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Tomaszewska JZ, Georgakis A. Electroglottography in Medical Diagnostics of Vocal Tract Pathologies: A Systematic Review. J Voice 2023:S0892-1997(23)00388-0. [PMID: 38143204 DOI: 10.1016/j.jvoice.2023.12.004] [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: 09/29/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 12/26/2023]
Abstract
Electroglottography (EGG) is a technology developed for measuring the vocal fold contact area during human voice production. Although considered subjective and unreliable as a sole diagnostic method, with the correct application of relevant computational methods, it can constitute a most promising non-invasive voice disorder diagnostic tools in a form of a digital vocal tract pathology classifier. The aim of the following study is to gather and evaluate currently existing digital voice quality assessment systems and vocal tract abnormality classification systems that rely on the use of electroglottographic bio-impedance signals. To fully comprehend the findings of this review, first the subject of EGG is introduced. For that, we summarise most relevant existing research on EGG with a particular focus on its application in diagnostics. Then, we move on to the focal point of this work, which is describing and comparing the existing EGG-based digital voice pathology classification systems. With the application of PRISMA model, 13 articles were chosen and analysed in detail. Direct comparison between chosen studies brought us to pivotal conclusions, which have been described in Section 5 of this report. Meanwhile, certain limitations arising from the literature were identified, such as questionable understanding of the nature of EGG bio-impedance signals. The appropriate recommendations for future work were made, including the application of different methods for EGG feature extraction, as well as the need for continuous EGG datasets development containing signals gathered in various conditions and with different equipments.
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Menon JR, Mathew AS. Hyperfunctional Laryngeal Behavior: Is It the Cause or Consequence of Vocal Fold Polyps? Ann Otol Rhinol Laryngol 2022:34894221129906. [PMID: 36239318 DOI: 10.1177/00034894221129906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the relationship between arytenoid adduction asymmetry (AAA) and the demographic and morphological characteristics of true vocal fold (TVF) polyps and establish the cause and effect relationship between AAA and TVF polyps. METHODS Videolaryngostroboscopic findings of 163 patients with TVF polyps were retrospectively reviewed and categorized into Group 1 with AAA or Group 2 without AAA. Demographic details, clinicomorphological polyp characteristics, supraglottic phenomena, and AAA attributes were analyzed. RESULTS Group 1 was younger than Group 2 (fourth vs fifth decade; P = .0066). Polyp characteristics showed no significant intergroup differences. The association between AAA and false vocal fold (FVF) adduction (65.28% vs 47.62% in Group 1 and 2 respectively; P = .0441) was significant. In relation to TVF polyp laterality, contralateral and bilateral AAA and FVF adduction respectively, was significant. CONCLUSION AAA is a compensatory laryngeal adaptation akin to a FVF adduction muscle tension pattern. With a concomitant laryngeal pathology and high vocal demand, AAA is a consequence and not the cause for underlying laryngeal pathology which hinders glottic closure.
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Affiliation(s)
- Jayakumar R Menon
- Department of Laryngology, Dr Jayakumar's Institute of Laryngology, Trivandrum, Kerala, India
| | - Amrita Suzanne Mathew
- Department of Laryngology, Dr Jayakumar's Institute of Laryngology, Trivandrum, Kerala, India
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Evaluation of the Electroglottographic Signal Variability in Organic and Functional Dysphonia. J Voice 2020; 36:881.e5-881.e16. [DOI: 10.1016/j.jvoice.2020.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 11/18/2022]
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Electroglottography – An Update. J Voice 2020; 34:503-526. [DOI: 10.1016/j.jvoice.2018.12.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 12/27/2018] [Accepted: 12/28/2018] [Indexed: 11/21/2022]
