Effects of voice therapy on the voice range profiles of dysphonic patients

Muscle Tension Dysphonia: Experience from a Conflict Zone

We sought to explore the frequency of stress among OPD attending Kashmiri public diagnosed as muscle tension dysphonia (MTD) and determine the subjective consequences of voice therapy in management of muscle tension dysphonia. 72 subjects that attended to ENT and HNS OPD with change of voice were prospectively evaluated and also underwent an extensive otolaryngological examination. Patients identified as MTD were provided a questionnaire which was split into 3 parts: First part dealt with the identification of the subject (age, geography, gender, profession) and also provided evaluation of perceived anxiety using Perceived Stress Scale-10. In the next part the individuals needed to assess their vocal quality based on parameters of GRBAS 4-point score scale before and also after the treatment. In the final component the subjects also needed to answer the VHI-10 (Voice Handicap Index) and also the outcome was compared with those acquired at the assessment before the beginning of the treatment. The mean age of the cohort was 30.31 ± 07.43 (age range, 12-71) and every subject was an indigenous Kashmiri. As expected, vast majority of subjects were females (43 patients). In the pooled information set, women had numerically higher PSS-10 scores than males. For women, the typical stress score was M = 18.6 and for men the average stress score was M = 16.65. In a healthy population, the typical PSS stress score is described to be 13.7 (SD = 6.6) for women and 12.1 (SD = 5.9) for men. At the Wilcoxon test for paired data, we observed a significant difference between the VHI pretreatment (mean = 19.7) and VHI post-treatment, that's at time of the research (mean = 9.73; P = 0.017). The grade (G) was assessed in terms of improvement of the vocal quality as opposed with before treatment and also the individuals demonstrated a high level of satisfaction (mean = 0.65). When looking at roughness (R) as well as breathiness (B), the individuals remember that their speech is seldom rough (mean = 0.62) and also less breathy (median = 0.44). Patients likewise noted improvement in other variables of GRBAS scale. Stress is persistent, pervasive and nearly unavoidable in contemporary life. The decades old perplexing and mind baffling pandemonium hovering around the Kashmiri population has had a tremendous impression on the psychological development of people in this region. A careful conclusion is the fact that emotional stress might play a major role in the upkeep of MTD. MTD has to be approached in a multidisciplinary environment in which closer cooperation between a laryngologist, a speech language pathologist and also a psychologist is likely.

Tessa: A Novel MATLAB Program for Automated Tessitura Analysis

OBJECTIVE

Tessitura-the habitual pitch range of a musical piece or role-is widely accepted as a significant factor in determining whether a singer should perform a given piece or role. However, attempts to quantify tessitura have historically relied on laborious hand calculations. The current study introduces a novel MATLAB program ("Tessa") that automates tessitura analysis of digital sheet music in the MusicXML format. This program will allow voice teachers and singing voice specialists to assess the appropriateness of musical pieces or roles for their students and clients.

METHODS

Tessa converts sheet music in the open-source MusicXML (MXL or XML) format to a MATLAB-compatible structure array (MAT). Once converted, the program extracts pitch, duration, and lyric information from the structure file, then saves relevant arrays to the user's computer. Finally, Tessa performs analyses on the piece's tessitura data, including histogram, box plot, and descriptive statistical analyses. Variables such as tempo, score part number, and the piece's title are automatically saved in order to facilitate repeated analyses.

RESULTS

A sample analysis of Franz Schubert's song cycle Winterreise, D.911 is presented, with specific reference to the songs "3. Gefrorne Tränen" and "4. Erstarrung" as examples of pieces with markedly different tessituras-and, consequently, markedly different levels of vocal demand.

DISCUSSION

Tessa is hosted on a GitHub repository (https://github.com/Allerseelen/Tessa) and is intended for open-source use and modification under the GNU General Public License v3.0. Voice teachers, singing voice specialists, and musicians may compare Tessa's analyses with voice range profiles or other assessment tools in order to evaluate repertoire and plan pacing strategies for extended performances.

