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Chadwick KA, Andreadis K, Sulica L. Prospective Outcomes of Microlaryngoscopy Versus Office Laser Photoangiolysis for Vocal Fold Polyps. Laryngoscope 2024; 134 Suppl 8:S1-S20. [PMID: 38742623 DOI: 10.1002/lary.31484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/02/2024] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE(S) The objective of this study is to compare treatment outcomes for vocal fold polyps (VFPs) between operating room microlaryngoscopy and office-based photoangiolysis with the potassium titanyl phosphate (KTP) laser. METHODS Prospective nonrandomized cohort study of patients with VFPs undergoing microlaryngoscopy ("OR group") or KTP laser photoangiolysis ("KTP group"). Voice outcomes (patient-reported outcome measures [Voice Handicap Index-10 (VHI-10) and Singing VHI-10 (SVHI-10)], auditory-perceptual measures [Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)], videostroboscopic characteristics [Voice-Vibratory Assessment of Laryngeal Imaging (VALI)], and acoustic and aerodynamic measures) were performed at baseline and regular intervals after intervention. RESULTS Forty-four subjects (17 OR group, 27 KTP group) with VFPs were enrolled. Mean VHI-10 significantly improved from baseline to each follow-up interval in both groups, except for the 1-2-week interval in the OR group. Mean SVHI-10 improved for both groups at some intervals. Growth curve models and time-to-event analyses for patient-reported outcomes did not differ between groups. There were significant improvements in all categories of auditory-perceptual voice quality and some categories of videostroboscopic characteristics in both groups. No significant trends were identified in acoustic and aerodynamic measures. Improvements in most outcomes did not significantly differ between groups or based on polyp size. There were no major complications. CONCLUSIONS Significant improvements in patient-reported voice outcomes measures, auditory-perceptual voice evaluation, and videostroboscopic characteristics occur following surgical treatment of vocal fold polyps with either microlaryngoscopy or office-based KTP laser. Long-term voice outcomes do not significantly differ between treatment modalities. LEVEL OF EVIDENCE 3 Laryngoscope, 134:S1-S20, 2024.
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Affiliation(s)
- Keith A Chadwick
- Division of Otolaryngology-Head & Neck Surgery, Stony Brook University, Stony Brook, New York, USA
| | | | - Lucian Sulica
- Department of Otolaryngology-Head and Neck Surgery, The Sean Parker Institute for the Voice, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York, USA
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Yadav S. Letter to the Editor: Evaluating the Potential of AI Chatbots in Treatment Decision-making for Acquired Bilateral Vocal Fold Paralysis in Adults. J Voice 2024:S0892-1997(24)00203-0. [PMID: 39095241 DOI: 10.1016/j.jvoice.2024.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 06/24/2024] [Indexed: 08/04/2024]
Affiliation(s)
- Sanjeev Yadav
- Department of ENT & Head Neck Surgery, UPUMS, Saifai, Uttar Pradesh, India.
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Iob NA, He L, Ternström S, Cai H, Brockmann-Bauser M. Effects of Speech Characteristics on Electroglottographic and Instrumental Acoustic Voice Analysis Metrics in Women With Structural Dysphonia Before and After Treatment. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1660-1681. [PMID: 38758676 DOI: 10.1044/2024_jslhr-23-00253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
PURPOSE Literature suggests a dependency of the acoustic metrics, smoothed cepstral peak prominence (CPPS) and harmonics-to-noise ratio (HNR), on human voice loudness and fundamental frequency (F0). Even though this has been explained with different oscillatory patterns of the vocal folds, so far, it has not been specifically investigated. In the present work, the influence of three elicitation levels, calibrated sound pressure level (SPL), F0 and vowel on the electroglottographic (EGG) and time-differentiated EGG (dEGG) metrics hybrid open quotient (OQ), dEGG OQ and peak dEGG, as well as on the acoustic metrics CPPS and HNR, was examined, and their suitability for voice assessment was evaluated. METHOD In a retrospective study, 29 women with a mean age of 25 years (± 8.9, range: 18-53) diagnosed with structural vocal fold pathologies were examined before and after voice therapy or phonosurgery. Both acoustic and EGG signals were recorded simultaneously during the phonation of the sustained vowels /ɑ/, /i/, and /u/ at three elicited levels of loudness (soft/comfortable/loud) and unconstrained F0 conditions. RESULTS A linear mixed-model analysis showed a significant effect of elicitation effort levels on peak dEGG, HNR, and CPPS (all p < .01). Calibrated SPL significantly influenced HNR and CPPS (both p < .01). Furthermore, F0 had a significant effect on peak dEGG and CPPS (p < .0001). All metrics showed significant changes with regard to vowel (all p < .05). However, the treatment had no effect on the examined metrics, regardless of the treatment type (surgery vs. voice therapy). CONCLUSIONS The value of the investigated metrics for voice assessment purposes when sampled without sufficient control of SPL and F0 is limited, in that they are significantly influenced by the phonatory context, be it speech or elicited sustained vowels. Future studies should explore the diagnostic value of new data collation approaches such as voice mapping, which take SPL and F0 effects into account.
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Affiliation(s)
- Naomi Anna Iob
- Division of Phoniatrics and Speech Pathology, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Switzerland
| | - Lei He
- Division of Phoniatrics and Speech Pathology, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Switzerland
- Department of Computational Linguistics, University of Zurich, Switzerland
| | - Sten Ternström
- Division of Speech, Music and Hearing, School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Huanchen Cai
- Division of Speech, Music and Hearing, School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Meike Brockmann-Bauser
- Division of Phoniatrics and Speech Pathology, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Switzerland
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Toles LE, Shembel AC. Acoustic and Physiologic Correlates of Vocal Effort in Individuals With and Without Primary Muscle Tension Dysphonia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:237-247. [PMID: 37931092 PMCID: PMC11000796 DOI: 10.1044/2023_ajslp-23-00159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/23/2023] [Accepted: 09/16/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES The aims of this study were to determine relationships between vocal effort and (a) acoustic correlates of vocal output and (b) supraglottic compression in individuals with primary muscle tension dysphonia (pMTD) and without voice disorders (controls) in the context of a vocal load challenge. METHOD Twenty-six individuals with pMTD and 35 vocally healthy controls participated in a 30-min vocal load challenge. The pre- and postload relationships among self-ratings of vocal effort, various acoustic voice measures, and supraglottic compression (mediolateral and anteroposterior) were tested with multiple regression models and post hoc Pearson's correlations. Acoustic measures included cepstral peak prominence (CPP), low-to-high spectral ratio, difference in intensity between the first two harmonics, fundamental frequency, and sound pressure level (dB SPL). RESULTS Regression models for CPP and mediolateral compression were statistically significant. Vocal effort, diagnosis of pMTD, and vocal demand were each significant variables influencing CPP measures. CPP was lower in the pMTD group across stages. There was no statistical change in CPP following the vocal load challenge within either group, but both groups had an increase in vocal effort postload. Vocal effort and diagnosis influenced the mediolateral compression model. Mediolateral compression was higher in the pMTD group across stages and had a negative relationship with vocal effort, but it did not differ after vocal loading. CONCLUSIONS CPP and mediolateral supraglottic compression were influenced by vocal effort and diagnosis of pMTD. Increased vocal effort was associated with lower CPP, particularly after vocal load, and decreased mediolateral supraglottic compression in the pMTD group.
