Acoustic Measures of the Voices of Older Singers and Nonsingers

Preliminary Findings of Vocal Fold Vibratory Characteristics of Singers Analyzed by Laryngeal High-Speed Videoendoscopy

OBJECTIVES

This study investigates the vocal fold vibratory dynamics of singers, which are postulated to differ from those of normal speakers due to the singers' regular vocal training. The measurement of vocal fold vibration involved the utilization of laryngeal high-speed videoendoscopy (LHSV) and subsequent LHSV-based analysis. The focus of the present study is to characterize and compare the LHSV-based measures derived from the glottal area waveform (GAW), namely fundamental frequency (F0GAW), glottal perturbation (jitterGAW and shimmerGAW), open quotient (OQGAW), and Nyquist plots, between singers and normal speakers across genders.

METHODS

Participants comprised 13 singers from a local cultural and heritage academy and 56 normal speakers from a local university, all were evaluated to have normal voices. Each participant underwent LHSV procedures to capture images of vocal fold vibration, which were subsequently analyzed to generate the LHSV-based measures.

RESULTS

Male singers exhibited lower F0GAW, jitterGAW, shimmerGAW, and OQGAW than female singers. When compared to normal speakers, male singers demonstrated higher F0GAW, and lower jitterGAW and shimmerGAW. No difference in OQGAW was found between male singers and normal speakers. Female singers exhibited lower jitterGAW compared to normal speakers, but no differences were observed in shimmerGAW and OQGAW. The results of Nyquist plots indicated no gender-related associations between types of rim width and among singers. However, for rim pattern, male singers were associated with a higher percentage of clustered rim, suggesting more regular vocal fold vibration, compared to female singers and normal male speakers.

CONCLUSIONS

Singers, particularly male singers, demonstrate distinct and potentially superior vocal fold vibrations compared to normal speakers, likely attributed to their regular vocal training, resulting in refined vocal fold configurations even during speaking. Despite the limited sample of singers, the study offers valuable insights into the vocal fold vibratory behaviors in singers analyzed using LHSV.

How older adults relate to their own voices: a qualitative study of subjective experiences of the aging voice

AIM

The aim of this study was to investigate how otherwise healthy older adults with self-assessed voice problems relate to their voice and voice changes.

METHOD

Focus groups were conducted at an activity center to identify how older adults reflect on their own voice and the aging voice in general. The interviews were audio recorded and transcribed. The analysis was done using thematic content analysis.

RESULTS

The analysis resulted in three main themes: "communicational aspects of the aging voice," "consequences of deteriorating vocal and communicative capacity," and "attitudes, strategies, and ideas". The participants considered voice to be an important communication tool and presented what could be interpreted as awareness regarding their voice. Voice changes were considered a natural part of aging. This attitude was also an important reason why the participants had not sought medical care for their voice problems. The participants discussed ideas concerning extended voice use to maintain a functioning voice when aging. Simultaneously, voice changes due to aging were considered to have a negative effect on communication and social participation.

CONCLUSIONS

The voice is important for older adults, and an insufficient voice can affect communication and social participation. Information about aging voice and voice exercises, for example from speech language pathologists, could be of interest among older adults. Further studies on the voice of older adults are needed regarding how they experience their voice and the general aspects of a healthy aging voice.

Speech Production in Healthy Older Adults With or Without Amateur Singing Experience

PURPOSE

Amateur singing is a universal, accessible, and enjoyable musical activity that may have positive impacts on human communication. However, evidence of an impact of singing on speech articulation is still scarce, yet understanding the effects of vocal training on speech production could provide a model for treating people with speech deficits. The aim of this study was to examine speech production in younger and older adults with or without amateur singing experience.

METHOD

Thirty-eight amateur singers (aged 20-87 years, 23 women and 15 men) and 40 nonmusician active controls (aged 23-88 years, 19 women and 21 men) were recruited. A set of tasks were used to evaluate the oral motor sphere: two voice production tasks, a passage reading task, and a modified diadochokinetic (DDK) rates task performed at a natural rhythm and as quickly as possible.

RESULTS

Our results show that older age was associated with lower reading rate, lower articulation rate, and articulation rate variability in the DDK task, as well as reduced accuracy for the phonologically complex stimuli. Most importantly, our results show an advantage for singers over cognitively active nonsingers in terms of articulatory accuracy in the most challenging situations.

CONCLUSION

This result suggests extended maximal performance capacities in amateur singers perhaps resulting from the articulatory efforts required during singing.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24274813.

Cepstral Measurements: A Comparison of Results Between Singing and Non-Singing Individuals

OBJECTIVE

To analyze and compare cepstral measurements in singing and non-singing men and women to understand if vocal adaptations of singers reflect greater cepstral measurement results.

METHOD

The study included 91 vocally healthy individuals, consisting of 60 erudite or popular singers (30 males, 30 females) and 31 non-singers (16 males, 15 females). The Cepstral Peak Prominence (CPP) and Cepstral Peak Prominence-Smoothed (CPPS) measures were carried out using the sustained /a/ vowel recorded with a unidirectional condenser microphone associated with a sound card on the computer. The Praat software (version 6.1.16) was used to extract the CPP and CPPS measurements. The intra and intergroup values obtained for each sex were compared using the t-test with a 5% significance level.

RESULTS

There was a CPP (P = 0,000) and CPPS (P = 0,000 and P = 0,001) value difference between the sexes in both groups. Cepstral measurements showed no statistically significant difference between singing and non-singing participants (male: P = 0,778 and P = 0,622; female: P = 0,622 and P = 0,460).

