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Kitayama I, Hosokawa K, Iwaki S, Yoshida M, Miyauchi A, Ogawa M, Inohara H. Validation of Subharmonics Quantification Using Two-Stage Cepstral Analysis. J Voice 2023:S0892-1997(23)00389-2. [PMID: 38142187 DOI: 10.1016/j.jvoice.2023.12.002] [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: 10/13/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVES Hoarseness is primarily perceived as breathiness or roughness. Despite the various tools that quantitatively assess hoarseness, roughness has been difficult to quantify because of its complex acoustic structure, such as subharmonics. The parameter obtained from the two-stage cepstral analysis is promising for evaluating roughness. Thus, this study aimed to improve the accuracy of the parameter using a customized pitch setting and investigate the relationship between roughness and subharmonics. STUDY DESIGN The design is a retrospective study. METHODS Two-stage cepstral analysis was used to analyze the voice recordings of 455 participants, speech impaired and normal controls, using the Analysis of Dysphonia in Speech and Voice and Praat software. For validation, the ground truth of subharmonics was visually quantified using a narrowband spectrogram. The reliability and validity of the two-stage cepstral analysis and subharmonics measures on spectrograms were evaluated. RESULTS The two-stage cepstral analysis showed a very strong correlation (r = 0.963) between the two software programs. Intra- and inter-rater reliability of the subharmonics measures on spectrograms were also good. Two-stage cepstral analysis showed that even with customized pitch settings, the diagnostic systems and correlations for perceptual roughness and subharmonics were weak to moderate. The subharmonics measures on spectrograms showed a strong correlation with roughness and moderate diagnostic accuracy of subharmonics. CONCLUSIONS The two-stage cepstral analysis showed some improvement in diagnostic accuracy and correlation with customized pitch settings, but it did not sufficiently detect subharmonics or roughness. The analysis using subharmonics measures on spectrograms proved the high correlation between subharmonics and roughness, indicating that developing acoustic analysis parameters that sufficiently detect subharmonics is necessary.
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Affiliation(s)
- Itsuki Kitayama
- Department of Otorhinolaryngology and Head & Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kiyohito Hosokawa
- Department of Otorhinolaryngology and Head & Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Otorhinolaryngology, Osaka Police Hospital, Osaka, Japan.
| | - Shinobu Iwaki
- Department of Rehabilitation, Kobe University Hospital, Hyogo, Japan
| | - Misao Yoshida
- Department of Rehabilitation, Sakai Heisei Hospital, Osaka, Japan
| | | | - Makoto Ogawa
- Department of Otorhinolaryngology and Head & Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology and Head & Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Aichinger P, Schoentgen J. Detection of Diplophonation in Audio Recordings of German Standard Text Readings. J Voice 2019; 33:949.e1-949.e10. [DOI: 10.1016/j.jvoice.2018.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 11/29/2022]
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Aichinger P, Hagmüller M, Roesner I, Schneider-Stickler B, Schoentgen J, Pernkopf F. Fundamental frequency tracking in diplophonic voices. Biomed Signal Process Control 2017. [DOI: 10.1016/j.bspc.2016.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Towards Objective Voice Assessment: The Diplophonia Diagram. J Voice 2017; 31:253.e17-253.e26. [DOI: 10.1016/j.jvoice.2016.06.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2014] [Indexed: 11/19/2022]
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Aichinger P, Roesner I, Leonhard M, Schneider-Stickler B, Denk-Linnert DM, Bigenzahn W, Fuchs AK, Hagmüller M, Kubin G. Comparison of an audio-based and a video-based approach for detecting diplophonia. Biomed Signal Process Control 2017. [DOI: 10.1016/j.bspc.2014.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Quantitative Analysis of Vocal Fold Vibration in Vocal Fold Paralysis With the Use of High-speed Digital Imaging. J Voice 2016; 30:766.e13-766.e22. [DOI: 10.1016/j.jvoice.2015.10.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/22/2015] [Indexed: 11/21/2022]