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Affiliation(s)
- Laura E. Toles
- Department of Otolaryngology–Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas
| | - Adrianna C. Shembel
- Department of Otolaryngology–Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, The University of Texas at Dallas, Richardson
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Shembel AC, Lee J, Sacher JR, Johnson AM. Characterization of Primary Muscle Tension Dysphonia Using Acoustic and Aerodynamic Voice Metrics. J Voice 2023; 37:897-906. [PMID: 34281751 PMCID: PMC9762233 DOI: 10.1016/j.jvoice.2021.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES/HYPOTHESIS The objectives of this study were to (1) identify optimal clusters of 15 standard acoustic and aerodynamic voice metrics recommended by the American Speech-Language-Hearing Association (ASHA) to improve characterization of patients with primary muscle tension dysphonia (pMTD) and (2) identify combinations of these 15 metrics that could differentiate pMTD from other types of voice disorders. STUDY DESIGN Retrospective multiparametric METHODS: Random forest modeling, independent t-tests, logistic regression, and affinity propagation clustering were implemented on a retrospective dataset of 15 acoustic and aerodynamic metrics. RESULTS Ten percent of patients seen at the New York University (NYU) Voice Center over two years met the study criteria for pMTD (92 out of 983 patients), with 65 patients with pMTD and 701 of non-pMTD patients with complete data across all 15 acoustic and aerodynamic voice metrics. PCA plots and affinity propagation clustering demonstrated substantial overlap between the two groups on these parameters. The highest ranked parameters by level of importance with random forest models-(1) mean airflow during voicing (L/sec), (2) mean SPL during voicing (dB), (3) mean peak air pressure (cmH2O), (4) highest F0 (Hz), and (5) CPP mean vowel (dB)-accounted for only 65% of variance. T-tests showed three of these parameters-(1) CPP mean vowel (dB), (2) highest F0 (Hz), and (3) mean peak air pressure (cmH2O)-were statistically significant; however, the log2-fold change for each parameter was minimal. CONCLUSION Computational models and multivariate statistical testing on 15 acoustic and aerodynamic voice metrics were unable to adequately characterize pMTD and determine differences between the two groups (pMTD and non-pMTD). Further validation of these metrics is needed with voice elicitation tasks that target physiological challenges to the vocal system from baseline vocal acoustic and aerodynamic ouput. Future work should also place greater focus on validating metrics of physiological correlates (eg, neuromuscular processes, laryngeal-respiratory kinematics) across the vocal subsystems over traditional vocal output measures (eg, acoustics, aerodynamics) for patients with pMTD. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Adrianna C Shembel
- Department of Speech, Language, and Hearing, University of Texas at Dallas, Dallas, Texas; Department of Otolaryngology-Head and Neck Surgery, University of Texas at Southwestern Medical Center, Dallas, Texas; Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York.
| | - Jeon Lee
- Lyda Hill Department of Bioinformatics, University of Texas at Southwestern, Dallas, Texas
| | - Joshua R Sacher
- Center for the Development of Therapeutics, Broad Institute, Cambridge, Massachusetts
| | - Aaron M Johnson
- Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York
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Abur D, Hillman RE, Stepp CE. Auditory-Motor Function Pre- and Post-Therapy in Hyperfunctional Voice Disorders: A Case Series. J Voice 2023:S0892-1997(23)00264-3. [PMID: 37716889 DOI: 10.1016/j.jvoice.2023.08.017] [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: 07/13/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE/HYPOTHESIS Behavioral voice therapy is the most common treatment for hyperfunctional voice disorders (HVDs) but has limited long-term effectiveness since the comprehensive mechanisms underlying HVDs remain unclear. Recent work has implicated disordered sensorimotor integration during speech in some speakers with HVDs and suggests that auditory processing is a key factor to consider in HVD assessment and therapy. The purpose of this case-series study was to assess whether current voice therapy approaches for HVDs resulted in improvements to auditory-motor function. STUDY DESIGN Longitudinal (pre-post) study. METHOD Pre and postvoice therapy for HVDs, 11 speakers underwent an assessment of auditory-motor function via auditory discrimination of vocal pitch, responses to unanticipated auditory perturbations, and responses to predictable auditory perturbations of vocal pitch. RESULTS At the post-therapy session, 10 out of 11 participants demonstrated voice therapy success (via self-reported voice problems and/or auditory-perceptual judgements of voice by a clinician) and eight of the 11 participants demonstrated improvements in at least one measure of auditory discrimination and/or auditory-motor control. Specifically, three speakers demonstrated improvements in auditory discrimination, five speakers demonstrated improved (within typical cutoffs) responses to predictable perturbations, and two speakers demonstrated improvements in both auditory discrimination and auditory-motor measures. CONCLUSIONS Together, these findings support that voice therapy in individuals with HVDs may impact auditory-motor control and highlight the potential benefit of systematically addressing auditory function in voice therapy and assessment for HVDs.
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Affiliation(s)
- Defne Abur
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA; Department of Computational Linguistics, Center for Language and Cognition Groningen, University of Groningen, Groningen, the Netherlands; Research School of Behavioral and Cognitive Neurosciences, University of Groningen, Groningen, the Netherlands.
| | - Robert E Hillman
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA; Department of Surgery, Harvard Medical School, Boston, MA; MGH Institute of Health Professions, Boston, MA
| | - Cara E Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA; Department of Biomedical Engineering, Boston University, Boston, MA; Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA
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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.
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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
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Lin KJY, Chan RW, Wu CH, Liu SCH. A Vocal Hygiene Program for Mitigating the Effects of Occupational Vocal Demand in Primary School Teachers. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:1-16. [PMID: 37080241 DOI: 10.1044/2023_jslhr-22-00490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE Teachers are occupational voice users with significant vocal demand. This study examined if a vocal hygiene program could mitigate the effects of occupational vocal demand in primary school teachers across 1 month. METHOD Sixty female teachers participated, with 30 in an experimental group receiving vocal hygiene education plus daily home practice for 1 month and 30 in a control group with no intervention. Their vocal changes across the month were quantified with (a) acoustic measures on fundamental frequency (fo), vocal intensity, jitter and shimmer, harmonics-to-noise ratio, and smoothed cepstral peak prominence and (b) Voice Handicap Index (VHI-10) and Vocal Fatigue Index (VFI) scores. RESULTS Analysis of covariance showed significantly larger changes (significant decreases) in conversational fo and in jitter for the experimental group relative to the control group. Post hoc pairwise comparisons following repeated-measures analysis of variance showed significant decreases in conversational fo and in jitter across the month for the experimental group. No significant differences in VHI-10 and VFI scores were found between the groups. CONCLUSIONS Vocal demand-related changes in acoustic measures could be partially mitigated with the vocal hygiene program. Future studies with a more refined intervention program and more long-term follow-up are recommended to better understand the long-term benefits of vocal hygiene programs on primary school teachers.
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Affiliation(s)
| | - Roger W Chan
- Geriatric Care Research Center, Xiamen Medical College, Xiamen, Fujian, China
- Department of Voice Medicine, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Chia-Hsin Wu
- Yu-Sheng Speech Language Communication Rehabilitation Center, Taipei, Taiwan
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Becker DR, Shelly S, Kavalieratos D, Maira C, Gillespie AI. Immediate Effects of Mindfulness Meditation on the Voice. J Voice 2022:S0892-1997(22)00342-3. [PMID: 36428173 DOI: 10.1016/j.jvoice.2022.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The benefits of mindfulness meditation are well documented. This study evaluated the immediate effects of mindfulness meditation (MM) on the voice and voice user. STUDY DESIGN Prospective experimental study. METHODS Participants: 19 vocally healthy (VH) individuals, and 26 individuals with common voice disorders (CVD; benign lesions and hyperfunctional muscle tension) deemed stimulable for voice therapy. Exclusionary criteria: prior training or regular meditation practice. Participants recorded speech samples before and after a 11.5-minute prerecorded session of MM. PRIMARY OUTCOMES phonatory aerodynamics and participants' self-reported experience of voice. SECONDARY OUTCOMES self-reported anxiety, vocal acoustics, speech breathing patterns, and auditory-perceptual outcomes. Baseline self-reported measures of voice (Voice Handicap Index-10 - VHI-10), breathing (Dyspnea Index - DI), stress (Perceived Stress Scale - PSS), and trait mindfulness (Cognitive and Mindfulness Scale - Revised, CAMS-R, Five Facet Mindfulness Questionnaire - FFMQ) were compared between groups. RESULTS At baseline, CVD had significantly higher VHI-10 (P< 0.001) and DI (P= 0.0014), and lower trait mindfulness (CAMS-R, P= 0.02). No difference between groups for PSS or FFMQ. Changes postMM: decreased CPP for all-voiced sentences for VH (P= 0.003), decreased mean SPL (P= 0.012) on sustained vowel for VH, increased mean phonatory airflow during sustained vowel for CVD (P = 0.012). VH demonstrated a decrease in CPP on the all-voice sentence, and CVD demonstrated an increase, resulting in a significant between group difference (P= 0.013). Participants reported improvements in voice, emotional and physical states. State anxiety decreased for both groups (= < 0.001). No other objective outcomes reached significance. CONCLUSIONS After a brief MM, participants experienced improvement in physical, emotional, and cognitive states, and in their perceptions of their voice. Results indicate that a brief, single session of MM may be beneficial for some, but not sufficient to override habitual voice and speech patterns. Given the benefits of MM, future work should evaluate MM in a standard voice therapy protocol.
