Speech and voice range profiles of adults with untrained normal voices: Methodological implications

The Impact of a Vocal Loading Task on Voice Characteristics of Female Speakers With Benign Vocal Fold Lesions

OBJECTIVES

To examine the effect of a vocal loading task on measures of vocal structure and function in females with benign vocal fold lesions (BVFLs) and determine if change is observed in voice and lesion characteristics.

STUDY DESIGN

Prospective cohort study.

METHODS

Twenty-eight (n = 28) female subjects with phonotraumatic BVFLs completed a vocal loading task of 30 minutes of reading aloud at 75-85 dBA. Multidimensional voice evaluation was completed pre- and post-load, including audio and videostroboscopy recordings and images for expert perceptual ratings and acoustic and aerodynamic evaluation. Subjects also scored themselves using a 10 cm visual analogue scale for Perceived Phonatory Effort, and completed the Evaluation of Ability to Voice Easily, a 12 item self-report scale of current perceived speaking voice function. An exploratory rather than confirmatory approach to data analysis was adopted. The direction and magnitude of the change scores (pre- to post-load) for each individual, across a wide variety of instrumental and self-report measures, were assessed against a Minimal Clinically Important Difference criteria.

RESULTS

Observations of change and the direction of change in vocal response of individuals with BVFLs to 30 minutes of loud vocal load was variable. Minimal to no change was noted for participants pre- to post-load as rated perceptually, for auditory and videostroboscopy samples. For most instrumental measures, change was shown for many participants including an overall improvement in aerodynamic and acoustic measures of function and efficiency post-load for 20 participants (77%) and decline in function for 4 participants (15%). Self-reported effort and vocal function post-load was multidirectional with similar numbers of participants reporting no change, improved function or a decline.

CONCLUSION

Subjects with BVFLs demonstrate change in vocal function following 30 minutes of vocal load. While this change can be variable and multidirectional, overall improvement was observed in instrumental measures of function and efficiency for most participants. Some participants perceived this change to be an increase in effort, some a reduction in effort and some perceived no change. Improved vocal function despite relative lesion stability can seemingly occur after loading in some pathological voices.

CPPS and Voice-Source Parameters: Objective Analysis of the Singing Voice

INTRODUCTION

In recent years cepstral analysis and specific cepstrum-based measures such as smoothed cepstral peak prominence (CPPS) has become increasingly researched and utilized in attempts to determine the extent of overall dysphonia in voice signals. Yet, few studies have extensively examined how specific voice-source parameters affect CPPS values.

OBJECTIVE

Using a range of synthesized tones, this exploratory study sought to systematically analyze the effect of fundamental frequency (fo), vibrato extent, source-spectrum tilt, and the amplitude of the voice-source fundamental on CPPS values.

MATERIALS AND METHODS

A series of scales were synthesised using the freeware Madde. Fundamental frequency, vibrato extent, source-spectrum tilt, and the amplitude of the voice-source fundamental were systematically and independently varied. The tones were analysed in PRAAT, and statistical analyses were conducted in SPSS.

RESULTS

CPPS was significantly affected by both fo and source-spectrum tilt, independently. A nonlinear association was seen between vibrato extent and CPPS, where CPPS values increased from 0 to 0.6 semitones (ST), then rapidly decreased approaching 1.0 ST. No relationship was seen between the amplitude of the voice-source fundamental and CPPS.

CONCLUSION

The large effect of fo should be taken into account when analyzing the voice, particularly in singing-voice research, when comparing pre and posttreatment data, and when comparing inter-subject CPPS data.

Vocal Range Variations Elicited With a Standard Mandarin Reading Passage in Individuals With Voice Disorders

PURPOSE

This study examined whether the "Three Bears Passage" (TB), a standard Mandarin reading passage, could elicit significant vocal range variations in individuals with voice disorders. Relative sensitivity of TB versus another existing standard reading passage, "Passage in Mandarin" (PM), for differentiating between individuals with and without voice disorders was also evaluated.

