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Tesema N, Lackey TG, O'Connor M, Kwak PE, Johnson AM, Amin MR. Factors Associated With Improvement Following In-office Steroid Injections for Vocal Fold Scar. Laryngoscope 2024. [PMID: 39264157 DOI: 10.1002/lary.31734] [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: 04/25/2024] [Revised: 08/07/2024] [Accepted: 08/14/2024] [Indexed: 09/13/2024]
Abstract
OBJECTIVE This study aims to evaluate the clinical outcomes of patients receiving in-office vocal fold steroid injections (VFSI), highlighting relatively new measures around vocal pitch. METHODS Patients with a diagnosis of vocal fold scar who received in-office VFSI from 2013 to 2024 were evaluated. Pre- and post-steroid Voice Handicap Index (VHI-10) scores, stroboscopic vibratory parameters, acoustic measures of cepstral peak prominence (CPP), and fundamental frequency coefficient of variation (F0CoV) during sustained phonation were analyzed using Wilcoxon signed-rank tests and McNemar's tests. RESULTS Twenty-two patients had follow-up data 1-3 months after steroid injection. The median decrease in VHI-10 after one injection was 4 points (p = 0.02). We found no difference in CPP and F0CoV measures at follow-up. Forty-five percent of patients improved in mucosal wave and amplitude of at least one vocal fold. Earlier presentation from vocal injury was associated with improvement in mucosal wave and amplitude of the left vocal fold (p = 0.03). We found no difference in sex, tobacco smoking history, singing status, secondary diagnosis, and baseline VHI-10 score between patients who improved in vibratory parameters and those who did not. CONCLUSION This single-center study is one of the largest exploring patient outcomes following in-office VFSI. Though patients reported modest improvement in voice use after VFSI, this may not be as impactful as previously believed. Improvement in videostroboscopy is expected in about half of the patients, with recency from vocal injury a likely predictor of success. These partially negative results provide insight into counseling patients regarding benefits from in-office VFSI. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
| | | | | | - Paul E Kwak
- NYU Langone Health, New York, New York, U.S.A
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Toles LE, Turner M, Harris AL. Patient Motivation for Voice Therapy Increases After Stimulability Testing: Validation of a Voice Therapy Motivation and Voice Perception Inventory. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-16. [PMID: 39259877 DOI: 10.1044/2024_ajslp-24-00058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
OBJECTIVE Measuring patient motivation for voice therapy is an important component of determining prognosis and estimating compliance. Voice stimulability testing is assumed to influence the patient's motivation by improving their perception of the sound and/or feel of the voice. The purpose of this study was to validate a Voice Therapy Motivation and Voice Perception Inventory and to determine whether stimulability testing elicits improvements in motivation and patient-perceived voice status. METHOD Seventy-five patients who underwent initial voice therapy evaluation completed a four-item inventory that queried their commitment to voice therapy, confidence that they could change their voice through voice therapy, perception of their voice severity, and ratings of their vocal effort. Inventories were completed shortly before and after stimulability testing. A psychometric analysis of the survey was conducted, including the internal consistency of each construct of the inventory along with content, predictive, and concurrent validity. Paired-samples statistical analyses were conducted to determine differences before and after stimulability testing, and Spearman correlations between voice and motivation ratings were conducted to determine relationships between the patient's perception of their voice and their motivation for voice therapy. RESULTS Internal consistency reliability was acceptable to good for each construct, particularly after stimulability testing. Motivation scales were predictive of returning for voice therapy sessions, subjective improvement of voice by the first therapy session, and likelihood of the patient practicing the home practice program. Patient ratings of voice severity and effort were positively correlated with clinician ratings of overall severity. Motivation and voice impairment perception improved following stimulability testing. Reduction in vocal effort was related to improved motivation, but change in voice severity was not. CONCLUSIONS Voice stimulability testing can influence patient motivation for voice therapy and patient-perceived voice improvements. It should be considered a critical part of the voice evaluation.