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Aichinger P, Hagmüller M, Roesner I, Bigenzahn W, Schneider-Stickler B, Schoentgen J. Diplophonia Disturbs Jitter and Shimmer Measurement. Folia Phoniatr Logop 2016; 68:22-8. [DOI: 10.1159/000447589] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Konomi U, Watanabe Y, Komazawa D. Sex Differences in Pitch Range and Speech Fundamental Frequency After Arytenoid Adduction and Thyroplasty. J Voice 2016; 30:362-70. [DOI: 10.1016/j.jvoice.2015.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
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Deliyski DD, Hillman RE, Mehta DD. Laryngeal High-Speed Videoendoscopy: Rationale and Recommendation for Accurate and Consistent Terminology. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2015; 58:1488-92. [PMID: 26375398 PMCID: PMC4686309 DOI: 10.1044/2015_jslhr-s-14-0253] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 02/25/2015] [Accepted: 06/09/2015] [Indexed: 05/24/2023]
Abstract
PURPOSE The authors discuss the rationale behind the term laryngeal high-speed videoendoscopy to describe the application of high-speed endoscopic imaging techniques to the visualization of vocal fold vibration. METHOD Commentary on the advantages of using accurate and consistent terminology in the field of voice research is provided. Specific justification is described for each component of the term high-speed videoendoscopy, which is compared and contrasted with alternative terminologies in the literature. RESULTS In addition to the ubiquitous high-speed descriptor, the term endoscopy is necessary to specify the appropriate imaging technology and distinguish among modalities such as ultrasound, magnetic resonance imaging, and nonendoscopic optical imaging. Furthermore, the term video critically indicates the electronic recording of a sequence of optical still images representing scenes in motion, in contrast to strobed images using high-speed photography and non-optical high-speed magnetic resonance imaging. High-speed videoendoscopy thus concisely describes the technology and can be appended by the desired anatomical nomenclature such as laryngeal. CONCLUSIONS Laryngeal high-speed videoendoscopy strikes a balance between conciseness and specificity when referring to the typical high-speed imaging method performed on human participants. Guidance for the creation of future terminology provides clarity and context for current and future experiments and the dissemination of results among researchers.
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Affiliation(s)
- Dimitar D. Deliyski
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, OH
- University of Cincinnati, OH
| | - Robert E. Hillman
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Massachusetts General Hospital Institute of Health Professions, Charlestown, MA
| | - Daryush D. Mehta
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Massachusetts General Hospital Institute of Health Professions, Charlestown, MA
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Chen W, Woo P, Murry T. Vocal Fold Vibratory Changes Following Surgical Intervention. J Voice 2015; 30:224-7. [PMID: 26028368 DOI: 10.1016/j.jvoice.2015.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 03/24/2015] [Indexed: 10/23/2022]
Abstract
High-speed videoendoscopy (HSV) captures direct cycle-to-cycle visualization of vocal fold movement in real time. This ultrafast recording rate is capable of visualizing the vibratory motion of the vocal folds in severely disordered phonation and provides a direct method for examining vibratory changes after vocal fold surgery. The purpose of this study was to examine the vibratory motion before and after surgical intervention. HSV was captured from two subjects with identifiable midvocal fold benign lesions and six subjects with highly aperiodic vocal fold vibration before and after phonosurgery. Digital kymography (DKG) was used to extract high-speed kymographic vocal fold images sampled at the midmembranous, anterior 1/3, and posterior 1/3 region. Spectral analysis was subsequently applied to the DKG to quantify the cycle-to-cycle movements of the left and the right vocal fold, expressed as a spectrum. Before intervention, the vibratory spectrum consisted of decreased and flat-like spectral peaks with robust power asymmetry. After intervention, increases in spectral power and decreases in power symmetry were noted. Spectral power increases were most remarkable in the midmembranous region of the vocal fold. Surgical modification resulted in improved lateral excursion of the vocal folds, vibratory function, and perceptual measures of Voice Handicap Index-10. These changes in vibratory behavior trended toward normal vocal fold vibration.