CONCLUSION

Men presented higher CPP and CPPS values than women, which may be related to the presence of the physiological posterior glottic cleft in women. The knowledge of the cepstral values of singers shows that singing specificities may not reflect in all vocal evaluations.

Assessing the Prevalence and Associated Risk Factors for Presbylarynx in the Elderly Laryngology Population

OBJECTIVE

The primary objective of this study was to assess the prevalence of presbylarynx and its associated features in an elderly population representative of patients seen in a tertiary care laryngology practice. The secondary objective of this study was to compare laryngeal electromyography (LEMG) findings, coexisting VF conditions, medical history, surgical history, medication use, and other parameters between patients with and without presbylarynx.

METHODS

Adult voice patients aged 60 years and older who underwent strobovideolaryngoscopy were included in the study. Patients were assigned to one of two groups based on the majority (≥2/3) agreement of three blinded authors' (GA, KL, and HP) graded examinations of strobovideolaryngoscopy (SVL) videos for findings consistent with presbylarynx (atrophic vocal folds [VFA], vocal fold bowing [VFB], vocal process prominence [VPP] and anterior glottic insufficiency [GI]). Patient demographics, medical history, surgical history, medication use, laboratory results, and SVL videos were compiled. Statistical analysis was performed using SPSS 28.0.0.0 (IBM, Armonk, NY). All tests were performed two-tailed, and a P-value of less than 0.05 was considered statistically significant.

RESULTS

One hundred sixty-four patients (84 female/80 male, mean age of 68.397 ± 4.947 years) were included in this study. The prevalence of presbylarynx was 52.4% (n = 86) in the study population. The mean age of patients in the presbylarynx group was significantly higher than the nonpresbylarynx group. Additionally, there were significantly more males than females in the presbylarynx group. The presbylarynx group also was found to have a higher proportion of ACE inhibitor (ACEi) use. Further, laboratory results revealed a significantly higher proportion of patients with elevated thyroid stimulating hormone (TSH) levels in the presbylarynx group. Conversely, patients in the nonpresbylarynx group were found to have a significantly higher rate of levothyroxine use. On SVL, patients in the nonpresbylarynx cohort were found to have a significantly higher proportion of benign vocal fold lesions and vocal fold paresis. However, LEMG testing revealed no statistically significant differences in muscle recruitment between groups. Men with presbylarynx were found to have a significantly higher proportion of VFB and VPP compared to women with presbylarynx.

CONCLUSION

This retrospective study investigated the prevalence and risk factors associated with presbylarynx in patients representative of those treated by laryngologists. Signs consistent with presbylarynx are observable even in the presence of coexisting VF conditions. Older age, elevated TSH, the use of ACEi, and male gender was associated with signs of presbylarynx on SVL. Of those diagnosed with presbylarynx, males were identified as having higher proportions of VFB and VPP compared to females. More education regarding presbylarynx and further studies to improve standardization of the criteria for its diagnosis, as well as its relationship with other VF conditions, are encouraged to improve management of the aging voice.

Effects of Participation in a Structured Choral Program on the Voice of Older Adults

OBJECTIVES

To examine the effects of short-term and long-term engagement with structured choral singing on vocal function and quality of life outcomes in older adults.

METHODS

Two groups of older adult singers over 55 years, one with fewer than 4 semesters and one with 4 or more semesters singing in a chorale, were assessed at 3 time points: baseline, after 1 semester of singing, and either after 1 semester of rest or after 1 semester of rest and 1 semester more of singing. Acoustic and aerodynamic measures, voice-related quality of life ratings, and measures of singing accuracy were obtained. Percent change between time points were calculated to determine three outcomes: improvement, lack of change, or worsening of measures across time.

RESULTS

Long-term average spectrum (LTAS), difference in first and second harmonics and estimated subglottic pressure were significantly more likely to improve after a semester of singing with less experience singers, and LTAS continued to improve after a semester of rest. Flow was significantly more likely to improve with more singing experience after a semester of singing. Aerodynamic variables consistently changed in more experienced singers and improvement was maintained over the three visits. No significant changes occurred over time for singing accuracy for any singer type. Self-perception of singing voice continued to improve with more singing experience.

CONCLUSIONS

This study demonstrated that for older adults in good health, regular singing provided a mechanism for maintaining speaking voice over time.

Presbylarynx: Is It a Sign of the Health Status of the Elderly?

PURPOSE

Only a full understanding of how different diseases affect the same or different anatomical/functional entities, may provide a clue on how comorbidity should be taken into consideration. The aim of this study was to evaluate the chronic medical illnesses of an elderly population, in order to analyze potential correlation of specific comorbidities with presbylarynx.

METHODS

This case-control, prospective, observational, and cross-sectional study was carried out on consecutive subjects observed by otorhinolaryngology, in a tertiary center, from January to September 2020. The inclusion criteria were ability to report an accurate medical history and ≥65 years of age. The exclusion criteria were neurologic diagnoses, autoimmune disease, history of thoracic or head and neck surgery, cancer, radiotherapy, thyroid pathology, vocal fold mass lesions, acute laryngitis, or vocal fold paralysis. Based on videostroboscopy of the larynx, the patients were subdivided into two main groups: presbylarynx versus no presbylarynx. Health status was assessed by evaluation of chronic medical illnesses (individual diagnoses of chronic conditions plus Charlson comorbidity index [CCI]), functional status (Katz index of independence in activities of daily living and functional Ambulation ambulation classification), and emotional status (Geriatric Depression Scale).