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Affiliation(s)
- Laura E Toles
- Department of Otolaryngology - Head and Neck Surgery, Voice Center, University of Texas Southwestern Medical Center, Dallas
| | - Melanie Turner
- Department of Otolaryngology - Head and Neck Surgery, Voice Center, University of Texas Southwestern Medical Center, Dallas
| | - Amy L Harris
- Department of Otolaryngology - Head and Neck Surgery, Voice Center, University of Texas Southwestern Medical Center, Dallas
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Paz KEDS, de Almeida AAF, Almeida LNA, Sousa ESDS, Lopes LW. Auditory Perception of Roughness and Breathiness by Dysphonic Women. J Voice 2024; 38:1249.e1-1249.e18. [PMID: 35082050 DOI: 10.1016/j.jvoice.2022.01.005] [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: 10/27/2021] [Revised: 12/31/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the auditory perception of roughness and breathiness by dysphonic women. METHODS Twenty-two dysphonic native Brazilian Portuguese women participated in this research. All participants underwent audiological evaluation and laryngeal examination to confirm the diagnosis. During the tests, they recorded the sustained vowel /Ɛ/. A speech-language pathologist performed the auditory-perceptual judgment of voice quality for these vocal samples, categorizing the general degree of vocal deviation (mild, moderate, and severe degree) and the predominant type of deviation (roughness or breathiness). Thirty-two (32) stimuli were selected from a voice database, including twenty-four (24) dysphonic voice samples and eight (8) voice samples from vocally healthy women. The authors conducted five perception experiments, being three categorization tasks (normal vs. deviated, breathy vs. nonbreathy, rough vs. nonrough) and two tasks for discriminating the degree of deviation (roughness degree and breathiness degree). RESULTS The experiments showed a difference between the answers for presence/absence of deviation, presence/absence of breathiness, and presence/absence of roughness in the stimuli, and a difference in the proportion of similar answers of dysphonic women (P < 0.001) regarding the identification of the deviation. Participants classified a large part of the deviated (57.9%), breathy (63.13%), and rough (65.31%) voices as normal. The degree of vocal deviation (P = 0.008) and the degree of roughness in the stimuli correlated positively with the proportion of similar answers of the participants. As for the discrimination of breathiness degrees, less deviated (normal and mild) voices were less discriminated, and more deviated (moderate and severe) voices were better discriminated. Regarding the discrimination of roughness degrees, only the voices with severe deviations showed good discrimination. CONCLUSION Dysphonic women had a high rate of not similar answers in the identification of normal and deviated voices. They identified more than half of the deviated voices as normal. Samples with more severe deviations were proportionally more identified as deviated by the participants. The greater the vocal deviation of the participants' voices, the smallest the number of similar answers. Participants had a high rate of not similar answers in the identification of normal and breathy voices. Dysphonic women show less ability to perceive mildly and moderately breathy voices in the breathy category. Participants had a high rate of similar answers in the identification of normal and rough voices. Dysphonic women show less ability to perceive mildly and moderately breathy voices in the breathy category. Participants show less ability to perceive only mildly roughness voices with similar responses. Dysphonic women could discriminate between voices with adjacent degrees of roughness but had a low percentage of similar answers for discrimination between voices with adjacent degrees of breathiness.
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Affiliation(s)
- Karoline Evangelista da Silva Paz
- Master degree at the Speech, Language, and Hearing Sciences Graduate Program at the Federal University of Paraíba (Universidade Federal da Paraíba-UFPB), João Pessoa, Paraíba, Brazil
| | - Anna Alice Figueiredo de Almeida
- Professor at the Speech, Language, and Hearing Sciences Graduate Program at the Federal University of Paraíba (Universidade Federal da Paraíba-UFPB), João Pessoa, Paraíba, Brazil
| | - Larissa Nadjara Alves Almeida
- Member of Integrated Voice Studies Laboratory Speech, Language, and Hearing Sciences Graduate Program at the Federal University of Paraíba (Universidade Federal da Paraíba-UFPB), João Pessoa, Paraíba, Brazil
| | - Estevão Silvestre da Silva Sousa
- Member of Integrated Voice Studies Laboratory Speech, Language, and Hearing Sciences Graduate Program at the Federal University of Paraíba (Universidade Federal da Paraíba-UFPB), João Pessoa, Paraíba, Brazil
| | - Leonardo Wanderley Lopes
- Professor at the Speech, Language, and Hearing Sciences Graduate Program at the Federal University of Paraíba (Universidade Federal da Paraíba-UFPB), João Pessoa, Paraíba, Brazil.
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Yun EWT, Nguyen DD, Carding P, Hodges NJ, Chacon AM, Madill C. The Relationship Between Pitch Discrimination and Acoustic Voice Measures in a Cohort of Female Speakers. J Voice 2024; 38:1023-1034. [PMID: 35317969 DOI: 10.1016/j.jvoice.2022.02.015] [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: 10/18/2021] [Revised: 02/13/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evidence across a range of musically trained, hearing disordered and voice disordered populations present conflicting results regarding the relationship between pitch discrimination (PD) and voice quality. PD characteristics of female speakers with and without a musical training background and no self-reported voice disorder, and the relationship between PD and voice quality in this particular population, have not been investigated. AIMS To evaluate PD characteristics in a cohort of female participants without a self-reported voice disorder and the relationship between PD and acoustic voice measures. METHOD One hundred fourteen female participants were studied, all of whom self-reported as being non-voice disordered. All completed the Newcastle Assessment of Pitch Discrimination which involved a two-tone PD task. Their voices were recorded producing standardized vocal tasks. Voice samples were acoustically analyzed for frequency-domain measures (fundamental frequency and its standard deviation, and harmonics-to-noise ratio) and spectral-domain measures (cepstral peak prominence and the Cepstral/Spectral Index of Dysphonia). Data were analyzed for the whole cohort and for musical and non-musical training backgrounds. RESULTS In the whole cohort, there were no significant correlations between PD and acoustic voice measures. PD accuracy in musically trained speakers was better than in non-trained speakers and correlated with fundamental frequency standard deviation in prolonged vowel tasks. Vocalists demonstrated superior PD accuracy and fundamental frequency standard deviation in prolonged vowels compared to instrumentalists but did not show significant correlations between PD and acoustic measures. The Newcastle Assessment of Pitch Discrimination was a reliable tool, showing moderate-good prediction value in differentiating musical background. CONCLUSIONS There was little evidence of a relationship between PD and acoustic measures of voice quality, regardless of musical training background and superior PD accuracy among the musically trained. These data do not support ideas concerning the co-development of perception and action among individuals identified as having voice quality measures within normal ranges. Numerous measures of voice quality, including measures sensitive to pitch, did not distinguish across musically and non-musically trained individuals, despite individual differences in pitch discrimination.
