Articulatory changes following treatment of muscle tension dysphonia: preliminary acoustic evidence

The Effectiveness of Lee Silverman Voice Treatment (LSVT LOUD) on Children's Speech and Voice: A Scoping Review

BACKGROUND

This scoping review had as a primary goal a review of the literature and the an analysis of the possible effectiveness of the LSVT LOUD approach in children with voice and speech deficits.

METHODS

A search was conducted in the Scopus and PubMed databases in May of 2024. Eleven articles were obtained from the search. The standards of PRISMA recommendations were used for scoping reviews and the PCC framework was used for the eligibility criteria. Furthermore, the study used the instructions in the Cochrane Handbook for a quality assessment. The Mendeley Reference Manager software collected the studies and removed duplicates.

RESULTS

The reviewed studies employed formal and informal measures to assess voice and speech abilities in the children. Regarding the sample's characteristics, the studies mostly included children with Cerebral Palsy (CP) and also those with Down Syndrome (DS). All the studies reported that children with CP and DS undertook a total dose of the LSVT LOUD treatment. Significant post-treatment findings indicated increased speech function and sound pressure level, regarding the auditory-perceptual ratings of voice and speech improvement. In many studies, parents' and expert listeners' ratings of voice, perception of vocal loudness, speech, and communication indicated improvement.

CONCLUSIONS

The majority of the included studies provide positive evidence for the LSVT as an approach. However, the small sample size that featured in the studies, as well as their limitations, made these conclusions uncertain. Moreover, the study's findings provided recommendations that speech language therapists and other clinicians need to follow when setting a treatment plan with children with CP and DS.

Implementation of Eclectic Voice Therapy Program via Telepractice in Hyperfunctional Voice Disorders: A Preliminary Efficacy Study

PURPOSE

Hyperfunctional voice disorder (HFVD) has a multifaceted origin. Individuals with HFVD work in professions that demand high vocal usage and are bound to work for longer hours with very inflexible work schedules. In consequence, it can be speculated that an eclectic voice therapy program that uses combinatory approaches delivered via telepractice could bring about better efficiency of voice in these individuals. Nevertheless, very less attempts have been made in these lines. Therefore, the present study aims to implement eclectic voice therapy via telepractice and examine the efficacy of the same in HFVD.

METHOD

In total, 10 individuals with HFVD in the age range of 20-55years received Comprehensive Voice Habilitation Program (CVHP), an eclectic voice therapy approach via a videoconferencing platform, Zoom Video Communications, Inc. All the participants completed 15 sessions of voice therapy spread across 3weeks. Stroboscopy examination was performed at the baseline and post therapy to track the changes in laryngeal functions. Further, Consensus Auditory Perceptual Evaluation-Voice (CAPE-V), Acoustic Voice Quality Index (AVQI), and Voice Handicap Index in Kannada (VHI-K) were obtained at the baseline, post therapy, and two follow-ups to report the therapy outcomes. Related-sample Friedman's Two-way Analysis of Variance by Ranks and Wilcoxon Signed Rank Test were used to note the pre-post and follow-up changes in voice outcomes.

RESULTS

Significant improvement in movement patterns of the vocal folds and a reduction in ventricular hyperadduction were noted in stroboscopy. CAPE-V and AVQI scores decreased in post-therapy and follow-up evaluations indicating reduction in dysphonia severity over time. Also, decrease in VHI-K scores indicated improved psychosocial aspects and quality of life in HFVD.

CONCLUSION

The current study provided preliminary evidence on the possible benefits of telepractice in the delivery of CVHP in HFVD. Hence, telepractice could be recommended as an alternate treatment modality for patients with HFVD.

Eclectic Voice Therapy Program in Hyperfunctional Voice Disorders: Evidence from Multidimensional Vocal Profiling

PURPOSE

Hyperfunctional voice disorder (HFVD) is a disorder of multifactorial origin. It can be speculated that an eclectic voice therapy program that uses combinatory approaches could bring about better efficiency of voice in these individuals. Nevertheless, very less attempts have been made to examine the efficacy of eclectic voice therapy using multidimensional voice outcome measures in the treatment of HFVD.

METHOD

Ten individuals with HFVD in the age range of 20-55years attended Comprehensive Voice Habilitation Program (CVHP), an eclectic voice therapy approach for 15 sessions spread across 3weeks. A stroboscopy examination was performed at the baseline and post-therapy to track the changes in laryngeal functions. Further, perceptual voice analysis, Acoustic Voice Quality Index (AVQI), and Voice Handicap Index in Kannada (VHI-K) were obtained at the baseline, post-therapy, and two follow-ups to report the therapy outcomes. Related samples Friedman's Two-way Analysis of Variance by Ranks and Wilcoxon Signed Rank Test were used to note the pre-post and follow-up changes in voice outcomes.

RESULTS

Stroboscopy findings revealed significant improvement in movement patterns of the vocal folds and a reduction in ventricular hyperadduction. Perceptual ratings and AVQI scores decreased in post-therapy and follow-up evaluations indicating a decrease in dysphonia severity over time. In addition, a significant decrease in VHI-K scores indicated the alleviation of self-perceived disability/handicap.

CONCLUSION

The current study provided preliminary evidence to support the efficacy of eclectic voice therapy in HFVD by documenting significant changes in the voice-related outcome measures.

Vocal Effort and Acoustic Analysis of Gargle Phonation Versus Water Swallow in Patients With Muscle Tension Dysphonia: A Clinical Trial

PURPOSE

To determine the effects of gargle phonation (GP) on self-perceived vocal improvement, vocal effort, acoustic parameters, and speech rate in patients with muscle tension dysphonia (MTD). We hypothesized that GP would improve voice, reduce phonatory effort, and alter acoustic and speech measures.

STUDY DESIGN

Prospective randomized, single-blind cross-over clinical trial METHODS: Thirty-four participants (26 females, 8 males; average age 53 years) who were diagnosed with MTD completed the Voice Handicap Index-10 (VHI-10) and were assigned three study conditions: Baseline (B), GP, and Water Swallow (WS; sham), presented in one of two counterbalanced orders B-WS-GP (WS1st) or B-GP-WS (GP1st). Participants recorded stimuli from the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and rated their perceived vocal effort and vocal improvement. F0, vocal intensity, cepstral peak prominence (CPP), and speaking rate were measured.