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Affiliation(s)
| | - Sandeep Shelly
- Emory Healthcare, Department of Otolaryngology, Atlanta, Geogia
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Geogia
| | - Carissa Maira
- Emory Healthcare, Department of Otolaryngology, Atlanta, Geogia
| | - Amanda I Gillespie
- Emory Healthcare, Department of Otolaryngology, Atlanta, Geogia; Department of Otolaryngology, Emory University School of Medicine, Atlanta, Geogia
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10
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Afacan NN, Özergin Coşkun Z, Çeliker M, Erdivanlı ÖÇ, Terzi S, Dursun E. Test-Retest Reliability and Discriminatory Power of Multi-Dimensional Voice Analysis Program (MDVP). Clin Otolaryngol 2022; 47:628-633. [PMID: 35833689 DOI: 10.1111/coa.13958] [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: 10/16/2021] [Revised: 05/18/2022] [Accepted: 06/26/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objectives of this study were to evaluate and compare the test-retest reliability of acoustic parameters (jitter [%], shimmer [%], noise-to-harmonic ratio (NHR), and voice turbulence index (VTI)) by using multidimensional voice program (MDVP), and to detect the discriminatory power of the acoustic measures with respect to dysphonic voices and normal voices. DESIGN, SETTING, PARTICIPANTS, AND METHODS Fifty-four (25 male and 29 female) participants with voice disorders and fifty-one (27 male and 24 female) participants with normal voices were enrolled in this study. They were assessed by anamnesis, visual examination, auditory perceptual assessment (GRBAS), and acoustic measurements. The intraclass correlation coefficient was used to determine the test-retest reliability. The effect size (d value) and p value obtained from the t-test were used to determine the discriminatory power. RESULTS In the normal group, good reliability was observed for jitter, shimmer, and NHR, and moderate reliability was observed for VTI. With regard to the dysphonic group, jitter, shimmer, and VTI were moderately reliable, and the NHR had good reliability. Meanwhile, the discriminatory powers of jitter and shimmer were evaluated as 'medium', and those of NHR and VTI as 'small'. CONCLUSIONS The reliability and discriminatory powers of our acoustic measures were high compared with most other studies. Their level of reliability and discriminatory power can be maximised by using stringent rules. However, attaining an excellent level of reliability and discriminatory seems infeasible power owing to the variable characteristic of voice. Therefore, acoustic measures should be adopted as a complementary tool.
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Affiliation(s)
| | | | | | | | - Suat Terzi
- Recep Tayyip Erdoğan University, Turkey, Rize
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Houle N, Johnson AM. Relationships Across Clinical Measures of Vocal Quality and Functioning and Their Relationship With Patient Perception. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2668-2680. [PMID: 34723650 DOI: 10.1044/2021_ajslp-21-00128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose The purpose of this study was to investigate the relationships among subjective auditory-perceptual ratings of vocal quality, objective acoustic and aerodynamic measures of vocal function, and patient-perceived severity of their vocal complaint. Method This study was a retrospective chart review of adult patients evaluated at a single outpatient center over a 1.5-year time period. Twenty-two clinical objective and subjective measures of voice were extracted from 676 charts (310 males, 366 females). To identify the underlying concepts addressed in an initial voice assessment, principal component analyses were conducted for males and females to account for sex differences. Linear regression models were conducted to examine the relationship between the principal components and patient perceived severity. Results Seven principal components were identified for both sexes and accounted for 75% and 71% of the variance in the clinical measures, respectively. Of these seven principal components, only two predicted male patient perceived severity, which accounted for 22% of the variance. In contrast, four principal components predicted female patient perceived severity of their voice disorder and accounted for 19% of the variance. Conclusions The results highlight the underlying aspects of vocal quality and functioning that are evaluated during an initial assessment. Male and female patients differ in which of these components may contribute self-perceived severity of a voice disorder. Identifying these underlying components may support clinical decision making when developing a clinical protocol and highlights the overlap between patient concerns and clinical measures. Supplemental Material https://doi.org/10.23641/asha.16879603.
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Affiliation(s)
- Nichole Houle
- Department of Communicative Sciences and Disorders, New York University, NY
| | - Aaron M Johnson
- Department of Communicative Sciences and Disorders, New York University, NY
- New York University Voice Center, Department of Otolaryngology-Head & Neck Surgery, New York University Grossman School of Medicine, NY
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12
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Pierce JL, Tanner K, Merrill RM, Shnowske L, Roy N. A Field-Based Approach to Establish Normative Acoustic Data for Healthy Female Voices. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:691-706. [PMID: 33561361 DOI: 10.1044/2020_jslhr-20-00490] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The primary aim of this study was to obtain high-quality acoustic normative data in natural field environments for female voices. A secondary aim was to examine acoustic measurement variability in field environments. Method This study employed a within-subject repeated-measures experimental design that included 45 young female adults with normal voices. Participants were stratified by age (18-23, 24-29, and 30-35 years). After initial evaluation and instruction, participants completed voice recordings during seven consecutive days using a standard protocol, including both connected speech and sustained vowels. Thirty-two cepstral-, spectral-, and time-based acoustic measures were acquired using Praat and the Analysis of Dysphonia in Speech and Voice. Results Among the 958 total recordings, greater than 90% satisfied inclusion criteria based on protocol compliance, peak clipping, and signal-to-noise ratio. Significant differences were observed for age (p < .05). For 19 acoustic measures, values improved significantly as signal-to-noise ratio increased. Cepstral- and spectral-based measures demonstrated less measurement variability as compared with time-based measures. Conclusions With adequate training, field audio recordings represent a viable option for clinical voice management. The significant age effects observed in this study support the need for more specific criteria when collecting and applying normative data. Cepstral- and spectral-based measures demonstrated the least measurement variability. This study provides additional evidence for multiparameter acoustic voice measurement, specifically toward ecologically valid sampling in natural environments. Future studies should expand on these findings in other populations with normal and disordered voices.
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Affiliation(s)
- Jenny L Pierce
- Department of Surgery, The University of Utah, Salt Lake City
- Department of Communication Sciences & Disorders, The University of Utah, Salt Lake City
| | - Kristine Tanner
- Department of Communication Disorders, Brigham Young University, Provo, UT
| | - Ray M Merrill
- Department of Public Health, Brigham Young University, Provo, UT
| | - Lauren Shnowske
- Department of Communication Sciences & Disorders, The University of Utah, Salt Lake City
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington
| | - Nelson Roy
- Department of Communication Sciences & Disorders, The University of Utah, Salt Lake City
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13
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Procter T, Joshi A. Cultural Competency in Voice Evaluation: Considerations of Normative Standards for Sociolinguistically Diverse Voices. J Voice 2020; 36:793-801. [PMID: 33060004 DOI: 10.1016/j.jvoice.2020.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/26/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
AIM Significant differences exist in anatomical, acoustic, and aerodynamic parameters for nonspeech tasks between culturally and linguistically diverse sample populations. There is a need for expansion of the normative acoustic data to include sociolinguistically diverse groups to ensure that clinical objective measurements are accurately classifying the voice quality of all individuals. This study examined objective measures of voice quality assessment of monolingual speakers of Standard American English (SAE) with sequential bilingual, native (L1) French and Spanish speakers on perturbation, noise, spectral/cepstral analyses, and compared ratings on auditory-perceptual assessment with acoustic data secondary to degree of accentedness. METHOD Thirty speakers with normal voice quality were rated on the Consensus Auditory-Perceptual Evaluation of Voice scale. Voice quality measures were analyzed using the Multi-Dimensional Voice Program and Analysis of Dysphonia in Speech and Voice. A measure of accentedness of SAE was calculated using an informal task by two evaluators. RESULTS Objective acoustic measures of jitter and all-voiced cepstral peak prominence were statistically significant between SAE speakers and L1 Spanish and French speakers. SAE speakers demonstrated significantly higher group mean cepstral peak prominence for the all-voiced sentence ("We were away a year ago.") than native French and Spanish speakers. There were no significant differences in perception of voice quality and acoustic measures secondary to degree of accentedness of the non-native SAE speakers. CONCLUSION It is important to engage and strengthen voice diagnostic measures to support culturally competent service delivery for the diversifying clinical population. Normative databases established on SAE speakers should reflect the statistically significant differences evidenced between diverse sociolinguistic populations in anatomical, auditory-perceptual, aerodynamic, and acoustical parameters.
