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Menezes DP, de Lira ZS, Araújo ANBD, de Almeida AAF, Gomes ADOC, Moraes BT, Lucena JA. Prosodic Differences in the Voices of Transgender and Cisgender Women: Self-Perception of Voice - An Auditory and Acoustic Analysis. J Voice 2024; 38:844-857. [PMID: 35135714 DOI: 10.1016/j.jvoice.2021.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/22/2021] [Accepted: 12/28/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The voice is an important parameter for identifying the speaker's gender. Transgender people seek to adapt their bodies to gender identity, and transgender women have greater difficulties in achieving vocal acceptance. In this context, the evaluation of the various parameters of the voice of transgender and cisgender women is essential to make it possible to propose appropriate intervention measures. OBJECTIVES To identify the differences in vocal characteristics of transgender and cisgender women. METHODS An sectional study was conducted. The sample comprised 20 transgender women and 20 cisgender women who underwent evaluation of acoustic parameters, emotional prosody, self-perception, and perception of gender by lay listeners. RESULTS The vocal characteristics of transgender and cisgender women differ in terms of the following parameters: f0, glottal noise excitation (GNE), vocal intensity, speech range profile (SRP), the first three formants of the vowel /a/, and in terms of emotional prosody, including duration and melodic contour. Higher values were mostly found in the cisgender population, except for noise level and vocal intensity. In addition, in most cases lay listeners identified the voices of transgender women as belonging to the male gender. There was a negative correlation between vocal dissatisfaction and f0 among transgender women. CONCLUSIONS Even though they perform vocal adjustments, the voices of transgender women are different from cisgender women in terms of acoustic parameters, vocal extension, and emotional prosody including duration and melodic contour. These differences have repercussions on the perception of gender by listeners.
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Affiliation(s)
- Danielle Pereira Menezes
- Speech-Language Pathology and Audiology Department, Graduate Program in Human Communication Health at the Federal University of Pernambuco. Health Sciences Center, Recife, Pernambuco, Brazil.
| | - Zulina Souza de Lira
- Speech-Language Pathology and Audiology Department, Graduate Program in Human Communication Health at the Federal University of Pernambuco. Health Sciences Center, Recife, Pernambuco, Brazil
| | - Ana Nery Barbosa de Araújo
- *Speech-Language Pathology and Audiology Department, at the Federal University of Pernambuco. Health Sciences Center, Recife, Pernambuco, Brazil
| | - Anna Alice Figueirêdo de Almeida
- Speech-Language Pathology and Audiology Department, Graduate Program in Speech Therapy at the Federal University of Paraíba. Health Sciences Center, João Pessoa, Paraíba, Brazil
| | - Adriana de Oliveira Camargo Gomes
- Speech-Language Pathology and Audiology Department, Graduate Program in Human Communication Health at the Federal University of Pernambuco. Health Sciences Center, Recife, Pernambuco, Brazil
| | - Bruno Teixeira Moraes
- Surgery Department, Health Sciences Center. University Federal of Pernambuco, Recife, Pernambuco, Brazil
| | - Jonia Alves Lucena
- Speech-Language Pathology and Audiology Department, Graduate Program in Human Communication Health at the Federal University of Pernambuco. Health Sciences Center, Recife, Pernambuco, Brazil
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Yamauchi A, Imagawa H, Yokonishi H, Sakakibara KI, Tayama N. Gender- and Age- Stratified Normative Voice Data in Japanese-Speaking Subjects: Analysis of Sustained Habitual Phonations. J Voice 2024; 38:619-629. [PMID: 34980522 DOI: 10.1016/j.jvoice.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/17/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION There is no normative voice dataset for Japanese speakers in the English literature. We constructed age- and gender-stratified normative voice data with the assistance of vocally healthy Japanese speakers. METHODS A total of 111 vocally healthy Japanese speakers (42 men, 69 women) were divided into young (13 men, 30 women), middle-aged (18 men, 27 women), and elderly (11 men, 12 women) groups. Participants underwent aerodynamic, acoustic, and audio-perceptual studies of sustained habitual vowel phonations, and the obtained data were statistically analyzed in terms of age and gender. RESULTS Both gender- and age-related differences were noted in fundamental frequencies, sound pressure level, shimmer, and amplitude perturbation quotient, while only gender-related differences were noted in mean flow rate and only age-related changes were observed in subglottal pressure; laryngeal resistance; and G, R, B, and S scores of the GRBAS scale. The gender- and age-related difference data were comparable with the reported data in other languages, ethnicities, or countries. CONCLUSIONS The present study is the first to provide a database of normative voice data of Japanese speakers. The idiosyncrasy of Japanese is considered minor in sustained habitual vowel phonations.
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Affiliation(s)
- Akihito Yamauchi
- Department of Otolaryngology, The University of Tokyo Hospital, Tokyo, Japan.
| | - Hiroshi Imagawa
- Department of Otolaryngology, The University of Tokyo Hospital, Tokyo, Japan
| | - Hisayuki Yokonishi
- Department of Otolaryngology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Ken-Ichi Sakakibara
- Department of Communication Disorders, Health Sciences University of Hokkaido, Hokkaido, Japan
| | - Niro Tayama
- Department of Otolaryngology and Tracheo-esophagology, National Center for Global Health and Medicine, Tokyo, Japan
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Silva WJ, Lopes L, Galdino MKC, Almeida AA. Voice Acoustic Parameters as Predictors of Depression. J Voice 2024; 38:77-85. [PMID: 34353686 DOI: 10.1016/j.jvoice.2021.06.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To analyze whether voice acoustic parameters are discriminant and predictive in patients with and without depression. METHODS Observational case-control study. The following instruments were administered to the participants: Self-Reporting Questionnaire (SRQ-20), Beck Depression Inventory-Second Edition (BDI-II), Voice Symptom Scale (VoiSS) and voice collection for subsequent extraction of the following acoustic parameters: mean, mode and standard deviation (SD) of the fundamental frequency (F0); jitter; shimmer; glottal to noise excitation ratio (GNE); cepstral peak prominence-smoothed (CPPS); and spectral tilt. A total of 144 individuals participated in the study: 54 patients diagnosed with depression (case group) and 90 without a diagnosis of depression (control group). RESULTS The means of the acoustic parameters showed differences between the groups: F0 (SD), jitter, and shimmer values were high, while values for GNE, CPPS and spectral tilt were lower in the case group than in the control group. There was a significant association between BDI-II and jitter, shimmer, CPPS, and spectral tilt and between CPPS and the class of antidepressants used. The multiple linear regression model showed that jitter and CPPS were predictors of depression, as measured by the BDI-II. CONCLUSION Acoustic parameters were able to discriminate between patients with and without depression and were associated with BDI-II scores. The class of antidepressants used was associated with CPPS, and the jitter and CPPS parameters were able to predict the presence of depression, as measured by the BDI-II clinical score.
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Affiliation(s)
- Wegina Jordana Silva
- Department of Speech Therapy, Federal University of Paraíba (UFPB) and Federal University of Rio Grande do Norte (UFRN), João Pessoa, Paraíba, Brazil.
| | - Leonardo Lopes
- Department of Speech Therapy, Federal University of Paraíba (UFPB), Graduate Program in Speech Therapy, Federal University of Paraíba (UFPB) and Federal University of Rio Grande do Norte (UFRN - PPgFon), Graduate Program in Decision and Health Models (PPgMDS), and Graduate Program in Linguistic (PROLING) of UFPB, João Pessoa, Paraíba, Brazil.
| | - Melyssa Kellyane Cavalcanti Galdino
- Department of Psychology, Federal University of Paraíba (UFPB), Graduate Program in Cognitive Neuroscience and Behavior (PPgNeC) of UFPB, João Pessoa, Paraíba, Brazil.
| | - Anna Alice Almeida
- Department of Speech Therapy, Federal University of Paraíba (UFPB), Graduate Program in Speech Therapy, Federal University of Paraíba (UFPB) and Federal University of Rio Grande do Norte (UFRN - PPgFon), Graduate Program in Decision and Health Models (PPgMDS), and Graduate Program in Cognitive Neuroscience and Behavior (PPgNeC) of UFPB, João Pessoa, Paraíba, Brazil.
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Mandour YMH, El Hamshary A, Abdel-Elhay SA, Abdel-Hamid MS, Gomaa M. Laryngeal Changes After Septoplasty and Turbinectomy. Indian J Otolaryngol Head Neck Surg 2023; 75:3242-3247. [PMID: 37974822 PMCID: PMC10645820 DOI: 10.1007/s12070-023-03951-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/08/2023] [Indexed: 11/19/2023] Open
Abstract
Studies found only a little amount of evidence about the impact of septoplasty on the mechanism of voice production, as well as vocal cord and laryngeal mucosal changes. Nasal obstruction is a common medical issue that is linked to changes in the quality of resonance of voice. To assess patients with deviated nasal septum and inferior turbinate hypertrophy's voice alterations using laryngeal stroboscope before and after septoplasty and turbinectomy. In this prospective case-control study, patients in group A had inferior turbinate hypertrophy and a nasal septal deviation, while participants in group B were healthy controls who were matched for age and gender. All of the included patients had their laryngeal stroboscope and acoustic voice characteristics evaluated both preoperatively and three months after surgery. Only the baseline evaluation of healthy controls was done. We included 30 patients with mean age 24.43 ± 7.81 years, and males accounted for two thirds of the included cases, speech testing showed that Amplitude perturbation significantly improved post septoplasty with p values < 0.05, while Fundamental frequency and NHR parameters didn't show statistically significant improvement compared to preoperative measurements and control groups. Paired comparison of laryngeal erythema, mucosal edema and mucosal waves showed significant improvement compared to preoperative laryngeal stroboscopic findings with p values < 0.001 each. Significant improvements were made to septal deviation following surgery nasal obstruction caused by nasal septal deviation and inferior turbinate hypertrophy is associated with amplitude perturbation, laryngeal erythema, mucosal edema, and mucosal waves in the patients.
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Paiva GM, Silva POC, Silva LJAD, Nascimento KA, Silva ABDVE, Abreu SRD, Almeida AAFD, Lopes LW. Spectral and cepstral measurements in women with behavioral dysphonia. Codas 2023; 36:e20220327. [PMID: 37970895 DOI: 10.1590/2317-1782/20232022327pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/20/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE To investigate whether there are differences in cepstral and spectral acoustic measures between women with behavioral dysphonia with and without laryngeal lesions and verify whether there is a correlation between such measures and the auditory-perceptual evaluation of voice quality. METHODS The sample comprised 78 women with behavioral dysphonia without laryngeal lesions (BDWOL) and 68 with behavioral dysphonia with laryngeal lesions (vocal nodules) (BDWL). Cepstral peak prominence (CPP), cepstral peak prominence-smoothed (CPPS), spectral decrease, and H1-H2 (difference between the amplitude of the first and second harmonics) were extracted. They were submitted to the auditory-perceptual evaluation (APE) of the grade of hoarseness (GH), roughness (RO), breathiness (BR), and strain (ST). RESULTS BDWL women had higher H1-H2 values and lower CPP and CPPS values than BDWOL women. More deviant voices had lower CPP and CPPS values. Breathy voices had lower CPP and CPPS values and higher H1-H2 values than rough ones. There was a weak negative correlation between CPP and RO, a moderate negative correlation with GH, and a strong negative correlation with BR. CPPS had a moderate negative correlation with GH, RO, and BR. H1-H2 had a weak positive correlation with BR. There was a weak positive correlation between spectral decrease and ST. CONCLUSION H1-H2, CPP, and CPPS were different between BDWOL and BDWL women. Furthermore, cepstral and spectral measures were correlated with the different APE parameters.
