Dysphonia Severity Degree and Phonation Onset Latency in Laryngeal Adductor Dystonia

Laryngeal Imaging Study of Glottal Attack/Offset Time in Adductor Spasmodic Dysphonia during Connected Speech

Adductor spasmodic dysphonia (AdSD) disrupts laryngeal muscle control during speech and, therefore, affects the onset and offset of phonation. In this study, the goal is to use laryngeal high-speed videoendoscopy (HSV) to measure the glottal attack time (GAT) and glottal offset time (GOT) during connected speech for normophonic (vocally normal) and AdSD voices. A monochrome HSV system was used to record readings of six CAPE-V sentences and part of the "Rainbow Passage" from the participants. Three raters visually analyzed the HSV data using a playback software to measure the GAT and GOT. The results show that the GAT was greater in the AdSD group than in the normophonic group; however, the clinical significance of the amount of this difference needs to be studied further. More variability was observed in both GATs and GOTs of the disorder group. Additionally, the GAT and GOT time series were found to be nonstationary for the AdSD group while they were stationary for the normophonic voices. This study shows that the GAT and GOT measures can be potentially used as objective markers to characterize AdSD. The findings will potentially help in the development of standardized measures for voice evaluation and the accurate diagnosis of AdSD.

Effects of Volume, Pitch, and Phonation Type on Oscillation Initiation and Termination Phases Investigated With High-speed Videoendoscopy

OBJECTIVES

This study aimed to investigate the effects of varying volume, pitch, and phonation types on the initiation and termination phases of vocal fold oscillation using high-speed digital videoendoscopy. Specifically, it addressed the effects of the variation of volume, pitch, and phonation type (normal, pressed, and breathy) on the transient duration of the vibrating glottal length (length transient duration, T_len), the transient duration of the glottal area waveform (area transient duration, T_area), the time offset between the beginning (or the end) of the full-length vibration and the full-amplitude vibration, T_Δ, and the variation of the fundamental frequency during the vocal fold oscillation initiation and termination segments (pitch instability, %PI).

METHODS

A female subject with no voice problem produced voices with varying pitch and loudness, including comfortable pitch and comfortable loudness, normal pitch loud, high pitch and comfortable loudness, and high pitch and loud. Breathy and pressed phonations were also recorded. Each of the six phonation types was recorded six times, which resulted in 72 transient segments (each recording included both initiation and termination phases). Mixed model statistical analyses were employed to the five objective high-speed digital videoendoscopy parameters.

RESULTS

Preliminary findings demonstrated significant findings for voice type effects for the length and area transient durations for the oscillation initiation segment but not for the oscillation termination segment.

CONCLUSIONS

This study demonstrates that voice types appear to influence vibration initiation patterns more than the vibration termination patterns.

Dynamics of phonatory posturing at phonation onset

INTRODUCTION

In speech and singing, the intrinsic laryngeal muscles set the prephonatory posture prior to the onset of phonation. The timing and shape of the prephonatory glottal posture can directly affect the resulting phonation type. We investigated the dynamics of human laryngeal phonatory posturing.

METHODS

Onset of vocal fold adduction to phonation was observed in 27 normal subjects using high-speed video recording. Subjects were asked to utter a variety of phonation types (modal, breathy, pressed, /i/ following sniff). Digital videokymography with concurrent acoustic signal was analyzed to assess the timing of the following: onset of adduction to final phonatory posture (FPT), phonation onset time (POT), and phonatory posture time (PPT). Final phonatory posture time was determined as the moment at which the laryngeal configuration used in phonation was first achieved.

RESULTS

Thirty-three audiovisual recordings met inclusion criteria. Average FPT, PPT, and POT were as follows: 303, 106, and 409 ms for modal; 430, 104, and 534 ms for breathy; 483, 213, and 696 ms for pressed; and 278, 98, and 376 ms for sniff-/i/. The following posturing features were observed: 1) pressed phonation: increased speed of closure just prior to final posture, complete glottal closure, and increased supraglottic hyperactivity; and 2) breathy phonation: decreased speed of closure prior to final posture, increased posterior glottal gap, and increased midmembranous gap.

CONCLUSIONS

Phonation onset latency was shortest for modal and longest for pressed voice. These findings are likely explained by glottal resistance and subglottal pressure requirements.

LEVEL OF EVIDENCE

NA. Laryngoscope, 126:1837-1843, 2016.

A Spatiotemporal Approach to the Objective Analysis of Initiation and Termination of Vocal-fold Oscillation With High-speed Videoendoscopy

High-speed videoendoscopy excels in the ability to observe the vocal-fold oscillatory patterns during voice initiation and termination. The initial and most critical step in the analysis of these transient regions is to identify the locations of these transient periods, that is, determining when the vocal-fold oscillation is absent and when the oscillation has reached its steady-state behavior. The latter is more challenging as the "steady" oscillation during sustained phonation is not truly steady and is expected to vary over time. This variation may cause unreliable identification of the transient periods, possibly resulting in less accurate or less reliable parameter measurements. An oscillation feature that is relatively consistent in the steady state is the glottal length, that is, the extent of the oscillation along vocal folds. This paper proposes an autonomous algorithm to estimate the vocal-fold oscillation length and its use to detect four transient events: oscillation onset and offset, and attainment and loss of full-length oscillation. The detected event markers are intended to be used to improve the transient parameter measurements. The autonomous algorithm manipulates the set of glottal width waveforms spatiotemporally to estimate the oscillation length. Examples with in vivo high-speed videoendoscopy recordings of both normal and pathological cases are included to show the efficacy of the proposed algorithm to identify the transient markers.

Refractory Dysphonia Due to Isolated Cricothyroid Muscle Dystonia

OBJECTIVE

To demonstrate the utility of electromyography (EMG) in the evaluation and management of treatment-resistant dysphonia.

METHOD

We report a case of refractory dysphonia in which EMG was used to identify and treat isolated cricothyroid (CT) dystonia.

RESULTS

The patient, a healthy 43-year-old woman, presented with 9 months of progressive hoarseness. Her symptoms were present across vocal tasks but were particularly bothersome while dictating. On presentation, her voice was rated grade 3, roughness 3, breathiness 1, asthenia 0, and strain 3 (G3R3B1A0S3). Videostroboscopy was remarkable for hyperfunction. Voice therapy was not beneficial despite appropriate effort. Microdirect laryngoscopy revealed no evidence of structural pathology. The patient was referred for EMG because of her normal examination and failure to improve with therapy. The CT muscle demonstrated an increased latency of 750 ms in all vocal tasks. One month after CT injection with 3 units of botulinum toxin (BTX), her voice was improved. Perceptual voice evaluation was rated G1R1B0A0S1. Voice Handicap Index improved from 87 to 35.

CONCLUSIONS

In the absence of structural pathology, EMG can be a useful adjunct in the diagnosis of dysphonia that persists despite adequate trials of voice therapy. To our knowledge, this is the only report of laryngeal dystonia due to isolated CT dysfunction successfully treated with BTX.