RESULTS

A total of 174 subjects (60 males; 114 females) were included (mean age = 73.99 years; range 65-95 years). Presbylarynx was identified in 71 patients (41%). A statistically significant difference was found concerning diabetes mellitus type 2 (T2DM); P< 0.001), asthma or chronic obstructive pulmonary disease (COPD; P< 0.001), and psychiatric disorder (P< 0.001). The mean score of CCI between "presbylarynx" and "no presbylarynx" groups was statistically different (P= 0.021). Results showed an association between some functional dependence (P< 0.001), and mild or severe depression (P< 0.001) and the presence of presbylarynx.

CONCLUSIONS

Presbylarynx may be considered a sign of the health status of the elderly. Based on CCI, It was found that patients with higher probability of 10-year mortality exhibit more endoscopic signs of presbylarynx. It was also found that patients with better scores in functionality scales exhibited less endoscopic findings compatible with presbylarynx. Among chronic medical illnesses, T2DM, asthma, or COPD may be considered risk factors for noticeable endoscopic signs of presbylarynx.

Presbylarynx: Is it Possible to Predict Glottal Gap by Cut-Off Points in Auto-Assessment Questionnaires?

PURPOSE

To determine cut-off points in auto-assessment questionnaires to predict the presence and extent of presbylarynx signs.

METHOD

This case control, prospective, observational, and cross-sectional study was carried out on consecutive subjects observed by Otorhinolaryngology, in a tertiary center, in 2020. Each subject underwent fiberoptic videolaryngoscopy with stroboscopy, and presbylarynx was considered when it was identified two or more of the following endoscopic findings: vocal fold bowing, prominence of vocal processes in abduction, and a spindle-shaped glottal gap. Each subject completed three questionnaires: the Voice Handicap Index (VHI), with 30 and 10 questions, and the "Screening for voice disorders in older adults questionnaire" (RAVI).

RESULTS

The studied population included 174 Caucasian subjects (60 males; 114 females), with a mean age of 73.99 years (standard deviation = 6.37; range 65-95 years). Presbylarynx was identified in 71 patients (41%). Among patients with presbylarynx, a glottal gap was identified in 22 patients (31%). The mean score of VHI-30 between "no presbylarynx" and "presbylarynx" groups was statistically different (P < 0.001), with a higher score for subjects with signs of presbylarynx. The presence of glottal gap was associated to a higher mean score of VHI-30 (41.64 ± 11.87) (P < 0.001). The mean score of VHI-10 between "no presbylarynx" and "presbylarynx" groups was statistically different (P < 0.001), with a higher score for subjects with signs of presbylarynx. Among patients with presbylarynx, the presence of glottal gap was associated to higher mean score of VHI-10 (14.04 ± 3.91) (P < 0.001). There was a strong positive correlation between VHI-30 and VHI-10 (rs = 0.969; P < 0.001). The mean score of RAVI between "no presbylarynx" and "presbylarynx" groups was statistically different (P < 0.001), with a higher score for subjects with signs of presbylarynx. Among patients with presbylarynx, the presence of glottal gap was associated to a higher mean score of RAVI (11.68 ± 1.61) (P < 0.001). There was a strong positive correlation not only between RAVI and VHI-30 (rs = 0.922; P < 0.001), but also between RAVI and VHI-10 (rs = 0.906; P < 0.001). The optimal cut-off points to discriminate "no presbylarynx" from "presbylarynx", obtained by the Youden' index, were 3.5 for RAVI, 4.5 for VHI-30 and 1.5 for VHI-10. RAVI had the highest sensitivity and specificity. The optimal cut-off points to predict glottal gap, obtained by the Youden' index, were 9.5 for RAVI, 21 for VHI-30 and 7.5 for VHI-10.

CONCLUSION

The optimal cut-off points do discriminate "no presbylarynx" from "presbylarynx" were 3.5 for RAVI, 4.5 for VHI-30 and 1.5 for VHI-10. RAVI had the highest sensitivity and specificity, probably because it was designed specifically for vocal complaints of the elderly. Among patients with presbylarynx, cut-off points of 9.5 for RAVI, 21 for VHI-30 and 7.5 for VHI-10 were determined to predict patients with and without glottal gap. It was found a strong positive correlation between RAVI, VHI-30 and VHI-10. Thus, VHI-10 can be preferred to VHI-30 to assess voice impairment in clinical practice, because for elderly patients it is easier to answer. However, to predict endoscopic signs of presbylarynx, RAVI should be preferred.

Analysis of the singing voice handicap index for elderly choristers

PURPOSE

To analyze the singing voice handicap index in elderly choristers and verify its relationship with the profile, habits and health conditions of the participants.

METHODS

110 individuals aged 60 years or older, participating in amateur choirs, were included. Choir singers were interviewed in order to verify data such as age, time in choir singing, vocal classification, and the presence of habits and health conditions adverse to voice production. Subsequently, they answered the questionnaire "Singing Voice Handicap Index (SVHI)", which assesses the individual's self-perception in relation to experiences in the use of the singing voice.