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Shembel AC, Lee J, Sacher JR, Johnson AM. Characterization of Primary Muscle Tension Dysphonia Using Acoustic and Aerodynamic Voice Metrics. J Voice 2023; 37:897-906. [PMID: 34281751 PMCID: PMC9762233 DOI: 10.1016/j.jvoice.2021.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES/HYPOTHESIS The objectives of this study were to (1) identify optimal clusters of 15 standard acoustic and aerodynamic voice metrics recommended by the American Speech-Language-Hearing Association (ASHA) to improve characterization of patients with primary muscle tension dysphonia (pMTD) and (2) identify combinations of these 15 metrics that could differentiate pMTD from other types of voice disorders. STUDY DESIGN Retrospective multiparametric METHODS: Random forest modeling, independent t-tests, logistic regression, and affinity propagation clustering were implemented on a retrospective dataset of 15 acoustic and aerodynamic metrics. RESULTS Ten percent of patients seen at the New York University (NYU) Voice Center over two years met the study criteria for pMTD (92 out of 983 patients), with 65 patients with pMTD and 701 of non-pMTD patients with complete data across all 15 acoustic and aerodynamic voice metrics. PCA plots and affinity propagation clustering demonstrated substantial overlap between the two groups on these parameters. The highest ranked parameters by level of importance with random forest models-(1) mean airflow during voicing (L/sec), (2) mean SPL during voicing (dB), (3) mean peak air pressure (cmH2O), (4) highest F0 (Hz), and (5) CPP mean vowel (dB)-accounted for only 65% of variance. T-tests showed three of these parameters-(1) CPP mean vowel (dB), (2) highest F0 (Hz), and (3) mean peak air pressure (cmH2O)-were statistically significant; however, the log2-fold change for each parameter was minimal. CONCLUSION Computational models and multivariate statistical testing on 15 acoustic and aerodynamic voice metrics were unable to adequately characterize pMTD and determine differences between the two groups (pMTD and non-pMTD). Further validation of these metrics is needed with voice elicitation tasks that target physiological challenges to the vocal system from baseline vocal acoustic and aerodynamic ouput. Future work should also place greater focus on validating metrics of physiological correlates (eg, neuromuscular processes, laryngeal-respiratory kinematics) across the vocal subsystems over traditional vocal output measures (eg, acoustics, aerodynamics) for patients with pMTD. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Adrianna C Shembel
- Department of Speech, Language, and Hearing, University of Texas at Dallas, Dallas, Texas; Department of Otolaryngology-Head and Neck Surgery, University of Texas at Southwestern Medical Center, Dallas, Texas; Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York.
| | - Jeon Lee
- Lyda Hill Department of Bioinformatics, University of Texas at Southwestern, Dallas, Texas
| | - Joshua R Sacher
- Center for the Development of Therapeutics, Broad Institute, Cambridge, Massachusetts
| | - Aaron M Johnson
- Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York
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de Oliveira Florencio V, Almeida AA, Balata P, Nascimento S, Brockmann-Bauser M, Lopes LW. Differences and Reliability of Linear and Nonlinear Acoustic Measures as a Function of Vocal Intensity in Individuals With Voice Disorders. J Voice 2023; 37:663-681. [PMID: 34116889 DOI: 10.1016/j.jvoice.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Linear acoustic indices are significantly influenced by speaking voice intensity. The main aim of this work was to compare acoustic measures based on linear and nonlinear models in different speaking voice intensity levels and to analyze the reliability of those measures in different intensity levels in subjects with voice disorders. METHODS 435 samples from subjects (314 women, 121 men with a mean age of 41.07 ± 13.73) diagnosed with various voice disorders were used. In total, 17 acoustic measures were derived from the vowel /ɛ/ sustained at three intensity levels (soft, comfortable, and loud). Five were linear (standard deviation of the fundamental frequency (f0), jitter, shimmer, harmonics-to-noise ratio (HNR) and smoothed cepstral peak prominence (CPPS)), and twelve were nonlinear measures, namely correlation dimension (D2), correlation entropy (H2), first minimum of the mutual information function (FMMI), relative entropy (ENTR-R), largest Lyapunov exponent (Lyap), determinism (DET), transitivity, mean diagonal line length (Lmed), Shannon entropy (ENTR-S), mean length of vertical structures, also known as trapping time (TT), laminarity (LAM) and recurrence period density entropy (RPDE). Differences between speaking voice intensity levels were assessed by Friedman's test and Nemenyi as posthoc test. Intraclass correlation coefficient was used to investigate if each acoustic measure remains in agreement (reliability) between different voice intensity levels. RESULTS There were significant differences in all acoustic measures about vocal intensity level (P < 0.001). Intraclass correlation coefficient was very good for HNR (>0.61) and good for Lyap, DET, ENTR-S, Lmed, RPDE, and TT (0.41-0.60). CONCLUSIONS All acoustic measures varied as a function of vocal intensity in voice disordered adults, while this relation was different for linear and nonlinear measures. Only the measures HNR, Lyap, DET, ENTR-S, Lmed, RPDE and TT had an acceptable reliability between different voice intensity levels. Therefore, patient`s voice SPL should be controlled or indicated during acoustic vocal assessment.
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Affiliation(s)
- Vanessa de Oliveira Florencio
- Graduate Program in Speech, Language and Hearing Sciences, Universidade Federal da Paraíba (UFPB), João Pessoa, Paraíba, Brazil
| | - Anna Alice Almeida
- Department of Speech, Language and Hearing Sciences, Universidade Federal da Paraíba (UFPB), Graduate Program in Speech, Language and Hearing Sciences, UFPB, João Pessoa, Paraíba, Brazil
| | - Patrícia Balata
- Department of Speech, Language and Hearing Sciences, Universidade Federal da Paraíba (UFPB), Graduate Program in Speech, Language and Hearing Sciences, UFPB, João Pessoa, Paraíba, Brazil
| | - Silvana Nascimento
- Electrical Engineering Department, Instituto Federal de Educação, Ciência e Tecnologia (IFPB), João Pessoa, Paraíba, Brazil
| | - Meike Brockmann-Bauser
- Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland and University of Zurich, Zurich, Switzerland
| | - Leonardo Wanderley Lopes
- Department of Speech, Language and Hearing Sciences, Universidade Federal da Paraíba (UFPB), Graduate Program in Speech, Language and Hearing Sciences, UFPB, João Pessoa, Paraíba, Brazil.
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Kent SAK, Fletcher TL, Morgan A, Morton M, Hall RJ, Sandage MJ. Updated Acoustic Normative Data through the Lifespan: A Scoping Review. J Voice 2023:S0892-1997(23)00066-8. [PMID: 36941164 DOI: 10.1016/j.jvoice.2023.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To assess the recent literature for voice acoustic data values reported for individuals without voice disorder through the lifespan as a means to develop an updated normative acoustic data resource for children and adults. METHODS A scoping review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. English language, full-text publications were identified through Medline (EBSCO & OVID), PubMed, APA PsycINFO, Web of Science, Google Scholar, and ProQuest Theses and Dissertations Global. RESULTS A total of 903 sources were retrieved; of these 510 were duplicates. Abstracts of 393 were screened, with 68 full-text review. From the eligible studies, citation review yielded 51 additional resources. Twenty-eight sources were included for data extraction. For the normative acoustic data extracted for males and females across the lifespan, lower fundamental frequency for adult females was observed and few studies collected semitone range, sound level range, or frequency range. Data extraction also indicated a predominately gender binary reporting of acoustic measures with few studies reporting gender identity, race, or ethnicity as variables of interest. CONCLUSIONS The scoping review yielded updated acoustic normative data that is of value for clinicians and researchers who rely on this normative data to make determinations about vocal function. The limited availability of acoustic data by gender, race, and ethnicity creates barriers for generalization of these normative values across all patients, clients, and research volunteers.
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Affiliation(s)
- Samantha A K Kent
- Department of Speech, Language & Hearing Sciences, Auburn University, Auburn, Alabama
| | - T Laine Fletcher
- Department of Speech, Language & Hearing Sciences, Auburn University, Auburn, Alabama
| | - Abigail Morgan
- Department of Speech, Language & Hearing Sciences, Auburn University, Auburn, Alabama
| | - Mariah Morton
- School of Kinesiology, Auburn University, Auburn, Alabama
| | - Rebecca J Hall
- Department of Speech, Language & Hearing Sciences, Auburn University, Auburn, Alabama
| | - Mary J Sandage
- Department of Speech, Language & Hearing Sciences, Auburn University, Auburn, Alabama.
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Maffei MF, Green JR, Murton O, Yunusova Y, Rowe HP, Wehbe F, Diana K, Nicholson K, Berry JD, Connaghan KP. Acoustic Measures of Dysphonia in Amyotrophic Lateral Sclerosis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:872-887. [PMID: 36802910 PMCID: PMC10205101 DOI: 10.1044/2022_jslhr-22-00363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/25/2022] [Accepted: 12/01/2022] [Indexed: 05/25/2023]
Abstract
PURPOSE Identifying efficacious measures to characterize dysphonia in complex neurodegenerative diseases is key to optimal assessment and intervention. This study evaluates the validity and sensitivity of acoustic features of phonatory disruption in amyotrophic lateral sclerosis (ALS). METHOD Forty-nine individuals with ALS (40-79 years old) were audio-recorded while producing a sustained vowel and continuous speech. Perturbation/noise-based (jitter, shimmer, and harmonics-to-noise ratio) and cepstral/spectral (cepstral peak prominence, low-high spectral ratio, and related features) acoustic measures were extracted. The criterion validity of each measure was assessed using correlations with perceptual voice ratings provided by three speech-language pathologists. Diagnostic accuracy of the acoustic features was evaluated using area-under-the-curve analysis. RESULTS Perturbation/noise-based and cepstral/spectral features extracted from /a/ were significantly correlated with listener ratings of roughness, breathiness, strain, and overall dysphonia. Fewer and smaller correlations between cepstral/spectral measures and perceptual ratings were observed for the continuous speech task, although post hoc analyses revealed stronger correlations in speakers with less perceptually impaired speech. Area-under-the-curve analyses revealed that multiple acoustic features, particularly from the sustained vowel task, adequately differentiated between individuals with ALS with and without perceptually dysphonic voices. CONCLUSIONS Our findings support using both perturbation/noise-based and cepstral/spectral measures of sustained /a/ to assess phonatory quality in ALS. Results from the continuous speech task suggest that multisubsystem involvement impacts cepstral/spectral analyses in complex motor speech disorders such as ALS. Further investigation of the validity and sensitivity of cepstral/spectral measures during continuous speech in ALS is warranted.