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Affiliation(s)
- Teresa Procter
- Texas Voice Center, Houston Methodist ENT Specialists, Houston, Texas
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Saggio G, Costantini G. Worldwide Healthy Adult Voice Baseline Parameters: A Comprehensive Review. J Voice 2020; 36:637-649. [PMID: 33039203 DOI: 10.1016/j.jvoice.2020.08.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/17/2022]
Abstract
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.
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Affiliation(s)
- Giovanni Saggio
- Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy.
| | - Giovanni Costantini
- Department of Electronic Engineering, University of Rome Tor Vergata, Rome, Italy
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Jorge A, Dastolfo-Hromack C, Lipski WJ, Kratter IH, Smith LJ, Gartner-Schmidt JL, Richardson RM. Anterior Sensorimotor Subthalamic Nucleus Stimulation Is Associated With Improved Voice Function. Neurosurgery 2020; 87:788-795. [PMID: 32199026 PMCID: PMC7490159 DOI: 10.1093/neuros/nyaa024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite the impact of Parkinson disease (PD) on speech communication, there is no consensus regarding the effect of lead location on voice-related outcomes in subthalamic nucleus (STN) deep brain stimulation (DBS). OBJECTIVE To determine the relationship of stimulation location to changes in cepstral analyses of voice following STN DBS. METHODS Speech pathology evaluations were obtained from 14 PD subjects, before and after STN DBS, including audio-perceptual voice ratings (overall severity, loudness, hoarseness changes), measured indices of dysphonia (cepstral peak prominence and cepstral spectral index of dysphonia), and phonatory aerodynamics. The contact locations used for active stimulation at the time of postoperative voice evaluations were determined and assessed in relation to voice outcomes. RESULTS Voice outcomes remained relatively unchanged on average. Stimulation locations in the anterior portion of the sensorimotor region of the left STN, however, were associated with improvements in voice severity scores, cepstral spectral index of dysphonia, shortness of breath, and phonatory airflow during connected speech. Posterior locations were associated with worsening of these outcomes. Variation in the medial-lateral or dorsal-ventral position on the left, and in any direction on the right, did not correlate with any voice outcome. CONCLUSION Active contact placement within the anterior sensorimotor STN was associated with improved perceptual and acoustic-aerodynamic voice-related outcomes. These findings suggest an STN topography for improving airflow for speech, in turn improving how PD patients' voices sound.
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Affiliation(s)
- Ahmed Jorge
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christina Dastolfo-Hromack
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Witold J Lipski
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ian H Kratter
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Libby J Smith
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Young VN, Yousef A, Zhao NW, Schneider SL. Voice and Stroboscopic Characteristics in Transgender Patients Seeking Gender-Affirming Voice Care. Laryngoscope 2020; 131:1071-1077. [PMID: 32750170 DOI: 10.1002/lary.28932] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/09/2020] [Accepted: 06/20/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Understanding transgender voice is in nascent stages. This study describes voice characteristics in treatment-seeking trans women by comparing two validated questionnaires-Voice Handicap Index-10 (VHI-10) and Transsexual Voice Questionnaire (TVQMtF )-and reports incidence of abnormal stroboscopy findings and acoustic characteristics. METHODS Retrospective review of transgender patients presenting to tertiary-care laryngology center between February 2018-February 2019. Mean VHI-10, TVQ, and Singing VHI-10 (SVHI-10) scores; audio-perceptual grade; acoustic measures; and stroboscopy findings were analyzed. VHI-10 and SVHI-10 vs TVQMtF were compared. RESULTS Sixty-one trans female patients (mean age: 32 ± 11 years) were analyzed. Mean duration since start of transition was 41.5 ± 61 months. Sixty-nine percent presented full-time female in all contexts. Pathologic stroboscopy findings were found in 5%. Mean questionnaire scores were 16 ± 10 (VHI-10), 19 ± 13 (SVHI-10), and 81 ± 22 (TVQMtF ). Correlation between VHI-10 and SVHI-10 versus TVQMtF was weak, R = 0.47 (P = .053) and R = 0.35 (P = .17), respectively. Mean audio-perceptual grade was 0.27 ± 0.15. Mean Cepstral Spectral Index of Dysphonia (CSID, sustained vowel) was 8.5 ± 21.9. Mean Cepstral Peak Prominence (CPP) Fo and CPP Fo SD in rainbow passage were 157.3 ± 16 and 59.4 ± 15.9, respectively. CONCLUSION Trans women report perceived voice handicap in speaking and singing, which appears separate from gender-related voice/communication concerns. This study is the first to report stroboscopy findings in transgender individuals, with 5% being abnormal. Stroboscopy is encouraged before initiating voice intervention in transgender patients. Preliminary evaluation suggests weak correlation between VHI-10 or SVHI-10 and TVQMtF but requires further investigation. TVQMtF may provide information which more specifically reflects voice concerns of trans women as compared to VHI-10 and SVHI-10. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1071-1077, 2021.
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Affiliation(s)
- VyVy N Young
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Andrew Yousef
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Nina W Zhao
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Sarah L Schneider
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A
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Marks KL, Lin JZ, Burns JA, Hron TA, Hillman RE, Mehta DD. Estimation of Subglottal Pressure From Neck Surface Vibration in Patients With Voice Disorders. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:2202-2218. [PMID: 32610028 PMCID: PMC7838842 DOI: 10.1044/2020_jslhr-19-00409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/12/2020] [Accepted: 04/15/2020] [Indexed: 05/15/2023]
Abstract
Purpose Given the established linear relationship between neck surface vibration magnitude and mean subglottal pressure (Ps) in vocally healthy speakers, the purpose of this study was to better understand the impact of the presence of a voice disorder on this baseline relationship. Method Data were obtained from participants with voice disorders representing a variety of glottal conditions, including phonotraumatic vocal hyperfunction, nonphonotraumatic vocal hyperfunction, and unilateral vocal fold paralysis. Participants were asked to repeat /p/-vowel syllable strings from loud-to-soft loudness levels in multiple vowel contexts (/pa/, /pi/, /pu/) and pitch levels (comfortable, higher than comfortable, lower than comfortable). Three statistical metrics were computed to analyze the regression line between neck surface accelerometer (ACC) signal magnitude and Ps within and across pitch, vowel, and voice disorder category: coefficient of determination (r 2), slope, and intercept. Three linear mixed-effects models were used to evaluate the impact of voice disorder category, pitch level, and vowel context on the relationship between ACC signal magnitude and Ps. Results The relationship between ACC signal magnitude and Ps was statistically different in patients with voice disorders than in vocally healthy controls; patients exhibited higher levels of Ps given similar values of ACC signal magnitude. Negligible effects were found for pitch condition within each voice disorder category, and negligible-to-small effects were found for vowel context. The mean of patient-specific r 2 values was .63, ranging from .13 to .92. Conclusions The baseline, linear relationship between ACC signal magnitude and Ps is affected by the presence of a voice disorder, with the relationship being participant-specific. Further work is needed to improve ACC-based prediction of Ps, across treatment, and during naturalistic speech production.
