Test-Retest Reliability of the Dual-Microphone Voice Range Profile

The Voice Range Profile-A Shortened Protocol Pilot Study

INTRODUCTION

Voice production is a complex process involving the coordination of various anatomical structures and physiologic systems. The Voice Range Profile (VRP) is an established acoustic measure for evaluating voice production that examines minimum and maximum intensity across the frequency range. This pilot study sought to establish a consistent, efficient, and accessible VRP elicitation method. One primary research question was addressed: Does the proposed Short method provide at least as much information as a full, discrete-steps method, which is generally accepted in the literature?

METHODS

In this quasi-repeated measures design, twenty-four singers completed a full VRP based on accepted methods from the literature, and the same participants returned within one to three weeks to complete the proposed Short VRP protocol. The full VRP consisted of steady state productions at every semitone within a participant's range for both minimum and maximum intensities. The Short VRP consisted of steady state productions at every octave and perfect fifth across the semitone range for both minimum and maximum intensities. Additional sampling was completed between points when a 7 dB or greater difference was found between consecutive points. Analysis compared each protocol's average elicitation time differences, average semitone range differences, visual examination of the average VRP graph, and examination of average intensity differences between protocols at specific semitone points. Male and female results were analyzed separately.

RESULTS

The proposed Short protocol produced similar or better intensity ranges when compared with the accepted full elicitation method. The Short protocol produced intensities with 95% or greater similarity to the Full Protocol for male maximum intensity curve, female minimum intensity curve, and female maximum intensity curve.

CONCLUSIONS

When compared with a Full VRP, a Short VRP protocol appears to generate similar minimum and maximum intensity curves allowing for a time-efficient substitute.

Normative Voice Range Profile of the Young Female Voice

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.

Vocal Outcome After Cordectomy by Transoral CO2 Laser Microsurgery in Patients With Laryngeal Intraepithelial Neoplasia and Non-neoplastic Lesions

OBJECTIVES

This study investigates vocal outcome after cordectomy by transoral CO2 laser microsurgery (TLM-cordectomy) in patients with laryngeal intra-epithelial neoplasia (LIN) or non-neoplastic lesions (NNL), for improved individual patient advice and potential adjustment of national treatment strategy by which patients suspected to have glottic LIN or T1a cancer are offered TLM-cordectomy, without prior biopsy.

STUDY DESIGN

Prospective, longitudinal, quasi-experimental time series.

METHODS

Consecutively included patients (n = 155) with LIN (n = 84) or NNL (n = 71) who underwent voice assessments before and after TLM-cordectomy. The multi-dimensional voice assessment protocol comprised voice and speech range profiles, aerodynamics, acoustic analysis, self-evaluated voice handicap, and perceptual auditory voice ratings.

RESULTS

Median follow-up time was 195 (range 50-1121) days for patients with LIN and 193 (range 69-1294) days for patients with NNL. Statistically significant changes, LIN: in voice handicap index (VHI) and breathiness after TLM-cordectomy. Statistically significant changes, NNL: voice range profile (voice range area, intensity range, and frequency range) and VHI after TLM-cordectomy. All group-wise changes were to less disordered voices. Previous smokers had the largest decreases in VHI and breathiness. Patients with baseline VHI scores >65 had smaller increases in VHI, however 13-19% of the patients had increases in VHI above the clinically relevant threshold after TLM-cordectomy.

CONCLUSION

Overall, TLM-cordectomy in patients with LIN and NNL improved vocal outcome and our study thus supports the current Danish treatment strategy and improves the basis for proper patient advice. Multi-dimensional voice assessment is suggested preoperatively and six-nine months postoperatively, with focus on individual vocal differences and voice demands.

Data Collection Methods for the Voice Range Profile: A Systematic Review

Purpose To assess data collection variability in the voice range profile (VRP) across clinicians and researchers, a systematic review was conducted to evaluate the extent of variability of specific data collection points that affect the determination of frequency range and sound level and determine next steps in standardization of a VRP protocol. Method A systematic review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis checklist. Full-text journal articles were identified through PubMed, Web of Science, Psych Info, ProQuest Dissertations and Theses Global, Google Scholar, and hand searching of journals. Results A total of 1,134 articles were retrieved from the search; of these, 463 were duplicates. Titles and abstracts of 671 articles were screened, with 202 selected for full-text review. Fifty-four articles were considered eligible for inclusion. The information extracted from these articles revealed the methodology used to derive the VRP was extremely variable across the data points selected. Additionally, there were eight common acoustic measures used for statistical analysis described in included studies that were added as a data point. Conclusions The data collection methods for the VRP varied considerably. Standardization of procedures was recommended for clinicians and researchers.

A Case of Nervus Laryngeus Superior Paresis Treated With Novafon Local Vibration Voice Therapy

OBJECTIVE

The aim of the study is to present a case of chronic idiopathic superior laryngeal nerve paresis (SLNp) treated with a novel voice therapy approach called Novafon Local Vibration Voice Therapy (NLVVT).

METHODS

Outcome measurements including acoustics, aerodynamics, and self-perception of voice handicap were acquired before intervention (i.e., NLVVT) and after intervention (i.e.,follow-up). The use of NLVVT was modified from previous reports of use in functional voice disorders for application to a neurological voice disorder (SLNp).

RESULTS

The results showed that NLVVT had meaningful improvements in Voice Range Profile boundaries, an increase in speaking fundamental frequency, and improved acoustic indices of voice quality in a case of SLNp. The follow-up after NLVVT intervention revealed maintenance of the post-treatment improvements at a 1-month measurement interval.