RESULTS

The SVHI score had a median of 25, with a minimum score of 0 and a maximum score of 86. The most scored items were related to physical aspects in the use of singing voice: "I am unable to use my 'high voice'" (Q10) and "My throat is dry when I sing"(Q13). It was found that older adults over 75 years of age had a greater voice handicap when compared to younger ones (p=0.020). Choir singers classified as contralto also had a higher SVHI score (p=0.023), as well as individuals who reported drinking little water (p=0.007).

CONCLUSION

The choristers in this study presented a singing voice handicap index compatible with healthy singing voices. When verifying the relationship of the SVHI score with the characteristics of the participants and with respect to habits and health conditions, it was found that the elderly choir singers over 75 years old, the contralto choir singers, and those who claimed to drink little water had higher scores for the singing voice handicap.

Normative Speech Data in Professional Opera Singers- A Retrospective Study

The term "singer" refers to a population of individuals who perform musical songs or related artistic material using their voices. Research has indicated that, as a population, singers' voice parameters differ from the non-singer population. Given the fact that diagnosed voice pathologies are more prevalent in the singer population, normative speech data in singers are necessary for diagnosis and for outcome analysis.

OBJECTIVES

The purpose of this study was to compare objective voice parameters for the professional opera singer population with KAYPENTAX CSL normative values.

METHODOLOGY

Medical records of students at an elite opera conservatory who came into the senior author's (RTS) office for a baseline evaluation were reviewed retrospectively. All subjects had no voice complaint and had not undergone voice surgery. Subjects with vocal fold mass and scar were excluded. All subjects had undergone objective voice measurements by one of three board certified speech-language pathologists using the KAYPENTAX CSL (computerized Speech Lab) protocol. Mean, standard deviation, median and range were compared with normative values provided by KAYPENTAX CSL.

RESULTS

Twenty-seven elite opera conservatory students (11 females and 16 males, ages 21-29 years) were included in the study. There were significant differences between singers and normative values of KAYPENTAX CSL. Among men, the jitter, relative average perturbation and noise- to- harmonic ratio among singers were significantly lower than KAYPENTAX CSL normative values. Among the females, the shimmer percent of singers was significantly higher than KAYPENTAX CSL normative values.

CONCLUSION

Our findings indicate that singers may have different normative voice parameters. However, further research is needed to confirm or refute these findings, and similar studies are needed for singers in other genres.

Worldwide Healthy Adult Voice Baseline Parameters: A Comprehensive Review

The voice results in acoustic signals analyzed and synthetized at first for telecommunication matters, and more recently investigated for medical purposes. In particular, voice signal characteristics can evidence individual health conditions useful for screening, diagnostic and remote monitoring aims. Within this frame, the knowledge of baseline features of healthy voice is mandatory, in order to balance a comparison with their unhealthy counterpart. However, the baseline features of the human voice depend on gender, age-range and ethnicity and, as far as we know, no work reports as those features spread worldwide. This paper intends to cover this lack. Our database research yielded 179 relevant published studies, retrieved using digital libraries of IEEE Xplore, Scopus, Web of Science, Iop Science, Taylor and Francis Online, and Scitepress. These relevant studies report different features, among which here we consider the most investigated ones, within the most investigated age-range. In particular, the features are the fundamental frequency, the jitter, the shimmer, the harmonic-to-noise ratio, and the cepstral peak prominence, the most investigated age-range is within 20-40 years and, related to the ethnicity, 20 countries are considered.

Machine-Learning Analysis of Voice Samples Recorded through Smartphones: The Combined Effect of Ageing and Gender

Background: Experimental studies using qualitative or quantitative analysis have demonstrated that the human voice progressively worsens with ageing. These studies, however, have mostly focused on specific voice features without examining their dynamic interaction. To examine the complexity of age-related changes in voice, more advanced techniques based on machine learning have been recently applied to voice recordings but only in a laboratory setting. We here recorded voice samples in a large sample of healthy subjects. To improve the ecological value of our analysis, we collected voice samples directly at home using smartphones. Methods: 138 younger adults (65 males and 73 females, age range: 15–30) and 123 older adults (47 males and 76 females, age range: 40–85) produced a sustained emission of a vowel and a sentence. The recorded voice samples underwent a machine learning analysis through a support vector machine algorithm. Results: The machine learning analysis of voice samples from both speech tasks discriminated between younger and older adults, and between males and females, with high statistical accuracy. Conclusions: By recording voice samples through smartphones in an ecological setting, we demonstrated the combined effect of age and gender on voice. Our machine learning analysis demonstrates the effect of ageing on voice.

The Role of Choral Singing in Speaking Voice Preservation of Aging Adults

Purpose This descriptive cohort pilot study, using a convenience sample, examined whether evidence from vocal function measures, auditory-perceptual ratings, and/or endoscopic signs of aging supported singing in senior chorales as a possible intervention to preserve the speaking voice in aging adults. Method Thirteen singers and five nonsinging controls, all over 65 years of age, participated. They were assessed at two visits, 15-20 months apart. Vocal function measures and auditory-perceptual ratings of estimated age and the presence of voice disorders were compared across singing status and visit. Changes in the presence and degree of laryngeal signs of aging between visits were compared across singing status. Results Using an alpha of .2, deemed acceptable for pilot studies, vocal function measures supported choral singing as an intervention to preserve the speaking voice as less noise energy between 2 and 3 kHz (p = .01) and lower phonation threshold pressures (PTPs) were present (p = .09) for singers compared to nonsinging controls. Greater flows at comfortable pitch (p = .04) and high pitch (p = .06) as well as lower cepstral peak prominence smoothed (CPPS) for the vowel /a/ (p < .01) were found at Visit 2 for both groups, but singers demonstrated lower flows at Visit 2 than nonsinging controls at comfortable pitch (p = .06). Auditory-perceptual ratings did not support preservation of speaking voice, although a larger percentage of listeners rated nonsinging controls as voice disordered at Visit 2. Endoscopic ratings supported preservation, as singers were more likely than nonsinging controls to be rated as having laryngeal signs of aging absent at both visits (p = .02). Conclusion The findings from this pilot study provide evidence that regular singing in senior chorales may assist in preserving older adults' speaking voices.