METHOD

Forty-two individuals with normal voice and 30 individuals with voice disorders participated in the study. Maximum fundamental frequency (f0), minimum f0, mean f0, f0 range, maximum vocal intensity, minimum intensity, mean intensity, and intensity range of all participants reading aloud the two passages were measured with Praat to construct speech range profiles (SRPs).

RESULTS

Significantly larger vocal range was found for TB than for PM in individuals with voice disorders, including significantly higher maximum f0, mean f0, maximum intensity, mean intensity, and significantly larger f0 range and intensity range. Significantly more limited vocal range was observed in individuals with voice disorders than those without, with more obviously restricted SRPs while reading aloud TB compared to PM. Receiver operating characteristic analysis suggested that TB was more sensitive than PM in distinguishing between individuals with and without voice disorders.

CONCLUSIONS

Our findings supported the potential of TB as a standard clinical assessment tool for evaluating pathological changes in vocal range. Future studies should explore if therapeutic approaches based on the passage or variations of it could be developed for overcoming functional limitations and restrictions in vocal range for specific voice disorders.

The Voice Range Profile-A Shortened Protocol Pilot Study

INTRODUCTION

Voice production is a complex process involving the coordination of various anatomical structures and physiologic systems. The Voice Range Profile (VRP) is an established acoustic measure for evaluating voice production that examines minimum and maximum intensity across the frequency range. This pilot study sought to establish a consistent, efficient, and accessible VRP elicitation method. One primary research question was addressed: Does the proposed Short method provide at least as much information as a full, discrete-steps method, which is generally accepted in the literature?

METHODS

In this quasi-repeated measures design, twenty-four singers completed a full VRP based on accepted methods from the literature, and the same participants returned within one to three weeks to complete the proposed Short VRP protocol. The full VRP consisted of steady state productions at every semitone within a participant's range for both minimum and maximum intensities. The Short VRP consisted of steady state productions at every octave and perfect fifth across the semitone range for both minimum and maximum intensities. Additional sampling was completed between points when a 7 dB or greater difference was found between consecutive points. Analysis compared each protocol's average elicitation time differences, average semitone range differences, visual examination of the average VRP graph, and examination of average intensity differences between protocols at specific semitone points. Male and female results were analyzed separately.

RESULTS

The proposed Short protocol produced similar or better intensity ranges when compared with the accepted full elicitation method. The Short protocol produced intensities with 95% or greater similarity to the Full Protocol for male maximum intensity curve, female minimum intensity curve, and female maximum intensity curve.

CONCLUSIONS

When compared with a Full VRP, a Short VRP protocol appears to generate similar minimum and maximum intensity curves allowing for a time-efficient substitute.

Normative Voice Range Profile of the Young Female Voice

OBJECTIVES

Normative data are important in the clinical setting of Speech and Language Pathology. The purpose of this study was to develop a normative reference dataset of voice range profiles from young females.

STUDY DESIGN

Descriptive study including a prospective collection of voice range profile data.

METHODS

Voice range profile recordings from 39 females with healthy voices aged 18 to 28 years were conducted. Seven voice range profile variables were analyzed: minimum and maximum fundamental frequency and intensity, semitone and intensity ranges, and voice range profile area. Descriptive statistical methods were applied.

RESULTS

An age-specific voice range profile normative dataset was established. The mean values and standard deviations were as follows: semitone range 34.7 ± 3.9 ST, minimum fundamental frequency 143.6 ± 21.7 hertz, maximum fundamental frequency 1063.5 ± 160 hertz, intensity range 65.6 ± 5.0 dB, minimum intensity 43.2 ± 2.5 dB SPL, maximum SPL 108.9 ± 5.1 dB SPL, and voice range profile area 1346 ± 222 cells.

CONCLUSION

A normative dataset usable for optimization of future voice assessments has been established. It may especially benefit evaluation and treatment planning for younger females suffering from vocal fold nodules.

Variability in Voice Characteristics of Female Speakers With Phonotraumatic Vocal Fold Lesions

OBJECTIVE

To examine the variability of lesion characteristics and vocal function in female speakers with phonotraumatic vocal fold lesions (PVFLs).