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Affiliation(s)
- Emily Wing-Tung Yun
- Discipline of Speech Pathology, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia; Doctor Liang Voice Program, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Duy Duong Nguyen
- Discipline of Speech Pathology, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia; Doctor Liang Voice Program, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Paul Carding
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, England
| | - Nicola J Hodges
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Antonia Margarita Chacon
- Discipline of Speech Pathology, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia; Doctor Liang Voice Program, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Catherine Madill
- Discipline of Speech Pathology, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia; Doctor Liang Voice Program, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia.
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Alves MDC, Mancini PC, Teixeira LC. Modifications of auditory feedback and its effects on the voice of adult subjects: a scoping review. Codas 2023; 36:e20220202. [PMID: 38126424 PMCID: PMC10750862 DOI: 10.1590/2317-1782/20232022202pt] [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: 08/23/2022] [Accepted: 05/29/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION The auditory perception of voice and its production involve auditory feedback, kinesthetic cues and the feedforward system that produce different effects for the voice. The Lombard, Sidetone and Pitch-Shift-Reflex effects are the most studied. The mapping of scientific experiments on changes in auditory feedback for voice motor control makes it possible to examine the existing literature on the phenomenon and may contribute to voice training or therapies. PURPOSE To map experiments and research results with manipulation of auditory feedback for voice motor control in adults. METHOD Scope review following the Checklist Preferred Reporting Items for Systematic reviews and Meta-Analyses extension (PRISMA-ScR) to answer the question: "What are the investigation methods and main research findings on the manipulation of auditory feedback in voice self-monitoring of adults?". The search protocol was based on the Population, Concept, and Context (PCC) mnemonic strategy, in which the population is adult individuals, the concept is the manipulation of auditory feedback and the context is on motor voice control. Articles were searched in the databases: BVS/Virtual Health Library, MEDLINE/Medical Literature Analysis and Retrieval System online, COCHRANE, CINAHL/Cumulative Index to Nursing and Allied Health Literature, SCOPUS and WEB OF SCIENCE. RESULTS 60 articles were found, 19 on the Lombard Effect, 25 on the Pitch-shift-reflex effect, 12 on the Sidetone effect and four on the Sidetone/Lombard effect. The studies are in agreement that the insertion of a noise that masks the auditory feedback causes an increase in the individual's speech intensity and that the amplification of the auditory feedback promotes the reduction of the sound pressure level in the voice production. A reflex response to the change in pitch is observed in the auditory feedback, however, with particular characteristics in each study. CONCLUSION The material and method of the experiments are different, there are no standardizations in the tasks, the samples are varied and often reduced. The methodological diversity makes it difficult to generalize the results. The main findings of research on auditory feedback on voice motor control confirm that in the suppression of auditory feedback, the individual tends to increase the intensity of the voice. In auditory feedback amplification, the individual decreases the intensity and has greater control over the fundamental frequency, and in frequency manipulations, the individual tends to correct the manipulation. The few studies with dysphonic individuals show that they behave differently from non-dysphonic individuals.
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Affiliation(s)
- Moisés do Carmo Alves
- Programa de Pós-graduação em Ciências Fonoaudiológicas, Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.
| | - Patrícia Cotta Mancini
- Programa de Pós-graduação em Ciências Fonoaudiológicas, Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.
| | - Leticia Caldas Teixeira
- Programa de Pós-graduação em Ciências Fonoaudiológicas, Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.
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Nudelman C, Udd D, Åhlander VL, Bottalico P. Reducing Vocal Fatigue With Bone Conduction Devices: Comparing Forbrain and Sidetone Amplification. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:4380-4397. [PMID: 37844616 DOI: 10.1044/2023_jslhr-23-00409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
PURPOSE Altered auditory feedback research aims to identify methods to strengthen speakers' awareness of their own voicing behaviors, diminish their perception of vocal fatigue, and improve their voice production. This study aims to compare the effects of two bone conduction devices that provide altered auditory feedback. METHOD Twenty participants (19-33 years old, age: M [SD] = 25.5 [3.85] years) participated in a vocal loading task using a standard Forbrain device that provides filtered auditory feedback via bone conduction and a modified Forbrain device that provides only sidetone amplification, and a control condition with no device was also included. They rated their vocal fatigue on a visual analog scale every 2 min during the vocal loading task. Additionally, pre- and postloading voice samples were analyzed for acoustic voice parameters. RESULTS Across all participants, the use of bone conduction-altered auditory feedback devices resulted in a lower vocal fatigue when compared to the condition with no feedback. During the pre- and postvoice samples, the sound pressure level decreased significantly during feedback conditions. During feedback conditions, spectral mean and standard deviation significantly decreased, and spectral skew significantly increased. CONCLUSION The results promote bone conduction as a possible preventative tool that may reduce self-reported vocal fatigue and compensatory voice production for healthy individuals without voice disorders.