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Affiliation(s)
- Marc F. Maffei
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Jordan R. Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
- Speech and Hearing Bioscience and Technology Program, Harvard University, Cambridge, MA
| | - Olivia Murton
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Hannah P. Rowe
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Farah Wehbe
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Kathleen Diana
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Boston
| | - Katharine Nicholson
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Boston
| | - James D. Berry
- Department of Neurology, Neurological Clinical Research Institute, Massachusetts General Hospital, Boston
| | - Kathryn P. Connaghan
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
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Klein-Rodríguez A, Cabo-Varela I, Vázquez de la Iglesia F. Acoustic Characterization of the Voice With a Tracheoesophageal Speech in Laryngectomized Patients. Similarities and Differences With the Laryngeal Voice. J Voice 2023; 37:144.e9-144.e14. [PMID: 33358071 DOI: 10.1016/j.jvoice.2020.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Voice with tracheoesophageal speech (TES) is an effective, widely recognized option to restore the ability of oral communication to laryngectomized patients. In this study, we try to characterize the TES, taking account different variables and making an acoustic analysis of voice with TES versus laryngeal voice (LV). METHODS We compare different acoustic and subjective variables like GRABS or VHI in 34 patients with TES and 31 controls with LV. RESULTS Patients with TES reach a good quality of voice with F0, F1, F2, F3, Jitter, Shimmer, and Yanahigara test similar to control group. Furthermore, the subjective scales show a good perception of voice for patients and examiners. CONCLUSIONS Patients with tracheoesophageal voices show acceptable voice results, in many cases reaching to be near to controls with LV.
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Affiliation(s)
| | - Irma Cabo-Varela
- Department of ENT, Complexo Hospitalario Universitario de A Coruña, Galicia, Spain
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Stappenbeck LE, Bartel S, Brockmann-Bauser M. [Vocal fatigue as an indicator of complex voice disorders-a diagnostic and therapeutic challenge]. HNO 2022; 70:837-841. [PMID: 35788696 PMCID: PMC9581815 DOI: 10.1007/s00106-022-01186-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/27/2022]
Abstract
Vocal fatigue is increasingly observed among professional voice users (e.g., teachers). This pathologic state is associated with restrictions in everyday life and is considered to be an indicator of complex voice disorders. Since there are few systematic studies on the phenomenon, there is currently no uniform definition or diagnostic workup. Based on the case study of a professional speaker, possibilities for a structured vocal fatigue assessment are presented. These are discussed with regard to their laryngoscopic, instrumental acoustic ("performance fatigue") and subjective symptom-related characteristics ("perceived fatigue"). In addition, a differentiation from the vocal effort, vocal demand, and vocal demand response models according to Hunter et al. (2020) is made.
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Affiliation(s)
- L E Stappenbeck
- Abtl. für Phoniatrie und Pädaudiologie, Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Hallesches Hör- und ImplantCentrum, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
- Abteilung Phoniatrie und Klinische Logopädie, Klinik für Ohren‑, Nasen‑, Hals- und Gesichtschirurgie, Universitätsspital Zürich, Zürich, Schweiz.
| | - S Bartel
- Abtl. für Phoniatrie und Pädaudiologie, Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Hallesches Hör- und ImplantCentrum, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
| | - M Brockmann-Bauser
- Abteilung Phoniatrie und Klinische Logopädie, Klinik für Ohren‑, Nasen‑, Hals- und Gesichtschirurgie, Universitätsspital Zürich, Zürich, Schweiz
- Universität Zürich, Zürich, Schweiz
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12
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de Abreu SR, Sousa ESDS, de Moraes RM, Lopes LW. Performance of Acoustic Measures for the Discrimination Among Healthy, Rough, Breathy, and Strained Voices Using the Feedforward Neural Network. J Voice 2022:S0892-1997(22)00203-X. [PMID: 36028370 DOI: 10.1016/j.jvoice.2022.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To identify and evaluate the best set of acoustic measures to discriminate among healthy, rough, breathy, and strained voices. METHODS This study used the vocal samples of the sustained /ε/ vowel from 251 patients with the vocal complaints, among which 51, 80, 63, and 57 patients exhibited healthy, rough, breathy, and strained voices, respectively. Twenty-two acoustic measures were extracted, and feature selection was applied to reduce the number of combinations of acoustic measures and obtain an optimal subset of measures according to the information gain attribute ranking algorithm. To classify signals as a function of predominant voice quality, a feedforward neural network was applied using a Levenberg-Marquardt supervised learning algorithm. RESULTS The best results were obtained from 11 combinations, with each combination presenting six acoustic measures. Kappa indices ranged from 0.7527 to 0.7743, the overall hit rates are 81.67%-83.27%, and the hit rates of healthy, rough, breathy, and strained voices are 74.51%-84.31%, 78.75%-90.00%, 85.71%-98.41%, and 68.42%-82.46%, respectively. CONCLUSIONS We obtained the best results from 11 combinations, with each combination exhibiting six acoustic measures for discriminating among healthy, rough, breathy, and strained voices. These sets exhibited good Kappa performance and a good overall hit rate. The hit rate varied between acceptable and good for healthy voices, acceptable and excellent for rough voices, good and excellent for breathy voices, and poor and good for strained voices.
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Affiliation(s)
- Samuel Ribeiro de Abreu
- Graduate Program in Decision Models and Health, Statistics Departament, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
| | - Estevão Silvestre da Silva Sousa
- Graduate Program in Decision Models and Health, Statistics Departament, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
| | | | - Leonardo Wanderley Lopes
- Department of Speech-Language and Hearing Sciences, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil.
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13
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Pierce JL, Tanner K, Merrill RM, Shnowske L, Roy N. Acoustic Variability in the Healthy Female Voice Within and Across Days: How Much and Why? JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:3015-3031. [PMID: 34269598 DOI: 10.1044/2021_jslhr-21-00018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose The aims of this study were (1) to quantify variability in voice production (as measured acoustically) within and across consecutive days in vocally healthy female speakers, (2) to identify which acoustic measures are sensitive to this variability, and (3) to identify participant characteristics related to such voice variability. Method Participants included 45 young women with normal voices who were stratified by age, specifically 18-23, 24-29, and 30-35 years. Following an initial acoustic and auditory-perceptual voice assessment, participants performed standardized field voice recordings 3 times daily across a 7-day period. Acoustic analyses involved 32 cepstral-, spectral-, and time-based measures of connected speech and sustained vowels. Relationships among acoustic data and select demographic, health, and lifestyle (i.e., participant-based) factors were also examined. Results Significant time-of-day effects were observed for acoustic analyses within speakers (p < .05), with voices generally being worse in the morning. No significant differences were observed across consecutive days. Variations in voice production were associated with several participant factors, including improved voice with increased voice use; self-perceived poor voice function, minimal or no alcohol consumption, and extroverted personality; and worse voice with regular or current menstruation, depression, and anxiety. Conclusions This acoustic study provides essential information regarding the nature and extent to which healthy voices vary throughout the day and week. Participant-based factors that were associated with improved voice over time included increased voice use, self-perceived poor voice function, minimal or no alcohol consumption, and extroverted personality. Factors associated with worse voice production over time included regular or current menstruation, and depression and anxiety.
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Affiliation(s)
- Jenny L Pierce
- Department of Surgery, The University of Utah, Salt Lake City
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
| | - Kristine Tanner
- Department of Communication Disorders, Brigham Young University, Provo, UT
| | - Ray M Merrill
- Department of Public Health, Brigham Young University, Provo, UT
| | - Lauren Shnowske
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington
| | - Nelson Roy
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City
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14
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Brockmann-Bauser M, Van Stan JH, Carvalho Sampaio M, Bohlender JE, Hillman RE, Mehta DD. Effects of Vocal Intensity and Fundamental Frequency on Cepstral Peak Prominence in Patients with Voice Disorders and Vocally Healthy Controls. J Voice 2021; 35:411-417. [PMID: 31859213 PMCID: PMC7295673 DOI: 10.1016/j.jvoice.2019.11.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/21/2019] [Accepted: 11/21/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Cepstrum-based voice measures, such as smoothed cepstral peak prominence (CPPS), are influenced by voice sound pressure level (SPL) in vocally healthy adults. Since it is unclear if similar effects hold in voice disordered adults and how these interact with natural fundamental frequency (fo) changes, this study examines voice SPL and fo effects on CPPS in women with vocal hyperfunction and vocally healthy controls. STUDY DESIGN Retrospective matched case-control study. METHODS Fifty-eight women with vocal hyperfunction were individually matched with 58 vocally healthy women for occupation and approximate age. The patient group comprised women exhibiting phonotraumatic vocal hyperfunction associated with vocal fold nodules (n = 39) or polyps (n = 5), and nonphonotraumatic vocal hyperfunction associated with primary muscle tension dysphonia (n = 14). All participants sustained the vowel /a/ at soft, comfortable, and loud loudness conditions. Voice SPL, fo, and CPPS (dB) were computed from acoustic voice recordings using Praat. The effects of loudness condition, measured voice SPL, and fo on CPPS were assessed with linear mixed models. Pairwise correlations among voice SPL, fo, and CPPS were assessed using multiple regression analysis. RESULTS Increasing voice SPL correlated significantly (P < 0.001) with higher CPPS in both patient (r2 = 0.53) and normative groups (r2 = 0.45). fo had statistically significant effects on CPPS (P < 0.001), but with a weak relation for the patient (r2 = 0.02) and control groups (r2 = 0.05). CONCLUSIONS In women with and without voice disorder, CPPS is highly affected by the individual's voice SPL in vowel phonation. Future studies could investigate how these effects should be controlled for to improve the diagnostic value of acoustic-based cepstral measures.