The Effects of Therapeutic Singing on Vocal Functions of the Elderly: A Study on Korean Elderly

This study investigated the effects of therapeutic singing as an intervention for improving the vocal functions of the elderly. Data collection for this study took place at five senior community centers in Seoul, South Korea, from August 2018 to March 2019. A total of 54 elderly with healthy voices were assigned to a therapeutic singing group, a general singing group, or a control group, using convenience sampling. The therapeutic singing intervention involved using the Alexander technique, performing oral motor and respiratory exercises, and singing participant-written songs, across 12 sessions. The general singing group sang popular and folk songs of their choice. The control group received no treatment. Using peak expiratory flow rate (PEF) and Praat analysis, the participants' vocal functions were measured before and immediately after the intervention. Vocal function was compared among the groups pre- and post-test; the therapeutic singing group showed statistically significant improvement in all vocal parameters: PEF, maximum phonation time, voice intensity (intensity), fundamental frequency (F0), jitter, shimmer, and noise-to harmonics ratio. The general singing group showed improvement only in F0, jitter, and noise-to harmonics ratio. The control group showed an overall reduction in all vocal functions, with a significant decrease in PEF and intensity, and a decrease in jitter and shimmer. Although singing is considered helpful for the voice health of the elderly, therapeutic singing, which involves posture correction and breathing exercises, is even more effective, thus proving to be a viable intervention for preventive voice care of the elderly.

How Does Our Voice Change as We Age? A Systematic Review and Meta-Analysis of Acoustic and Perceptual Voice Data From Healthy Adults Over 50 Years of Age

Purpose Approximately 30% of adults over the age of 50 years present with altered vocal function. Our understanding of how these changes manifest acoustically and perceptually is derived from relatively modest-sized studies using a diversity of tools. Voice changes can arise from the onset of disease or disorder, but also age-related physiological changes, which may not reflect pathology as such. Here, we bring together data on acoustic, perceptual, and instrumental assessments (electroglottography), with the aim of gaining a better understanding of the changes occurring across these measurement domains. We consider these changes in the context of different acoustic features, software programs, and perceptual protocols. Method Studies of voice function in healthy older adults over the age of 50 years were sought. Literature was systematically searched with 746 abstracts reviewed. Forty-seven studies were included in the review. A meta-analysis of included studies compared voice acoustic parameters between sex and age. Sixteen acoustic parameters collected from 1,475 participants were analyzed in the meta-analysis. These included some previously unpublished analyses using data provided by authors of included studies. Results Data from the systematic review suggest that older individuals are perceived to present with higher overall scores of dysphonia and roughness, breathiness, strain, and instability. Acoustically, males have significantly higher scores on measures of perturbation, including noise-to-harmonic ratio and absolute jitter. The meta-analysis outcomes suggest that participants aged 80-89 years produce significantly higher fundamental frequency, jitter percent, shimmer percent, and shimmer in decibels compared to participants aged 60-69 years and a significant increase in relative average perturbation, jitter percent, and shimmer in decibels compared to participants aged 70-79 years. Limited data were available comparing acoustic measures using the same acoustic software. Conclusions Variations in fundamental frequency and frequency and amplitude perturbation increase as healthy adults age. It was difficult to draw definitive conclusions based on existing literature due to variability in hardware used, limited descriptions of study cohorts, or missing data from statistical analysis. Supplemental Material https://doi.org/10.23641/asha.11868663.

Vocal Dose in Older Adults with Presbyphonia: An Analytic, Cross-Sectional Study

PURPOSE

Older patients with age-related voice changes (presbyphonia) are considered vocal under-doers due to a reportedly low a amount and intensity of voice use (ie, low vocal dose). This low voice use may be consequential to negative effects of presbyphonia like throat discomfort, as well as anxiety and frustration from difficulty communicating. Causally speaking, vocal fold atrophy (presbylaryngis) may indicate inadequate intrinsic laryngeal muscle loading with low voice use, though research is lacking. As a first step, this study examined voice use objectively using vocal dosimetry in older adults with presbyphonia. We hypothesized participants, especially if retired, would exhibit low vocal doses, and lower than reported for other populations.

METHOD

This research used an analytic, cross-sectional design with subgroup analyses to determine feasibility of vocal dosimetry in older adults with presbyphonia. Thirteen older adults with presbyphonia (7 males) completed vocal dose monitoring using an ambulatory phonation monitor (APM). The APM measured vocal parameters over a day of monitoring, from which time, cycle, and distance doses were calculated. Data also were gathered on demographics, vocal handicap, and vocal effort.

RESULTS

Descriptively, the group showed a low mean time dose as compared to published vocal dose data from other populations. Females exhibited significantly higher mean values of time dose, cycle dose, and fundamental frequency than males. Time dose for males was negatively correlated with vocal effort. Subgroup analyses failed to detect an effect of age group, but found significantly a higher mean value for time dose in employed, compared to retired, participants.