RESULTS

Average VHI-10 scores by group were 16 (min/max 2-29) for WS1st and 15 (min/max 3-40) for GP1st. About 73.5% reported more vocal improvement after GP, 17.65% after WS, and 8.8% noted no difference between conditions. Reduced effort was reported after GP, compared to B (P < 0.001) and WS (P = 0.005). Lower effort was also reported after the WS condition, compared to B (P = 0.011). Key acoustic findings included an increase in F0 after GP for sustained /i/ for females. CPP was significantly higher for females reading CAPE-V sentences after GP, when GP preceded WS, compared to B (P = 0.004) and WS (P = 0.003). Speech rate was faster for females after GP versus B (P = 0.029).

CONCLUSIONS

GP may be beneficial in the treatment of MTD. CPP may be a useful marker for vocal improvement after GP for women with mild MTD. Further studies would benefit from having more male participants and those with moderate and severe MTD.

Telling Stories in Noise: The Impact of Background Noises on Spoken Language for People With Aphasia

PURPOSE

The purpose of this study was to determine how different background noise conditions affect the spoken language of participants with aphasia during a story retell task.

METHOD

Participants included 11 adults with mild to moderate aphasia and 11 age- and gender-matched controls. Participants retold stories in a silent baseline and five background noise conditions (conversation, monologue, phone call, cocktail, and pink noise). Dependent measures of speech acoustics (fundamental frequency and mean intensity), speech fluency (speech rate and disfluent words), and language production (correct information units [CIUs], lexical errors, lexical diversity, and cohesive utterances) were compared between groups and across conditions.

RESULTS

Background noise resulted in higher fundamental frequency (fo) and increased mean intensity for control participants across all noise conditions but only across some conditions for participants with aphasia. In relation to language production, background noise interfered significantly more with communication efficiency (i.e., percent CIUs) for participants with aphasia than the control group. For participants with aphasia, the phone call condition led to decreased lexical diversity. Across groups, condition effects generally suggested more interference on speech acoustics in conditions where continuous noise was present and more interference on language in conditions that presented continuous informational noise.

CONCLUSIONS

Although additional research is needed, preliminary findings suggest that background noise interferes with narrative discourse more for people with aphasia (PWA) than neurologically healthy adults. PWA may benefit from therapy that directly addresses communicating in noise.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23681703.

Auditory-Motor Function Pre- and Post-Therapy in Hyperfunctional Voice Disorders: A Case Series

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.

Comparison of Tongue Acupuncture and Traditional Acupuncture in the Treatment of Poststroke Dysarthria: A Meta-Analysis and Tongue Acupuncture System Classification Evaluation

OBJECTIVE

To discuss whether tongue acupuncture is more effective than traditional acupuncture in the treatment of poststroke dysarthria and explore the advantage of tongue acupuncture treatment parameters.

METHODS

We evaluated the efficacy of tongue acupuncture compared with traditional acupuncture through a rigorous meta-analysis process. The included studies were from eight databases in English and Chinese. The Cochrane risk of bias assessment tool was used to evaluate the quality of studies. Stata15.1 software was used for meta-analysis and sensitivity analysis. Tongue acupuncture therapeutic parameters were classified and counted based on tongue acupoint location, acupuncture manipulation, and the number of manipulations. Subgroup analysis was used to compare the differences between various treatment parameters. Outcome The meta-analysis eventually included a total of 9 studies. Tongue acupuncture is superior to traditional acupuncture in clinical efficacy [OR = 3.62, 95%Cl (2.24, 5.85), P < 0.0001], FDA score [SMD = -1.99, 95%Cl (-3.77, -0.21), P=0.028], and NIHSS score [WMD = 0.86, 95%Cl (0.15, 1.57), P=0.017, I2 = 31.7%] in the treatment of poststroke dysarthria. According to the classified statistics of tongue acupuncture treatment parameters, there are three kinds of tongue acupuncture points in 9 studies: lingual surface, sublingual, and both lingual surface and sublingual acupoints. The operation methods include the oblique stabbing of the root of the tongue, twisting after stabbing, and acupoint pricking. The number of operation methods varies from 1 to 3.

CONCLUSION

Tongue acupuncture outperforms traditional acupuncture in terms of clinical efficacy, FDA score, and NIHSS score in the treatment of poststroke dysarthria. The curative effect of sublingual acupoints is better than that of lingual surface acupoints, the combined use of multiple manipulations is better than that of a single manipulation, and acupuncture manipulation has a cumulative effect. PROSPERO registration number: CRD42021285722.

The Copenhagen Neck Functional Disability Scale: an analysis of singers with dysphonia and without vocal complaints

PURPOSE

To analyze and compare the degree of cervical disability in singers with dysphonia and in singers without self-reported vocal complaints.

METHODS

A cross-sectional observational analysis. Sixty-two singers participated in the study: Thirty-two singers without vocal complaints and 30 singers with a speech-language pathology and otorhinolaryngological diagnosis of dysphonia. For singers without vocal complaints, two questionnaires were applied via Google Forms: A three-question questionnaire regarding vocal complaints and how each singer perceived their speaking and singing voice, and the Copenhagen Neck Functional Disability Scale (CNFDS). Data on singers with dysphonia were extracted from a database previously collected by a team of researchers at the speech-language pathology department of the Federal University of Minas Gerais. The difference in data collection methodology between the two groups was due to restrictions presented by the coronavirus pandemic. The Mann-Whitney test was used to compare the two groups, at a significance level of 5%.

RESULTS

There was a significant difference between the groups (p=0.0001), demonstrating that singers with dysphonia suffered more from cervical pain and discomfort than singers without vocal complaints.

CONCLUSION

Singers with dysphonia have more cervical pain and discomfort than singers without vocal complaints, thus presenting with greater cervical disability.

Integrative Review and Framework of Suggested Mechanisms in Primary Muscle Tension Dysphonia

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.

Impact of Vocal Effort on Respiratory and Articulatory Kinematics

PURPOSE

The goal of this study was to examine the effects of increases in vocal effort, without changing speech intensity, on respiratory and articulatory kinematics in young adults with typical voices.