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Affiliation(s)
- Meike Brockmann-Bauser
- Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland.
| | - Jarrad H Van Stan
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School; MGH Institute of Health Professions, Boston, Massachusetts
| | - Marilia Carvalho Sampaio
- Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland; Federal University of Bahia, Institute of Health Sciences, Department of Speech, Language and Hearing Sciences, Salvador, Brazil
| | - Joerg E Bohlender
- Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | - Robert E Hillman
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts
| | - Daryush D Mehta
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts
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15
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Grillo EU. A Nonrandomized Trial for Student Teachers of an In-Person and Telepractice Global Voice Prevention and Therapy Model With Estill Voice Training Assessed by the VoiceEvalU8 App. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:566-583. [PMID: 33524262 PMCID: PMC8740681 DOI: 10.1044/2020_ajslp-20-00200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/03/2020] [Accepted: 11/03/2020] [Indexed: 05/30/2023]
Abstract
Purpose This study investigated the effects of the in-person and telepractice Global Voice Prevention and Therapy Model (GVPTM) treatment conditions and a control condition with vocally healthy student teachers. Method In this single-blinded, nonrandomized trial, 82 participants completed all aspects of the study. Estill Voice Training was used as the stimulability component of the GVPTM to train multiple new voices meeting all the vocal needs of the student teachers. Outcomes were assessed using acoustic, perceptual, and aerodynamic measures captured by the VoiceEvalU8 app at pre and post in fall and during student teaching in spring. Results Significant improvements were achieved for several acoustic and perceptual measures in the treatment conditions, but not in the control condition. The in-person and telepractice conditions produced similar results. The all-voiced phrase and connected speech were more successful in demonstrating voice change for some of the perturbation measures as compared to sustained /a/. Conclusions The treatment conditions were successful in improving the participants' voices for fundamental frequency and some acoustic perturbation measures while maintaining the improvements during student teaching. In addition, the treatment conditions were successful in decreasing the negative impact of voice-related quality of life and vocal fatigue during student teaching. Future research should address the effectiveness of the various components of the GVPTM, the application of the GVPTM with patients with voice disorders, the relevance of defining auditory-perceptual terms by the anatomy and physiology of the voice production system (i.e., Estill Voice Training), and the continued use of the VoiceEvalU8 app for clinical voice investigations. Supplemental Material https://doi.org/10.23641/asha.13626824.
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Affiliation(s)
- Elizabeth U. Grillo
- Department of Communication Sciences and Disorders, West Chester University, PA
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16
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Pierce JL, Tanner K, Merrill RM, Shnowske L, Roy N. A Field-Based Approach to Establish Normative Acoustic Data for Healthy Female Voices. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:691-706. [PMID: 33561361 DOI: 10.1044/2020_jslhr-20-00490] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The primary aim of this study was to obtain high-quality acoustic normative data in natural field environments for female voices. A secondary aim was to examine acoustic measurement variability in field environments. Method This study employed a within-subject repeated-measures experimental design that included 45 young female adults with normal voices. Participants were stratified by age (18-23, 24-29, and 30-35 years). After initial evaluation and instruction, participants completed voice recordings during seven consecutive days using a standard protocol, including both connected speech and sustained vowels. Thirty-two cepstral-, spectral-, and time-based acoustic measures were acquired using Praat and the Analysis of Dysphonia in Speech and Voice. Results Among the 958 total recordings, greater than 90% satisfied inclusion criteria based on protocol compliance, peak clipping, and signal-to-noise ratio. Significant differences were observed for age (p < .05). For 19 acoustic measures, values improved significantly as signal-to-noise ratio increased. Cepstral- and spectral-based measures demonstrated less measurement variability as compared with time-based measures. Conclusions With adequate training, field audio recordings represent a viable option for clinical voice management. The significant age effects observed in this study support the need for more specific criteria when collecting and applying normative data. Cepstral- and spectral-based measures demonstrated the least measurement variability. This study provides additional evidence for multiparameter acoustic voice measurement, specifically toward ecologically valid sampling in natural environments. Future studies should expand on these findings in other populations with normal and disordered voices.
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Affiliation(s)
- Jenny L Pierce
- Department of Surgery, The University of Utah, Salt Lake City
- Department of Communication Sciences & Disorders, The University of Utah, Salt Lake City
| | - Kristine Tanner
- Department of Communication Disorders, Brigham Young University, Provo, UT
| | - Ray M Merrill
- Department of Public Health, Brigham Young University, Provo, UT
| | - Lauren Shnowske
- Department of Communication Sciences & Disorders, The University of Utah, Salt Lake City
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington
| | - Nelson Roy
- Department of Communication Sciences & Disorders, The University of Utah, Salt Lake City
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Kent RD, Eichhorn JT, Vorperian HK. Acoustic parameters of voice in typically developing children ages 4-19 years. Int J Pediatr Otorhinolaryngol 2021; 142:110614. [PMID: 33450527 PMCID: PMC7902385 DOI: 10.1016/j.ijporl.2021.110614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/31/2020] [Accepted: 12/31/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Report data on acoustic measures of voice in sustained vowels produced by typically developing children, aged 4-19 years, to add to the cross-sectional reference values in a pediatric database. METHODS Recordings of sustained vowel/ɑ/phonation were obtained from 158 children (80 males, 78 females) aged 4-19 years who were judged to be typically developing with respect to speech and voice. Acoustic analyses were performed with the Multidimensional Voice Program (MDVP™) and the Analysis of Dysphonia in Speech and Voice (ADSV™), both from Pentax Medical. RESULTS Values from both MDVP and ADSV are reported for children in the following age cohorts: 4-6 years, 7-9 years, 10-12 years, 13-15 years, and 16-19 years. CONCLUSION The data in this study complement previously published data and contribute to a pediatric reference database useful for research and for clinical practice related to children's voice. Acoustic parameters most sensitive to age and sex are identified.
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Affiliation(s)
- Raymond D. Kent
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI 53705
| | - Julie T. Eichhorn
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI 53705
| | - Houri K. Vorperian
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI 53705
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Pathology-Related Influences on the VEM: Three Years' Experience since Implementation of a New Parameter in Phoniatric Voice Diagnostics. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5309508. [PMID: 33506007 PMCID: PMC7814951 DOI: 10.1155/2020/5309508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 11/17/2020] [Accepted: 12/10/2020] [Indexed: 02/08/2023]
Abstract
The vocal extent measure (VEM) represents a new diagnostic tool to express vocal capacity by quantifying the dynamic performance and frequency range of voice range profiles (VRPs). For VEM calculation, the VRP area is multiplied by the quotient of the theoretical perimeter of a circle with equal VRP area and the actual VRP perimeter. Since different diseases affect voice function to varying degrees, pathology-related influences on the VEM should be investigated more detailed in this retrospective study, three years after VEM implementation. Data was obtained in a standardized voice assessment comprising videolaryngostroboscopy, voice handicap index (VHI-9i), and acoustic-aerodynamic analysis with automatic calculation of VEM and dysphonia severity index (DSI). The complete dataset comprised 1030 subjects, from which 994 adults (376 male, 618 female; 18-86 years) were analyzed more detailed. The VEM differed significantly between pathology subgroups (p < 0.001) and correlated with the corresponding DSI values. Regarding VHI-9i, the VEM reflected the subjective impairment better than the DSI. We conclude that the VEM proved to be a comprehensible and easy-to-use interval-scaled parameter for objective VRP evaluation in all pathology subgroups. As expected, exclusive consideration of the measured pathology-related influences on the VEM does not allow conclusions regarding the specific underlying diagnosis.
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Lopes LW, França FP, Evangelista DDS, Alves JDN, Vieira VJD, de Lima-Silva MFB, Pernambuco LDA. Does the Combination of Glottal and Supraglottic Acoustic Measures Improve Discrimination Between Women With and Without Voice Disorders? J Voice 2020; 36:583.e17-583.e29. [PMID: 32917459 DOI: 10.1016/j.jvoice.2020.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 12/28/2022]
Abstract
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.
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Affiliation(s)
- Leonardo Wanderley Lopes
- Professor at the Department of Speech-Language Pathology at the Federal University of Paraíba (Universidade Federal da Paraíba-UFPB), João Pessoa, Paraíba, Brazil.
| | - Fernanda Pereira França
- Ph.D Candidate of the Graduate Program in Linguistics at the Federal University of Paraíba (Universidade Federal da Paraíba-UFPB), João Pessoa, Paraíba, Brazil
| | - Deyverson da Silva Evangelista
- Ph.D Candidate of the Graduate Program in Linguistics at the Federal University of Paraíba (Universidade Federal da Paraíba-UFPB), João Pessoa, Paraíba, Brazil
| | - Jônatas do Nascimento Alves
- Master degree of the Graduate Program in Linguistics at the Federal University of Paraíba (Universidade Federal da Paraíba-UFPB), João Pessoa, Paraíba, Brazil
| | - Vinícius Jefferson Dias Vieira
- Post doctorate researcher in the Graduate Program in Linguistics at the Federal University of Paraíba (Universidade Federal da Paraíba-UFPB), João Pessoa, Paraíba, Brazil
| | - Maria Fabiana Bonfim de Lima-Silva
- Professor at the Department of Speech-Language Pathology at the Federal University of Paraíba (Universidade Federal da Paraíba-UFPB), João Pessoa, Paraíba, Brazil
| | - Leandro de Araújo Pernambuco
- Professor at the Department of Speech-Language Pathology at the Federal University of Paraíba (Universidade Federal da Paraíba-UFPB), João Pessoa, Paraíba, Brazil
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Analyzing Longitudinal Data on Singing Voice Parameters of Boys and Girls Aged 8 to 12.5 and Possible Effects of a Music Pedagogical Intervention. J Voice 2020; 36:583.e1-583.e16. [PMID: 32843260 DOI: 10.1016/j.jvoice.2020.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Controlled and randomized study to analyze longitudinal voice data of boys and girls aged 8-12.5, to describe their physiological development and to evaluate the influence of a one-year music pedagogical interventional program focused on the singing voice. METHODS Singing voice profiles of 116 children (52 boys, 64 girls) aged 8-12.5 years were collected longitudinally at the beginning and the end of the third school year and the end of the fourth school year. 64 of the 116 children received a music pedagogical program during their third school year (interventional group). Maximum and minimum voice intensity, highest and lowest frequency, maximum phonation time (MPT) and Jitter were investigated. RESULTS In two years' time highest frequency increased on average by 100.23 Hz from G1 up to A1 for boys and for girls. Lowest frequency decreased by 18.36Hz from Gis-1 to G-1 (boys: Gis-1-Fis-1; girls: A-1-G-1). There was no clinically relevant development of the intensity parameters for both sexes. However, after the interventional year, minimum voice intensity significantly decreased in the interventional group compared to the control group. The MPT increased by 2.41 seconds from 10.67 seconds up to 13.09 seconds in two years. Here the increase was higher for boys (+3.2 seconds) than for girls (+1.77 seconds). Jitter was found to be 0.84%-1.11%, showing no clinically relevant changes in two years. CONCLUSION To the best of our knowledge, for the first time this study presents longitudinal data on singing voice parameters of the voice range profile of boys and girls aged 8-12.5 years. While frequency and intensity parameters develop equally for boys and girls, the MPT is found to develop more distinctly within boys. A music pedagogical intervention of a small extent has a positive effect on the ability to sing as soft as possible.
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Performance of Different Acoustic Measures to Discriminate Individuals With and Without Voice Disorders. J Voice 2020; 36:487-498. [PMID: 32798120 DOI: 10.1016/j.jvoice.2020.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 11/20/2022]
Abstract
The goal of this study is to compare and combine different acoustic features in discriminating subjects with and without voice disorders. A database of 484 adult patients participated in the research. All subjects recorded a sustained vowel /Ɛ/ and underwent a laryngoscopic examination of the larynx. From the results of the laryngeal examination performed by a physician and the auditory-perceptual judgment performed by a Speech-Language Pathologist, the subjects were allocated to the group with (n = 52) and without (n = 432) voice disorder. Four types of acoustic features were used: traditional measures, cepstral measures, nonlinear measures, and recurrence quantification measures. Recordings comprised the emission of the vowel /ε/. Quadratic discriminant analysis was used as classifier. Individual features in the context of traditional, cepstral, and recurrence quantification measures achieved an acceptable performance of ≥70%. Combination of measures improved the classifier performance. The best classification result (86.43% accuracy) was obtained by combining traditional linear and recurrence quantification measures. Results shown that Traditional, Cepstral, and recurrence quantification measures are promising features that capture meaningful information about voice production, which provides good classification performances. The findings of this study can be used to develop a computational tool for voice disorders diagnosis and monitoring.