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Affiliation(s)
- Wenli Chen
- Department of Rehabilitation, NYU Lutheran Medical Center, Brooklyn, New York.
| | - Peak Woo
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Thomas Murry
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University, Loma Linda, California
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Afsah OE. Approach to diagnosis of vocal fold immobility: a literature review. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2015. [DOI: 10.4103/1012-5574.156088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Yamauchi A, Yokonishi H, Imagawa H, Sakakibara KI, Nito T, Tayama N, Yamasoba T. Quantitative analysis of digital videokymography: a preliminary study on age- and gender-related difference of vocal fold vibration in normal speakers. J Voice 2014; 29:109-19. [PMID: 25228432 DOI: 10.1016/j.jvoice.2014.05.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 05/12/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Kymography is an effective method for assessing temporal patterns of vocal fold vibrations. Because kymographic data for a number of normal speakers based on high-speed digital imaging (HSDI) were limited in the literature, this prospective study was conducted to provide normative kymographic HSDI data and clarify gender- and age-related normal variations. METHODS Vocally healthy adults were divided into young (≤35 years) and elderly groups (≥65 years). Kymograms were recomposed from HSDI data at the midglottal level, and kymographic parameters were analyzed quantitatively. Then gender- and age-related differences were evaluated. RESULTS A total of 26 young subjects (9 men and 17 women, mean age: 27 years) and 20 elderly subjects (8 men and 12 women, mean age: 73 years) were investigated. Obtained data generally matched the values in the literature. Slight asymmetry was seen in all groups, with the elderly subjects having more evident asymmetry than the young subjects. Most of the kymographic parameters showed a negative correlation with fundamental frequency (F0), whereas the open quotient displayed a positive correlation with F0. There were significant intergroup differences in F0, amplitude and lateral peak at a speaking F0. CONCLUSIONS The present quantitative findings generally matched the qualitative kymographic data reported in the literature. When judging whether a vibratory pattern is normal or pathological, both gender and age should be taken into account, because gender- and age-related variations of symmetry, F0, and phase were frequently observed in the present study.
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Affiliation(s)
- Akihito Yamauchi
- Department of Otolaryngology, The University of Tokyo Hospital, Tokyo, Japan.
| | - Hisayuki Yokonishi
- Department of Otolaryngology, The Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Hiroshi Imagawa
- Department of Otolaryngology, The University of Tokyo Hospital, Tokyo, Japan
| | - Ken-Ichi Sakakibara
- Department of Communication Disorders, The Health Sciences University of Hokkaido, Ishikari-Gun, Hokkaido, Japan
| | - Takaharu Nito
- Department of Otolaryngology, The University of Tokyo Hospital, Tokyo, Japan
| | - Niro Tayama
- Department of Otolaryngology and Tracheo-esophagology, The National Center for Global Health and Medicine, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, The University of Tokyo Hospital, Tokyo, Japan
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Yamauchi A, Yokonishi H, Imagawa H, Sakakibara KI, Nito T, Tayama N, Yamasoba T. Age- and gender-related difference of vocal fold vibration and glottal configuration in normal speakers: analysis with glottal area waveform. J Voice 2014; 28:525-31. [PMID: 24836359 DOI: 10.1016/j.jvoice.2014.01.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 01/28/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Glottal area waveform (GAW) analysis is widely used in the assessment of vocal fold vibration by high-speed digital imaging (HSDI). Because normative GAW data obtained from a large number of subjects have not been reported, we conducted a prospective study to obtain normative results for GAW analysis of HSDI findings and clarify normal variations associated with gender and age. METHODS Vocally healthy adults were divided into a young group (aged ≤ 35 years) and an elderly group (aged ≥ 65 years). The configuration and size of the glottal area were assessed at different phases of the glottal cycle, and gender- and age-related differences were evaluated. RESULTS A total of 26 young subjects (nine men and 17 women; mean age: 27 years) and 20 elderly subjects (eight men and 12 women; mean age: 73 years) were investigated. The glottal area at different points of the glottal cycle showed a negative correlation with frequency. Although the GAW parameters of young women appeared to be different from those of the other subgroups, the differences were not statistically significant. Young women predominantly had a triangular- or vase-shaped glottal configuration at all frequencies, whereas the other subgroups showed various glottal shapes. CONCLUSION The present study clarified gender- and age-related differences of GAW parameters obtained with HSDI. Young women were likely to show different glottal configurations and different responses to frequency changes from those of young men, elderly men, and elderly women. Phonosurgeons should pay attention to the normal variations detected in the present study.