METHOD

A total of 10 participants completed a reading task under three speaking conditions: baseline, mild vocal effort, and maximum vocal effort. Respiratory inductance plethysmography bands around the chest and abdomen were used to estimate lung volumes during speech, and sensor coils for electromagnetic articulography were used to transduce articulatory movements, resulting in the following outcome measures: lung volume at speech initiation (LVSI) and at speech termination (LVST), articulatory kinematic vowel space (AKVS) of two points on the tongue dorsum (body and blade), and lip aperture.

RESULTS

With increases in vocal effort, and no statistical changes in speech intensity, speakers showed: (a) no statistically significant differences in LVST, (b) statistically significant increases in LVSI, (c) no statistically significant differences in AKVS measures, and (d) statistically significant reductions in lip aperture.

CONCLUSIONS

Speakers with typical voices exhibited larger lung volumes at speech initiation during increases in vocal effort, paired with reduced lip displacements. To our knowledge, this is the first study to demonstrate evidence that articulatory kinematics are impacted by modulations in vocal effort. However, the mechanisms underlying vocal effort may differ between speakers with and without voice disorders. Thus, future work should examine the relationship between articulatory kinematics, respiratory kinematics, and laryngeal-level changes during vocal effort in speakers with and without voice disorders.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.17065457.

The Copenhagen Neck Functional Disability Scale: an analysis of singers with dysphonia and without vocal complaints

ABSTRACT Purpose To analyze and compare the degree of cervical disability in singers with dysphonia and in singers without self-reported vocal complaints. Methods A cross-sectional observational analysis. Sixty-two singers participated in the study: Thirty-two singers without vocal complaints and 30 singers with a speech-language pathology and otorhinolaryngological diagnosis of dysphonia. For singers without vocal complaints, two questionnaires were applied via Google Forms: A three-question questionnaire regarding vocal complaints and how each singer perceived their speaking and singing voice, and the Copenhagen Neck Functional Disability Scale (CNFDS). Data on singers with dysphonia were extracted from a database previously collected by a team of researchers at the speech-language pathology department of the Federal University of Minas Gerais. The difference in data collection methodology between the two groups was due to restrictions presented by the coronavirus pandemic. The Mann-Whitney test was used to compare the two groups, at a significance level of 5%. Results There was a significant difference between the groups (p=0.0001), demonstrating that singers with dysphonia suffered more from cervical pain and discomfort than singers without vocal complaints. Conclusion Singers with dysphonia have more cervical pain and discomfort than singers without vocal complaints, thus presenting with greater cervical disability.

[Dynamics of vowel acoustic space indicators in patients with long-term hearing loss]

New procedure of vowel acoustic space (VAS) (of vowel acoustic triangles) transformation for the purpose of characterization of vowel production in individuals with long-term hearing loss (HL) was developed.

OBJECTIVE

To characterize VAS of adult Russian speakers with long-term HL using newly developed acoustic indicators.

MATERIAL AND METHODS

Recordings of sustained Russian cardinal vowels /a/, /i/, /u/ of 10 women and 10 men with long-term HL were acoustically analyzed. For each participant, two first formants of each vowel were measured and log-transformed (logF₁, logF₂). VAS was transformed into right triangles, their /u/ corners were moved to the origin, and their legs were aligned with axes. VAS was almost symmetrical, equal and have a maximum size in the control group consisted of subjects without hearing impairment while these of long-term HL group VAS size tended to have reduced and VAS stretched along one axis.

RESULTS

Our study showed that a new VAS normalization approach can distinguish at least three groups of people with long-term HL.

CONCLUSION

There are those with vowel triangles stretched along logF₁-axis, with vowel triangles stretched along logF₂-axis, and with symmetrical vowel triangles. Causes of the VAS differences require further investigation.

Study of the Role of Hearing Aid on the Area of the Acoustic Field of Vowels

The method of transformation of acoustic vowel triangles (AVT) /a/, /i/, /u/ was used for an objective assessment of the acoustic features of vowels in the speech production of 20 persons with long-term hearing impairment (LHI). The logarithm of the values ​​of the first two formants of each vowel (logF1, logF2) was determined for each subject. AVTs were transformed into the right-angled triangles, the vertices of the sound /u/ of which were moved to the origin of coordinates and the legs were aligned with the coordinate axes. In patients with LHI, the size of the triangles usually decreased, and they were stretched along one of the axes, which probably depends not only on the hearing loss severity but also on the duration of hearing aid use. The presented approach to the normalization of AVTs makes it possible to distinguish at least three groups of persons with LHI: in the first group, vowel triangles are stretched along the logF1 axis; in the second group, vowel triangles are stretched along the logF2 axis; and in the third group, AVT are symmetric.

Effects of Background Noise on Speech and Language in Young Adults

Purpose The aim of this study was to investigate how different types of background noise that differ in their level of linguistic content affect speech acoustics, speech fluency, and language production for young adult speakers when performing a monologue discourse task. Method Forty young adults monologued by responding to open-ended questions in a silent baseline and five background noise conditions (debate, movie dialogue, contemporary music, classical music, and pink noise). Measures related to speech acoustics (intensity and frequency), speech fluency (speech rate, pausing, and disfluencies), and language production (lexical, morphosyntactic, and macrolinguistic structure) were analyzed and compared across conditions. Participants also reported on which conditions they perceived as more distracting. Results All noise conditions resulted in some change to spoken language compared with the silent baseline. Effects on speech acoustics were consistent with expected changes due to the Lombard effect (e.g., increased intensity and fundamental frequency). Effects on speech fluency showed decreased pausing and increased disfluencies. Several background noise conditions also seemed to interfere with language production. Conclusions Findings suggest that young adults present with both compensatory and interference effects when speaking in noise. Several adjustments may facilitate intelligibility when noise is present and help both speaker and listener maintain attention on the production. Other adjustments provide evidence that background noise eliciting linguistic interference has the potential to degrade spoken language even for healthy young adults, because of increased cognitive demands.