Student perceptions of factors that influence clinical competency in voice

PURPOSE

This study aimed to explore factors, perceived by students themselves, that help or hinder development of competency in voice.

METHOD

Focus group interviews were conducted with a convenience sample of 14 speech pathology students (93% female, mean age 22 years). Interviews were transcribed verbatim and analysed using template analysis.

RESULT

Students' perceptions of influencing factors were grouped into two major themes: (1) personal factors, and (2) educational factors. A key finding was that many participants perceived a student's own voice to be a major factor impacting their development and attainment of clinical competency in voice, and that mindsets towards the (un)changeability of students' own voices varied across participants. Students with a performance background were considered to be at an advantage in terms of performing vocal tasks and suitability to work with specific populations. Key facilitatory educational factors included access to and experience of demonstrations (face-to-face and video), additional training workshops, peer learning, and simulation.

CONCLUSION

This study identified a number of personal and educational factors that students perceive to impact the development of competency in voice. Consideration of these holistic factors may assist speech-language pathology educators to deliver optimally effective voice-related curricula.

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

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

Treatment Efficacy of Voice Therapy Following Injection Laryngoplasty for Unilateral Vocal Fold Paralysis

OBJECTIVES

Injection laryngoplasty (IL) is performed to reduce the gap between vocal folds induced by unilateral vocal fold paralysis (UVFP). Voice quality after IL may be different due to other factors that influence voice quality. Voice therapy has been reported to improve voice quality after IL in patients with UVFP. This study evaluated the efficacy of voice therapy combined with IL.

METHODS

Patients with UVFP who underwent IL as primary therapy from March 2017 to June 2019 were evaluated. The enrolled patients were divided into two groups, those who did and did not receive voice therapy after IL. Voice quality was evaluated using perceptual, acoustic, and aerodynamic parameters, and voice handicap index-30 scores one month after IL and after completing each treatment.

RESULTS

Of 261 patients who underwent IL during the study period, 40 were enrolled, including 21 who did and 19 who did not receive voice therapy. Voice parameters one month after IL did not differ between these two groups. Jitter, shimmer, noise-to-harmonic ratio, and mean flow rate decreased, while maximum phonation time increased after voice therapy (both P < 0.05). In the absence of voice therapy, improved voice parameters were maintained for six months after IL. Total voice handicap index-30 scores decreased, from 35.6 to 19.1 (P < 0.05), in patients who received voice therapy.

CONCLUSION

Voice therapy following IL is beneficial to patients with UVFP. Combined treatment can help to maintain improved voice quality more than six months after IL.

Effects of Resonance Voice Therapy on Hormone-Related Vocal Disorders in Professional Singers: A Pilot Study

BACKGROUND

Menstruation-related hormonal alteration can be detrimental to the professional singing voice of women. Resonance Voice Therapy (RVT) has been proven to improve vocal production. However, no research to date has been conducted examining the subjective, acoustic, and stroboscopic effects of RVT on professional female singers having premenstrual or postmenopausal voice disorders.

AIM

The aim of this study is to compare the vocal effects of RVT with a control cervical-thoracic intervention in healthy female singers during the premenstrual phase as well as in postmenopausal singers and to evaluate which intervention will allow singers to improve vocal performance regardless of changes in hormonal status.

DESIGN

A randomized study was designed for this research. The research subjects were 20 professional female singers from the Southern California area, USA, with 10 premenstrual subjects in one group and 10 postmenopausal subjects in the other group. Among each group, 5 subjects were randomly selected to receive RVT and the remaining subjects received cervical-thoracic-focused exercises. The therapies consisted of 1 month of daily 15-minute sessions. For premenstrual subjects, voice data were collected at days 25 to 27 of the premenstrual phase during a scheduled initial voice evaluation. Follow-up data were collected during the same phase of the menstrual cycle (days 25-27) after 1 month of exercises. For postmenopausal subjects, voice data were collected at an initial voice evaluation with follow-up after 1 month of the assigned voice treatment. Outcomes were assessed with the singer's voice handicap index (VHI), laryngeal videostroboscopic examination, maximum phonation time (MPT), relative average perturbation (RAP), and pitch range before and following completion of therapies. Alleviation or deterioration percentages were used for statistical analysis. Student t test was used for statistical comparison between therapies.