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Kitayama I, Hosokawa K, Iwahashi T, Iwahashi M, Iwaki S, Kato C, Yoshida M, Umatani M, Matsushiro N, Ogawa M, Inohara H. Intertext Variability of Smoothed Cepstral Peak Prominence, Methods to Control It, and Its Diagnostic Properties. J Voice 2020; 34:305-319. [DOI: 10.1016/j.jvoice.2018.09.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 11/30/2022]
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Nacci A, Romeo SO, Cavaliere MD, Macerata A, Bastiani L, Paludetti G, Galli J, Marchese MR, Barillari MR, Barillari U, Berrettini S, Laschi C, Cianchetti M, Manti M, Ursino F, Fattori B. Comparison of electroglottographic variability index in euphonic and pathological voice. ACTA ACUST UNITED AC 2019; 39:381-388. [PMID: 30745592 PMCID: PMC6966776 DOI: 10.14639/0392-100x-2127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 03/26/2018] [Indexed: 11/23/2022]
Abstract
In a recent study we introduced a new approach for analysis of the electroglottographic (ECG) signal. This method is based on the evaluation of variation of the EGG signal and its first derivative, through new software developed by the Pisan phoniatric school. This software is designed to extract quantitative indices related to the contacting and decontacting phases of the vocal folds during phonation. The software allows us to study the combined variability of vibration amplitude and velocity (i.e. the first derivative of the EGG signal). Pathological voices show a much more variable EGG signal compared to normal voices, since cordal vibration is made irregular due to the presence of glottis plane pathologies. With the aim of demonstrating the differences between normal and pathological voices relevant to combined vibration amplitude and velocity variability, we have introduced a new quantitative parameter named “variability index, VI”. We studied 95 subjects (35 normal and 60 with pathological voice); among pathologic subjects, 15 showed functional dysphonia and 45 showed organic dysphonia. Subjects affected by organic dysphonia presented: 15 bilateral vocal nodules, 15 unilateral polyps and 15 unilateral cysts. All subjects were studied with videolaryngostroboscopy; electro-acoustic parameters of the voice were analysed with the KayPENTAX CSL (Model 4500) system. The EGG signal was recorded using KAY Model 6103 connected to the CSL system. The new software for the analysis of the EGG signal allows us to obtain not only a VI total value relevant to variability during all the recording, but also partial VI values relevant to the different glottis cycle phases. In fact, plotting the amplitude variation and its first derivative on a Lissajous graph, it is possible to divide the whole glottis cycle into four phases (each represented by four quadrants on the graph): the initial vocal folds contacting activity (VI-Q1), the last phase of vocal folds contacting (VI-Q2), the first phase of vocal folds decontacting (VI-Q3) and the last phase, up to the complete decontacting of vocal folds (VI-Q4). For each quadrant, it is also possible to work out the percent variability index. By comparing the variability indices in the normal and pathological groups, we obtained the following results: the total VI was significantly higher in the pathological subjects (0.25 vs 0.18; p = 0.01); the absolute value of VI was higher in pathological subjects, although the difference was not significant (VI-Q2, 0.041 vs 0.029; VI-Q3, 0.065 vs 0.058; VI-Q4, 0.054 vs 0.052). The percent variability in the Q2 quadrant (VI-Q2%) was significantly higher in pathological subjects compared to normal subjects (0.22 vs 0.16) (p = 0.01). The results of this study confirm that our new software for analysis of EGG signal can distinguish normal voice from pathological voice based on the new quantitative parameter VI. Moreover, this study emphasises that the final contact phase of vocal folds is the most representative of the difference between the normal and pathological voice and shows a wider variability in terms of amplitude and vibration velocity. Further studies on larger groups of subjects will be required to confirm these results and assess differences in the EGG signal among the various vocal fold pathologies.