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Affiliation(s)
- Charles Nudelman
- Department of Speech and Hearing Science, University of Illinois Urbana-Champaign
| | - Daniela Udd
- Faculty of Arts, Psychology and Theology, Department of Speech and Language Pathology, Åbo Akademi University, Turku, Finland
| | - Viveka Lyberg Åhlander
- Faculty of Arts, Psychology and Theology, Department of Speech and Language Pathology, Åbo Akademi University, Turku, Finland
| | - Pasquale Bottalico
- Department of Speech and Hearing Science, University of Illinois Urbana-Champaign
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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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Nudelman CJ, Codino J, Fry AC, Bottalico P, Rubin AD. Voice Biofeedback via Bone Conduction Headphones: Effects on Acoustic Voice Parameters and Self-Reported Vocal Effort in Individuals With Voice Disorders. J Voice 2022:S0892-1997(22)00320-4. [PMID: 36372674 DOI: 10.1016/j.jvoice.2022.10.014] [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: 08/23/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE This study explores sidetone amplification (amplified playback of one's own voice) provided via bone conduction in participants with voice disorders. The effects of bone conduction feedback on acoustic voice parameters and vocal effort ratings are examined. METHODS Speech samples of 47 participants with voice disorders were recorded in three auditory feedback conditions: two with sidetone amplification delivered via bone conduction and one condition with no alteration of the feedback. After each task, the participants rated their vocal effort on a visual analog scale. The voice recordings were evaluated by a speech-language pathologist through the GRBAS scale and processed to calculate the within-participant centered sound pressure level (SPL) values, the mean pitch strength (PS), the time dose (Dt%), and cepstral peak prominence smoothed (CPPS). The effects of the feedback conditions on these acoustic parameters and vocal effort ratings were analyzed. RESULTS The high sidetone amplification condition resulted in a statistically significant decrease in the within-participant centered SPL values and mean pitch strength across all participants. The feedback conditions had no statistically significant effects on the vocal effort ratings, time dose (Dt%), or CPPS. CONCLUSIONS This study provides an evidence that bone conduction sidetone amplification contributes to a consistent adaptation in the within-participant centered SPL values (ΔSPL) in patients with vocal hyperfunction, glottal insufficiency, and organic/neurological laryngeal pathologies compared to conditions with no feedback.
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Affiliation(s)
- Charles J Nudelman
- Department of Speech and Hearing Science, University of Illinois Urbana-Champaign, Champaign, Illinois.
| | - Juliana Codino
- Lakeshore Professional Voice Center, Lakeshore Ear, Nose, and Throat Center, St. Clair Shores, Michigan
| | - Adam C Fry
- Lakeshore Professional Voice Center, Lakeshore Ear, Nose, and Throat Center, St. Clair Shores, Michigan
| | - Pasquale Bottalico
- Department of Speech and Hearing Science, University of Illinois Urbana-Champaign, Champaign, Illinois
| | - Adam D Rubin
- Lakeshore Professional Voice Center, Lakeshore Ear, Nose, and Throat Center, St. Clair Shores, Michigan
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McDowell S, Morrison R, Mau T, Shembel AC. Clinical Characteristics and Effects of Vocal Demands in Occupational Voice Users With and Without Primary Muscle Tension Dysphonia. J Voice 2022:S0892-1997(22)00311-3. [PMID: 36334967 PMCID: PMC10151438 DOI: 10.1016/j.jvoice.2022.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/10/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The objectives of this study were to (1) compare laryngeal configuration patterns in occupational voice users with and without primary muscle tension dysphonia (pMTD), (2) characterize laryngeal configurations in relation to other clinical metrics (acoustic, perceptual), and (3) determine the effects of vocal demands (load) on these clinical parameters. METHODS Thirty subjects (15 pMTD, 15 control) were recruited for the study. Laryngoscopic examinations and voice samples for sustained /i/ were obtained before and after a half hour vocal load task. Subjects rated their vocal effort and discomfort before and after the vocal load. Laryngeal configurations were analyzed subjectively with dichotomous and categorical rating scales and hyper function severity quantified (endolaryngeal area outlets). Overall dysphonia severity and vocal instability of each voice sample was rated on 100mm visual analog scales and cepstral peak prominence (CPP) extracted from each voice sample. RESULTS Laryngeal configurations between groups or vocal load condition were not distinguishable with any of the dichotomous, categorical, or quantitative laryngeal metrics. Vocal effort and discomfort ratings were significantly higher in the pMTD group compared to the control group. Vocal load also had significant effects across groups on vocal effort and vocal tract discomfort ratings. Although CPP values fell within the normal range in both groups, CPP was significantly lower in the pMTD group at both pre-load and post-load time points. Auditory-perceptual ratings were also significantly worse in the pMTD group. Vocal load did not have a significant effect on acoustic or auditory-perceptual measures. CONCLUSION Similar laryngeal configurations between groups at both pre- and post-vocal load suggests classic patterns of laryngeal "hyperadduction" may occur variably in occupational voice users and may not be indicative of pMTD pathophysiology. Greater vocal effort, discomfort, instability, and perturbation within the vocal system may better define pMTD than laryngeal configuration in occupational voice users with pMTD.
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Affiliation(s)
- Sarah McDowell
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Dallas, Texas
| | - Robert Morrison
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Dallas, Texas
| | - Ted Mau
- Department of Otolaryngology-Head and Neck, Voice Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Adrianna C Shembel
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Dallas, Texas; Department of Otolaryngology-Head and Neck, Voice Center, University of Texas Southwestern Medical Center, Dallas, Texas.