Strain Elastosonography Measurement in Patients with Primary Muscle Tension Dysphonia Compared with Healthy Speakers: A Pilot Study

OBJECTIVES

The purpose of this study was to investigate real-time elastosonography (RTE) to measure strain of the (para)laryngeal muscles in patients with primary muscle tension dysphonia (MTD) and healthy speakers.

STUDY DESIGN

This is a cross-sectional study.

METHODS

Ten patients with primary MTD (37.8 ± 10.53 years) and 10 healthy speakers (36.9 ± 9.8 years) participated. Participants were diagnosed as MTD patient or healthy via voice history, voice self-assessment, perceptual voice evaluation, laryngeal palpation, and videostroboscopy. Then, RTE was performed to extract strain index (SI) and strain ratio (SR) for all participants. The RTE was utilized for the suprahyoid, thyrohyoid, and the cricothyroid muscles, both in right and left sides during rest, /a/, and /i/ prolongations. To study the effect of group, task, and interactive effect on the SI and SR, two-way repeated-measures analysis of variance was performed.

RESULTS

The effect of group on the SI was significant for the right cricothyroid (P ˂ 0.001). Significant effect of group on the SR obtained for the right suprahyoid, left thyrohyoid, and right cricothyroid (P < 0.05). Moreover, the only muscle whose SR was significantly affected by task was the left suprahyoid (P < 0.05). Compared to healthy speakers, the interactive effect was significantly lower in SI for the left cricothyroid, and higher in SR for both the right suprahyoid and left cricothyroid in patients (P < 0.05).

CONCLUSIONS

The RTE can discriminate patients with primary MTD from healthy subjects in some laryngeal muscles, especially suprahyoid and cricothyroid. It may be regarded as a clinical instrument in the assessment of MTD in future. Further studies with bigger sample size are recommended.

Does the Combination of Glottal and Supraglottic Acoustic Measures Improve Discrimination Between Women With and Without Voice Disorders?

AIM

To analyze the accuracy of traditional acoustic measurements (F0, perturbation, and noise) and formant measurements in discriminating between women with and without voice disorders, and with different laryngeal disorders.

STUDY DESIGN

A descriptive, cross-sectional, and retrospective.

METHOD

Two hundred and sixty women participated. All participants recorded the spoken vowel /Ɛ/ and underwent laryngeal visual examination. Acoustic measures of the mean and standard deviation of the fundamental frequency (F0), jitter, shimmer, glottal-to-noise excitation ratio, and the values of the first three formants (F1, F2, and F3) were obtained.

RESULTS

Individual acoustic measurements did not demonstrate adequate (<70%) performance when discriminating between women with and without voice disorders. The combination of the standard deviation of the F0, shimmer, glottal-to-noise excitation ratio, F1, F2, and F3 showed acceptable (>70%) performance in classifying women with and without voice disorders. Individual measures of jitter as well as F1 and F3 demonstrated acceptable (>70%) performance when distinguishing women with different laryngeal diagnoses, including without voice disorders (healthy larynges), Reinke's edema, unilateral vocal fold paralysis, and sulcus vocalis. The combination of acoustic measurements showed excellent (>80%) performance when discriminating women without voice disorder from those with Reinke's edema (mean of F0, F1, and F3) and with sulcus vocalis (mean of F0, F1, and F2).

CONCLUSIONS

Individual formant and traditional acoustic measurements do not demonstrate adequate performance when discriminating between women with and without voice disorders. However, the combination of traditional and formant measurements improves the discrimination between the presence and absence of voice disorders and differentiates several laryngeal diagnoses.

Does More Compression Mean More Pressure? A New Classification for Muscle Tension Dysphonia

Objective The aims of this study were to test the hypothesis that greater supraglottic compression (anteroposterior or lateral) correlates with higher subglottic pressure (SGP) and to develop a classification of muscle tension dysphonia (MTD), based on the degree of supraglottic compression during speech. Method A prospective, cross-sectional study was conducted in a series of 37 consecutive patients diagnosed with MTD with an altered aerodynamic profile characterized by high SGP (more than 90 mmH₂O). Supraglottic anteroposterior and lateral compression were categorized in three grades and assessed during the laryngoscopic examination. All patients completed the Spanish Voice Handicap Index (VHI) questionnaire and completed an acoustic and aerodynamic voice assessment. The relationship between compression grade and VHI with SGP was analyzed. Results More than 90% of patients demonstrated some degree of anteroposterior compression, and 67% had some degree of lateral compression. The mean (SD) SGP was 111.03 (16.7) mmH₂O, and the mean VHI was 27.86 (12.5). The degree of SGP was statistically different in the different grades of anteroposterior compression, and also anteroposterior compression correlated with an SGP (p < .05). The degree of lateral compression was not correlated with SGP. Neither the degree of anteroposterior or lateral compression nor the value of SGP was found to correlate with VHI. Conclusions Because grade of anteroposterior compression correlates with SGP, these grades can be used for diagnosis and follow-up of MTD patients. To this end and on this basis, we propose a new classification for MTD. Unlike the established classification, our proposed one makes it possible to combine different laryngoscopic features, improving the description of the larynx during phonation.

Isolated and Combined Respiratory Training for Muscle Tension Dysphonia: Preliminary Findings

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.

Age-Related Changes in Speech and Voice: Spectral and Cepstral Measures

Purpose This study examined differences in selected acoustic measures of speech and voice according to age and sex and across families. Method Participants included 169 individuals, 79 men and 90 women, from 18 families, ranging in age from 17 to 87 years. Participants reported no history of articulation disorders, stroke or active neurologic disease, or severe-to-profound hearing loss. They read aloud two passages to facilitate examination of the following speech and voice acoustic parameters: fricative spectral moments (center of gravity, standard deviation, skewness, and kurtosis), the proportion of time spent speaking, mean speaking fundamental frequency, semitone standard deviation (STSD), and cepstral peak prominence smoothed. Results The results indicated a significant age effect for fricative spectral center of gravity, spectral skewness, and speaking STSD. There was a significant sex effect for spectral center of gravity, spectral kurtosis, and mean fundamental frequency. Familial relationship was significant for spectral skewness, STSD, and cepstral peak prominence smoothed. Conclusions These findings revealed that certain speech and voice features change with age and some change differently for men and women. Additionally, speakers from the same family units may demonstrate similar patterns for prosody, voicing, and articulatory behavior. The results also demonstrated normal differences in speech and voice variation across age, sex, and family unit. Understanding patterns and differences across these demographic variables in healthy speakers is important to distinguishing more confidently between normal and disordered speech and voice patterns clinically.