RESULTS

The RVT decreased singer's VHI for both premenstrual and postmenopausal subjects by an average of 67%, compared with 7.8% for the cervical-thoracic therapy. The RVT also effectively decreased RAP by an average of 57% when combining the premenstrual and postmenopausal groups. The RVT increased MPT and pitch range among both premenstrual and postmenopausal subjects. The stroboscopic examination did not detect any significant differences between the 2 interventions.

CONCLUSIONS

The RVT is effective for professional female singers with hormone-related premenstrual and postmenopausal vocal changes. The RVT is suggested as one of the therapeutic approaches for vocal abnormalities in such a population. A larger cohort may be needed for future research.

LEVEL OF EVIDENCE

1b.

Reproducibility of Dual-Microphone Voice Range Profile Equipment

PURPOSE

The aim of this study was to add further knowledge about the usefulness of the Voice Range Profile (VRP) assessment in clinical settings and research by analyzing VRP dual-microphone equipment precision, reliability, and room effect.

METHOD

Test-retest studies were conducted in an anechoic chamber and an office: (a) comparing sound pressure levels (SPLs) from a dual-microphone VRP device, the Voice Profiler, when given the same input repeatedly (test-retest reliability); (b) comparing SPLs from 3 devices when given the same input repeatedly (intervariation); and (c) assessing the room effect.

RESULTS

(a) The mean standard deviation across 17 measurement points was 0.7 dB for 1 device. (b) One device was less precise than the other 2 devices. All devices presented high SPLs at low frequencies compared with the reference. (c) Mean SPLs were almost equal in the anechoic chamber and the office.

CONCLUSIONS

The high test-retest reliability of the dual-microphone VRP equipment, especially in general office surroundings, is a positive finding. Attention must be paid to specific factors such as using the same device when comparing the same voice before and after treatment, caution in headset placement, and manual recalibrations when automatic recalibration occurs. We suggest recalibrations verified with a reference source at regular intervals.

Voice Range Change After Injection Laryngoplasty for Unilateral Vocal Fold Paralysis

OBJECTIVES

Patients with unilateral vocal fold paralysis (UVFP) caused by nerve injury manifest with voice changes. This study investigated vocal performance measured by voice range profile (VRP) in patients with UVFP and changes in VRP in response to intracordal hyaluronate injection.

METHODS

Eighty-five patients with UVFP were enrolled prospectively, among whom 68 received intracordal hyaluronate injections. The outcome measurements included VRP, acoustic and aerodynamic analyses, peak turn frequency of thyroarytenoid-lateral cricoarytenoid muscle complex (TA-LCA) measured by laryngeal electromyography, and normalized glottal gap area by videolaryngostroboscopy.

RESULTS

The peak turn frequency of the paralyzed TA-LCA showed a modest correlation with max fundamental frequency (F0) and F0 range. Closed-phase normalized glottal gap area showed modest negative correlations with max F0 and F0 semitone range. Regarding conventional acoustic and aerodynamic analyses, the paralyzed TA-LCA peak turn frequency was only correlated with maximal phonation time. Intracordal hyaluronate injection improved VRP performance by increasing max F0, decreasing min F0, increasing F0 range, and increasing semitone range (all P <0.01) with small or medium strength of effect size (Cohen d, 0.39-0.76).

CONCLUSIONS

Change in voice pitch in patients with UVFP can partly predict impairment of neuromuscular functions and glottal gap. VRP provides a more sensitive reflection of the severity of neuromuscular impairment, compared with conventional voice analysis. The validity of VRP is further supported by a robust response to voice improvements following injection laryngoplasty.