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Castro C, Prado P, Espinoza VM, Testart A, Marfull D, Manriquez R, Stepp CE, Mehta DD, Hillman RE, Zañartu M. Lombard Effect in Individuals With Nonphonotraumatic Vocal Hyperfunction: Impact on Acoustic, Aerodynamic, and Vocal Fold Vibratory Parameters. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2881-2895. [PMID: 35930680 PMCID: PMC9913286 DOI: 10.1044/2022_jslhr-21-00508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/17/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE This exploratory study aims to investigate variations in voice production in the presence of background noise (Lombard effect) in individuals with nonphonotraumatic vocal hyperfunction (NPVH) and individuals with typical voices using acoustic, aerodynamic, and vocal fold vibratory measures of phonatory function. METHOD Nineteen participants with NPVH and 19 participants with typical voices produced simple vocal tasks in three sequential background conditions: baseline (in quiet), Lombard (in noise), and recovery (5 min after removing the noise). The Lombard condition consisted of speech-shaped noise at 80 dB SPL through audiometric headphones. Acoustic measures from a microphone, glottal aerodynamic parameters estimated from the oral airflow measured with a circumferentially vented pneumotachograph mask, and vocal fold vibratory parameters from high-speed videoendoscopy were analyzed. RESULTS During the Lombard condition, both groups exhibited a decrease in open quotient and increases in sound pressure level, peak-to-peak glottal airflow, maximum flow declination rate, and subglottal pressure. During the recovery condition, the acoustic and aerodynamic measures of individuals with typical voices returned to those of the baseline condition; however, recovery measures for individuals with NPVH did not return to baseline values. CONCLUSIONS As expected, individuals with NPVH and participants with typical voices exhibited a Lombard effect in the presence of elevated background noise levels. During the recovery condition, individuals with NPVH did not return to their baseline state, pointing to a persistence of the Lombard effect after noise removal. This behavior could be related to disruptions in laryngeal motor control and may play a role in the etiology of NPVH. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.20415600.
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Affiliation(s)
- Christian Castro
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso, Chile
- Department of Speech and Language Pathology, Universidad de Valparaíso, Chile
- Department of Speech and Language Pathology, Universidad de Chile, Santiago
| | - Pavel Prado
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
| | | | - Alba Testart
- Department of Speech and Language Pathology, Universidad de Playa Ancha, Valparaíso, Chile
| | - Daphne Marfull
- Department of Speech and Language Pathology, Universidad de Valparaíso, Chile
| | - Rodrigo Manriquez
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso, Chile
| | - Cara E. Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- Department of Biomedical Engineering, Boston University, MA
- Department of Otolaryngology-Head and Neck Surgery, Boston University, MA
| | - Daryush D. Mehta
- Center for Laryngeal Surgery & Voice Rehabilitation, Massachusetts General Hospital, Boston
- Department of Surgery, Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | - Robert E. Hillman
- Center for Laryngeal Surgery & Voice Rehabilitation, Massachusetts General Hospital, Boston
- Department of Surgery, Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | - Matías Zañartu
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso, Chile
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11
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Weerathunge HR, Alzamendi GA, Cler GJ, Guenther FH, Stepp CE, Zañartu M. LaDIVA: A neurocomputational model providing laryngeal motor control for speech acquisition and production. PLoS Comput Biol 2022; 18:e1010159. [PMID: 35737706 PMCID: PMC9258861 DOI: 10.1371/journal.pcbi.1010159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 07/06/2022] [Accepted: 05/02/2022] [Indexed: 11/18/2022] Open
Abstract
Many voice disorders are the result of intricate neural and/or biomechanical impairments that are poorly understood. The limited knowledge of their etiological and pathophysiological mechanisms hampers effective clinical management. Behavioral studies have been used concurrently with computational models to better understand typical and pathological laryngeal motor control. Thus far, however, a unified computational framework that quantitatively integrates physiologically relevant models of phonation with the neural control of speech has not been developed. Here, we introduce LaDIVA, a novel neurocomputational model with physiologically based laryngeal motor control. We combined the DIVA model (an established neural network model of speech motor control) with the extended body-cover model (a physics-based vocal fold model). The resulting integrated model, LaDIVA, was validated by comparing its model simulations with behavioral responses to perturbations of auditory vocal fundamental frequency (fo) feedback in adults with typical speech. LaDIVA demonstrated capability to simulate different modes of laryngeal motor control, ranging from short-term (i.e., reflexive) and long-term (i.e., adaptive) auditory feedback paradigms, to generating prosodic contours in speech. Simulations showed that LaDIVA's laryngeal motor control displays properties of motor equivalence, i.e., LaDIVA could robustly generate compensatory responses to reflexive vocal fo perturbations with varying initial laryngeal muscle activation levels leading to the same output. The model can also generate prosodic contours for studying laryngeal motor control in running speech. LaDIVA can expand the understanding of the physiology of human phonation to enable, for the first time, the investigation of causal effects of neural motor control in the fine structure of the vocal signal.