Assessment of Tongue Position and Laryngeal Height in Two Professional Voice Populations

Purpose To advance our current knowledge of singer physiology by using ultrasonography in combination with acoustic measures to compare physiological differences between musical theater (MT) and opera (OP) singers under controlled phonation conditions. Primary objectives addressed in this study were (a) to determine if differences in hyolaryngeal and vocal fold contact dynamics occur between two professional voice populations (MT and OP) during singing tasks and (b) to determine if differences occur between MT and OP singers in oral configuration and associated acoustic resonance during singing tasks. Method Twenty-one singers (10 MT and 11 OP) were included. All participants were currently enrolled in a music program. Experimental procedures consisted of sustained phonation on the vowels /i/ and /ɑ/ during both a low-pitch task and a high-pitch task. Measures of hyolaryngeal elevation, tongue height, and tongue advancement were assessed using ultrasonography. Vocal fold contact dynamics were measured using electroglottography. Simultaneous acoustic recordings were obtained during all ultrasonography procedures for analysis of the first two formant frequencies. Results Significant oral configuration differences, reflected by measures of tongue height and tongue advancement, were seen between groups. Measures of acoustic resonance also showed significant differences between groups during specific tasks. Both singer groups significantly raised their hyoid position when singing high-pitched vowels, but hyoid elevation was not statistically different between groups. Likewise, vocal fold contact dynamics did not significantly differentiate the two singer groups. Conclusions These findings suggest that, under controlled phonation conditions, MT singers alter their oral configuration and achieve differing resultant formants as compared with OP singers. Because singers are at a high risk of developing a voice disorder, understanding how these two groups of singers adjust their vocal tract configuration during their specific singing genre may help to identify risky vocal behavior and provide a basis for prevention of voice disorders.

Tongue- and Jaw-Specific Articulatory Underpinnings of Reduced and Enhanced Acoustic Vowel Contrast in Talkers With Parkinson's Disease

Purpose This study sought to identify the articulator-specific mechanisms that underlie reduced and enhanced acoustic vowel contrast in talkers with dysarthria due to Parkinson's disease (PD). Method Seventeen talkers with mild-moderate dysarthria due to PD and 17 controls completed a sentence repetition task using typical, slow, loud, and clear speech. Tongue and jaw articulatory movements were recorded using 3D electromagnetic articulography. Independent tongue displacements, jaw displacements, and acoustic vowel contrast were calculated for the diphthong /aɪ/ embedded in the word kite. Results During typical speech, independent tongue displacement, but not jaw displacement, contributed significantly to the intertalker variance in acoustic vowel contrast. Loudness-related acoustic vowel contrast gains were predominantly jaw driven in controls but driven by the tongue and jaw in talkers with PD. Further, in both groups, clarity-related acoustic vowel contrast gains were predominantly jaw driven. Finally, in both groups, rate-related acoustic vowel contrast gains were predominantly tongue driven; however, the jaw also contributed. These jaw contributions were greater in the PD group than in the control group. Conclusions Findings suggest that a tongue-specific articulatory impairment underlies acoustic vowel contrast deterioration in talkers with PD, at least during the early stages of speech decline. Findings further suggest that slow speech engages the impaired tongue more than loud and clear speech in talkers with PD. However, slow speech was also associated with an abnormally strong jaw response in these talkers, which suggests that a compensatory articulatory behavior may also be elicited.

Bidirectional Interference Between Simulated Driving and Speaking

Purpose This study relied on acoustic measures of connected speech and several indices of driving performance to quantify interference between speaking and simulated driving. Method Three groups of 20 younger (ages 20-30 years), middle-age (ages 40-50 years), and older (ages 60-71 years) adults produced monologues and completed a simulated driving task, which involved maintaining a constant speed and lane position on a freeway. Both tasks were completed separately and concurrently. Results There were significant divided attention effects, with a reduced speaking time ratio, and increases in vocal intensity, speed variability, and steering wheel adjustments. There was a significant between-subjects age effect for intensity and fundamental frequency as the younger group had less variation with these variables compared to the other age groups across conditions. There was a significant between-subjects age effect for lane position, steering wheel position, and speed as the younger group had less variation in lane position compared to the other 2 groups, and the older group had more variation in speed and steering wheel position compared to the other 2 groups across the experimental conditions. Conclusion These findings reveal that divided attention conditions can impact both speech and simulated driving performance. The results also shed some light on the effects of age on speech and driving tasks, although the degree of interference from divided attention did not differ by age.

An Update on Speech Pathology Management of Chronic Refractory Cough

Chronic cough is a common, debilitating condition that can persist for years with little relief from medical treatment. Speech pathology treatment is an effective treatment option for patients with chronic cough. This review outlines current speech pathology assessment and treatment for chronic cough and describes the evidence supporting the intervention. The rationale for speech pathology intervention is described with reference to speech pathology training and expertise that are relevant for this condition. Despite the efficacy and advantages of speech pathology intervention, there is limited guidance in the literature on when patients should be referred for treatment. Patients suitable for speech pathology intervention are those whose cough has persisted despite medical management. Speech pathology intervention may be particularly beneficial for patients with coexisting laryngeal disorders such as muscle tension dysphonia or inducible laryngeal obstruction. Limited information is available regarding current speech pathology training, practice, and service delivery for chronic cough internationally. Timely referral for speech pathology intervention could reduce the disease burden for individuals with chronic cough and decrease the economic burden of this complex condition.