Efficacy of Voice Therapy for Patients With Early Unilateral Adductor Vocal Fold Paralysis

OBJECTIVES

Although a variety of therapeutic techniques have been suggested for patients with unilateral adductor vocal fold paralysis (UAVFP), they were not aimed specifically at determining the efficacy of early intervention for these patients. The purposes of this study are to explore a protocol of voice therapy and to investigate its efficacy in voice therapy for patients with early UAVFP. A 12-week planned voice therapy protocol, including vocal function exercise, hard attack, and resonance voice therapy, was given to 10 patients within 6 months of initial diagnosis. Additionally, nine patients diagnosed with UAVFP within 6 months served as controls.

METHODS

Multidimensional evaluations of voice function were obtained for statistical analyses.

RESULTS

Compared to a control group, the experimental group receiving voice therapy exhibited significant improvement in the following: (1) glottal closure; (2) voice quality of grade, breathiness, monotone, and resonance; (3) acoustic measurements of jitter, shimmer, and noise-to-harmonic ratio; (4) aerodynamics measurements of maximum phonation time, phonation threshold pressure, and phonation quotient; and (5) Voice Handicap Index of functional subscale.

CONCLUSION

This prospective study established an effective protocol of early intervention of voice therapy in patients with UAVFP and demonstrated its efficacy in data on laryngeal physiology, voice quality, voice stability, voice efficiency, and communication function.

Tissue engineering-based therapeutic strategies for vocal fold repair and regeneration

Vocal folds are soft laryngeal connective tissues with distinct layered structures and complex multicomponent matrix compositions that endow phonatory and respiratory functions. This delicate tissue is easily damaged by various environmental factors and pathological conditions, altering vocal biomechanics and causing debilitating vocal disorders that detrimentally affect the daily lives of suffering individuals. Modern techniques and advanced knowledge of regenerative medicine have led to a deeper understanding of the microstructure, microphysiology, and micropathophysiology of vocal fold tissues. State-of-the-art materials ranging from extracecullar-matrix (ECM)-derived biomaterials to synthetic polymer scaffolds have been proposed for the prevention and treatment of voice disorders including vocal fold scarring and fibrosis. This review intends to provide a thorough overview of current achievements in the field of vocal fold tissue engineering, including the fabrication of injectable biomaterials to mimic in vitro cell microenvironments, novel designs of bioreactors that capture in vivo tissue biomechanics, and establishment of various animal models to characterize the in vivo biocompatibility of these materials. The combination of polymeric scaffolds, cell transplantation, biomechanical stimulation, and delivery of antifibrotic growth factors will lead to successful restoration of functional vocal folds and improved vocal recovery in animal models, facilitating the application of these materials and related methodologies in clinical practice.

Perfil de extensão vocal em coristas após técnica de vibração de língua associada a escalas

RESUMO: Objetivo: identificar o efeito imediato da técnica de vibração sonorizada de língua associada à variação tonal sobre o perfil de extensão vocal de coristas, analisando o tempo de prática de canto, naipe e tempo de execução do exercício. Métodos: estudo transversal quantitativo, com 13 cantores, sendo oito mulheres e cinco homens, com média de idade de 39±20,11 anos, pertencentes a diferentes naipes. O perfil de extensão vocal foi obtido a partir da análise pelo software Vocalgrama da CTS Informática. As amostras foram coletadas em três momentos: antes, após um minuto e após dois minutos de aplicação da técnica de vibração sonorizada de língua associada à variação tonal. Resultados: seis coristas (46,2%) aumentaram o valor do perfil de extensão vocal, após dois minutos de execução da técnica. Os naipes sopranos e tenores apresentaram valores médios maiores do perfil de extensão vocal após dois minutos de exercício. Em relação ao tempo de prática de canto, não houve diferença entre os grupos no valor do perfil de extensão vocal em nenhum dos três momentos considerados. Conclusão: a técnica de vibração sonorizada de língua associada à variação tonal não interferiu no perfil de extensão vocal dos coristas estudados. Entretanto, o tempo de execução do exercício parece influenciar nos resultados.