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Affiliation(s)
- A Nacci
- ENT, Audiology and Phoniatrics Unit, University Hospital of Pisa, Italy
| | - S O Romeo
- ENT, Audiology and Phoniatrics Unit, University Hospital of Pisa, Italy
| | - M D Cavaliere
- ENT, Audiology and Phoniatrics Unit, University Hospital of Pisa, Italy
| | - A Macerata
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - L Bastiani
- Institute of Clinical Physiology of the Italian National Research Council (IFC-CNR), Pisa, Italy
| | - G Paludetti
- Institute of Otorhinolaryngology, Department of Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - J Galli
- Institute of Otorhinolaryngology, Department of Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - M R Marchese
- Institute of Otorhinolaryngology, Department of Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M R Barillari
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - U Barillari
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - S Berrettini
- ENT, Audiology and Phoniatrics Unit, University Hospital of Pisa, Italy.,Division of ENT Diseases, Karolinska Institutet, Stockholm, Sweden
| | - C Laschi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - M Cianchetti
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - M Manti
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - F Ursino
- National Institute for Research in Phoniatrics, University of Pisa, Italy
| | - B Fattori
- ENT, Audiology and Phoniatrics Unit, University Hospital of Pisa, Italy
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Macerata A, Nacci A, Manti M, Cianchetti M, Matteucci J, Romeo SO, Fattori B, Berrettini S, Laschi C, Ursino F. Evaluation of the Electroglottographic signal variability by amplitude-speed combined analysis. Biomed Signal Process Control 2017. [DOI: 10.1016/j.bspc.2016.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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Iwahashi T, Ogawa M, Hosokawa K, Kato C, Inohara H. The Effects of Humming on the Prephonatory Vocal Fold Motions Under High-Speed Digital Imaging in Nondysphonic Speakers. J Voice 2017; 31:291-299. [DOI: 10.1016/j.jvoice.2016.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 09/04/2016] [Accepted: 09/08/2016] [Indexed: 10/20/2022]
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9
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Investigation of the Immediate Effects of Humming on Vocal Fold Vibration Irregularity Using Electroglottography and High-speed Laryngoscopy in Patients With Organic Voice Disorders. J Voice 2017; 31:48-56. [DOI: 10.1016/j.jvoice.2016.03.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/17/2016] [Indexed: 11/22/2022]
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Somanath K, Mau T. A Measure of the Auditory-perceptual Quality of Strain from Electroglottographic Analysis of Continuous Dysphonic Speech: Application to Adductor Spasmodic Dysphonia. J Voice 2016; 30:770.e9-770.e21. [PMID: 26739857 DOI: 10.1016/j.jvoice.2015.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/05/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES (1) To develop an automated algorithm to analyze electroglottographic (EGG) signal in continuous dysphonic speech, and (2) to identify EGG waveform parameters that correlate with the auditory-perceptual quality of strain in the speech of patients with adductor spasmodic dysphonia (ADSD). STUDY DESIGN Software development with application in a prospective controlled study. METHODS EGG was recorded from 12 normal speakers and 12 subjects with ADSD reading excerpts from the Rainbow Passage. Data were processed by a new algorithm developed with the specific goal of analyzing continuous dysphonic speech. The contact quotient, pulse width, a new parameter peak skew, and various contact closing slope quotient and contact opening slope quotient measures were extracted. EGG parameters were compared between normal and ADSD speech. Within the ADSD group, intra-subject comparison was also made between perceptually strained syllables and unstrained syllables. RESULTS The opening slope quotient SO7525 distinguished strained syllables from unstrained syllables in continuous speech within individual subjects with ADSD. The standard deviations, but not the means, of contact quotient, EGGW50, peak skew, and SO7525 were different between normal and ADSD speakers. The strain-stress pattern in continuous speech can be visualized as color gradients based on the variation of EGG parameter values. CONCLUSIONS EGG parameters may provide a within-subject measure of vocal strain and serve as a marker for treatment response. The addition of EGG to multidimensional assessment may lead to improved characterization of the voice disturbance in ADSD.
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Affiliation(s)
- Keerthan Somanath
- Clinical Center for Voice Care, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ted Mau
- Clinical Center for Voice Care, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas..
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Hohm J, Döllinger M, Bohr C, Kniesburges S, Ziethe A. Influence of F0 and Sequence Length of Audio and Electroglottographic Signals on Perturbation Measures for Voice Assessment. J Voice 2015; 29:517.e11-21. [PMID: 25944290 DOI: 10.1016/j.jvoice.2014.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 10/01/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Within the functional assessment of voice disorders, an objective analysis of measured parameters from audio, electroglottographic (EGG), or visual signals is desired. In a typical clinical situation, reliable objective analysis is not always possible due to missing standardization and unknown stability of the clinical parameters. The aim of this study was to investigate the robustness/stability of measured clinical parameters of the audio and EGG signals in a typical clinical setting to ensure a reliable objective analysis. In particular, the influence of F0 and of the sequence length on several definitions of jitter and shimmer will be analyzed. PATIENTS AND METHODS Seventy-four young healthy women produced a sustained vowel /a/ and an upward triad with abrupt changeovers. Different sequence lengths (100, 150, 500, and 1000 ms) of sustained phonation and triads (100 and 150 ms) were extracted from the audio and EGG signals. In total, six variations of jitter and four variations of shimmer parameters were analyzed. RESULTS Jitter%, Jitter11p, and JitterPPQ of the audio signal as well as Jittermean, Shimmer, and Shimmer11p of the EGG signal are unaffected by both sequence length and F0. CONCLUSIONS Influence of F0 and sequence length on several perturbation measures of the audio and EGG signals was identified. For an objective clinical voice assessment, unaffected definitions of jitter and shimmer should be preferred and applied to enable comparability between different recordings, examinations, and studies.