Configuração acústico-articulatória das vogais de mulheres com nódulos vocais e vocalmente saudáveis

RESUMO Objetivo Analisar a configuração acústico-articulatória das vogais em mulheres com nódulos vocais e vocalmente saudáveis. Método Participaram do estudo 12 mulheres com nódulos vocais (GE) e 12 vocalmente saudáveis (GC). Todas as mulheres gravaram frases-veículo com as vogais /a/, /i/ e /u/ em posição tônica, sucedidas e precedidas da oclusiva /p/: “Digo papa baixinho”, “Digo pipa baixinho” e “Digo pupa baixinho”. Posteriormente, foram extraídos os três primeiros formantes (F1, F2 e F3) dessas vogais. Resultados Observou-se diferença nas medidas de F1 para as vogais /a/ e /u/ e F2 para a vogal /a/ entre os dois grupos estudados. Mulheres com nódulos vocais apresentam menor valor dessas medidas em relação às mulheres vocalmente saudáveis. Pacientes com nódulos vocais apresentaram menor intervalo nos valores de F1 e F2 entre as vogais /a/, /i/ e /u/ em relação às mulheres vocalmente saudáveis. Conclusão Mulheres com nódulos vocais apresentam menores valores de F1 e F2, e menor amplitude de movimentação dos articuladores na produção vocálica em relação às mulheres vocalmente saudáveis.

Exercise-induced laryngeal obstruction in athletes: Contributory factors and treatment implications

Otherwise healthy adolescent athletes presenting with respiratory symptoms consistent with exercise-induced laryngeal obstruction (EILO) are frequently encountered in clinical practice. The symptoms are often incorrectly considered to result from exercise-induced asthma, and may be wrongly treated as such. Given the potential implications for health and performance if EILO is left untreated, a more comprehensive understanding of contributory mechanisms is essential in order to create appropriate treatment procedures. Informed by knowledge from physical therapy, as well as the fields of voice rehabilitation and vocal pedagogy, this theoretical article presents a novel way of understanding and managing EILO by exploring bodily mechanisms and structures that may disturb laryngeal function during strenuous exercise. Firstly, the status quo of the EILO diagnosis, its aetiology and treatment options are reviewed. Secondly, considerations associated with laryngeal structures and mechanisms, and their potential influence on laryngeal movement and sensitivity are examined. Thirdly, the manner in which postural de-alignment and breathing pattern may interfere with laryngeal functioning will be discussed. Finally, interventions for voice disorders and singing and the relevance of these for EILO are evaluated. It is argued that clients with EILO should undergo a thorough physical examination to identify constrictions in the body as a whole - such as postural de-alignments and a dysfunctional breathing pattern - as these are hypothesized as playing a critical role in laryngeal tightness during exercise. Physical therapists possess particular skills and competence with regard to examining breathing patterns and postural de-alignments, and should be included in the treatment process of EILO.

Assessment practices of Irish speech and language therapists in the evaluation of voice disorders

It is commonly accepted that the evaluation of voice disorders ought to include extensive perceptual, psychometric, and instrumental measurements. This serves to encapsulate the wide-reaching effects of such a disorder, from the physical impairment in voice production to the psycho-social impact of having a dysphonic voice. In spite of this, no international gold standard exists by which voice disorders should be evaluated, and so speech and language therapists (SLTs) are often tasked with developing an assessment battery for use in their own clinics. The purpose of this study is to determine whether the evaluation of voice disorders by Irish SLTs on a national scale is suitably comprehensive, with particular reference to the guidelines published by the European Laryngological Society. A total of 49 SLTs working in a variety of settings responded anonymously to an electronic survey regarding their assessment practices. Results indicate that therapists are comprehensive in non-instrumental evaluation of voice, but lack both access to and training in instrumental assessment techniques.

An Acoustic Study of Vowels Produced by Alaryngeal Speakers in Taiwan

PURPOSE

This study investigated the acoustic properties of 6 Taiwan Southern Min vowels produced by 10 laryngeal speakers (LA), 10 speakers with a pneumatic artificial larynx (PA), and 8 esophageal speakers (ES).

METHOD

Each of the 6 monophthongs of Taiwan Southern Min (/i, e, a, ɔ, u, ə/) was represented by a Taiwan Southern Min character and appeared randomly on a list 3 times (6 Taiwan Southern Min characters × 3 repetitions = 18 tokens). Each Taiwan Southern Min character in this study has the same syllable structure, /V/, and all were read with tone 1 (high and level). Acoustic measurements of the 1st formant, 2nd formant, and 3rd formant were taken for each vowel. Then, vowel space areas (VSAs) enclosed by /i, a, u/ were calculated for each group of speakers. The Euclidean distance between vowels in the pairs /i, a/, /i, u/, and /a, u/ was also calculated and compared across the groups.

RESULTS

PA and ES have higher 1st or 2nd formant values than LA for each vowel. The distance is significantly shorter between vowels in the corner vowel pairs /i, a/ and /i, u/. PA and ES have a significantly smaller VSA compared with LA.

CONCLUSIONS

In accordance with previous studies, alaryngeal speakers have higher formant frequency values than LA because they have a shortened vocal tract as a result of their total laryngectomy. Furthermore, the resonance frequencies are inversely related to the length of the vocal tract (on the basis of the assumption of the source filter theory). PA and ES have a smaller VSA and shorter distances between corner vowels compared with LA, which may be related to speech intelligibility. This hypothesis needs further support from future study.

Exploring the Clinical Utility of Relative Fundamental Frequency as an Objective Measure of Vocal Hyperfunction

PURPOSE

Vocal hyperfunction, related to abnormal laryngeal muscle activity, is considered the proximal cause of primary muscle tension dysphonia (pMTD). Relative fundamental frequency (RFF) has been proposed as an objective acoustic marker of vocal hyperfunction. This study examined (a) the ability of RFF to track changes in vocal hyperfunction after treatment for pMTD and (b) the influence of dysphonia severity, among other factors, on the feasibility of RFF computation.

METHOD

RFF calculations and dysphonia severity ratings were derived from pre- and posttreatment recordings from 111 women with pMTD and 20 healthy controls. Three vowel-voiceless consonant-vowel stimuli were analyzed.

RESULTS

RFF onset slope consistently varied as a function of group (pMTD vs. controls) and time (pretherapy vs. posttherapy). Significant correlations between RFF onset cycle 1 and dysphonia severity were observed. However, in many samples, RFF could not be computed, and adjusted odds ratios revealed that these unanalyzable data were linked to dysphonia severity, phonetic (vowel-voiceless consonant-vowel) context, and group (pMTD vs. control).