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Affiliation(s)
- Katherine L. Marks
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
- Rehabilitation Science, MGH Institute of Health Professions, Boston, MA
| | - Jonathan Z. Lin
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
| | - James A. Burns
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
- Department of Surgery, Harvard Medical School, Boston, MA
| | - Tiffiny A. Hron
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
- Department of Surgery, Harvard Medical School, Boston, MA
| | - Robert E. Hillman
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
- Rehabilitation Science, MGH Institute of Health Professions, Boston, MA
- Department of Surgery, Harvard Medical School, Boston, MA
- Speech and Hearing Bioscience and Technology Program, Division of Medical Sciences, Harvard Medical School, Boston, MA
| | - Daryush D. Mehta
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
- Rehabilitation Science, MGH Institute of Health Professions, Boston, MA
- Department of Surgery, Harvard Medical School, Boston, MA
- Speech and Hearing Bioscience and Technology Program, Division of Medical Sciences, Harvard Medical School, Boston, MA
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Lowell SY, Colton RH, Kelley RT, Auld M, Schmitz H. Isolated and Combined Respiratory Training for Muscle Tension Dysphonia: Preliminary Findings. J Voice 2020; 36:361-382. [PMID: 32682682 DOI: 10.1016/j.jvoice.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to determine the feasibility of altering speech breathing patterns and dysphonia severity through training increased levels of lung volume use during speech. It was hypothesized that respiratory-based training would increase lung volume levels during speech as well as improve acoustic voice measures, and that the addition of laryngeal-based treatment would further improve voice acoustics by treatment completion. METHOD A multiple baseline, single subject design was replicated over six participants with primary muscle tension dysphonia as a preliminary investigation of novel respiratory treatment methods. Following four baseline probes (1-4), two phases of treatment were implemented over 6 weeks. Respiratory lung volume-based training (RLVT) and subsequent performance was probed at sessions 5 to 7 and laryngeal-based training was added to the RLVT and probed at sessions 8 to 10. Visual biofeedback was used during RLVT to assist the motor learning process. Respiratory outcome measures of lung volume initiation, termination and excursion were objectively measured using respiratory plethysmography (InductoTrace), and cepstral and spectral-based acoustic measures were also determined at each time point. RESULTS All participants showed improvement in one or more respiratory measures as well as reduced acoustic dysphonia severity following phase 1 of RLVT alone. Two participants achieved further marked improvement in acoustic voice measures after laryngeal-based training was added in phase 2 of treatment, but this was generally also accompanied by further improvement or stabilization of respiratory measures. CONCLUSION Results from this preliminary study support the feasibility of RLVT for improving speech breathing behavior, and suggest that RLVT alone can improve objectively measured dysphonia severity.
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Affiliation(s)
- Soren Y Lowell
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York.
| | - Raymond H Colton
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York
| | - Richard T Kelley
- Department of Otolaryngology & Communication Sciences, SUNY Upstate Medical University, Syracuse, New York
| | - Madeline Auld
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York
| | - Hanna Schmitz
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York
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Lovato A, Bonora C, Genovese E, Amato C, Maiolino L, de Filippis C. A panel of jitter/shimmer may identify functional dysphonia at risk of failure after speech therapy. Am J Otolaryngol 2020; 41:102455. [PMID: 32475619 DOI: 10.1016/j.amjoto.2020.102455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND There are no reliable outcome predictors for functional dysphonia (FD) patients. OBJECTIVES To investigate if any clinical or phoniatric characteristics could identify FD patients at risk of negative outcome after speech therapy. METHODS We retrospectively reviewed the results of 78 FD patients treated with the proprioceptive elastic method. Before and one-month after therapy, patients underwent endoscopy, acoustic analysis with Multi-Dimensional Voice Program, and Voice Handicap Index-10 questionnaire (VHI-10). Negative outcome was the persistence of VHI-10 ≥ 13. RESULTS 26 FD patients had negative outcome (i.e. VHI-10 ≥ 13) after speech therapy. At univariate analysis, clinical variables (i.e. sex, age, comorbidities, dysphonia duration, and professional voice use) were not associated with the outcome. Elevated Jitter% (Jitt; p = 0.03), Shimmer% (Shim; statistical trend, p = 0.06), and Noise to Harmonics Ratio (statistical trend, p = 0.06) were found in patients with poor results. At multivariate analysis, higher Jitt was an independent negative prognostic factor (p = 0.02), while a statically trend was identified for Shim (p = 0.06). A panel of Jitt >1.5 and Shim >5.1 showed an acceptable discriminatory power (AUC [ROC] = 0.76) according to Hosmer and Lemeshow scale. CONCLUSION A panel of two acoustic analysis parameters could help in identifying FD patients at risk of speech therapy failure. Further studies in these patients are needed to evaluate the most efficient treatment protocol.
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Affiliation(s)
- Andrea Lovato
- Department of Neuroscience DNS, University of Padova, Audiology Unit at Treviso Hospital, Treviso, Italy.
| | - Chiara Bonora
- Department of Neuroscience DNS, University of Padova, Audiology Unit at Treviso Hospital, Treviso, Italy
| | - Elisabetta Genovese
- Department of Diagnostic, Clinical and Public Health, University of Modena and Reggio Emilia, Audiology Unit, Modena, Italy
| | - Chiara Amato
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, ENT Section, Catania, Italy
| | - Luigi Maiolino
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, ENT Section, Catania, Italy
| | - Cosimo de Filippis
- Department of Neuroscience DNS, University of Padova, Audiology Unit at Treviso Hospital, Treviso, Italy
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20
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Sampaio M, Vaz Masson ML, de Paula Soares MF, Bohlender JE, Brockmann-Bauser M. Effects of Fundamental Frequency, Vocal Intensity, Sample Duration, and Vowel Context in Cepstral and Spectral Measures of Dysphonic Voices. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:1326-1339. [PMID: 32348195 DOI: 10.1044/2020_jslhr-19-00049] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Smoothed cepstral peak prominence (CPPS) and harmonics-to-noise ratio (HNR) are acoustic measures related to the periodicity, harmonicity, and noise components of an acoustic signal. To date, there is little evidence about the advantages of CPPS over HNR in voice diagnostics. Recent studies indicate that voice fundamental frequency (F0) and intensity (sound pressure level [SPL]), sample duration (DUR), vowel context (speech vs. sustained phonation), and syllable stress (SS) may influence CPPS and HNR results. The scope of this work was to investigate the effects of voice F0 and SPL, DUR, SS, and token on CPPS and HNR in dysphonic voices. Method In this retrospective study, 27 Brazilian Portuguese speakers with voice disorders were investigated. Recordings of sustained vowels (SVs) /a:/ and manually extracted vowels (EVs) /a/ from Consensus Auditory-Perceptual Evaluation of Voice sentences were acoustically analyzed with the Praat program. Results There was a highly significant effect of F0, SPL, and DUR on both CPPS and HNR (p < .001), whereas SS and vowel context significantly affected CPPS only (p < .05). Higher SPL, F0, and lower DUR were related to higher CPPS and HNR. SVs moderately-to-highly correlated with EVs for CPPS, whereas HNR had few and moderate correlations. In addition, CPPS and HNR highly correlated in SVs and seven EVs (p < .05). Conclusion Speaking prosodic variations of F0, SPL, and DUR influenced both CPPS and HNR measures and led to acoustic differences between sustained and excised vowels, especially in CPPS. Vowel context, prosodic factors, and token type should be controlled for in clinical acoustic voice assessment.
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Affiliation(s)
- Marília Sampaio
- Department of Speech, Language and Hearing Sciences, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
- Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Switzerland
| | - Maria Lúcia Vaz Masson
- Department of Speech, Language and Hearing Sciences, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
| | - Maria Francisca de Paula Soares
- Department of Speech, Language and Hearing Sciences, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
| | - Jörg Edgar Bohlender
- Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Switzerland
- University of Zurich, Switzerland
| | - Meike Brockmann-Bauser
- Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Switzerland
- University of Zurich, Switzerland
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Do Phonatory Aerodynamic and Acoustic Measures in Connected Speech Differ Between Vocally Healthy Adults and Patients Diagnosed with Muscle Tension Dysphonia? J Voice 2020; 35:663.e1-663.e7. [PMID: 31932188 DOI: 10.1016/j.jvoice.2019.12.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/21/2019] [Accepted: 12/23/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES One of the presumed etiologies of primary muscle tension dysphonia (MTD) is a respiratory-phonatory disruption resulting in poor phonatory airflow in speech; however, few data exist on the differences between vocally healthy adults and patients diagnosed with MTD. The goal of this study was to compare aerodynamic and acoustic measures of self-perceived vocally healthy adults with patients diagnosed with MTD. STUDY DESIGN Retrospective, observational, matched cohort study. METHODS Vocally healthy adults age 19-60 years were matched on age, gender, and body mass index (BMI) to patients diagnosed with MTD. Recorded samples of the first four sentences of The Rainbow Passage were analyzed for between-group differences in the following acoustic and aerodynamic dependent measures in connected speech: mean airflow during voicing, breath number, reading passage duration, inspiratory and expiratory durations, phonation time, inspiratory and expiratory volumes, cepstral peak prominence (CPP), CPP standard deviation (CPP SD), low to high ratio (L/H ratio), L/H ratio SD, CPP Fo, CPP Fo SD, cepstral spectral index of dysphonia, and dB sound pressure level (SPL). RESULTS One hundred and seventy participants were studied; 85 patients diagnosed with primary MTD and 85 vocally healthy control participants. The two groups differed significantly in mean SPL, duration of the reading passage, and inspiratory and expiratory airflow duration (P ≤ 0.003). No significant differences were observed between the groups on any other phonatory aerodynamic or acoustic measure. Mean SPL, duration of the reading passage, and inspiratory and expiratory airflow durations were lower and longer, respectively, in patients with MTD. Ranges and standard deviations were greater for all aerodynamic and acoustic measurements in patients with MTD. CONCLUSION Large variability in aerodynamic and acoustic measurements were observed in patients with primary MTD with no salient differences at the group level compared to vocally healthy participants. Individual phonatory aerodynamic and acoustic profiles should be used when setting goals for patient treatment plans and to track response to treatment for patients with MTD. Taken in its entirety, connected speech from patients diagnosed with MTD essentially reflect normal acoustic and aerodynamic values.