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22
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Lopes LW, da Silva ACF, da Silva IM, de Paiva MAA, Silva SIDN, Almeida LNA, Ribeiro VV. Evidence of Internal Consistency in the Spectrographic Analysis Protocol. J Voice 2020; 36:445-456. [PMID: 32782177 DOI: 10.1016/j.jvoice.2020.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To verify the validity in the internal consistency in the spectrographic analysis protocol (SAP). MATERIAL AND METHODS Thirty-nine students of the Speech-Language Pathology graduate program and 38 speech-language pathologists, specialized in voice, participated in the study. The participants made visual inspections of 10 spectrograms and marked the items of the SAP. For analysis of the internal consistency in the SAP, the exploratory factor analysis (EFA) and confirmatory factor analysis were performed. RESULTS Most items showed corrected item-total correlation above 0.3, indicating that the items have a good relationship with each other and with the SAP as a whole. Six items presented values below the average, suggesting the exclusion of these from the construct. However, three of these were maintained because they were judged as important parameters in clinical practice, requiring the training of judges when using the SAP to properly understand the items. The EFA regrouped the previous domains of the SAP into three factors. All items presented a factor load above 0.4, suggesting the retention of all, except for the items previously indicated, for exclusion. The confirmatory factor analysis corroborated with the EFA and its indexes. CONCLUSION The SAP has good internal consistency. All items have a good degree of relationship with each other and contribute positively to the protocol as a whole. The final version of the SAP, at this stage, has 15 items (from the 25 items of the initial SAP version), distributed among three domains.
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Affiliation(s)
- Leonardo Wanderley Lopes
- Speech-Language Pathology Department, Universidade Federal da Paraíba - UFPB, Cidade Universitária, João Pessoa, Paraíba, Brazil.
| | - Allan Carlos França da Silva
- Speech-Language Pathology Department, Universidade Federal da Paraíba - UFPB, Cidade Universitária, João Pessoa, Paraíba, Brazil
| | - Itacely Marinho da Silva
- Speech-Language Pathology Department, Universidade Federal da Paraíba - UFPB, Cidade Universitária, João Pessoa, Paraíba, Brazil
| | - Maxsuel Alves Avelino de Paiva
- Speech-Language Pathology Department, Universidade Federal da Paraíba - UFPB, Cidade Universitária, João Pessoa, Paraíba, Brazil
| | - Saulo Iordan do Nascimento Silva
- Speech-Language Pathology Department, Universidade Federal da Paraíba - UFPB, Cidade Universitária, João Pessoa, Paraíba, Brazil
| | - Larissa Nadjara Alves Almeida
- Program of Decision and Health Models, Universidade Federal da Paraíba - UFPB, Cidade Universitária, João Pessoa, Paraíba, Brazil
| | - Vanessa Veis Ribeiro
- Speech-Language Pathology Department, Universidade Federal de Sergipe - UFS, Lagarto, Sergipe, Brazil
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Hassan EM, Abdel Hady AF, Shohdi SS, Eldessouky HM, Din MHB. Assessment of dysphonia: cepstral analysis versus conventional acoustic analysis. LOGOP PHONIATR VOCO 2020; 46:99-109. [PMID: 32436465 DOI: 10.1080/14015439.2020.1767202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE In this study, we aimed to determine the extent to which smoothed cepstral peak prominence (CPPS) can replace or complement the conventional acoustic measures of jitter, shimmer, and harmonic-to-noise ratio in the assessment of various types of dysphonia. METHODOLOGY A total of 60 males and 80 females were divided into two groups: dysphonic group and control group (30 males and 40 females in each group). The voice samples in the form of sustained vowel /a/ phonation and continuous speech were recorded and assessed using auditory perceptual analysis, acoustic analysis, and cepstral analysis. RESULTS Jitter was found to have the best predictive ability during sustained phonation, whereas CPPS was found to have the best predictive ability during continuous speech. CONCLUSION Cepstral analysis is as reliable as the conventional acoustic analysis in the diagnosis of dysphonia and to detect its severity. However, CPPS cannot replace conventional acoustic measures.
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Affiliation(s)
- Elham Moamen Hassan
- Faculty of Medicine, Department of Otolaryngology, Suez Canal University, Ismailia, Egypt
| | | | - Sahar Saad Shohdi
- Faculty of Medicine, Department of Otolaryngology, Cairo University, Cairo, Egypt
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Lopes LW, Vieira VJD, Costa SLDNC, Correia SÉN, Behlau M. Effectiveness of Recurrence Quantification Measures in Discriminating Subjects With and Without Voice Disorders. J Voice 2020; 34:208-220. [DOI: 10.1016/j.jvoice.2018.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
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Naunheim MR, Dai JB, Rubinstein BJ, Goldberg L, Weinberg A, Courey MS. A visual analog scale for patient-reported voice outcomes: The VAS voice. Laryngoscope Investig Otolaryngol 2020; 5:90-95. [PMID: 32128435 PMCID: PMC7042645 DOI: 10.1002/lio2.333] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/04/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Although patient-reported outcome measures (PROMs) can be useful for assessing quality of life, they can be complex and cognitively burdensome. In this study, we prospectively evaluated a simple patient-reported voice assessment measure on a visual analog scale (VAS voice) and compared it with the Voice Handicap Index (VHI-10). STUDY DESIGN Prospective survey. METHODS An abbreviated voice measure was designed by a team of otolaryngologists, speech pathologists, and patients that consisted of four VAS questions related to (a) a global question of voice disturbance, (b) physical function of voice, (c) functional issues, and (d) emotional handicap. All English-speaking patients presenting to an academic laryngology clinic for a voice complaint were included. Internal consistency and validity were assessed with comparison to the VHI-10. RESULTS A total of 209 patients were enrolled. Ninety-two percent of patients reported understanding the survey. The four-item VAS survey was highly correlated with VHI-10 score (Pearson correlation .81, P < .0001), and the Cronbach's alpha between all four VAS questions was .94. Age, gender, and diagnosis were not associated with either the global VAS or VHI-10 tool. CONCLUSION Reducing the complexity of instruments assessing voice-related quality of life is feasible, and the VAS voice correlated with existing measures. Simplified assessments may offer advantages compared to more cumbersome PROMs. LEVEL OF EVIDENCE 2c.
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Affiliation(s)
- Matthew R. Naunheim
- Massachusetts Eye and EarBostonMassachusetts
- Harvard Medical SchoolBostonMassachusetts
| | | | | | | | - Alan Weinberg
- Icahn School of Medicine at Mount SinaiNew YorkNew York
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Lopes LW, Sousa ESDS, Silva ACFD, Silva IMD, Paiva MAAD, Vieira VJD, Almeida AA. Cepstral measures in the assessment of severity of voice disorders. Codas 2019; 31:e20180175. [PMID: 31433040 DOI: 10.1590/2317-1782/20182018175] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/24/2018] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To analyze whether there is an association between the presence, intensity and type of voice disorder and the cepstral measures in samples of individuals with voice complaints. METHODS We used 376 vowel /Ɛ/ samples from individuals of both genders that had voice complaints. An analogue-visual scale was used for the auditory-perceptual analysis of voices regarding the overall grade of dysphonia (G) and the grades of roughness (R), breathiness (B), and strain (S), including a determination of voice quality (rough, breathy or strained). Measures related to cepstral peak prominence smoothed (CPPS) and spectral decline of vocal samples were extracted. RESULTS There were differences in the CPPS values between the groups with or without voice disorders as well as between the different intensities and types of voice disorder. CPPS values were lower because of the presence and intensity of voice disorders. The CPPS values differentiated the following voices: rough x breathy, rough x strained, and breathy x strained. The spectral decline only differentiated breathy x strained voices. CPPS correlated positively and strongly with G and B; moderately and negatively with R, and negatively and weakly with S. The spectral decline had a moderate positive correlation with S and a weak negative correlation with B. CONCLUSION There is association between voice disorder, G, predominant voice quality, and CPPS. In particular, G is strongly correlated with CPPS. Spectral decline is associated only with the parameters B and S.
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Affiliation(s)
| | | | | | - Itacely Marinho da Silva
- Departamento de Fonoaudiologia, Universidade Federal da Paraíba - UFPB - João Pessoa (PB), Brasil
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Kang J, Xue C, Chou A, Scholp A, Gong T, Zhang Y, Chen Z, Jiang JJ. Comparing the Exposure-Response Relationships of Physiological and Traditional Vocal Warm-ups on Aerodynamic and Acoustic Parameters in Untrained Singers. J Voice 2019; 33:420-428. [DOI: 10.1016/j.jvoice.2017.12.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 12/28/2017] [Indexed: 01/20/2023]
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Do Standard Instrumental Acoustic, Perceptual, and Subjective Voice Outcomes Indicate Therapy Success in Patients With Functional Dysphonia? J Voice 2019; 33:317-324. [DOI: 10.1016/j.jvoice.2017.11.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 11/23/2022]
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Lopes LW, Alves JDN, Evangelista DDS, França FP, Vieira VJD, Lima-Silva MFBD, Pernambuco LDA. Acurácia das medidas acústicas tradicionais e formânticas na avaliação da qualidade vocal. Codas 2018; 30:e20170282. [DOI: 10.1590/2317-1782/20182017282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/09/2018] [Indexed: 05/30/2023] Open
Abstract
RESUMO Objetivo Investigar a acurácia das medidas acústicas, isoladas e combinadas, na discriminação da intensidade do desvio vocal (GG) e da qualidade vocal predominante (QVP) em pacientes disfônicos. Método Participaram 302 pacientes do gênero feminino, com queixa vocal. A partir da vogal /ɛ/ sustentada, foram extraídas as medidas acústicas de média e desvio padrão (DP) da frequência fundamental (F0), o jitter, o shimmer e o Glottal to noise excitation (GNE) e a média dos três primeiros formantes (F1, F2, F3). A avaliação perceptivo-auditiva do GG e QVP foi realizada por três fonoaudiólogos especialistas em voz. Resultados Isoladamente, apenas o GNE obteve desempenho satisfatório na discriminação do GG e da QVP. Houve uma melhora na classificação do GG e QVP com a combinação das medidas acústicas. A média de F0, F2 e GNE (saudável × desvio leve a moderado), DP de F0, F1 e F3 (leve a moderado × desvio moderado), Jitter e GNE (moderado × desvio intenso) foram as melhores combinações para discriminar o GG. As melhores combinações para discriminação da QVP foram média de F0, Shimmer e GNE (saudável × rugosa), F3 e GNE (saudável × soprosa), média de F0, F3 e GNE (rugosa × tensa), média de F0, F1 e GNE (soprosa × tensa). Conclusão De forma isolada, o GNE mostrou-se o único parâmetro acústico capaz de discriminar o GG e a QVP. Houve um ganho no desempenho da classificação com a combinação das medidas acústicas tradicionais e formânticas, tanto para a discriminação do GG como da QVP.