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Affiliation(s)
- Akihito Yamauchi
- Department of Otolaryngology, The University of Tokyo Hospital, Bunkyo-Ku, Tokyo, Japan.
| | - Hisayuki Yokonishi
- Department of Otolaryngology, The Tokyo Metropolitan Police Hospital, Nakano-Ku, Tokyo, Japan
| | - Hiroshi Imagawa
- Department of Otolaryngology, The University of Tokyo Hospital, Bunkyo-Ku, Tokyo, Japan
| | - Ken-Ichi Sakakibara
- Department of Communication Disorders, The Health Sciences University of Hokkaido, Ishikari-Gun, Hokkaido, Japan
| | - Takaharu Nito
- Department of Otolaryngology, The University of Tokyo Hospital, Bunkyo-Ku, Tokyo, Japan
| | - Niro Tayama
- Department of Otolaryngology and Tracheo-esophagology, The National Center for Global Health and Medicine, Shinjuku-Ku, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, The University of Tokyo Hospital, Bunkyo-Ku, Tokyo, Japan
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Kupfer RA, Meyer TK. Evaluation of Unilateral Vocal Fold Immobility. CURRENT OTORHINOLARYNGOLOGY REPORTS 2014. [DOI: 10.1007/s40136-014-0043-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kwon SK, Kim HB, Song JJ, Cho CG, Park SW, Choi JS, Ryu J, Oh SH, Lee JH. Vocal fold augmentation with injectable polycaprolactone microspheres/pluronic F127 hydrogel: long-term in vivo study for the treatment of glottal insufficiency. PLoS One 2014; 9:e85512. [PMID: 24465582 PMCID: PMC3899012 DOI: 10.1371/journal.pone.0085512] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 11/27/2013] [Indexed: 11/18/2022] Open
Abstract
There is increasing demand for reconstruction of glottal insufficiency. Several injection materials have been examined for this purpose, but all had limitations, such as poor long-term durability, migration from the injection site, inflammation, granuloma formation, and interference with vocal fold vibration due to viscoelastic mismatch. Here, we developed a novel injection material, consisting of polycaprolactone (PCL) microspheres, which exhibits better viscoelasticity than conventional materials, and Pluronic F127 carrier, which decreases the migration of the injection materials. The material was injected into rabbits with glottal insufficiency and compared with the FDA-approved injection material, calcium hydroxylapatite (CaHA). Endoscopic and histological examinations indicated that PCL/Pluronic F127 remained at the injection site with no inflammatory response or granuloma formation, whereas CaHA leaked out and migrated from the injection site. Therefore, vocal fold augmentation was almost completely retained during the 12-month follow-up period in this study. Moreover, induced phonation and high-speed recording of vocal fold vibration showed decreased vocal fold gap area in the PCL/Pluronic F127 group. Our newly developed injection material, PCL/Pluronic F127, permits efficient augmentation of paralyzed vocal fold without complications, a concept that can be applied clinically, as demonstrated by the successful long-term follow-up.
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Affiliation(s)
- Seong Keun Kwon
- Department of Otorhinolaryngology, Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- Cancer Research Institute, Seoul, Republic of Korea
- Seoul National University Medical Research Center, Seoul, Republic of Korea
- * E-mail:
| | - Hee-Bok Kim
- Department of Otorhinolaryngology, Head and Neck Surgery, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Jae-Jun Song
- Department of Otorhinolaryngology, Head and Neck Surgery, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Chang Gun Cho
- Department of Otorhinolaryngology, Head and Neck Surgery, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Seok-Won Park
- Department of Otorhinolaryngology, Head and Neck Surgery, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Jong-Sun Choi
- Department of Pathology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Junsun Ryu
- Head and Neck Oncology Clinic, National Cancer Center, Goyang, Republic of Korea
| | - Se Heang Oh
- Department of Nanobiomedical Science & WCU Research Center, Dankook University, Cheonan, Republic of Korea
| | - Jin Ho Lee
- Department of Advanced Materials, Hannam University, Yuseong Gu, Daejeon, Republic of Korea
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Abstract
PURPOSE OF REVIEW Kymographic imaging is a modern method for displaying and evaluating vibratory behaviour of the vocal folds which is crucial for voice production. This review summarizes the state of the art of this method, and focuses on the progress in this area within the last 5 years. RECENT FINDINGS Videokymography, using a special videocamera, offers high-speed (video)kymographic images in real time, which is advantageous in daily clinical practice. Two other methods use software to create kymograms retrospectively: digital kymography processes high-speed videolaryngoscopic recordings and offers numerous research possibilities, whereas strobovideokymography processes videostroboscopic recordings, and its use is limited to regular vibration patterns. Current studies reveal that high-speed kymographic images allow more reliable visual evaluation of vibrations than by watching video recordings. Image analysis procedures have been advanced to quantify the vibration properties of the vocal folds. New information has been obtained on asymmetry, mucosal waves, irregularities, phonation onset, and nonlinear dynamic phenomena in voice disorders, as well as in singing. SUMMARY High-speed kymography visualizes vibratory features which are not simply observable via traditional methods. It shows large potential in better understanding the functional origin of hoarseness and unsteady phonatory states. Further research in this area is envisioned.