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Gillespie AI, Yabes J, Rosen CA, Gartner-Schmidt JL. Efficacy of Conversation Training Therapy for Patients With Benign Vocal Fold Lesions and Muscle Tension Dysphonia Compared to Historical Matched Control Patients. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:4062-4079. [PMID: 31619107 PMCID: PMC7203518 DOI: 10.1044/2019_jslhr-s-19-0136] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/08/2019] [Accepted: 08/08/2019] [Indexed: 05/22/2023]
Abstract
Purpose Conversation training therapy (CTT) is the 1st voice therapy approach to eliminate the traditional therapeutic hierarchy and use patient-driven conversation as the sole therapeutic stimulus. The purpose of this investigation was to determine the efficacy of CTT compared to standard-of-care voice therapy approaches for the treatment of patients with voice disorders. Method A prospective study of CTT treatment outcomes in adults with dysphonia due to primary muscle tension dysphonia or benign vocal fold lesions compared to age, gender, and diagnosis historical matched control (HMC) patients was used. The primary outcome was change in Voice Handicap Index-10 (VHI-10); secondary outcomes included acoustic, aerodynamic, and auditory-perceptual outcomes. Data were collected before treatment (baseline), at the start of each therapy session, 1 week after the final therapy session (short-term follow-up), and 3 months after the final therapy session (long-term follow-up). Results For the CTT group, statistically significant improvements were observed for VHI-10. Though statistically significant improvements were observed for the VHI-10 for the HMC group, the CTT group saw significantly greater improvement in VHI-10. Furthermore, equivalent gains were observed following only 2 sessions of CTT compared to 4-8 sessions of traditional therapy. Significant improvements in the CTT group were observed for cepstral peak prominence in a vowel, fundamental frequency, Cepstral Spectral Index of Dysphonia in a vowel and connected speech, vocal intensity, average airflow in speech in a reading passage, number of breaths and duration of reading passage, and auditory-perceptual measurement of overall voice severity. Conclusions Results support the hypothesis that training voice techniques in the context of spontaneous conversational speech improves patient perception of voice handicap and acoustic, aerodynamic, and auditory-perceptual voice outcomes both immediately following treatment and at long-term follow-up. CTT participants also demonstrated significantly larger decreases in VHI-10 compared to HMC participants who received standard-of-care, nonconversational, hierarchical-based voice therapy.
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Affiliation(s)
| | - Jonathan Yabes
- Department of Biostatistics, University of Pittsburgh, PA
| | - Clark A. Rosen
- Department of Otolaryngology, University of California, San Francisco
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Alharbi GG, Cannito MP, Buder EH, Awan SN. Spectral/Cepstral Analyses of Phonation in Parkinson's Disease before and after Voice Treatment: A Preliminary Study. Folia Phoniatr Logop 2019; 71:275-285. [PMID: 31117110 DOI: 10.1159/000495837] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/27/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE This article examines cepstral/spectral analyses of sustained /α/ vowels produced by speakers with hypokinetic dysarthria secondary to idiopathic Parkinson's disease (PD) before and after Lee Silverman Voice Treatment (LSVT®LOUD) and the relationship of these measures with overall voice intensity. METHODOLOGY Nine speakers with PD were examined in a pre-/post-treatment design, with multiple daily audio recordings before and after treatment. Sustained vowels were analyzed for cepstral peak prominence (CPP), CPP standard deviation (CPP SD), low/high spectral ratio (L/H SR), and Cepstral/Spectral Index of Dysphonia (CSID) using the KAYPENTAX computer software. RESULTS CPP and CPP SD increased significantly and CSID decreased significantly from pre- to post-treatment recordings, with strong effect sizes. Increased CPP indicates increased dominance of harmonics in the spectrum following LSVT. After restricting the frequency cutoff to the region just above the first formant and second formant and below the third formant, L/H SR was observed to decrease significantly following treatment. Correlation analyses demonstrated that CPP was more strongly associated with CSID before treatment than after. CONCLUSION In addition to increased vocal intensity following LSVT, speakers with PD exhibited both improved harmonic structure and voice quality as reflected by cepstral/spectral analysis, indicating that there was improved harmonic structure and reduced dysphonia following treatment.
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Affiliation(s)
- Ghadah G Alharbi
- Department of Special Education, College of Education, University of Jeddah, Jeddah, Saudi Arabia,
| | - Michael P Cannito
- Department of Communicative Disorders, University of Louisiana, Lafayette, Louisiana, USA
| | - Eugene H Buder
- School of Communication Sciences and Disorders, University of Memphis, Memphis, Tennessee, USA
| | - Shaheen N Awan
- Department of Communication Sciences and Disorders, Bloomsburg University of Pennsylvania, Bloomsburg, Pennsylvania, USA
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Do Standard Instrumental Acoustic, Perceptual, and Subjective Voice Outcomes Indicate Therapy Success in Patients With Functional Dysphonia? J Voice 2019; 33:317-324. [DOI: 10.1016/j.jvoice.2017.11.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 11/23/2022]
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van den Broek EMJM, Heijnen BJ, Hendriksma M, Langeveld APM, van Benthem PPG, Sjögren EV. Bilateral trial vocal fold injection with hyaluronic acid in patients with vocal fold atrophy with or without sulcus. Eur Arch Otorhinolaryngol 2019; 276:1413-1422. [PMID: 30859293 PMCID: PMC6458982 DOI: 10.1007/s00405-019-05347-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 02/13/2019] [Indexed: 11/28/2022]
Abstract
Purpose To evaluate the outcome of bilateral trial vocal fold injection (VFI) with hyaluronic acid in patients with vocal fold atrophy ± sulcus and to assess the predictive value of trial VFI on the outcome of durable medialization procedure. Methods Voice data collected according to a standardized protocol before and one month after trial VFI of 68 patients with vocal fold atrophy (30) and atrophy with sulcus (38) were analyzed. Voice Handicap Index (VHI)-30 was compared to the outcome of a durable medialization at 3 and 12 months. Results The overall VHI-30 improvement was 16.8 points (from 49.9 to 33.1), which was statistically significant and clinically relevant. 57.8% of the patients experienced enough subjective benefit after trial VFI to undergo durable medialization. Of the patients that experienced subjective benefit 62% had a clinically relevant improvement in VHI-30. There was no relevant change in other parameters and no difference between ± sulcus. After durable medialization 90–94% of the patients had VHI-30 scores similar to or better than post-trial VFI. Conclusion The majority of patients experience subjective improvement after bilateral trial VFI indicating that medialization is a valid treatment option for patients with vocal fold atrophy ± sulcus. The VHI-30 only partially overlaps with patients’ subjective evaluation and does not predict which patients will experience subjective improvement. It is, however, predictive for VHI-30 outcome after durable medialization. The aerodynamic and acoustic parameters showed no relevant change. Further identification of voice assessment parameters accurately reflecting the subjective experience of these patients is warranted.