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Karlsen T, Sandvik L, Heimdal JH, Aarstad HJ. Acoustic Voice Analysis and Maximum Phonation Time in Relation to Voice Handicap Index Score and Larynx Disease. J Voice 2018; 34:161.e27-161.e35. [PMID: 30093166 DOI: 10.1016/j.jvoice.2018.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Patients with voice-related disorders are ideally treated by a multidisciplinary team. Acoustic voice analysis and patient-reported outcome measures are recommended parts of the clinical assessment. The present paper aims at further documenting the importance of acoustic voice analyses, maximum phonation time (MPT) and Voice Handicap Index (VHI) into clinical investigations. STUDY DESIGN The participants (N = 80 larynx cancer, N = 32 recurrent palsy, N = 23 dysfunctional, N = 75 degenerative/inflammation (N = 19 various excluded)) were included consecutively at the outpatient laryngology clinic at Haukeland University Hospital. In addition, a control group of 98 healthy subjects were included. METHOD Voice samples, MPT, and the VHI scores in addition to standard clinical information were obtained. Acoustic analyses were performed from these samples determining level of jitter, shimmer and Noise-to-Harmonic ratio (NHR) as well as analyzing frequency of a prolonged vowel. RESULTS Jitter, shimmer, and NHR scores correlated strongly (r ≈ 0.8; P < 0.001) to each other. By Analysis of Variance analyses, we have determined significant dependence on diagnostic group analyzing all the obtained acoustic scores (all P < 0.001). All patient groups but the dysfunctional group scored to some extent worse than the control group (mostly at P < 0.001). In addition, jitter scores from dysfunction group were lower than recurrent palsy group (P < 0.05) and shimmer scores were lower among dysfunctional than the cancer group (P < 0.05). Regarding NHR the cancer patients scored higher than the degenerative/inflammatory group (P < 0.05). The cancer group scored with longer MPT than the degenerative/inflammatory (P < 0.001) and recurrent palsy groups (P < 0.05). CONCLUSION Among larynx disease patients acoustic and MPT analyses segregated with all determined analyses between patients and control conditions except the dysfunctional group, but also to some extent between various patient groups. VHI scores correlated to jitter, shimmer and NHR scores among cancer and degenerative/inflammatory disease patients. Acoustic analyses potentially add information useful to laryngological patient studies.
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Affiliation(s)
- Tom Karlsen
- Department of Otorhinolaryngology-Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway; Department of Speech and Language, Statped Vest, Bergen, Norway.
| | - Lorentz Sandvik
- Department of Otorhinolaryngology-Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - John-Helge Heimdal
- Department of Otorhinolaryngology-Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Hans Jørgen Aarstad
- Department of Otorhinolaryngology-Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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Vieira VJD, Costa SC, Correia SLN, Lopes LW, Costa WCDA, de Assis FM. Exploiting nonlinearity of the speech production system for voice disorder assessment by recurrence quantification analysis. CHAOS (WOODBURY, N.Y.) 2018; 28:085709. [PMID: 30180621 DOI: 10.1063/1.5024948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/27/2018] [Indexed: 06/08/2023]
Abstract
This work summarizes the research related to digital speech signal processing with recurrence quantification analysis (RQA) applied to voice disorder assessment. The main motivation for these studies is the fact that RQA is able to exploit the nonlinear dynamical nature of the speech production system. Due to the use of recurrence quantification measures to represent the behavior of speech signals, promising results were obtained in the characterization and classification of laryngeal pathologies and voice disorders. These contributions may help one to evaluate the usability and efficiency of RQA in vocal disorder assessment.
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Affiliation(s)
- Vinícius J D Vieira
- Linguistics Graduate Program (PROLING), Federal University of Paraíba, Cidade Universitária, Campus I - Castelo Branco, João Pessoa, Paraíba 58051-900, Brazil
| | - Silvana C Costa
- Academic Unity of Industry, Federal Institute of Paraíba, Avenida Primeiro de Maio, 720 - Jaguaribe, João Pessoa, Paraíba 58015-435, Brazil
| | - Suzete L N Correia
- Academic Unity of Industry, Federal Institute of Paraíba, Avenida Primeiro de Maio, 720 - Jaguaribe, João Pessoa, Paraíba 58015-435, Brazil
| | - Leonardo W Lopes
- Speech and Language Pathology Department, Federal University of Paraíba, Cidade Universitária, Campus I - Castelo Branco, João Pessoa, Paraíba 58051-900, Brazil
| | - Washington C de A Costa
- Academic Unity of Industry, Federal Institute of Paraíba, Avenida Primeiro de Maio, 720 - Jaguaribe, João Pessoa, Paraíba 58015-435, Brazil
| | - Francisco M de Assis
- Electrical Engineering Department, Federal University of Campina Grande, Rua Aprígio Veloso, 882 - Universitário, Campina Grande, Paraíba 58429-900, Brazil
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Lopes LW, Freitas JAD, Almeida AA, Silva POC, Alves GÂDS. Performance of the phonatory deviation diagram in the evaluation of rough and breathy synthesized voices. Braz J Otorhinolaryngol 2018; 84:460-472. [PMID: 28732642 PMCID: PMC9449180 DOI: 10.1016/j.bjorl.2017.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/10/2017] [Accepted: 05/24/2017] [Indexed: 11/16/2022] Open
Abstract
Introduction Voice disorders alter the sound signal in several ways, combining several types of vocal emission disturbances and noise. The phonatory deviation diagram is a two-dimensional chart that allows the evaluation of the vocal signal based on the combination of periodicity (jitter, shimmer, and correlation coefficient) and noise (Glottal to Noise Excitation) measurements. The use of synthesized signals, where one has a greater control and knowledge of the production conditions, may allow a better understanding of the physiological and acoustic mechanisms underlying the vocal emission and its main perceptual-auditory correlates regarding the intensity of the deviation and types of vocal quality. Objective To analyze the performance of the phonatory deviation diagram in the discrimination of the presence and degree of roughness and breathiness in synthesized voices. Methods 871 synthesized vocal signals were used corresponding to the vowel /ɛ/. The perceptual-auditory analysis of the degree of roughness and breathiness of the synthesized signals was performed using visual analogue scale. Subsequently, the signals were categorized regarding the presence/absence of these parameters based on the visual analogue scale cutoff values. Acoustic analysis was performed by assessing the distribution of vocal signals according to the phonatory deviation diagram area, quadrant, shape, and density. The equality of proportions and the chi-square tests were performed to compare the variables. Results Rough and breathy vocal signals were located predominantly outside the normal range and in the lower right quadrant of the phonatory deviation diagram. Voices with higher degrees of roughness and breathiness were located outside the area of normality in the lower right quadrant and had concentrated density. Conclusion The normality area and the phonatory deviation diagram quadrant can discriminate healthy voices from rough and breathy ones. Voices with higher degrees of roughness and breathiness are proportionally located outside the area of normality, in the lower right quadrant and with concentrated density.
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Affiliation(s)
- Leonardo Wanderley Lopes
- Universidade Federal da Paraíba (UFPB), Departamento de Fonoaudiologia, João Pessoa, PB, Brazil.
| | | | - Anna Alice Almeida
- Universidade Federal da Paraíba (UFPB), Departamento de Fonoaudiologia, João Pessoa, PB, Brazil
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Lopes LW, da Silva KE, da Silva Evangelista D, Almeida AA, Silva POC, Lucero J, Behlau M. Performance of Phonatory Deviation Diagrams in Synthesized Voice Analysis. Folia Phoniatr Logop 2018; 69:246-260. [PMID: 29719283 DOI: 10.1159/000487941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/23/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To analyze the performance of a phonatory deviation diagram (PDD) in discriminating the presence and severity of voice deviation and the predominant voice quality of synthesized voices. METHOD A speech-language pathologist performed the auditory-perceptual analysis of the synthesized voice (n = 871). The PDD distribution of voice signals was analyzed according to area, quadrant, shape, and density. RESULTS Differences in signal distribution regarding the PDD area and quadrant were detected when differentiating the signals with and without voice deviation and with different predominant voice quality. Differences in signal distribution were found in all PDD parameters as a function of the severity of voice disorder. CONCLUSION The PDD area and quadrant can differentiate normal voices from deviant synthesized voices. There are differences in signal distribution in PDD area and quadrant as a function of the severity of voice disorder and the predominant voice quality. However, the PDD area and quadrant do not differentiate the signals as a function of severity of voice disorder and differentiated only the breathy and rough voices from the normal and strained voices. PDD density is able to differentiate only signals with moderate and severe deviation. PDD shape shows differences between signals with different severities of voice deviation.
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Affiliation(s)
| | | | | | - Anna Alice Almeida
- Department of Speech Therapy, Universidade Federal da Paraíba - UFPB, João Pessoa, Brazil
| | | | - Jorge Lucero
- Department of Computer Science, Universidade de Brasília - UNB, Brasília, Brazil
| | - Mara Behlau
- Universidade Federal de São Paulo - UNIFESP and Centro de Estudos da Voz - CEV, São Paulo, São Paulo, Brazil
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Brockmann-Bauser M, Bohlender JE, Mehta DD. Acoustic Perturbation Measures Improve with Increasing Vocal Intensity in Individuals With and Without Voice Disorders. J Voice 2018; 32:162-168. [PMID: 28528786 PMCID: PMC7053781 DOI: 10.1016/j.jvoice.2017.04.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/13/2017] [Accepted: 04/17/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In vocally healthy children and adults, speaking voice loudness differences can significantly confound acoustic perturbation measurements. This study examines the effects of voice sound pressure level (SPL) on jitter, shimmer, and harmonics-to-noise ratio (HNR) in adults with voice disorders and a control group with normal vocal status. STUDY DESIGN This is a matched case-control study. METHODS We assessed 58 adult female voice patients matched according to approximate age and occupation with 58 vocally healthy women. Diagnoses included vocal fold nodules (n = 39, 67.2%), polyps (n = 5, 8.6%), and muscle tension dysphonia (n = 14, 24.1%). All participants sustained the vowel /a/ at soft, comfortable, and loud phonation levels. Acoustic voice SPL, jitter, shimmer, and HNR were computed using Praat. The effects of loudness condition, voice SPL, pathology, differential diagnosis, age, and professional voice use level on acoustic perturbation measures were assessed using linear mixed models and Wilcoxon signed rank tests. RESULTS In both patient and normative control groups, increasing voice SPL correlated significantly (P < 0.001) with decreased jitter and shimmer, and increased HNR. Voice pathology and differential diagnosis were not linked to systematically higher jitter and shimmer. HNR levels, however, were statistically higher in the patient group than in the control group at comfortable phonation levels. Professional voice use level had a significant effect (P < 0.05) on jitter, shimmer, and HNR. CONCLUSIONS The clinical value of acoustic jitter, shimmer, and HNR may be limited if speaking voice SPL and professional voice use level effects are not controlled for. Future studies are warranted to investigate whether perturbation measures are useful clinical outcome metrics when controlling for these effects.