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Affiliation(s)
- Hasini R. Weerathunge
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, United States of America
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts, United States of America
| | - Gabriel A. Alzamendi
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso, Chile
- Institute for Research and Development on Bioengineering and Bioinformatics (IBB), CONICET-UNER, Oro Verde, Argentina
| | - Gabriel J. Cler
- Department of Speech & Hearing Sciences, University of Washington, Seattle, Washington, United States of America
| | - Frank H. Guenther
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, United States of America
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts, United States of America
| | - Cara E. Stepp
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, United States of America
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, Massachusetts, United States of America
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Matías Zañartu
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso, Chile
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12
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Weerathunge HR, Tomassi NE, Stepp CE. What Can Altered Auditory Feedback Paradigms Tell Us About Vocal Motor Control in Individuals With Voice Disorders? PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2022; 7:959-976. [PMID: 37397620 PMCID: PMC10312128 DOI: 10.1044/2022_persp-21-00195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Purpose The goal of this review article is to provide a summary of the progression of altered auditory feedback (AAF) as a method to understand the pathophysiology of voice disorders. This review article focuses on populations with voice disorders that have thus far been studied using AAF, including individuals with Parkinson's disease, cerebellar degeneration, hyperfunctional voice disorders, vocal fold paralysis, and laryngeal dystonia. Studies using AAF have found that individuals with Parkinson's disease, cerebellar degeneration, and laryngeal dystonia have hyperactive auditory feedback responses due to differing underlying causes. In persons with PD, the hyperactivity may be a compensatory mechanism for atypically weak feedforward motor control. In individuals with cerebellar degeneration and laryngeal dystonia, the reasons for hyperactivity remain unknown. Individuals with hyperfunctional voice disorders may have auditory-motor integration deficits, suggesting atypical updating of feedforward motor control. Conclusions These findings have the potential to provide critical insights to clinicians in selecting the most effective therapy techniques for individuals with voice disorders. Future collaboration between clinicians and researchers with the shared objective of improving AAF as an ecologically feasible and valid tool for clinical assessment may provide more personalized therapy targets for individuals with voice disorders.
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Affiliation(s)
- Hasini R. Weerathunge
- Department of Biomedical Engineering, Boston University, MA
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - Nicole E. Tomassi
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- Graduate Program for Neuroscience, Boston University, MA
| | - Cara E. Stepp
- Department of Biomedical Engineering, Boston University, MA
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- Department of Otolaryngology—Head and Neck Surgery, Boston University School of Medicine, MA
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13
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Desjardins M, Apfelbach C, Rubino M, Verdolini Abbott K. Integrative Review and Framework of Suggested Mechanisms in Primary Muscle Tension Dysphonia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1867-1893. [PMID: 35446683 PMCID: PMC9559660 DOI: 10.1044/2022_jslhr-21-00575] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/14/2021] [Accepted: 01/12/2022] [Indexed: 05/26/2023]
Abstract
PURPOSE Despite the high prevalence of primary muscle tension dysphonia (MTD-1), its underlying mechanisms and their interrelationships have yet to be fully identified. The objectives of this integrative review were (a) to describe and classify the suggested underlying mechanisms for MTD-1, (b) to appraise the empirical evidence supporting each of the proposed mechanisms, and (c) to summarize the information in an integrative model. METHOD PubMed, Scopus, and CINAHL were searched for all publications pertaining to muscle tension dysphonia. Papers were retained if they included theoretical or empirical data pertaining to underlying mechanisms of MTD-1. A total of 921 papers initially qualified for screening, of which 100 remained for consideration in this review. Underlying mechanisms of MTD-1 were extracted using a consensus approach. RESULTS Seven broad categories of putative mechanisms involved in MTD-1 were identified: psychosocial, autonomic, sensorimotor, respiratory, postural, inflammatory, and neuromuscular. These categories were further divided into 19 subcategories detailed in the body of this review article. Based on the reviewed evidence, our proposed integrative model presents MTD-1 as an idiosyncratic motor adaptation to physiological perturbation or perceived threat. Under this model, physiologically or psychologically aversive stimuli can instigate a series of motor adaptations at multiple levels of the nervous system, ultimately disturbing muscle activation patterns and their biomechanical outcomes. Importantly, these adaptations appear to have the potential to become chronic even after threatening stimuli are withdrawn. CONCLUSIONS The proposed model highlights the importance of personalized rehabilitation in MTD-1 treatment. Limitations of the literature are discussed to provide guidance for future research aimed at improving our understanding of MTD-1. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19586065.
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Affiliation(s)
- Maude Desjardins
- Department of Communication Sciences & Disorders, University of Delaware, Newark
| | | | - Marianna Rubino
- Department of Communication Sciences & Disorders, University of Delaware, Newark
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14
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Nguyen DD, Chacon AM, Novakovic D, Hodges NJ, Carding PN, Madill C. Pitch Discrimination Testing in Patients with a Voice Disorder. J Clin Med 2022; 11:584. [PMID: 35160036 PMCID: PMC8836960 DOI: 10.3390/jcm11030584] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 02/01/2023] Open
Abstract
Auditory perception plays an important role in voice control. Pitch discrimination (PD) is a key index of auditory perception and is influenced by a variety of factors. Little is known about the potential effects of voice disorders on PD and whether PD testing can differentiate people with and without a voice disorder. We thus evaluated PD in a voice-disordered group (n = 71) and a non-voice-disordered control group (n = 80). The voice disorders included muscle tension dysphonia and neurological voice disorders and all participants underwent PD testing as part of a comprehensive voice assessment. Percentage of accurate responses and PD threshold were compared across groups. The PD percentage accuracy was significantly lower in the voice-disordered group than the control group, irrespective of musical background. Participants with voice disorders also required a larger PD threshold to correctly discriminate pitch differences. The mean PD threshold significantly discriminated the voice-disordered groups from the control group. These results have implications for the voice control and pathogenesis of voice disorders. They support the inclusion of PD testing during comprehensive voice assessment and throughout the treatment process for patients with voice disorders.