CONCLUSION

The NLVVT program may have potential to improve voice quality and vocal function in a case of SLNp. Further research is necessary to test a potential effectiveness for NLVVT applied to vocal fold immobility due to paresis in both larger numbers of patients and more well-designed, controlled experiments.

The Impact of Post-thyroidectomy Paresis on Quality of Life in Patients with Nodular Thyroid Disease

Objective

To investigate the impact of postoperative paresis on disease-specific quality of life (DSQoL) after thyroidectomy in patients with benign nodular thyroid disease.

Study Design

Observational study.

Setting

University hospital.

Subjects and Methods

Patients were evaluated before and 3 weeks and 6 months after surgery in an individual prospective cohort study using videolaryngostroboscopy (VLS), voice range profile, voice handicap index (VHI), multidimensional voice program, maximum phonation time (MPT), and auditory perceptual evaluation. Changes in DSQoL were assessed by the Thyroid-specific Patient-Reported Outcome measure. Cohen’s effect size was used to evaluate changes.

Results

Sixty-two patients were included, 55 of whom completed all examinations. Three weeks after surgery, a blinded VLS examination showed signs of paresis of either the recurrent laryngeal nerve or the external branch of the superior laryngeal nerve (RLN/EBSLN) in 13 patients (24%). A paresis corresponded to a 12 ± 28 point increase in VHI ( P = .002) and was associated with a significant 4.3 ± 7.5 semitone decrease in the maximum fundamental frequency ( P < .001) and a 5.3 ± 8.2 dB reduction in maximum intensity. Further, it was associated with a 4.5 ± 11.2 second reduction in MPT ( P = .001) and an increase of 0.40 ± 1.19 in grade, 0.42 ± 1.41 in roughness, and 0.36 ± 1.11 in breathiness. Signs of postoperative RLN/EBSLN paresis correlated with an 11.0-point ( P = .02) poorer improvement in goiter symptoms at both 3 weeks and 6 months after surgery.

Conclusion

Signs of RLN/EBSLN paresis after thyroidectomy were associated with less pronounced improvement in goiter symptoms in patients with thyroid nodular disease. However, thyroidectomy was associated with an overall improved DSQoL by 6 months after surgery.

Dynamics of Intrinsic Laryngeal Muscle Contraction

OBJECTIVES

Laryngeal function requires neuromuscular activation of the intrinsic laryngeal muscles (ILMs). Rapid activation of the ILMs occurs in cough, laughter, and voice-unvoiced-voiced segments in speech and singing. Abnormal activation is observed in hyperfunctional disorders such as vocal tremor and dystonia. In this study, we evaluate the dynamics of ILM contraction.

STUDY/DESIGN

Basic science study in an in vivo canine model.

METHODS

The following ILMs were stimulated: thyroarytenoid (TA), lateral cricoarytenoid/interarytenoid (LCA/IA), cricothyroid (CT), all laryngeal adductors (LCA/IA/TA), and the posterior cricoarytenoid (PCA). Neuromuscular stimulation was performed via the respective nerves at current levels needed to achieve maximum vocal fold posture change. Muscle contraction and posture changes were recorded with high speed video (HSV). HSV frames were then analyzed to measure response times required from the onset of muscle contraction to the time the vocal folds achieved maximum posture change.

RESULTS

In all muscles, the onset of posture change occurred within 10 to 12 milliseconds after neuromuscular stimulation. The average times ( ± standard deviation) to achieve final posture were as follows: TA 34.5 ± 6 ms (N = 15), LCA/IA 55 ± 12 ms (N = 14), recurrent laryngeal nerve 43 ± 8 ms (N = 18), CT 100.8 ± 17 ms (N = 26), and PCA 91.2 ± 8 ms (N = 3). Data distribution appeared normal.

CONCLUSION

Results showed a difference in muscle activation time between different ILMs consistent with reported differences in muscle fiber composition. These data also provide an estimate of the limits of laryngeal contraction frequency in physiologic and pathologic laryngeal states.

LEVEL OF EVIDENCE

NA Laryngoscope, 129:E21-E25, 2019.

The Vocal Extent Measure: Development of a Novel Parameter in Voice Diagnostics and Initial Clinical Experience

Voice range profile (VRP) and evaluation using the dysphonia severity index (DSI) represent essentials of instrument-based objective voice diagnostics and are implemented in different standardized registration programs. The respective measurement results, however, show differences. The aim of the study was to prove these differences statistically and to develop a new parameter, the Vocal Extent Measure (VEM), which is not influenced by the measurement program. VRPs of 97 subjects were recorded by two examiners using the established registration programs DiVAS (XION medical) and LingWAVES (WEVOSYS) simultaneously. The VEM was developed on the basis of VRP area and perimeter. All 194 VRP files were analyzed for various parameters and gender independence. The registration programs exhibited significant differences in several vocal parameters. A significant gender influence for DSI was found with DiVAS (p < 0.01), but not with LingWAVES. The VEM quantified the dynamic performance and frequency range by a unidimensional, interval-scaled value without unit, mostly between 0 and 120. This novel parameter represents an intelligible and user-friendly positive measure of vocal function, allows simple and stable VRP description, and seems to be suitable for quantification of vocal capacity. In contrast to DSI, the VEM proved to be less susceptible to registration program and gender.