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Affiliation(s)
- M Brockmann-Bauser
- Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland.
| | - J E Bohlender
- Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland
| | - D D Mehta
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, One Bowdoin Square, 11th Floor, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts; MGH Institute of Health Professions, Boston, Massachusetts
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Acoustic and Perceptual Analyses of Adductor Spasmodic Dysphonia in Mandarin-speaking Chinese. J Voice 2018; 33:333-339. [PMID: 29449062 DOI: 10.1016/j.jvoice.2017.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 12/14/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to examine the perceptual structure and acoustic characteristics of speech of patients with adductor spasmodic dysphonia (ADSD) in Mandarin. STUDY DESIGN Case-Control Study MATERIALS AND METHODS: For the estimation of dysphonia level, perceptual and acoustic analysis were used for patients with ADSD (N = 20) and the control group (N = 20) that are Mandarin-Chinese speakers. For both subgroups, a sustained vowel and connected speech samples were obtained. The difference of perceptual and acoustic parameters between the two subgroups was assessed and analyzed. RESULTS For acoustic assessment, the percentage of phonatory breaks (PBs) of connected reading and the percentage of aperiodic segments and frequency shifts (FS) of vowel and reading in patients with ADSD were significantly worse than controls, the mean harmonics-to-noise ratio and the fundamental frequency standard deviation of vowel as well. For perceptual evaluation, the rating of speech and vowel in patients with ADSD are significantly higher than controls. The percentage of aberrant acoustic events (PB, frequency shift, and aperiodic segment) and the fundamental frequency standard deviation and mean harmonics-to-noise ratio were significantly correlated with the perceptual rating in the vowel and reading productions. CONCLUSIONS The perceptual and acoustic parameters of connected vowel and reading in patients with ADSD are worse than those in normal controls, and could validly and reliably estimate dysphonia of ADSD in Mandarin-speaking Chinese.
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Gunjawate DR, Ravi R, Bellur R. Acoustic Analysis of Voice in Singers: A Systematic Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:40-51. [PMID: 29344619 DOI: 10.1044/2017_jslhr-s-17-0145] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 09/05/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Singers are vocal athletes having specific demands from their voice and require special consideration during voice evaluation. Presently, there is a lack of standards for acoustic evaluation in them. The aim of the present study was to systematically review the available literature on the acoustic analysis of voice in singers. METHOD A systematic review of studies on acoustic analysis of voice in singers (PubMed/MEDLINE, CINAHL, Scopus, ProQuest, Cochrane, Ovid, Science Direct, and Shodhganga) was carried out. Key words based on PIO (population-investigation-outcome) were used to develop search strings. Titles and abstracts were screened independently, and appropriate studies were read in full for data extraction. RESULTS Of the 895 studies, 26 studies met the inclusion criteria. Great variability was noted in the instruments and task used. Different acoustic measures were employed, such as fundamental frequency, perturbation, cepstral, spectral, dysphonia severity index, singing power ratio, and so forth. CONCLUSION Overall, a great heterogeneity was noted regarding population, tasks, instruments, and parameters. There is a lack of standardized criteria for the evaluation of singing voice. In order to implement acoustic analysis as a part of comprehensive voice evaluation exclusively for singers, there is a certain need for methodical sound studies.
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Affiliation(s)
- Dhanshree R Gunjawate
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Rohit Ravi
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal Academy of Higher Education, Karnataka, India
| | - Rajashekhar Bellur
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal Academy of Higher Education, Karnataka, India
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Objective and subjective voice outcomes after total laryngectomy: a systematic review. Eur Arch Otorhinolaryngol 2017; 275:11-26. [PMID: 29086803 PMCID: PMC5754416 DOI: 10.1007/s00405-017-4790-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/24/2017] [Indexed: 11/12/2022]
Abstract
Background Esophageal speech (ES), tracheoesophageal speech (TES) and/or electrolarynx speech (ELS) are three speech rehabilitation methods which are commonly provided after total laryngectomy (TL). Methods A systematic review of the literature was conducted to evaluate comparative acoustic, perceptual, and patient-reported outcomes for ES, TES, ELS and healthy speakers. Results Twenty-six articles could be included. In most studies, methodological quality was low. It is likely that an inclusion bias exists, many studies only included exceptional speakers. Significant better outcomes are reported for TES compared to ES for the acoustic parameters, fundamental frequency, maximum phonation time and intensity. Perceptually, TES is rated with a significant better voice quality and intelligibility than ES and ELS. None of the speech rehabilitation groups reported clearly better outcomes in patient-reported outcomes. Conclusions Studies on speech outcomes after TL are flawed in design and represent weak levels of evidence. There is an urge for standardized measurement tools for evaluations of substitute voice speakers. TES is the favorable speech rehabilitation method according to acoustic and perceptual outcomes. All speaker groups after TL report a degree of voice handicap. Knowledge of caretakers and differences in health care and insurance systems play a role in the speech rehabilitation options that can be offered. Electronic supplementary material The online version of this article (doi:10.1007/s00405-017-4790-6) contains supplementary material, which is available to authorized users.
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Abstract
ABSTRACT Objective: to verify the content evidence of a spectrographic analysis protocol. Methods: a methodological study in which five speech therapists who assessed the clarity and the relevance of the protocol were selected. The Content Validity Index (CVI) was used to investigate the level of agreement among judges regarding overall aspects, items and domains of the protocol. Results: most judges considered the overall aspects of the protocol as comprehensive. As for clarity, 17 items showed an excellent content validity (CVI ≥ 0.78), three showed a good content validity (0.60 ≤ CVI ≤ 0.77) and two items were judged as poor (CVI ≤ 0.59). As for relevance, 19 items obtained an excellent content validity (CVI ≥ 0.78) and three had a good content validity (0.60 ≤ CVI ≤ 0.77). The judges suggested adding items related to vocal signal normality in all domains. After the analysis, 18 items required no reformulation, five items were added, three were reformulated and one was excluded. Conclusion: the proposed protocol was regarded as a comprehensive one. The items presented a good to excellent content validity as for clarity and relevance. After this validation step, the protocol ended up presenting 25 items distributed into five domains.
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Lopes LW, Batista Simões L, Delfino da Silva J, da Silva Evangelista D, da Nóbrega e Ugulino AC, Oliveira Costa Silva P, Jefferson Dias Vieira V. Accuracy of Acoustic Analysis Measurements in the Evaluation of Patients With Different Laryngeal Diagnoses. J Voice 2017; 31:382.e15-382.e26. [DOI: 10.1016/j.jvoice.2016.08.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/20/2016] [Accepted: 08/23/2016] [Indexed: 11/29/2022]
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Acoustic and Auditory Perception Effects of the Voice Therapy Technique Finger Kazoo in Adult Women. J Voice 2017; 31:390.e9-390.e15. [DOI: 10.1016/j.jvoice.2016.09.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/23/2016] [Indexed: 11/20/2022]
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Villafuerte-Gonzalez R, Valadez-Jimenez VM, Sierra-Ramirez JA, Ysunza PA, Chavarria-Villafuerte K, Hernandez-Lopez X. Acoustic Analysis and Electroglottography in Elite Vocal Performers. J Voice 2017; 31:391.e1-391.e6. [DOI: 10.1016/j.jvoice.2016.09.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 09/21/2016] [Accepted: 09/23/2016] [Indexed: 11/27/2022]
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Siau RTK, Goswamy J, Jones S, Khwaja S. Is OperaVOX a clinically useful tool for the assessment of voice in a general ENT clinic? BMC EAR, NOSE, AND THROAT DISORDERS 2017; 17:4. [PMID: 28439206 PMCID: PMC5399865 DOI: 10.1186/s12901-017-0037-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 04/05/2017] [Indexed: 01/26/2023]
Abstract
Background Objective acoustic analysis is a key component of multidimensional voice assessment. OperaVOX is an iOS app which has been shown to be comparable to Multi Dimensional Voice Program for most principal measures of vocal function. As a relatively cheap, portable and easily accessible form of acoustic analysis, OperaVOX may be more clinically useful than laboratory-based software in many situations. This study aims to determine whether correlation exists between acoustic measurements obtained using OperaVOX, and perceptual evaluation of voice. Methods Forty-four voices from the multidisciplinary voice clinic were examined. Each voice was assessed blindly by a single experienced voice therapist using the GRBAS scale, and analysed using OperaVOX. The Spearman rank correlation co-efficient was calculated between each element of the GRBAS scale and acoustic measurements obtained by OperaVOX. Results Significant correlations were identified between GRBAS scores and OperaVOX parameters. Grade correlated significantly with jitter (ρ = 0.495, p < 0.05), shimmer (ρ = 0.385, p < 0.05), noise-to-harmonic ratio (NHR; ρ = 0.526, p < 0.05) and maximum phonation time (MPT; ρ = −0.415, p < 0.05). Roughness did not correlate with any of the measured variables. Breathiness correlated significantly with jitter (ρ = 0.342, p < 0.05), NHR (ρ = 0.344, p < 0.05) and MPT (ρ = −0.336, p < 0.05). Aesthenia correlated with NHR (ρ = 0.413, p < 0.05) and MPT (ρ = −0.399, p < 0.05). Strain correlated with Jitter (ρ = 0.560, p < 0.05), NHR (ρ = 0.600, p < 0.05) and MPT (ρ = −0.356, p < 0.05). Conclusions OperaVOX provides objective acoustic analysis which has shown statistically significant correlation to perceptual evaluation using the GRBAS scale. The accessibility of the software package makes it possible for a wide range of health practitioners, e.g. general ENT surgeons, vascular surgeons, thyroid surgeons and cardiothoracic surgeons to objectively monitor outcomes and complications of surgical procedures that may affect vocal function. Given the increasing requirement for surgeons to monitor their outcomes as part of the move towards ‘surgeon reported outcomes’ this may become an invaluable tool towards that goal.