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Affiliation(s)
- Emke M J M van den Broek
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Bas J Heijnen
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands
| | - Martine Hendriksma
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands
| | - Antonius P M Langeveld
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands
| | - Peter Paul G van Benthem
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands
| | - Elisabeth V Sjögren
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Centre, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands
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Esen Aydinli F, Özcebe E, İncebay Ö. Use of cepstral analysis for differentiating dysphonic from normal voices in children. Int J Pediatr Otorhinolaryngol 2019; 116:107-113. [PMID: 30554679 DOI: 10.1016/j.ijporl.2018.10.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Cepstral measures have mainly been evaluated by studies conducted on dysphonic and healthy adults, and many of these studies have reported the advantages of using cepstral measures for the evaluation of dysphonia however there is a paucity regarding to the cepstral analyses' results in dysphonic children. In this present study, it is hypothesized that cepstral peak prominence (CPP) and some other parameters of cepstral analysis would differ in children with vocal nodules when compared with the same parameters of cepstral analysis of healthy children. METHODS In this present study, totally 54 children aged between 5 years old to 12 years and 7 months participated. The study group consisted of 20 males and 7 females diagnosed with vocal nodules. The control group consisted of an equal number of age- and gender-matched healthy peers. Analysis of Dysphonia in Speech and Voice software (CSL Model 4500 equipment, Kay Elemetrics Group) was used to gather speech sample recordings according to the Consensus Auditory-Perceptual Evaluation of Voice/Turkish protocol. Cepstral measures of all the six CAPE-V sentences and sustained/a/sample were calculated. CPP, CPP fundamental frequency, CPP standard deviation (CPP SD), Low_high spectral ratio (L/H ratio), L/H ratio standard deviation parameters were taken into account when statistical analyses were completed. In addition to the descriptive statistics of ceptral measures for both groups, the differences between the study and control groups according to the gender were documented. RESULTS It was found that for both genders CPP and CPP SD values were significantly higher for the control group for vowel-weighted sample, all voiced-weighted sample, glottal attack-weighted sample, nasal weighted sample, and voiceless-weighted sample. In the vowel-weighted sample, CPP and CPP SD were significantly higher for the control group in males. In females, a difference was only observed on the CPP parameter for the same sentence. In terms of the CPP value of the sustained phonation sample, a significant difference was only detected for males, whereas no difference was detected for females. CONCLUSIONS In conclusion, present study found that cepstral analysis can be used to determine the difference between dysphonic and healthy voices of children and indicated that cepstral analysis should be a compulsory component of routine clinical voice evaluation of children. In addition, this present study indicates that of the cepstral analysis of sentences appear to be more sensitive to dysphonia than the analysis of vowel samples. In future studies, normative values of the CAPE-V/Turkish sentences and cutoff values for differentiating dysphonia from normal voice should be evaluated using a larger sample size.
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Affiliation(s)
- Fatma Esen Aydinli
- Speech and Language Pathology, Department of Speech and Language Therapy, Hacettepe University Faculty of Health Sciences, Sıhhiye, 06100, Ankara, Turkey.
| | - Esra Özcebe
- Speech and Language Pathology, Department of Speech and Language Therapy, Hacettepe University Faculty of Health Sciences, Sıhhiye, 06100, Ankara, Turkey.
| | - Önal İncebay
- Speech and Language Pathology, Department of Speech and Language Therapy, Hacettepe University Faculty of Health Sciences, Sıhhiye, 06100, Ankara, Turkey.
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Grillo EU. A phrase captures aerodynamic and acoustic data in healthy voice users and in patients with voice disorders. LOGOP PHONIATR VOCO 2018; 45:24-29. [PMID: 30514141 DOI: 10.1080/14015439.2018.1545866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Elizabeth U. Grillo
- Department of Communication Sciences and Disorders, West Chester University, West Chester, PA, USA
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Andrea M, Andrea M, Figueira ML. Self-perception of quality of life in patients with functional voice disorders: the effects of psychological and vocal acoustic variables. Eur Arch Otorhinolaryngol 2018; 275:2745-2754. [PMID: 30116878 DOI: 10.1007/s00405-018-5090-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 07/31/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Functional voice disorders (FVD) are multifactorial and may have a significant impact on the patients' quality of life (QOL). The aim of this study was to explore and analyze the relationship between the VHI scores, psychological variables, and objective voice measurements, and to develop a psychological and/or vocal acoustic model for the overall self-perceived evaluation of quality of life for three different types of FVD. METHODS After ENT examination, 83 women were classified into three groups: psychogenic voice disorder (PVD = 39), primary muscle tension voice disorder (MTVD1 = 16), and secondary muscle tension voice disorder (MTVD2 = 28). All patients were evaluated according to a multidisciplinary assessment protocol, which included the self-evaluation of quality of life (Voice Handicap Index, VHI), psychological evaluation (Hamilton Rating Scales for Depression (HAM-D) and for Anxiety (HARS), and Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Auto questionnaire (TEMPS-A)), and vocal acoustic analysis [mean fundamental frequency (F0, Hz), jitter (local, %), shimmer (local, %), and harmonic-to-noise ratio (HNR, dB)]. RESULTS Our findings revealed a moderate impact on QOL, regardless of the type of FVD. There were significant correlations between VHI scores, psychological variables, and voice perturbation parameters, with the exception of the MTVD1 and MTVD2 groups. The stepwise multiple linear regression analysis suggested that QOL could be explained by: anxious temperament together with shimmer in PVD group, jitter in the MTVD1 group, and depressive temperament in the MTVD2 group. CONCLUSIONS Affective temperaments and/or voice perturbation parameters were meaningful predictors of self-evaluation of quality of life in patients with different types of FVD.
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Affiliation(s)
- Mafalda Andrea
- Department of Psychiatry, Santa Maria Hospital, Lisbon, Portugal.
| | - Mario Andrea
- University Clinic of Otolaryngology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Maria Luísa Figueira
- University Clinic of Psychiatric and Medical Psychology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Karlsen T, Sandvik L, Heimdal JH, Aarstad HJ. Acoustic Voice Analysis and Maximum Phonation Time in Relation to Voice Handicap Index Score and Larynx Disease. J Voice 2018; 34:161.e27-161.e35. [PMID: 30093166 DOI: 10.1016/j.jvoice.2018.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Patients with voice-related disorders are ideally treated by a multidisciplinary team. Acoustic voice analysis and patient-reported outcome measures are recommended parts of the clinical assessment. The present paper aims at further documenting the importance of acoustic voice analyses, maximum phonation time (MPT) and Voice Handicap Index (VHI) into clinical investigations. STUDY DESIGN The participants (N = 80 larynx cancer, N = 32 recurrent palsy, N = 23 dysfunctional, N = 75 degenerative/inflammation (N = 19 various excluded)) were included consecutively at the outpatient laryngology clinic at Haukeland University Hospital. In addition, a control group of 98 healthy subjects were included. METHOD Voice samples, MPT, and the VHI scores in addition to standard clinical information were obtained. Acoustic analyses were performed from these samples determining level of jitter, shimmer and Noise-to-Harmonic ratio (NHR) as well as analyzing frequency of a prolonged vowel. RESULTS Jitter, shimmer, and NHR scores correlated strongly (r ≈ 0.8; P < 0.001) to each other. By Analysis of Variance analyses, we have determined significant dependence on diagnostic group analyzing all the obtained acoustic scores (all P < 0.001). All patient groups but the dysfunctional group scored to some extent worse than the control group (mostly at P < 0.001). In addition, jitter scores from dysfunction group were lower than recurrent palsy group (P < 0.05) and shimmer scores were lower among dysfunctional than the cancer group (P < 0.05). Regarding NHR the cancer patients scored higher than the degenerative/inflammatory group (P < 0.05). The cancer group scored with longer MPT than the degenerative/inflammatory (P < 0.001) and recurrent palsy groups (P < 0.05). CONCLUSION Among larynx disease patients acoustic and MPT analyses segregated with all determined analyses between patients and control conditions except the dysfunctional group, but also to some extent between various patient groups. VHI scores correlated to jitter, shimmer and NHR scores among cancer and degenerative/inflammatory disease patients. Acoustic analyses potentially add information useful to laryngological patient studies.