Voice Range Profile and Health-related Quality of Life Measurements Following Voice Rehabilitation After Radiotherapy; a Randomized Controlled Study

PURPOSE

The aim of the present study was to investigate the effects of voice rehabilitation in patients treated with radiotherapy for laryngeal cancer.

METHOD

A total of 42 patients with laryngeal cancer who are treated with radiotherapy with curative intent participated in a randomized controlled study. The collected data were voice range profiles (VPRs) and patient-reported outcome (PRO) instruments for measurement of self-perceived communication function (Swedish Self-Evaluation for Communication Experiences after Laryngeal cancer (S-SECEL)) and health related quality of life (HRQL) (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30/Head and Neck module). Data were collected 1 month (pre voice rehabilitation), 6 months, and 12 months postradiotherapy. Of the patients, 19 received voice rehabilitation, whereas 23 constituted a control group.

RESULTS

There were several statistically significant improvements in the study group concerning the HRQL and self-perceived communication function. The largest improvements occurred between occasions 1 (prevoice rehabilitation) and 2 (6-month postradiotherapy) and then remained constant. VRP area demonstrated a statistically significant difference when comparing changes over time, where the study group improved more than the control group.

CONCLUSION

HRQL and self-perceived communication function showed improvement in the study group and trends of impairment in the control group. This result might suggest that it would be beneficial for the patients as well as in a health economic perspecitve, to receive voice rehabilitatiom to make a faster improvement of the HRQL and self-perceived communication function.

Long-term effects of an intensive voice treatment for vocal fold nodules

PURPOSE

The purpose of the current study was to examine the long-term effects of intensive voice treatment for vocal fold nodules, compared to outcomes for patients treated with traditional voice therapy. It was hypothesised that intensive treatment would provide comparable maintenance of vocal function, voice quality, and patients' perception of quality-of-life when compared with traditional treatment at 6 month follow-up.

METHOD

Thirty-six women diagnosed with bilateral vocal fold nodules who were treated with either traditional (n = 20; once a week for 8 weeks) or intensive (n = 16; eight sessions within 3 weeks) therapy. Each participant completed voice, stroboscopic, and acoustic assessments and the Voice Handicap Index before, immediately post and 6 months post-treatment.

RESULT

Results revealed most improved perceptual, stroboscopic and acoustic parameters were maintained in both groups at 6 months post-treatment, with no significant differences between the two groups. In addition, both groups maintained satisfaction on their perception of vocal function, with no significant difference between the two groups.

CONCLUSION

The investigation provided further evidence that individuals with vocal fold nodules are able to maintain improved voice quality and vocal health following intensive voice treatment to a similar degree to traditional voice treatment.

The softest sound levels of the human voice in normal subjects

Accurate measurement of the softest sound levels of phonation presents technical and methodological challenges. This study aimed at (1) reliably obtaining normative data on sustained softest sound levels for the vowel [a:] at comfortable pitch; (2) comparing the results for different frequency and time weighting methods; and (3) refining the Union of European Phoniatricians' recommendation on allowed background noise levels for scientific and equipment manufacturers' purposes. Eighty healthy untrained participants (40 females, 40 males) were investigated in quiet rooms using a head-mounted microphone and a sound level meter at 30 cm distance. The one-second-equivalent sound levels were more stable and more representative for evaluating the softest sustained phonations than the fast-time-weighted levels. At 30 cm, these levels were in the range of 48-61 dB(C)/41-53 dB(A) for females and 49 - 64 dB(C)/35-53 dB(A) for males (5% to 95% quantile range). These ranges may serve as reference data in evaluating vocal normality. In order to reach a signal-to-noise ratio of at least 10 dB for more than 95% of the normal population, the background noise should be below 25 dB(A) and 38 dB(C), respectively, for the softest phonation measurements at 30 cm distance. For the A-weighting, this is 15 dB lower than the previously recommended value.