CONCLUSIONS

Consistent with self-report, we found older adults with presbyphonia exhibit low time doses, which were in contrast to high vocal doses published on teachers, patients with dysphonia, and even office workers. We found differences in vocal dose as a function of sex and employment status. Though a limited sample, findings suggest patients with presbyphonia may demonstrate low vocal dose, which may be a useful target in treatment.

Age Differences in Voice Evaluation: From Auditory-Perceptual Evaluation to Social Interactions

PURPOSE

The factors that influence the evaluation of voice in adulthood, as well as the consequences of such evaluation on social interactions, are not well understood. Here, we examined the effect of listeners' age and the effect of talker age, sex, and smoking status on the auditory-perceptual evaluation of voice, voice-related psychosocial attributions, and perceived speech tempo. We also examined the voice dimensions affecting the propensity to engage in social interactions.

METHOD

Twenty-five younger (age 19-37 years) and 25 older (age 51-74 years) healthy adults participated in this cross-sectional study. Their task was to evaluate the voice of 80 talkers.

RESULTS

Statistical analyses revealed limited effects of the age of the listener on voice evaluation. Specifically, older listeners provided relatively more favorable voice ratings than younger listeners, mainly in terms of roughness. In contrast, the age of the talker had a broader impact on voice evaluation, affecting auditory-perceptual evaluations, psychosocial attributions, and perceived speech tempo. Some of these talker differences were dependent upon the sex of the talker and his or her smoking status. Finally, the results also show that voice-related psychosocial attribution was more strongly associated with the propensity of the listener to engage in social interactions with a person than auditory-perceptual dimensions and perceived speech tempo, especially for the younger adults.

CONCLUSIONS

These results suggest that age has a broad influence on voice evaluation, with a stronger impact for talker age compared with listener age. While voice-related psychosocial attributions may be an important determinant of social interactions, perceived voice quality and speech tempo appear to be less influential.

SUPPLEMENTAL MATERIALS

https://doi.org/10.23641/asha.5844102.

Acoustic Analysis of Voice in Singers: A Systematic Review

PURPOSE

Singers are vocal athletes having specific demands from their voice and require special consideration during voice evaluation. Presently, there is a lack of standards for acoustic evaluation in them. The aim of the present study was to systematically review the available literature on the acoustic analysis of voice in singers.

METHOD

A systematic review of studies on acoustic analysis of voice in singers (PubMed/MEDLINE, CINAHL, Scopus, ProQuest, Cochrane, Ovid, Science Direct, and Shodhganga) was carried out. Key words based on PIO (population-investigation-outcome) were used to develop search strings. Titles and abstracts were screened independently, and appropriate studies were read in full for data extraction.

RESULTS

Of the 895 studies, 26 studies met the inclusion criteria. Great variability was noted in the instruments and task used. Different acoustic measures were employed, such as fundamental frequency, perturbation, cepstral, spectral, dysphonia severity index, singing power ratio, and so forth.

CONCLUSION

Overall, a great heterogeneity was noted regarding population, tasks, instruments, and parameters. There is a lack of standardized criteria for the evaluation of singing voice. In order to implement acoustic analysis as a part of comprehensive voice evaluation exclusively for singers, there is a certain need for methodical sound studies.

Acoustics of Clear and Noise-Adapted Speech in Children, Young, and Older Adults

PURPOSE

This study investigated acoustic-phonetic modifications produced in noise-adapted speech (NAS) and clear speech (CS) by children, young adults, and older adults.

METHOD

Ten children (11-13 years of age), 10 young adults (18-29 years of age), and 10 older adults (60-84 years of age) read sentences in conversational and clear speaking style in quiet and in noise. A number of acoustic measurements were obtained.

RESULTS

NAS and CS were characterized by a decrease in speaking rate and an increase in 1-3 kHz energy, sound pressure level (SPL), vowel space area (VSA), and harmonics-to-noise ratio. NAS increased fundamental frequency (F0) mean and decreased jitter and shimmer. CS increased frequency and duration of pauses. Older adults produced the slowest speaking rate, longest pauses, and smallest increase in F0 mean, 1-3 kHz energy, and SPL when speaking clearly. They produced the smallest increases in VSA in NAS and CS. Children slowed down less, increased the VSA least, increased harmonics-to-noise ratio, and decreased jitter and shimmer most in CS. Children increased mean F0 and F1 most in noise.

CONCLUSIONS

Findings have implications for a model of speech production in healthy speakers as well as the potential to aid in clinical decision making for individuals with speech disorders, particularly dysarthria.

The Impact of a Teaching or Singing Career on the Female Vocal Quality at the Mean Age of 67 Years: A Pilot Study

OBJECTIVES

The purpose of this study was to measure the objective and subjective vocal quality in women aged between 60 and 75 years. Secondly, the impact of a teaching or singing career on the vocal quality was investigated by comparing the vocal quality of retired women with different careers.

STUDY DESIGN

This is a case-control study.

METHODS

Seventy-three retired women between 60 and 75 years (mean age: 67 years, standard deviation: 4.49) participated in the study and were divided into three groups: women with a teaching career (n = 21), choir singers with a singing career (n = 12), and women with a non-vocal career (n = 40). All subjects underwent the same assessment protocol consisting of objective (aerodynamic, maximum performance, vocal range, acoustic measurements, and the Dysphonia Severity Index) and subjective (the Voice Handicap Index, auditory-perceptual evaluations by three listeners) voice measurements.