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Affiliation(s)
- Duy Duong Nguyen
- Voice Research Laboratory, Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.M.C.); (D.N.); (C.M.)
- National Hospital of Otorhinolaryngology, Hanoi 11519, Vietnam
| | - Antonia M. Chacon
- Voice Research Laboratory, Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.M.C.); (D.N.); (C.M.)
| | - Daniel Novakovic
- Voice Research Laboratory, Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.M.C.); (D.N.); (C.M.)
- The Canterbury Hospital, Campsie, NSW 2194, Australia
| | - Nicola J. Hodges
- School of Kinesiology, University of British Columbia, Vancouver, BC V6T 1Z1, Canada;
| | - Paul N. Carding
- Faculty of Health and Life Sciences, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford OX3 0BP, UK;
| | - Catherine Madill
- Voice Research Laboratory, Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.M.C.); (D.N.); (C.M.)
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15
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Abur D, Subaciute A, Kapsner-Smith M, Segina RK, Tracy LF, Noordzij JP, Stepp CE. Impaired auditory discrimination and auditory-motor integration in hyperfunctional voice disorders. Sci Rep 2021; 11:13123. [PMID: 34162907 PMCID: PMC8222324 DOI: 10.1038/s41598-021-92250-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/04/2021] [Indexed: 12/04/2022] Open
Abstract
Hyperfunctional voice disorders (HVDs) are the most common class of voice disorders, consisting of diagnoses such as vocal fold nodules and muscle tension dysphonia. These speech production disorders result in effort, fatigue, pain, and even complete loss of voice. The mechanisms underlying HVDs are largely unknown. Here, the auditory-motor control of voice fundamental frequency (fo) was examined in 62 speakers with and 62 speakers without HVDs. Due to the high prevalence of HVDs in singers, and the known impacts of singing experience on auditory-motor function, groups were matched for singing experience. Speakers completed three tasks, yielding: (1) auditory discrimination of voice fo; (2) reflexive responses to sudden fo shifts; and (3) adaptive responses to sustained fo shifts. Compared to controls, and regardless of singing experience, individuals with HVDs showed: (1) worse auditory discrimination; (2) comparable reflexive responses; and (3) a greater frequency of atypical adaptive responses. Atypical adaptive responses were associated with poorer auditory discrimination, directly implicating auditory function in this motor disorder. These findings motivate a paradigm shift for understanding development and treatment of HVDs.
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Affiliation(s)
- Defne Abur
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, 02215, USA.
| | - Austeja Subaciute
- Department of Biomedical Engineering, Boston University, Boston, MA, 02215, USA
| | - Mara Kapsner-Smith
- Department of Speech and Hearing Sciences, University of Washington, Seattle, WA, 98195, USA
| | - Roxanne K Segina
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, 02215, USA
| | - Lauren F Tracy
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, 02215, USA
| | - J Pieter Noordzij
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, 02215, USA
- Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Cara E Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, 02215, USA
- Department of Biomedical Engineering, Boston University, Boston, MA, 02215, USA
- Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA, 02118, USA
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16
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Kist AM, Gómez P, Dubrovskiy D, Schlegel P, Kunduk M, Echternach M, Patel R, Semmler M, Bohr C, Dürr S, Schützenberger A, Döllinger M. A Deep Learning Enhanced Novel Software Tool for Laryngeal Dynamics Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:1889-1903. [PMID: 34000199 DOI: 10.1044/2021_jslhr-20-00498] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose High-speed videoendoscopy (HSV) is an emerging, but barely used, endoscopy technique in the clinic to assess and diagnose voice disorders because of the lack of dedicated software to analyze the data. HSV allows to quantify the vocal fold oscillations by segmenting the glottal area. This challenging task has been tackled by various studies; however, the proposed approaches are mostly limited and not suitable for daily clinical routine. Method We developed a user-friendly software in C# that allows the editing, motion correction, segmentation, and quantitative analysis of HSV data. We further provide pretrained deep neural networks for fully automatic glottis segmentation. Results We freely provide our software Glottis Analysis Tools (GAT). Using GAT, we provide a general threshold-based region growing platform that enables the user to analyze data from various sources, such as in vivo recordings, ex vivo recordings, and high-speed footage of artificial vocal folds. Additionally, especially for in vivo recordings, we provide three robust neural networks at various speed and quality settings to allow a fully automatic glottis segmentation needed for application by untrained personnel. GAT further evaluates video and audio data in parallel and is able to extract various features from the video data, among others the glottal area waveform, that is, the changing glottal area over time. In total, GAT provides 79 unique quantitative analysis parameters for video- and audio-based signals. Many of these parameters have already been shown to reflect voice disorders, highlighting the clinical importance and usefulness of the GAT software. Conclusion GAT is a unique tool to process HSV and audio data to determine quantitative, clinically relevant parameters for research, diagnosis, and treatment of laryngeal disorders. Supplemental Material https://doi.org/10.23641/asha.14575533.