Fourier descriptor analysis and unification of voice range profile contours: method and applications

PURPOSE

To describe a method for unified description, statistical modeling, and comparison of voice range profile (VRP) contours, even from diverse sources.

METHOD

A morphologic modeling technique, which is based on Fourier descriptors (FDs), is applied to the VRP contour. The technique, which essentially involves resampling of the curve of the contour, is assessed and also is compared to density-based VRP averaging methods that use the overlap count.

RESULTS

VRP contours can be usefully described and compared using FDs. The method also permits the visualization of the local covariation along the contour average. For example, the FD-based analysis shows that the population variance for ensembles of VRP contours is usually smallest at the upper left part of the VRP. To illustrate the method's advantages and possible further application, graphs are given that compare the averaged contours from different authors and recording devices--for normal, trained, and untrained male and female voices as well as for child voices.

CONCLUSIONS

The proposed technique allows any VRP shape to be brought to the same uniform base. On this uniform base, VRP contours or contour elements coming from a variety of sources may be placed within the same graph for comparison and for statistical analysis.

Feasibility of measurement of a voice range profile with a semi-occluded vocal tract

Semi-occlusion of the vocal tract may provide a new method for assessing ranges of F(0) and a physiological correlate of vocal intensity. Signals can be obtained without concern about room noise, steadiness in mouth-to-microphone distance, and possibly without vocal injury caused by excessive loudness produced. Nine volunteers participated. Steady and acoustic pressures behind the lips were measured. Traditional voice range profiles were obtained on the vowels /α/ and /u/ for comparison. Range of F(0) was not limited in most subjects with the semi-occlusion but may be restricted in some subjects. In the lower portion of the F(0) range, the highest and lowest steady pressures at the semi-occlusion constitute an oral pressure range profile.

Som fricativo sonoro /ℑ/: modificações vocais

OBJETIVO: verificar as modificações vocais após a utilização do fricativo sonoro /ž/, em dez mulheres sem alterações vocais/laríngeas. MÉTODOS: foram realizadas medidas acústicas, perceptivo-auditiva, eletroglotografia e auto-avaliação da voz pré e pós-produção da técnica. RESULTADOS: foram estatisticamente significantes: as sensações subjetivas positivas; a maior definição de harmônicos e de formantes, diminuição do ruído, e maior regularidade no traçado. CONCLUSÃO: a técnica promove estabilidade vocal, gerando menor esforço fonatório, maior conforto durante a produção vocal e maior projeção vocal no grupo estudado.

Effects of Voice Therapy: A Systematic Review

Medical as well as paramedical treatments should be evaluated by scientific methods. This systematic review focuses on the effects of voice therapy, excluding pharmacological or surgical treatments. In general, statistically significant positive but modest and varying therapy effects are found. Many of these effect studies cope with diverse methodological problems. Furthermore, the conclusions of most studies cannot be generalized easily or compared to one another. As a consequence, many issues in the field of effects of voice therapy have yet been unanswered.

The effectiveness of voice therapy for teachers with dysphonia

OBJECTIVE

An incorrect voice emission is a risk factor for developing occupational voice disorders. The study aimed at assessing the effectiveness of voice therapy in female teachers with dysphonia.

METHODS

The study comprised 133 subjects with voice disorders, taking part in a vocal training programme. A reference group for the present study included 53 teachers with dysphonia. Questionnaire surveys, phoniatric examination and videostroboscopic evaluation were conducted at initial and control examination.

RESULTS

In the study group, an improvement after the vocal training was noted in most of the reported symptoms and also in some quantitative parameters of phoniatric examinations compared to the findings for the reference group. The number of patients who assessed their voice as normal increased significantly after the vocal training (2.3 vs. 46.6%). A significant increase in the mean maximum phonation time, from 13.3 to 16.6 s, was observed. The same applied to voice frequency range (increase from 171 to 226.8 Hz).