RESULTS

In all three groups, objective and perceptual voice analysis showed a mild dysphonia. No differences in the Dysphonia Severity Index were found between the three groups. The voices of choir singers with a singing career were perceived significantly less rough than voices of the women with a non-vocal career. Additionally, the lowest frequency of the frequency range was significantly lower in the retired teachers and choir singers than in the controls.

CONCLUSION

The results of this study prudently suggest that a singing or a teaching career compared with a non-vocal career has a positive impact on the vocal frequency range, and that singing has a positive impact on the perceptual vocal quality of the older female voice.

Características da voz falada de idosas com prática de canto coral

RESUMO Introdução Apesar dos vários estudos relacionados à voz na terceira idade e o canto, ainda são necessárias pesquisas que busquem entender os efeitos dessa prática na voz falada de idosos. Objetivo comparar as características da voz falada de idosas com prática de canto coral às de idosas sem essa vivência. Método fizeram parte deste estudo 75 idosas, sendo 50 com prática de canto coral que compuseram o grupo corista (GC) e 25 sem essa prática (GNC), que foram comparadas. Para caracterização das idosas e levantamento de dados referentes aos hábitos de vida e voz, foi aplicado um questionário. Foram coletadas amostras de fala (vogal sustentada, repetição de frases e um trecho de fala espontânea) em uma sala silenciosa com as idosas sentadas. As vozes foram analisadas por três juízes fonoaudiólogos segundo o protocolo Consensus Auditory–Perceptual Evaluation of Voice (CAPE-V). Os dados foram submetidos à análise descritiva e estatística. Resultados as vozes das idosas do GNC apresentaram aumento significativo nos escores relacionados à alteração do grau geral e presença de rugosidade e tensão. Conclusão A análise das características da voz falada de idosas coristas, quando comparada a daquelas que não realizam essa prática, apontou para melhor qualidade vocal no aspecto geral, em decorrência de menor rugosidade e tensão.

Fonoterapia vocal e fisioterapia respiratória com idosos saudáveis: revisão de literatura

RESUMO Este estudo tem como tema a fonoterapia vocal e a fisioterapia respiratória no idoso saudável. O objetivo do presente estudo foi revisar a literatura sobre fonoterapia vocal e sobre fisioterapia respiratória com idosos saudáveis. Foi realizado um levantamento bibliográfico de artigos publicados entre 2004 e 2014 nas bases de dados Lilacs, Bireme, MedLine, PubMed e Scielo. Descritores utilizados: physical therapy specialty; breathing; speech therapy; aged; therapeutics e voice. A literatura sobre fonoterapia vocal com idosos saudáveis mostrou que as intervenções têm sido feitas por meio de orientação vocal; terapia vocal tradicional para presbifonia, independente do tipo de intervenção; exercícios vocais específicos; e programas terapêuticos padronizados, havendo evidências de melhora de medidas vocais perceptivoauditivas, acústicas, de autoavaliação vocal e de imagem laríngea. Quanto à fisioterapia respiratória, a literatura evidenciou que as técnicas ou procedimentos utilizados com idosos saudáveis foram: uso do aparelho Threshold, técnicas de terapia manual, espirometria de incentivo, exercícios respiratórios associados ao movimento do tronco e membros inferiores e atividade física em geral, apresentando evidências de melhora na força muscular respiratória, função pulmonar e autonomia funcional dos idosos.

Tempos máximos de fonação de idosas com e sem prótese dentária superior

OBJETIVO: caracterizar e comparar o tempo máximo de fonação de idosas usuárias de prótese dentária superior e de idosas com dentição superior natural. MÉTODOS: 31 idosas que foram divididas em: grupo experimental - 19 senhoras que utilizavam prótese dentária superior, média de idade de 71,21 anos; grupo controle - 12 senhoras que não utilizavam prótese dentária, média de idade de 69,83 anos. Analisaram-se os valores dos tempos máximos de fonação das fricativas /s/ e /z/, e das vogais /a/, /i/ e /u/ por meio do teste paramétrico T-Student Pareado. RESULTADOS: as médias das vogais /a/, /i/ e /u/ e das fricativas /s/ e /z/ estiveram dentro do esperado no grupo controle (14,86s; 15,40s; 15,85s; 14,09s e 14,30s, respectivamente) e abaixo no grupo experimental (10,84s; 10,53s; 10,74s; 10,25s e 10,95s, respectivamente). Houve diferença estatística entre as idosas dos dois grupos para o tempo máximo de fonação das vogais, o que não foi encontrado no das fricativas. CONCLUSÃO: o grupo de idosas com dentição natural atingiu o tempo máximo de fonação mínimo de vogais e de fricativas esperado para adultos do sexo feminino e o grupo de idosas com prótese dentária superior completa ficou abaixo do esperado. Ao contrário do esperado, a comparação do tempo máximo de fonação das fricativas entre os grupos não mostrou diferença, mas o tempo máximo de fonação de todas as vogais analisadas foi menor no grupo com prótese. Os resultados mostram a influência do uso de prótese dentária sobre os resultados de tempo máximo de fonação de idosas.