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Cantillo-Baños E, Jurado-Ramos A, Gutiérrez-Jódas J, Ariza-Vargas L. Vocal fold insufficiency: medialization laryngoplasty vs calcium hydroxylapatite microspheres (Radiesse Voice®). Acta Otolaryngol 2013; 133:270-5. [PMID: 23145984 DOI: 10.3109/00016489.2012.728717] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The choice of technique will depend on the glottic gap observed by stroboscopy, the alteration of the Voice Handicap Index (VHI) and the recorded values of harmonics-to-noise ratio (HNR), jitter and shimmer, and the general health, age and underlying pathology. There are statistically significant differences between the values of VHI, shimmer and jitter in favour of those cases operated on within 6 months of diagnosis. Alternatives are discussed. OBJECTIVES This study analysed and compared the functional, morphological and acoustic results, after surgery, through the techniques of medialization thyroplasty and infiltration of biomaterials to correct incomplete closure of the glottis. METHODS A total of 21 patients with dysphonia due to vocal fold insufficiency (13 women and 8 men) and ages ranging between 30 and 65 years (mean age 40.84, SD 12.5) were evaluated. The material used for augmentation surgery consisted of calcium hydroxylapatite microspheres. Measurements (VHI, jitter, shimmer and HNR) were performed before surgery and at 6 and 24 months post-intervention. RESULTS Overall, statistically significant differences were observed relating to measurements (p < 0.01) and surgical techniques (p < 0.05) analyzed. In particular, these differences were located in pairs pre-surgery - 6 months post-surgery and pre-surgery - post 24 months, in the four variables, and between the two techniques used in jitter (p = 0.008), HNR (p = 0.045) and VHI (p = 0.035).
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Affiliation(s)
- Enrique Cantillo-Baños
- Otolaryngology and Head and Neck Surgery Service, Reina Sofía University Hospital, Spain.
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Phase Difference of Vocally Healthy Subjects in High-Speed Digital Imaging Analyzed With Laryngotopography. J Voice 2013; 27:39-45. [DOI: 10.1016/j.jvoice.2012.08.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 08/02/2012] [Indexed: 11/19/2022]
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Zhang Z, Kreiman J, Gerratt BR, Garellek M. Acoustic and perceptual effects of changes in body layer stiffness in symmetric and asymmetric vocal fold models. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2013; 133:453-62. [PMID: 23297917 PMCID: PMC3548838 DOI: 10.1121/1.4770235] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
At present, it is not well understood how changes in vocal fold biomechanics correspond to changes in voice quality. Understanding such cross-domain links from physiology to acoustics to perception in the "speech chain" is of both theoretical and clinical importance. This study investigates links between changes in body layer stiffness, which is regulated primarily by the thyroarytenoid muscle, and the consequent changes in acoustics and voice quality under left-right symmetric and asymmetric stiffness conditions. Voice samples were generated using three series of two-layer physical vocal fold models, which differed only in body stiffness. Differences in perceived voice quality in each series were then measured in a "sort and rate" listening experiment. The results showed that increasing body stiffness better maintained vocal fold adductory position, thereby exciting more high-order harmonics, differences that listeners readily perceived. Changes to the degree of left-right stiffness mismatch and the resulting left-right vibratory asymmetry did not produce perceptually significant differences in quality unless the stiffness mismatch was large enough to cause a change in vibratory mode. This suggests that a vibration pattern with left-right asymmetry does not necessarily result in a salient deviation in voice quality, and thus may not always be of clinical significance.
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Affiliation(s)
- Zhaoyan Zhang
- Department of Head and Neck Surgery, UCLA School of Medicine, 31-24 Rehabilitation Center, 1000 Veteran Avenue, Los Angeles, California 90095-1794, USA.