CONCLUSIONS

The outcomes of vocal training, such as a subjective improvement of voice quality and an increase in the quantitative parameters (prolonged maximum phonation time, extended voice range) seem to be important parameters for monitoring the effectiveness of training in correct voice emission.

Reliability of Speaking and Maximum Voice Range Measures in Screening for Dysphonia

Speech range profile (SRP) is a graphical display of frequency-intensity occurring interactions during functional speech activity. Few studies have suggested the potential clinical applications of SRP. However, these studies are limited to qualitative case comparisons and vocally healthy participants. The present study aimed to examine the effects of voice disorders on speaking and maximum voice ranges in a group of vocally untrained women. It also aimed to examine whether voice limit measures derived from SRP were as sensitive as those derived from voice range profile (VRP) in distinguishing dysphonic from healthy voices. Ninety dysphonic women with laryngeal pathologies and 35 women with normal voices, who served as controls, participated in this study. Each subject recorded a VRP for her physiological vocal limits. In addition, each subject read aloud the "North Wind and the Sun" passage to record SRP. All the recordings were captured and analyzed by Soundswell's computerized real-time phonetogram Phog 1.0 (Hitech Development AB, Täby, Sweden). The SRPs and the VRPs were compared between the two groups of subjects. Univariate analysis results demonstrated that individual SRP measures were less sensitive than the corresponding VRP measures in discriminating dysphonic from normal voices. However, stepwise logistic regression analyses revealed that the combination of only two SRP measures was almost as effective as a combination of three VRP measures in predicting the presence of dysphonia (overall prediction accuracy: 93.6% for SRP vs 96.0% for VRP). These results suggest that in a busy clinic where quick voice screening results are desirable, SRP can be an acceptable alternate procedure to VRP.

[Comparison of the results obtained through manual and automatic phonetogram]

INTRODUCTION

The phonetogram (F) is the graphic representation of a person phonatory potential. The F carried out with a sonometer and a frequency analyser is what is called "manual phonetogram" (MPh), and the one obtained by means of a computer is called the "automatic phonetogram" (APh).

MATERIAL AND METHODS

We have carried out in 12 lyrical singers a standard MPh and an APh with the program Dr. Speech Science 3.0.

RESULTS

It was showed a significant difference with a p < 0.0005 in 14 of the 15 measures compared, and a p < 0.05 for the other one, being in general the results of the automatic test different from those of the manual in excess, with a correlation between the results obtained through both methods.

CONCLUSIONS

The APh obtained with the program Dr. Speech Science 3.0 is a faster and easier way to obtain the phonetogram than the one used to obtain the MPh, showing however big differences in excess compared with the ones of the MPh in all the usual phonetometric parameters.

Examen de la función vocal y análisis acústico de 905 docentes de La Rioja

OBJECTIVE

Examination of the vocal function and acoustic analysis in 905 teachers in La Rioja.

DESIGN

A case control study: 576 cases and 329 controls.

PATIENTS

905 teaching staff of La Rioja: 589 female and 316 male.

METHODS

All teachers filled in a standard questionnaire, ENT and vocal function examination, videolaryngostroboscopy and acoustic analysis with MDVP.

RESULTS

The prevalence of voice disorders among teaching staff was 57%. The most prevalent lesions were: vocal overeffors (18%) nodular lesions (14%) and hyperfunctional dysphonia (8%). The prevalence of vocal symtoms was 79%. A pathological vocal function was found more frequent among dysphonic teachers than among normals. Frequency perturbations and amplitude perturbations were bigger among dysphonic teachers than among normals. Poor correlations were found between algorithms of acoustic análisis with MDVP and perceptual evaluation GRBAS.

CONCLUSIONS

It is advisable to carry out a yearly clinical evaluation of all teaching staff because of the high prevalence of voice disorders among them.