Dysarthria and Quality of Life in neurologically healthy elderly and patients with Parkinson's disease

PURPOSE: To compare the speech and voice of Parkinson's disease (PD) patients and neurologically healthy elderly adults (control group, CG), to find out whether these features are related to the disease or the normal aging process, and investigate the impact that dysarthria has on the Quality of Life (QoL) of these individuals. METHODS: This is a cross-sectional study involving 25 individuals, 13 patients with PD and 12 CG. All the participants underwent vocal assessment, perceptual and acoustic analysis, based on "Dysarthria Assessment Protocol" and analysis of QoL using a questionnaire, "Living with Dysarthria". The data underwent statistical analysis to compare the groups in each parameter. RESULTS: In the assessment of dysarthria, patients with PD showed differences in prosody parameter (p=0.012), at the habitual frequency for females (p=0.025) and males (p=0.028), and the extent of intensity (p=0.039) when compared to CG. In QoL questionnaire, it was observed that patients with PD showed more negative impact on the QoL compared to CG, as indicated by the total score (p=0.005) with various aspects influencing this result. CONCLUSION: The degree of modification of speech and voice of patients with PD resembles those seen in normal aging process, with the exception of prosody and the habitual frequency, which are related to the greatest negative impact on the QoL of patients with PD.

Comparison of dysphonia severity index between younger and older carnatic classical singers and nonsingers

OBJECTIVES

The main objective of this study was to compare dysphonia severity index (DSI) and its parameters between Carnatic classical singers and nonsingers. The second objective was to investigate the effect of age on DSI and its parameters in both singers and nonsingers.

STUDY DESIGN

This study included 30 female Carnatic classical singers who were subdivided into two groups based on their age: 15 younger singers and 15 older singers. These 30 singers were compared with 30 age and gender matched nonsingers.

METHODS

From each participant, measures of highest phonational frequency, lowest intensity, jitter, and maximum phonation time were obtained. Using these, DSI values were calculated.

RESULTS

Singers had significantly greater highest phonational frequency, longer maximum phonation time, and higher DSI values. When compared with the younger participants, older participants had significantly reduced highest phonational frequency, maximum phonation time, and DSI values.

CONCLUSIONS

The results of this study suggest that DSI values vary between Carnatic classical singers and nonsingers, and hence separate normative data may need to be established for this group of singers for clinical comparison purposes.

Aging voice: presbyphonia

Presbyphonia is a physiological process of aging voice that includes morphological changes in the coverage mucosa, muscle, and cartilage. We revised the morphological, endoscopic, and vocal acoustic changes that occur in presbyphonia and discussed some treatments proposed to minimize glottal incompetence and improve vocal performance of the elderly.

Differences in acoustic and perceptual parameters of the voice between elderly and young women at habitual and high intensity

INTRODUCTION AND OBJECTIVES

The present study aimed to compare elderly and young female voices in habitual and high intensity. The effect of increased intensity on the acoustic and perceptual parameters was assessed.

METHODS

Sound pressure level, fundamental frequency, jitter, shimmer, and harmonic to noise ratio were obtained at habitual and high intensity voice in a group of 30 elderly women and 30 young women. Perceptual assessment was also performed.

RESULTS

Both groups demonstrated an increase in sound pressure level and fundamental frequency from habitual voice to high intensity voice. No differences were found between groups in any acoustic variables on samples recorded with habitual intensity level. No significant differences between groups were found in habitual intensity level for pitch, hoarseness, roughness, and breathiness. Asthenia and instability obtained significant higher values in elderly than young participants, whereas, the elderly demonstrated lower values for perceived tension and loudness than young subjects.

CONCLUSIONS

Acoustic and perceptual measures do not demonstrate evident differences between elderly and young speakers in habitual intensity level. The parameters analyzed may lack the sensitivity necessary to detect differences in subjects with normal voices. Phonation with high intensity highlights differences between groups, especially in perceptual parameters. Therefore, high intensity should be included to compare elderly and young voice.

Coralistas amadores: auto-imagem, dificuldades e sintomas na voz cantada

OBJETIVO: conhecer a auto-imagem, dificuldades e presença de sintomas negativos após o canto em coralistas amadores com diferentes classificações vocais, idades e experiência. MÉTODO: cento e vinte e cinco cantores responderam a um questionário que abordou dados de identificação, informações sobre a auto-imagem da voz cantada, dificuldades apresentadas no canto e ocorrência ou não de sintomas vocais após o canto. RESULTADOS: a comparação por naipes evidenciou maior dificuldade na emissão de sons agudos para os contraltos e baixos, maior dificuldade na emissão graves para os sopranos, maior dificuldade na transição de registro grave para agudo para os baixos, e maior cansaço vocal para os contraltos. Na divisão por idade, tanto adultos jovens e adultos referiram maior soprosidade do que os idosos. Os adultos referiram melhor intensidade vocal do que adultos jovens. Os adultos jovens consideraram seu timbre de voz adequado mais frequentemente do que adultos. Em relação à experiência, os cantores menos experientes referiram percepção de voz rouca em maior número do que os cantores mais experientes, que referiram apresentar intensidade adequada durante o canto em maior número do que os demais. Cantores menos experientes referiram maior ocorrência de rouquidão após o canto do que cantores mais experientes. CONCLUSÃO: as dificuldades encontradas no canto estão atreladas ao naipe, e não dependem da idade e nem da experiência. Sintomas estão relacionados ao naipe e ao grau de experiência com o canto. A auto-imagem vocal negativa também está relacionada ao naipe e ao nível de experiência, sendo que a auto-imagem positiva é mais comum em cantores experientes.