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Abstract
PURPOSE OF REVIEW This review presents recent advances in high-speed digital imaging (HSDI) of the larynx including data acquisition, data analysis, and clinical applicability. RECENT FINDINGS Software designed to summarize the large amounts of data captured with HSDI makes it possible to quantitatively analyze recordings from patients, improving the accuracy of the methodology. The new software has been used in studies of normal individuals, increasing our knowledge of normal vocal fold vibratory behavior. HSDI has also been used in patient populations and shows promise in distinguishing various laryngeal conditions that are difficult to distinguish with other imaging modalities. Studies of postoperative patients with HSDI demonstrate the return of some vibratory characteristics but not others, potentially leading the way to improvements in surgical technique. SUMMARY Recent advances in HSDI technology have increased the clinical usefulness of the imaging technology and recent studies demonstrate the clinical applicability of HSDI. However, challenges to widespread clinical use of HSDI remain.
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Tsutsui H, Manabe N, Uno M, Imamura H, Kamada T, Kusunoki H, Shiotani A, Hata J, Harada T, Haruma K. Esophageal motor dysfunction plays a key role in GERD with globus sensation--analysis of factors promoting resistance to PPI therapy. Scand J Gastroenterol 2012; 47:893-9. [PMID: 22594305 DOI: 10.3109/00365521.2012.685756] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Patients with gastroesophageal reflux disease (GERD) also have various extra-esophageal symptoms. Laryngopharyngeal reflux disease (LPRD) is a subtype of GERD associated with globus sensation, but proton pump inhibitor (PPI) therapy achieves disappointing results. This study investigated esophageal motility in GERD patients with globus sensation who were resistant to PPI therapy. DESIGN The subjects were 350 patients with globus sensation. All patients underwent both laryngoscopy and upper gastrointestinal endoscopy to exclude organic disease. After 4 weeks of treatment with rabeprazole sodium (20 mg daily), the patients were divided into PPI-responsive and PPI-resistant groups. Then we investigated esophageal motility in the PPI-resistant group by a multichannel intraluminal impedance and manometry study. RESULTS A total of 119 patients (55.6%) were resistant to PPI therapy, among whom 57 patients (47.9%) had abnormal esophageal motility. They included 36 patients (66.4%) with ineffective esophageal motility, 9 patients (14.4%) with achalasia, 6 patients (9.6%) with diffuse esophageal spasm, 5 patients (8%) with nutcracker esophagus, and 1 patient (1.6%) with hypertensive lower esophageal sphincter. There were significant differences of upper esophageal sphincter pressure and esophageal body peristalsis between the patients with PPI-resistant LPRD and healthy controls matched for age and sex. CONCLUSION Among patients with PPI-resistant LPRD, 47.9% had abnormal esophageal motility.
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Affiliation(s)
- Hideaki Tsutsui
- Department of Internal Medicine, Division of Gastroenterology, Kawasaki Medical School, Kurashiki, Japan
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Skodacek D, Arnold U, Storck K, Perez Alvarez C, Ratzinger S, Staudenmaier R. Chondrocytes suspended in modified fibrin glue for vocal fold augmentation: An in vitro study in a porcine larynx model. Head Neck 2011; 34:667-73. [PMID: 21717522 DOI: 10.1002/hed.21789] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Injection laryngoplasty is an option for treatment of dysphonia following vocal fold paralysis. Modified fibrin glue with suspended chondrocytes might be a favorable cell-based material for permanent vocal fold medialization. METHODS We compared fibrin glue with suspended chondrocytes to collagen and hyaluronic acid gels concerning alteration of vocal fold vibration and correct intralaryngeal placement after intralaryngeal injection into porcine larynges. Viscoelastic properties of the materials were analyzed by means of a parallel plate rheometer. RESULTS Fibrin glue with cells was comparable to collagen and hyaluronic acid with respect to amplitudes, symmetry, and periodicity of vocal fold vibration. Application and positioning of fibrin glue with suspended chondrocytes were technically undemanding and comparable with controls. Complex stress modulus of fibrin glue with suspended cells was comparable to that of collagen gel. CONCLUSIONS Fibrin glue with suspended chondrocytes seems suitable for the indication of injection laryngoplasty and holds promise for permanent vocal fold medialization.
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Affiliation(s)
- Daniel Skodacek
- Department of Otorhinolaryngology, Klinikum rechts der Isar, TU München, Munich, Germany.
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