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Affiliation(s)
- Richard Teck Kee Siau
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Jay Goswamy
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Sue Jones
- Department of Speech and Language Therapy, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Sadie Khwaja
- Department of Otolaryngology - Head and Neck Surgery, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
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Lopes LW, da Silva JD, Simões LB, Evangelista DDS, Silva POC, Almeida AA, de Lima-Silva MFB. Relationship Between Acoustic Measurements and Self-evaluation in Patients With Voice Disorders. J Voice 2017; 31:119.e1-119.e10. [DOI: 10.1016/j.jvoice.2016.02.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
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Cantor Cutiva LC, Fajardo A, Burdorf A. Associations between self-perceived voice disorders in teachers, perceptual assessment by speech-language pathologists, and instrumental analysis. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 18:550-559. [PMID: 27063687 DOI: 10.3109/17549507.2016.1143969] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE The three aims of this study were to assess agreement between self-perceived voice disorders, perceptual and instrumental assessment; to determine factors associated with perceptual voice assessment; and to determine which associated factors would serve as an initial screening tool for ascertainment of the presence or absence of voice disorders among teachers. METHOD A cross-sectional study was conducted among 574 Colombian teachers. Participants filled in a questionnaire and recorded a voice sample. The voice samples were perceptually evaluated by a speech-language pathologist with the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale and objectively with an automated voice analysis for fundamental frequency, jitter, shimmer and maximum phonation time. Agreements between GRBAS scale, self-reported voice disorders and instrumental analysis were determined by unweighted Coheńs Kappa coefficients and receiver operating characteristic curves. Multivariate logistic regression analysis was used to identify variables associated with the perceptual assessment. Diagnostic performance of these variables was assessed by the area under the curve. RESULT There was no agreement between self-reported voice disorders and GRBAS assessments. Maximum phonation time showed a slight agreement with perceptual assessment of voice disorders. CONCLUSION Since these three methods offer different information, it is advisable to include all methods in ascertainment of voice disorders among teachers at work.
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Affiliation(s)
| | - Adriana Fajardo
- b Programa de Fonoaudiología , Universidad del Rosario , Bogotá D.C. , Colombia
| | - Alex Burdorf
- a Department of Public Health, Erasmus MC , University Medical Center , Rotterdam , the Netherlands and
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Karlsson T, Tuomi L, Andréll P, Johansson M, Finizia C. Effects of voice rehabilitation after radiotherapy for laryngeal cancer: a longitudinal study. LOGOP PHONIATR VOCO 2016; 42:167-177. [DOI: 10.1080/14015439.2016.1250943] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Therese Karlsson
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lisa Tuomi
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Paulin Andréll
- Department of Molecular and Clinical Medicine/Multidisciplinary Pain Center, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mia Johansson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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Normative Values of Voice Analysis Parameters With Respect to Menstrual Cycle in Healthy Adult Turkish Women. J Voice 2016; 30:322-8. [DOI: 10.1016/j.jvoice.2015.04.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/21/2015] [Indexed: 11/18/2022]
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Brockmann-Bauser M, Beyer D, Bohlender JE. Reliable acoustic measurements in children between 5;0 and 9;11 years: Gender, age, height and weight effects on fundamental frequency, jitter and shimmer in phonations without and with controlled voice SPL. Int J Pediatr Otorhinolaryngol 2015; 79:2035-42. [PMID: 26412461 DOI: 10.1016/j.ijporl.2015.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/02/2015] [Accepted: 09/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Current pediatric voice assessment guidelines include instrumental measurements of fundamental frequency (F0) and the perturbation indices jitter and shimmer. In children below 10 years, gender, age, height and weight effects on these parameters have been inconsistently characterized. Recent research in healthy children showed, that differences in habitual speaking voice intensity (voice SPL) under the usual assessment procedure significantly affect jitter and shimmer. These effects were reduced in phonations with controlled voice SPL >80dBA. Reliable measurement methods and description of physiologic influencing factors are essential to identify pathologic voices. OBJECTIVE This cross-sectional single cohort study investigates in children between 5;0 and 9;11 years how gender, age, height and weight affect voice F0, jitter and shimmer in phonations at individually "medium" voice intensity (modeling the usual clinical practice) and with controlled voice SPL >80dBA. SUBJECTS AND METHODS 68 vocally healthy children (39 f/29 m) aged 5;0-9;11 years provided 3 prolonged phonations of/a/at individually "medium" and controlled voice intensity at ">80dBA" (visual feedback, 10cm distance). F0 (Hz), jitter (%), shimmer (%) and voice SPL (dBA) were determined with PRAAT. Gender, age, height and weight effects without and with controlled voice SPL were assessed by descriptive statistics, Analysis of Variance and Linear Mixed Models. RESULTS F0 (Hz), jitter (%), shimmer (%) and voice SPL (dBA) were significantly different in medium voice compared to >80dBA (p<0.01). In medium phonations girls had a higher F0 than boys (girls: 276.7(50.7), boys: 261.5(33.7)), but with >80dBA this difference was only minimal (girls: 328.9(52.2), boys 327.9(51.2)). Mean jitter (0.27(0.10)) and shimmer (4.34(1.68)) were smaller and showed less spread (jitter: 0.5(0.26); shimmer: 9.47(3.47)) with >80dBA. Gender, age, height and weight had no significant effects on F0, jitter, shimmer and voice SPL in both phonation types (p-range=0.42-0.99). CONCLUSIONS Neither without nor with controlled voice SPL there were systematic gender, age, height or weight effects on voice F0, jitter and shimmer. Gender related F0 discrepancies were equalized in phonations with >80dBA. In children below 10 years gender related acoustic voice differences may be mainly linked to behavior, which should be considered in future works regarding physiologic voice development.
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Affiliation(s)
- Meike Brockmann-Bauser
- Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland.
| | - Denis Beyer
- Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland.
| | - Jörg Edgar Bohlender
- Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland.
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Behlau M, Madazio G, Oliveira G. Functional dysphonia: strategies to improve patient outcomes. PATIENT-RELATED OUTCOME MEASURES 2015; 6:243-53. [PMID: 26664248 PMCID: PMC4671799 DOI: 10.2147/prom.s68631] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Functional dysphonia (FD) refers to a voice problem in the absence of a physical condition. It is a multifaceted voice disorder. There is no consensus with regard to its definition and inclusion criteria for diagnosis. FD has many predisposing and precipitating factors, which may include genetic susceptibility, psychological traits, and the vocal behavior itself. The assessment of voice disorders should be multidimensional. In addition to the clinical examination, auditory-perceptual, acoustic, and self-assessment analyses are very important. Self-assessment was introduced in the field of voice 25 years ago and has produced a major impact in the clinical and scientific scenario. The choice of treatment for FD is vocal rehabilitation by means of direct therapy; however, compliance has been an issue, except for cases of functional aphonia or when an intensive training is administered. Nevertheless, there are currently no controlled studies that have explored the different options of treatment regimens for these patients. Strategies to improve patient outcome involve proper multidisciplinary diagnosis in order to exclude neurological and psychiatric disorders, careful voice documentation with quantitative measurement and qualitative description of the vocal deviation for comparison after treatment, acoustic evaluation to gather data on the mechanism involved in voice production, self-assessment questionnaires to map the impact of the voice problem on the basis of the patient’s perspective, referral to psychological evaluation in cases of suspected clinical anxiety and/or depression, identification of dysfunctional coping strategies, self-regulation data to assist patients with their vocal load, and direct and intensive vocal rehabilitation to reduce psychological resistance and to reassure patient’s recovery. An international multicentric effort, involving a large population of voice-disordered patients with no physical pathology, could produce enough data for achieving a consensus regarding this complex problem.
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Affiliation(s)
- Mara Behlau
- Voice Department, Centro de Estudos da Voz - CEV, São Paulo, Brazil
| | - Glaucya Madazio
- Voice Department, Centro de Estudos da Voz - CEV, São Paulo, Brazil
| | - Gisele Oliveira
- Voice Department, Centro de Estudos da Voz - CEV, São Paulo, Brazil
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Mat Baki M, Wood G, Alston M, Ratcliffe P, Sandhu G, Rubin JS, Birchall MA. Reliability of OperaVOX against Multidimensional Voice Program (MDVP). Clin Otolaryngol 2015; 40:22-8. [PMID: 25263076 DOI: 10.1111/coa.12313] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the agreement between OperaVOX and MDVP. DESIGN Cross sectional reliability study. SETTING University teaching hospital. METHODS Fifty healthy volunteers and 50 voice disorder patients had supervised recordings in a quiet room using OperaVOX by the iPod's internal microphone with sampling rate of 45 kHz. A five-seconds recording of vowel/a/was used to measure fundamental frequency (F0), jitter, shimmer and noise-to-harmonic ratio (NHR). All healthy volunteers and 21 patients had a second recording. The recorded voices were also analysed using the MDVP. The inter- and intrasoftware reliability was analysed using intraclass correlation (ICC) test and Bland-Altman (BA) method. Mann-Whitney test was used to compare the acoustic parameters between healthy volunteers and patients. RESULTS Nine of 50 patients had severe aperiodic voice. The ICC was high with a confidence interval of >0.75 for the inter- and intrasoftware reliability except for the NHR. For the intersoftware BA analysis, excluding the severe aperiodic voice data sets, the bias (95% LOA) of F0, jitter, shimmer and NHR was 0.81 (11.32, -9.71); -0.13 (1.26, -1.52); -0.52 (1.68, -2.72); and 0.08 (0.27, -0.10). For the intrasoftware reliability, it was -1.48 (18.43, -21.39); 0.05 (1.31, -1.21); -0.01 (2.87, -2.89); and 0.005 (0.20, -0.18), respectively. Normative data from the healthy volunteers were obtained. There was a significant difference in all acoustic parameters between volunteers and patients measured by the Opera-VOX (P < 0.001) except for F0 in females (P = 0.87). CONCLUSION OperaVOX is comparable to MDVP and has high internal consistency for measuring the F0, jitter and shimmer of voice except for the NHR.
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Affiliation(s)
- M Mat Baki
- Ear Institute, University College London, London, UK; Royal National Throat Nose Ear Hospital, University College London Hospital NHS Trust, London, UK; Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Lopes LW, Lima ILB, Azevedo EHM, Silva MFBDL, Silva POC. Análise acústica de vozes infantis: contribuições do diagrama de desvio fonatório. REVISTA CEFAC 2015. [DOI: 10.1590/1982-0216201517415514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo:OBJETIVO:analisar o poder discriminatório do diagrama de desvio fonatório na avaliação do tipo de voz predominante e da intensidade do desvio vocal em crianças.MÉTODOS:coletou-se a vogal /ε/ sustentada de 93 crianças. A intensidade do desvio e a qualidade vocal foram analisadas por meio da escala analógico-visual. Utilizou-se o diagrama para a análise acústica, com avaliação da distribuição dos sinais vocais de acordo com a área, quadrante, forma e densidade. Realizou-se o teste de igualdade de proporções e o teste Qui-quadrado(x2) para comparar as variáveis, e o teste de Correlação de Spearman para correlacionar as medidas acústicas e perceptivo-auditivas.RESULTADOS: houve correlação entre a classificação de quadrantes e a intensidade do desvio vocal para todos os parâmetros analisados. Houve diferença estatisticamente significante entre a proporção de crianças com rugosidade, soprosidade, tensão e instabilidade em relação à área, ao quadrante e à forma. Não houve diferença estatisticamente significante entre a proporção de crianças com e sem desvio da qualidade vocal em relação a todos os parâmetros analisados, ao considerar a distribuição das vozes nos quadrantes.CONCLUSÃO: o diagrama de desvio fonatório foi capaz de diferenciar a qualidade vocal predominante por meio da distribuição nos quadrantes, embora não tenha discriminado as vozes infantis saudáveis e alteradas.
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