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Affiliation(s)
- Julian Hohm
- Department for Phoniatrics and Pediatric Audiology, University Hospital Erlangen, Erlangen, Germany
| | - Michael Döllinger
- Department for Phoniatrics and Pediatric Audiology, University Hospital Erlangen, Erlangen, Germany
| | - Christopher Bohr
- Department for Phoniatrics and Pediatric Audiology, University Hospital Erlangen, Erlangen, Germany
| | - Stefan Kniesburges
- Department for Phoniatrics and Pediatric Audiology, University Hospital Erlangen, Erlangen, Germany
| | - Anke Ziethe
- Department for Phoniatrics and Pediatric Audiology, University Hospital Erlangen, Erlangen, Germany.
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Hosokawa K, Ogawa M, Iwahashi T, Hashimoto M, Inohara H. Does Cervical Muscular Contraction Affect the Measurement for Electroglottographic Perturbation Parameters? J Voice 2015; 29:660-9. [PMID: 25873542 DOI: 10.1016/j.jvoice.2014.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 11/04/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The purpose was to assess whether cervical muscular contraction during phonation influences the period and amplitude perturbation quotients (PPQ and APQ, respectively) of electroglottographic (EGG) signals, and whether high-pass filtering can attenuate these effects. STUDY DESIGN Prospective. METHODS We included 19 nondysphonic speakers and 21 patients with muscle tension dysphonia. During the recording of acoustic and EGG signals, each participant was instructed to naturally phonate sustained vowels /i:/ and /a:/ (NP tasks), and additionally, each nondysphonic participant was asked to phonate the same vowels in a nondysphonic voice quality while contracting the cervical muscles (muscular contracted phonation [MCP] tasks). To confirm the contraction, surface and needle electromyography (EMG) was performed. The EGG signals were high-pass filtered at different cutoff frequencies from 0 to 90 Hz and were subsequently analyzed for the PPQ and APQ. RESULTS Compared with the NP tasks, the MCP tasks enhanced the cervical EMG activities ranging from 0 to more than 1000 Hz, but conferred only low-frequency noise to the EGG signals under 50 Hz and increased the values for EGG-APQ, but not EGG-PPQ. These EGG-APQ values exhibited gradual decreases after high-pass filtering with an increase in the cutoff frequency ranging from 0 to 50 Hz in both groups, followed by plateaus during the MCP tasks in the nondysphonic group. CONCLUSIONS The present results demonstrate that cervical muscular contraction seriously affects the EGG-APQ values for unfiltered EGG signals independent of the EMG activities and that appropriate high-pass filtering over 50 Hz can attenuate these effects.
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Affiliation(s)
- Kiyohito Hosokawa
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Makoto Ogawa
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Toshihiko Iwahashi
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Michiko Hashimoto
- Department of Otorhinolaryngology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Hyogo, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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Immediate Effects of Humming on Computed Electroglottographic Parameters in Patients With Muscle Tension Dysphonia. J Voice 2014; 28:733-41. [DOI: 10.1016/j.jvoice.2014.02.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 02/10/2014] [Indexed: 11/23/2022]
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Statistical Analysis of the Reliability of Acoustic and Electroglottographic Perturbation Parameters for the Detection of Vocal Roughness. J Voice 2014; 28:263.e9-263.e16. [DOI: 10.1016/j.jvoice.2013.07.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 07/15/2013] [Indexed: 11/22/2022]
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