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Affiliation(s)
- Tom Karlsen
- Department of Otorhinolaryngology-Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway; Department of Speech and Language, Statped Vest, Bergen, Norway.
| | - Lorentz Sandvik
- Department of Otorhinolaryngology-Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - John-Helge Heimdal
- Department of Otorhinolaryngology-Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Hans Jørgen Aarstad
- Department of Otorhinolaryngology-Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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Lu D, Chen F, Yang H, Yu R, Zhou Q, Zhang X, Ren J, Zheng Y, Zhang X, Zou J, Wang H, Liu J. Changes After Voice Therapy in Acoustic Voice Analysis of Chinese Patients With Voice Disorders. J Voice 2018; 32:386.e1-386.e9. [DOI: 10.1016/j.jvoice.2017.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 05/04/2017] [Accepted: 05/04/2017] [Indexed: 11/25/2022]
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Voice-Specialized Speech-Language Pathologist's Criteria for Discharge from Voice Therapy. J Voice 2018; 32:332-339. [DOI: 10.1016/j.jvoice.2017.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/24/2017] [Accepted: 05/25/2017] [Indexed: 11/17/2022]
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An Examination of Pre- and Posttreatment Acoustic Versus Auditory Perceptual Analyses of Voice Across Four Common Voice Disorders. J Voice 2018; 32:169-176. [PMID: 28688672 DOI: 10.1016/j.jvoice.2017.04.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 11/21/2022]
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Lin TC, Chen JC, Liu CH, Lee CY, Tsou YA, Chuang CC. A feasibility study on non-invasive oxidative metabolism detection and acoustic assessment of human vocal cords by using optical technique. Sci Rep 2017; 7:17002. [PMID: 29208920 PMCID: PMC5716992 DOI: 10.1038/s41598-017-16807-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 11/16/2017] [Indexed: 01/08/2023] Open
Abstract
Voice disorder such as vocal fatigue is a common and complex multifaceted clinical problem that presents a significant impact on quality of life. In this study, the functional near-infrared diffuse optical technique (fNIRS-DOT) was proposed as a novel approach for human vocal cords oxidative metabolism detection and acoustic assessment simultaneously to provide a multidimensional assessment of voice disorder. A totally of 60 healthy subjects included 30 male and 30 female adults of age-matched were recruited and performed a vocal loading task to trigger a mild inflammation of the vocal cords in this study. In the results of oxidative metabolism, the vocal cords expressed hypoxia after vocal loading task in both male and female groups that could provide relevant information on the relationship between tissue oxygen consumption and supply for vocal cords diagnosis. Additionally, the results of optical acoustic assessment revealed the worse/changes voice quality after vocal loading task. Therefore, integration of non-invasive oxidative metabolism detection and acoustic assessment by using optical technique could provide more relevant information for diagnosis of voice disorders. The multi-functional vocal cords detection system could provide a good feasibility for clinical applications such as diagnosis and therapeutic monitoring of voice disorder.
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Affiliation(s)
- Tzu-Chieh Lin
- Department of Otolaryngology, China Medical University Hospital, Taichung, 40447, Taiwan
| | - Jung-Chih Chen
- Institute of Biomedical Engineering, National Chiao Tung University, Hsinchu, 30010, Taiwan
| | - Chih-Hsien Liu
- Department of Otolaryngology, Hsinchu Cathay General Hospital, Hsinchu, 30060, Taiwan
| | - Chia-Yen Lee
- Department of Electrical Engineering, National United University, Miaoli, 36063, Taiwan
| | - Yung-An Tsou
- Department of Otolaryngology, China Medical University Hospital, Taichung, 40447, Taiwan
| | - Ching-Cheng Chuang
- Institute of Biomedical Engineering, National Chiao Tung University, Hsinchu, 30010, Taiwan.
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Emerging techniques in assessment and treatment of muscle tension dysphonia. Curr Opin Otolaryngol Head Neck Surg 2017; 25:447-452. [DOI: 10.1097/moo.0000000000000405] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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
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Pitch Strength as an Outcome Measure for Treatment of Dysphonia. J Voice 2017; 31:691-696. [PMID: 28318967 DOI: 10.1016/j.jvoice.2017.01.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/27/2017] [Accepted: 01/30/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Measurement of treatment outcomes is critical for the spectrum of voice treatments (ie, surgical, behavioral, or pharmacological). Outcome measures typically include visual (eg, stroboscopic data), auditory (eg, Consensus Auditory-Perceptual Evaluation of Voice; Grade, Roughness, Breathiness, Asthenia, Strain), and objective correlates of vocal fold vibratory characteristics, such as acoustic signals (eg, harmonics-to-noise ratio, cepstral peak prominence) or patient self-reported questionnaires (eg, Voice Handicap Index, Voice-Related Quality of Life). Subjective measures often show high variability, whereas most acoustic measures of voice are only valid for signals where some degree of periodicity can be assumed. However, this assumption is often invalid for dysphonic voices where signal periodicity is suspect. Furthermore, many of these measures are not useful in isolation for diagnostic purposes. OBJECTIVE We evaluated a recently developed algorithm (Auditory Sawtooth Waveform Inspired Pitch Estimator-Prime [Auditory-SWIPE']) for estimating pitch and pitch strength for dysphonic voices. Whereas fundamental frequency is a physical attribute of a signal, pitch is its psychophysical correlate. As such, the perception of pitch can extend to most signals irrespective of their periodicity. METHODS Post hoc analyses were conducted for three groups of patients evaluated and treated for voice problems at a major voice center: (1) muscle tension dysphonia/functional dysphonia, (2) vocal fold mass(es), and (3) presbyphonia. All patients were recorded before and after surgical/behavioral treatment for voice disorders. Pitch and pitch strength for each speaker were computed with the Auditory-SWIPE' algorithm. RESULTS Comparison of pre- and posttreatment data provides support for pitch strength as a measure of treatment outcomes for dysphonic voices.
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Lukaschyk J, Brockmann-Bauser M, Beushausen U. Transcultural Adaptation and Validation of the German Version of the Vocal Tract Discomfort Scale. J Voice 2017; 31:261.e1-261.e8. [DOI: 10.1016/j.jvoice.2016.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
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Gillespie AI, Gartner-Schmidt J. Immediate Effect of Stimulability Assessment on Acoustic, Aerodynamic, and Patient-Perceptual Measures of Voice. J Voice 2016; 30:507.e9-507.e14. [DOI: 10.1016/j.jvoice.2015.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 06/08/2015] [Indexed: 11/15/2022]
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Dastolfo-Hromack C, Thomas TL, Rosen CA, Gartner-Schmidt J. Singing voice outcomes following singing voice therapy. Laryngoscope 2016; 126:2546-2551. [DOI: 10.1002/lary.25962] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 01/29/2016] [Accepted: 02/10/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Christina Dastolfo-Hromack
- University of Pittsburgh Voice Center, Department of Otolaryngology, University of Pittsburgh Medical Center; Pittsburgh Pennsylvania U.S.A
| | - Tracey L. Thomas
- University of Pittsburgh Voice Center, Department of Otolaryngology, University of Pittsburgh Medical Center; Pittsburgh Pennsylvania U.S.A
| | - Clark A. Rosen
- University of Pittsburgh Voice Center, Department of Otolaryngology, University of Pittsburgh Medical Center; Pittsburgh Pennsylvania U.S.A
| | - Jackie Gartner-Schmidt
- University of Pittsburgh Voice Center, Department of Otolaryngology, University of Pittsburgh Medical Center; Pittsburgh Pennsylvania U.S.A
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40
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Aerodynamic Outcomes of Four Common Voice Disorders: Moving Toward Disorder-Specific Assessment. J Voice 2016; 30:301-7. [DOI: 10.1016/j.jvoice.2015.03.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 03/30/2015] [Indexed: 11/17/2022]
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41
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Awan SN, Roy N, Zhang D, Cohen SM. Validation of the Cepstral Spectral Index of Dysphonia (CSID) as a Screening Tool for Voice Disorders: Development of Clinical Cutoff Scores. J Voice 2016; 30:130-44. [DOI: 10.1016/j.jvoice.2015.04.009] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 04/10/2015] [Indexed: 11/25/2022]
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42
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Comparison of voice outcomes after trial and long-term vocal fold augmentation in vocal fold atrophy. Laryngoscope 2015; 125:934-40. [DOI: 10.1002/lary.25043] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2014] [Indexed: 11/07/2022]
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