CONCLUSIONS

RFF onset appears to be sensitive to the presence and degree of suspected vocal hyperfunction before and after therapy. The large number of unanalyzable samples (related especially to dysphonia severity in the pMTD group) represents an important limitation.

Uso da eletroestimulação na clínica fonoaudiológica: uma revisão integrativa da literatura

Resumo: Este trabalho tem como objetivo apresentar revisão integrativa de literatura sobre a aplicabilidade e o resultado do uso da eletroestimulação na prática clínica fonoaudiológica. Foram seguidos os preceitos do Cochrane Handbook, que envolveu a formulação da questão a ser investigada, localização e seleção dos estudos e avaliação crítica dos artigos. Foram utilizadas as bases de dados Medical Literature Analysis and Retrieval Sistem on-line (Medline), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), PubMed e Web of Science/ISI. Os descritores utilizados foram: "estimulação elétrica nervosa transcutânea", "estimulação elétrica", "disfagia", "transtornos de deglutição", "disfonia", "distúrbios da voz", "treinamento da voz" e "terapia por estimulação elétrica" em inglês, português e espanhol e suas combinações, no período entre 2003 e 2013. Os estudos analisados demonstraram que a eletroestimulação traz benefícios na reabilitação de pacientes na clínica fonoaudiológica, mas a metodologia utilizada nos estudos foi divergente e a população estudada muito heterogênea o que dificulta sua utilização clínica pelos profissionais da área. A eletroestimulação traz benefícios na reabilitação fonoaudiológica, porém novos estudos devem ser realizados utilizando uma amostra mais homogênea e descrevendo metodologia e técnicas fonoaudiológicas utilizadas nos procedimentos, a fim de comprovar seus resultados e viabilizar seu uso pelos profissionais da área.

A taxonomy of voice therapy

PURPOSE

Voice therapy practice and research, as in most types of rehabilitation, is currently limited by the lack of a taxonomy describing what occurs during a therapy session (with enough precision) to determine which techniques/components contribute most to treatment outcomes. To address this limitation, a classification system of voice therapy is proposed that integrates descriptions of therapeutic approaches from the clinical literature into a framework that includes relevant theoretical constructs.

METHOD

Literature searches identified existing rehabilitation taxonomies/therapy classification schemes to frame an initial taxonomic structure. An additional literature search and review of clinical documentation provided a comprehensive list of therapy tasks. The taxonomy's structure underwent several iterations to maximize accuracy, intuitive function, and theoretical underpinnings while minimizing redundancy. The taxonomy was then used to classify established voice therapy programs.

RESULTS

The taxonomy divided voice therapy into direct and indirect interventions delivered using extrinsic and/or intrinsic methods, and Venn diagrams depicted their overlapping nature. A dictionary was developed of the taxonomy's terms, and 7 established voice therapy programs were successfully classified.

CONCLUSION

The proposed taxonomy represents an important initial step toward a standardized voice therapy classification system expected to facilitate outcomes research and communication among clinical stakeholders.

The effects of emotional expression on vibrato

OBJECTIVES/HYPOTHESIS

The purpose of this study was to investigate the effect of emotional expression on several acoustic measures of vibrato, including its rate, extent, and steadiness. We hypothesized that singing a passage with emotional content would influence these variables.

STUDY DESIGN

This study used a within-subjects, repeated-measures design. Singer performance under different conditions was analyzed.

METHODS

Ten graduate student singers (eight women, two men) completed a series of tasks including sustained sung vowels at several pitch and loudness levels, an assigned song that was judged to have relatively neutral emotion, and a personal selection that included passages of intense emotion. Vowel tokens were extracted from the recordings and averaged for each task. Dependent measures included the mean fundamental frequency (F0), mean intensity, frequency modulation (FM) rate, FM extent, and measures of FM rate and extent variability.

RESULTS

The FM rate and extent were higher and the modulation variability was lower for the more emotional song than for the sustained vowels. Mean F0 and intensity were higher for the emotional song than for the neutral song.

CONCLUSIONS

Singing an emotional passage influences acoustic features of vibrato when compared with isolated, sustained vowels. The wider dynamic and pitch ranges for emotional passages only partly explain vibrato differences between emotional and neutral singing.

The effects of practice on the concurrent performance of a speech and postural task in persons with Parkinson disease and healthy controls

Purpose. Persons with Parkinson disease (PD) demonstrate deficits in motor learning as well as bidirectional interference (the performance of one task concurrently interferes with the performance of another task) during dual-task performance. Few studies have examined the practice dosages necessary for behavioral change in rehabilitation relevant tasks. Therefore, to compare the effects of age and PD on motor learning during dual-task performance, this pilot study examined persons with PD as well as neurologically healthy participants during concurrent performance of postural and speaking tasks. Methods. Seven persons with PD and 7 healthy age-matched and 10 healthy young control subjects were tested in a motion capture facility. Task performances were performed concurrently and recorded during 3 time periods (acquisition (beginning and ending), 48-hour retention, and 1-week retention). Postural control and speech articulatory acoustic variables were measured. Results. Healthy young participants consistently performed better than other groups on all measured postural and speech variables. Healthy young participants showed decreased variability at retention, while persons with PD and healthy age-matched controls were unable to consistently improve their performance as a result of practice. No changes were noted in the speech variables. Conclusion. The lack of consistent changes in motor performance in any of the tasks, except in the healthy young group, suggests a decreased efficiency of motor learning in the age-matched and PD groups and argues for increased practice dosages during balance training.

The evidence for laryngeal manual therapies in the treatment of muscle tension dysphonia

PURPOSE OF REVIEW

Clinicians involved in treating patients with voice disorders are showing an increasing interest in manual therapies aimed at reducing excessive tension in the perilaryngeal area. Studies investigating the effects of this treatment have been appearing in the literature since the early 1990s, but the evidence base remains extremely small. The purpose of this review is to provide the reader with current information about the types of laryngeal manual therapy in clinical use internationally and the evidence base for their use.

RECENT FINDINGS

The results of studies undertaken recently reinforce the results of earlier studies, most of which have been conducted using individuals with muscle tension dysphonia. The various types of laryngeal manual therapy have all been shown to have positive effects.

