de vogais, a capacidade vital (CV) e os tipos de afecções laríngeas (AL) de mulheres com disfonia organofuncional (DOF). MÉTODO: pesquisa retrospectiva, transversal, exploratória, não experimental, quantitativa, com banco de dados de medidas de TMF [a, i, u], de CV e de AL de mulheres com DOF; e os testes estatísticos Qui- quadrado e exato de Fisher, para verificar as diferenças entre as variáveis e suas relações e o teste binomial, a fim de verificar a significância de proporção ou percentual da análise descritiva, com p<0,05. RESULTADOS: a maioria (22; 75,86%) apresentou TMF significantemente reduzidos (p=0,0053) e sete (24,14%) TMF normais. A CV normal foi estatisticamente significante (p=0,0001) (26; 89,66%), mas três mulheres (10,34%) a apresentaram reduzida. Houve predomínio significante dos nódulos vocais (p=0,0016) (22; 75,86%), seguido de edema de Reinke (6; 20,69%) e de pólipo vocal (1; 3,45%). Dentre as 22 mulheres (75,86%) que mostraram TMF reduzidos, houve predomínio com CV normal (19; 86,36%), embora sem significância estatística (p=0,558). Das mulheres com TMF normais, todas apresentaram CV normal (7; 100%). A maioria com DOF apresentou CV normal, embora sem significância estatística (p=0,199). CONCLUSÃO: nas mulheres com DOF deste estudo, os TMF reduzidos, a CV normal e a presença de nódulos vocais foram significantes e não houve relação entre as variáveis TMF, CV e AL.
Collapse
|
24
|
Hallin AE, Fröst K, Holmberg EB, Södersten M. Voice and speech range profiles and Voice Handicap Index for males — methodological issues and data. LOGOP PHONIATR VOCO 2011; 37:47-61. [DOI: 10.3109/14015439.2011.607469] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
25
|
Titze IR, Hunter EJ. Feasibility of measurement of a voice range profile with a semi-occluded vocal tract. LOGOP PHONIATR VOCO 2011; 36:32-9. [PMID: 21244326 DOI: 10.3109/14015439.2010.548828] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
Collapse
Affiliation(s)
- Ingo R Titze
- National Center for Voice and Speech, The University of Utah, Salt Lake City, USA.
| | | |
Collapse
|
26
|
Svec JG, Granqvist S. Guidelines for selecting microphones for human voice production research. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2010; 19:356-368. [PMID: 20601621 DOI: 10.1044/1058-0360(2010/09-0091)] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE This tutorial addresses fundamental characteristics of microphones (frequency response, frequency range, dynamic range, and directionality), which are important for accurate measurements of voice and speech. METHOD Technical and voice literature was reviewed and analyzed. The following recommendations on desirable microphone characteristics were formulated: The frequency response of microphones should be flat (i.e., variation of less than 2 dB) within the frequency range between the lowest expected fundamental frequency of voice and the highest spectral component of interest. The equivalent noise level of the microphones is recommended to be at least 15 dB lower than the sound level of the softest phonations. The upper limit of the dynamic range of the microphone should be above the sound level of the loudest phonations. Directional microphones should be placed at the distance that corresponds to their maximally flat frequency response, to avoid the proximity effect; otherwise, they will be unsuitable for spectral and level measurements. Numerical values for these recommendations were derived for the microphone distances of 30 cm and 5 cm. CONCLUSIONS The recommendations, while preliminary and in need of further numerical justification, should provide the basis for better accuracy and repeatability of studies on voice and speech production in the future.
Collapse
Affiliation(s)
- Jan G Svec
- Palacký University Olomouc, Czech Republic.
| | | |
Collapse
|
27
|
Current World Literature. Curr Opin Otolaryngol Head Neck Surg 2008; 16:292-5. [DOI: 10.1097/moo.0b013e3283041256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|