Vocal fold nodules: A disorder of phonation organs or auditory feedback?

Reducing Vocal Fatigue With Bone Conduction Devices: Comparing Forbrain and Sidetone Amplification

PURPOSE

Altered auditory feedback research aims to identify methods to strengthen speakers' awareness of their own voicing behaviors, diminish their perception of vocal fatigue, and improve their voice production. This study aims to compare the effects of two bone conduction devices that provide altered auditory feedback.

METHOD

Twenty participants (19-33 years old, age: M [SD] = 25.5 [3.85] years) participated in a vocal loading task using a standard Forbrain device that provides filtered auditory feedback via bone conduction and a modified Forbrain device that provides only sidetone amplification, and a control condition with no device was also included. They rated their vocal fatigue on a visual analog scale every 2 min during the vocal loading task. Additionally, pre- and postloading voice samples were analyzed for acoustic voice parameters.

RESULTS

Across all participants, the use of bone conduction-altered auditory feedback devices resulted in a lower vocal fatigue when compared to the condition with no feedback. During the pre- and postvoice samples, the sound pressure level decreased significantly during feedback conditions. During feedback conditions, spectral mean and standard deviation significantly decreased, and spectral skew significantly increased.

CONCLUSION

The results promote bone conduction as a possible preventative tool that may reduce self-reported vocal fatigue and compensatory voice production for healthy individuals without voice disorders.

Voice Biofeedback via Bone Conduction Headphones: Effects on Acoustic Voice Parameters and Self-Reported Vocal Effort in Individuals With Voice Disorders

PURPOSE

This study explores sidetone amplification (amplified playback of one's own voice) provided via bone conduction in participants with voice disorders. The effects of bone conduction feedback on acoustic voice parameters and vocal effort ratings are examined.

METHODS

Speech samples of 47 participants with voice disorders were recorded in three auditory feedback conditions: two with sidetone amplification delivered via bone conduction and one condition with no alteration of the feedback. After each task, the participants rated their vocal effort on a visual analog scale. The voice recordings were evaluated by a speech-language pathologist through the GRBAS scale and processed to calculate the within-participant centered sound pressure level (SPL) values, the mean pitch strength (PS), the time dose (Dt%), and cepstral peak prominence smoothed (CPPS). The effects of the feedback conditions on these acoustic parameters and vocal effort ratings were analyzed.

RESULTS

The high sidetone amplification condition resulted in a statistically significant decrease in the within-participant centered SPL values and mean pitch strength across all participants. The feedback conditions had no statistically significant effects on the vocal effort ratings, time dose (Dt%), or CPPS.

CONCLUSIONS

This study provides an evidence that bone conduction sidetone amplification contributes to a consistent adaptation in the within-participant centered SPL values (ΔSPL) in patients with vocal hyperfunction, glottal insufficiency, and organic/neurological laryngeal pathologies compared to conditions with no feedback.

Long-term Average Spectrum and Nasal Accelerometry in Sentences of Differing Nasality and Forward-Focused Vowel Productions Under Altered Auditory Feedback

OBJECTIVES AND BACKGROUND

To investigate whether voice focus adjustments can alter the audio-vocal feedback and consequently modulate speech/voice motor control. Speaking with a forward-focused voice was expected to enhance audio-vocal feedback and thus decrease the variability of vocal fundamental frequency (F0).

MATERIALS AND METHOD

Twenty-two healthy, untrained adults (10 males and 12 females) were requested to sustain vowel /a/ with their natural focus and a forward focus and to naturally read the nasal, oral, and mixed oral-nasal sentences in normal noise-masked auditory conditions. Meanwhile, a miniature accelerometer was externally attached on the noise to detect the nasal vibrations during vocalization. Audio recordings were made and analyzed using the long-term average spectrum (LTAS) and power spectral analysis of F0.

RESULTS

Compared with naturally-focused vowel production and oral sentences, forward-focused vowel productions and nasal sentences both showed significant increases in nasal accelerometric amplitude and the spectral power within the range of 200∼300 Hz, and significantly decreased the F0 variability below 3 Hz, which has been reported to be associated with enhanced auditory feedback in our previous research. The auditory masking not only significantly increased the low-frequency F0 variability, but also significantly decreased the ratio of the spectral power within 200∼300 Hz to the power within 300∼1000 Hz for the vowel and sentence productions. Gender differences were found in the correlations between the degree of nasal coupling and F0 stability as well as in the LTAS characteristics in response to noise.

CONCLUSIONS

Variations in nasal-oral acoustic coupling not only change the formant features of speech signals, but involuntarily influence the auditory feedback control of vocal fold vibrations. Speakers tend to show improved F0 stability in response to a forward-focused voice adjustment.

Contributions of Forward-Focused Voice to Audio-Vocal Feedback Measured Using Nasal Accelerometry and Power Spectral Analysis of Vocal Fundamental Frequency

PURPOSE

The spectral powers of the modulations of vocal fundamental frequency (f _o) less than 3 Hz (low-frequency power, LFP) and between 3 and 8 Hz (middle-frequency power, MFP) had been established to indicate the audio-vocal feedback status and vocal efficiency of a speaker, and a resonant voice may enhance the auditory-vocal feedback. This study aims to determine whether the auditory feedback can be augmented by a forward and resonant voice and therefore contribute to the modulations of f _o variability.

METHOD

Vocal signals and accelerometric signals of lateral nasal cartilage were obtained from 27 healthy adults who, respectively, sustained vowels /a/ and /i/ with their habitual speaking voice and with a forward-focused voice under three auditory conditions: natural hearing (N0), high-level noise exposure (N90), and low-level noise exposure (N60). Nasal skin vibrations were measured using a nasal accelerometry to reflect voice resonance status. Vocal intensity and f _o variability were also analyzed to show the auditory-vocal interactions under varied conditions of auditory feedback and voice resonance.

RESULTS

In both N0 and N90 conditions, forward-focused voice showed a significantly lower LFP than the speakers' habitual voice. In addition, LFP of f _o would significantly increase during natural voice production as the voice feedback was greatly masked by high-intensity noise; however, with a forward-focused voice, the noise-induced variation in LFP was significantly decreased. Under N90, MFP significantly decreased during forward-focused voice production compared with that measured during natural voice production. The stability of f _o modulations was not adversely affected by N60.

CONCLUSION

The results support the idea that vocalizing with a forward-focused voice enhance the auditory feedback of the speaker's own voice and, thus, reduce the variability of f _o during sustained phonation, especially when vocalizing in the high noise condition.