SUMMARY

There is evidence that laryngeal manual therapy, in various forms, can be a useful primary intervention in cases of muscle tension dysphonia, although this is based on very few studies. A higher level of evidence is required, including randomized controlled trials, to investigate its role in comparison with other interventions. Studies are also needed to verify or refute the clinical observation that it is also an effective treatment for all voice disorders, including those of organic aetiology, when phonatory hyperfunction is a feature.

Transcutaneous electrical nerve stimulation in dysphonic women

BACKGROUND

studies indicate correlation between dysphonia and muscle tension.

AIM

to evaluate bilaterally the electrical activity of the suprahyoid muscles (SH), sternocleidomastoid (SCM), and trapezius (T), the presence of pain and the voice, after applying transcutaneous electrical nerve stimulation (TENS).

METHOD

ten (10) women with nodules or bilateral mucus thickening, and phonation fissure. Volunteers were submitted to 10 TENS sessions (200 micros and 10 Hz) for 30 minutes. Pain was evaluated using an analogical visual scale; the voice was evaluated through laryngoscopy and through a perceptive-auditory and acoustic analysis; and the myoelectric signal was converted using the Root Media Square (RMS). Voice and EMG data gathering was performed during the production of the E/vowel and during spontaneous speech (SS).

STATISTICAL ANALYSIS

Shapiro-Wilk Test followed by the Wilcoxon Test, or t Student, or Friedman Test (p < 0.05).

RESULTS

It was observed that the TENS decreased the RMS readings, pre and pos treatment, for the Right T (RT) (2.80 +/- 1.36 to 1.77 +/- 0.93), the Left T (LT) (3.62 +/- 2.10 to 2.10 +/- 1.06), the Left SCM (LSCM) (2.64 +/- 0.69 to 1.94 +/- 0.95), and the SH (11.59 +/- 7.72 to 7.82 +/- 5.95) during the production of the E/vowel; and for the RT (3.56 +/- 2.77 to 1.93 +/- 1.13), the LT (4.68 +/- 2.56 to 3.09 +/- 2.31), the Right SCM (RSCM) (3.94 +/- 2.04 to 2.51 +/- 1.87), and the LSCM (3.54 +/- 1.04 to 3.12 +/- 3.00) during SS. A relieve in pain was also observed. Regarding the voice analysis, there was a decrease in level of laryngeal injuries; no difference was observed during the production of the E/vowel in the perceptive-auditory analysis; there was a decrease in the level of dysphonia and hoarseness during SS.

CONCLUSION

TENS is effective in improving the clinical and functional signs of dysphonic women.

Articulatory changes in muscle tension dysphonia: evidence of vowel space expansion following manual circumlaryngeal therapy

In a preliminary study, we documented significant changes in formant transitions associated with successful manual circumlaryngeal treatment (MCT) of muscle tension dysphonia (MTD), suggesting improvement in speech articulation. The present study explores further the effects of MTD on vowel articulation by means of additional vowel acoustic measures. Pre- and post-treatment audio recordings of 111 women with MTD were analyzed acoustically using two measures: vowel space area (VSA) and vowel articulation index (VAI), constructed using the first (F1) and second (F2) formants of 4 point vowels/ a, i, ae, u/, extracted from eight words within a standard reading passage. Pairwise t-tests revealed significant increases in both VSA and VAI, confirming that successful treatment of MTD is associated with vowel space expansion. Although MTD is considered a voice disorder, its treatment with MCT appears to positively affect vocal tract dynamics. While the precise mechanism underlying vowel space expansion remains unknown, improvements may be related to lowering of the larynx, expanding oropharyngeal space, and improving articulatory movements.

LEARNING OUTCOMES

The reader will be able to: (1) describe possible articulatory changes associated with successful treatment of muscle tension dysphonia; (2) describe two acoustic methods to assess vowel centralization and decentralization, and; (3) understand the basis for viewing muscle tension dysphonia as a disorder not solely confined to the larynx.

Frequency response of the skin on the head and neck during production of selected speech sounds

Vibrations within the vocal tract during speech are transmitted through tissue to the skin surface and can be used to transmit speech. Achieving quality speech signals using skin vibration is desirable but problematic, primarily due to the several sound production locations along the vocal tract. The objective of this study was to characterize the frequency content of speech signals on various locations of the head and neck. Signals were recorded using a microphone and accelerometers attached to 15 locations on the heads and necks of 14 males and 10 females. The subjects voiced various phonemes and one phrase. The power spectral densities (PSD) of the phonemes were used to determine a quality ranking for each location and sound. Spectrograms were used to examine signal frequency content for selected locations. A perceptual listening test was conducted and compared to the PSD rankings. The signal-to-noise ratio was found for each location with and without background noise. These results are presented and discussed. Notably, while high-frequency content is attenuated at the throat, it is shown to be detectable at some other locations. The best locations for speech transmission were found to be generally common to males and females.

Current knowledge, controversies and future directions in hyperfunctional voice disorders

Taking the preceding five papers in this special issue of the International Journal of Speech-Language Pathology as a starting point, this paper synthesizes key aspects of hyperfunctional voice disorders (HFVD). Aetiological and contributing factors, defining features, prevention, assessment and intervention are canvassed, while controversial issues and future directions in research and clinical practice are discussed. Despite disagreements and inconsistencies in terminology surrounding HFVD, there is broad agreement that musculoskeletal tension is the hallmark of these voice disorders. There is also reasonable consensus that the pathogenesis and persistence of HFVD are associated with multiple and overlapping factors, some of which are likely to interact in as yet unknown ways. In addition to dysregulated laryngeal muscle functioning, key processes in the psychosocial and sensory domains are canvassed as likely contributors to HFVD. Vocal fatigue is considered as an intriguing relative of HFVD, the role of laryngopharyngeal reflux is debated and the proposition that particular individuals are psychologically and/or physiologically predisposed to HFVD is discussed. New directions in assessment highlight the use of client-centred measures to consider insider perspectives of psychological factors, vocal effort and vocal fatigue. Emerging psychosocial and physical-manipulative interventions are emphasized and the future educational needs of voice care professionals are considered.