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Affiliation(s)
- Andreas M Kist
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology-Head & Neck Surgery, University Hospital Erlangen, Germany
| | - Pablo Gómez
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology-Head & Neck Surgery, University Hospital Erlangen, Germany
| | - Denis Dubrovskiy
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology-Head & Neck Surgery, University Hospital Erlangen, Germany
| | - Patrick Schlegel
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology-Head & Neck Surgery, University Hospital Erlangen, Germany
| | - Melda Kunduk
- Department of Communication Sciences and Disorders, Louisiana State University, Baton Rouge
| | - Matthias Echternach
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Munich University Hospital (LMU), Germany
| | - Rita Patel
- Department of Speech, Language and Hearing Sciences, College of Arts and Sciences, Indiana University, Bloomington
| | - Marion Semmler
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology-Head & Neck Surgery, University Hospital Erlangen, Germany
| | - Christopher Bohr
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde Universitätsklinikum Regensburg, Germany
| | - Stephan Dürr
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology-Head & Neck Surgery, University Hospital Erlangen, Germany
| | - Anne Schützenberger
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology-Head & Neck Surgery, University Hospital Erlangen, Germany
| | - Michael Döllinger
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology-Head & Neck Surgery, University Hospital Erlangen, Germany
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Hillman RE, Stepp CE, Van Stan JH, Zañartu M, Mehta DD. An Updated Theoretical Framework for Vocal Hyperfunction. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:2254-2260. [PMID: 33007164 PMCID: PMC8740570 DOI: 10.1044/2020_ajslp-20-00104] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/07/2020] [Accepted: 08/09/2020] [Indexed: 05/21/2023]
Abstract
Purpose The purpose of this viewpoint article is to facilitate research on vocal hyperfunction (VH). VH is implicated in the most commonly occurring types of voice disorders, but there remains a pressing need to increase our understanding of the etiological and pathophysiological mechanisms associated with VH to improve the prevention, diagnosis, and treatment of VH-related disorders. Method A comprehensive theoretical framework for VH is proposed based on an integration of prevailing clinical views and research evidence. Results The fundamental structure of the current framework is based on a previous (simplified) version that was published over 30 years ago (Hillman et al., 1989). A central premise of the framework is that there are two primary manifestations of VH-phonotraumatic VH and nonphonotraumatic VH-and that multiple factors contribute and interact in different ways to cause and maintain these two types of VH. Key hypotheses are presented about the way different factors may contribute to phonotraumatic VH and nonphonotraumatic VH and how the associated disorders may respond to treatment. Conclusions This updated and expanded framework is meant to help guide future research, particularly the design of longitudinal studies, which can lead to a refinement in knowledge about the etiology and pathophysiology of VH-related disorders. Such new knowledge should lead to further refinements in the framework and serve as a basis for improving the prevention and evidence-based clinical management of VH.
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Affiliation(s)
- Robert E. Hillman
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | | | - Jarrad H. Van Stan
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
| | - Matías Zañartu
- Universidad Técnica Federico Santa María, Valparaíso, Chile
| | - Daryush D. Mehta
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- MGH Institute of Health Professions, Boston, MA
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18
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Weerathunge HR, Abur D, Enos NM, Brown KM, Stepp CE. Auditory-Motor Perturbations of Voice Fundamental Frequency: Feedback Delay and Amplification. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:2846-2860. [PMID: 32755506 PMCID: PMC7890227 DOI: 10.1044/2020_jslhr-19-00407] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/30/2020] [Accepted: 06/10/2020] [Indexed: 06/11/2023]
Abstract
Purpose Gradual and sudden perturbations of vocal fundamental frequency (f o), also known as adaptive and reflexive f o perturbations, are techniques to study the influence of auditory feedback on voice f o control mechanisms. Previous vocal f o perturbations have incorporated varied setup-specific feedback delays and amplifications. Here, we investigated the effects of feedback delays (10-100 ms) and amplifications on both adaptive and reflexive f o perturbation paradigms, encapsulating the variability in equipment-specific delays (3-45 ms) and amplifications utilized in previous experiments. Method Responses to adaptive and reflexive f o perturbations were recorded in 24 typical speakers for four delay conditions (10, 40, 70, and 100 ms) or three amplification conditions (-10, +5, and +10 dB relative to microphone) in a counterbalanced order. Repeated-measures analyses of variance were carried out on the magnitude of f o responses to determine the effect of feedback condition. Results There was a statistically significant effect of the level of auditory feedback amplification on the response magnitude during adaptive f o perturbations, driven by the difference between +10- and -10-dB amplification conditions (hold phase difference: M = 38.3 cents, SD = 51.2 cents; after-effect phase: M = 66.1 cents, SD = 84.6 cents). No other statistically significant effects of condition were found for either paradigm. Conclusions Experimental equipment delays below 100 ms in behavioral paradigms do not affect the results of f o perturbation paradigms. As there is no statistically significant difference between the response magnitudes elicited by +5- and +10-dB auditory amplification conditions, this study is a confirmation that an auditory feedback amplification of +5 dB relative to microphone is sufficient to elicit robust compensatory responses for f o perturbation paradigms.
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Affiliation(s)
| | - Defne Abur
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - Nicole M. Enos
- Department of Biomedical Engineering, Boston University, MA
- Department of Computer Engineering, Boston University, MA
| | - Katherine M. Brown
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - Cara E. Stepp
- Department of Biomedical Engineering, Boston University, MA
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- Department of Otolaryngology—Head and Neck Surgery, Boston University School of Medicine, MA
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