STUDY DESIGN

Prospective Cohort Study METHODS: Thirty adult female speakers with PVFL who were participating in voice therapy were recruited to complete a multidimensional voice analysis at four time points across 1 month. Analysis comprised self-ratings of effort and vocal function, expert ratings of videostroboscopy and audio recordings, and instrumental evaluation by selected aerodynamic and acoustic parameters. The degree of variability across time for each individual was assessed against a minimal clinically important difference threshold.

RESULTS

A high degree of variability across time was observed for participant self-ratings of perceived effort and vocal function, and for instrumental parameters. The greatest degree of variability was observed in aerodynamic measures of airflow and pressure, and the acoustic parameter semitone range. Comparatively less variability was observed in perceptual evaluation of speech, and lesion characteristics via stroboscopy still images. Findings suggest that individuals with all PVFL types and sizes present with variability in function across time, with the greatest degree of variability in function observed in participants with large lesions and vocal fold polyps.

CONCLUSION

Variability is observed in voice characteristics of female speakers with PVFLs across 1 month despite general stability in lesion presentation, suggesting vocal function can change despite the presence of laryngeal pathology. This study highlights the need to explore individual functional and lesion responses across time to determine potential for change and improvement in both aspects when selecting treatment options.

Sex and Age Stratified Voice Data in Japanese Vocally Healthy Individuals: Vocal Capacity

OBJECTIVE

There is no normative voice dataset regarding the vocal capacity of Japanese speakers in the English literature. We collected age- and sex-stratified data on the vocal capacity of vocally healthy Japanese speakers.

METHODS

In total, 111 vocally healthy Japanese speakers (42 men and 69 women) were divided into the young (13 men and 30 women), middle-aged (18 men and 27 women), and elderly (11 men and 12 women) groups. Participants underwent duration-, intensity-, and pitch-related vocal capacity tests using either a conventional method or an aerodynamic method or both. The data obtained were statistically analyzed in terms of age and sex.

RESULTS

Overall, the duration- and pitch-related parameters measured by the conventional method were generally comparable to the previous results in the literature, while duration-, pitch-, and intensity-related parameters measured by the aerodynamic method differed significantly from them. Significant sex differences were noted in all parameters in the duration-, intensity-, and pitch-related vocal capacity tests. Furthermore, significant age-related changes were observed in all parameters, except for the mean flow rate and highest pitch measured by the aerodynamic method.

CONCLUSION

This study is the first to provide a sex- and age-stratified database of the normative vocal capacity data of Japanese speakers. However, further improvements will be needed in the assessment protocols, conditions, or devices used for the duration-, intensity-, and pitch-related vocal capacity tests in the aerodynamic method.

Assessment of the Psychophysiological State of Female Operators Under Simulated Microgravity

The article describes methods of non-verbal speech characteristics analysis used to determine psychophysiological state of female subjects under simulated microgravity conditions ("dry" immersion, DI), as well as the results of the study. A number of indicators of the acute period of adaptation to microgravity conditions was described. The acute adaptation period in female subjects began earlier (evening of the 1st day of DI) and ended faster than in male ones in previous studies (2nd day of DI). This was indicated by a decrease in the level of state anxiety (STAI, p < 0,05) and depression-dejection [Profile of Mood States (POMS), p < 0,05], as well as a decrease in pitch (p < 0,05) and voice intensity (p < 0,05). In addition, women, apparently, used the "freeze" coping strategy - the proportion of neutral facial expressions on the most intense days of the experiment was at maximum. The subjects in this experiment assessed their feelings and emotions better, giving more accurate answers in self-assessment questionnaires, but at the same time tried to look and sound as calm and confident as possible, controlling their expressions. Same trends in the subjects' cognitive performance were identified as in similar experimental conditions earlier: the subjects' psychophysiological excitement corresponded to better performance in sensorimotor tasks. The difference was in the speed of mathematical computation: women in the present study performed the computation faster on the same days when they made fewer pauses in speech, while in men in previous experiments this relationship was inverse.

The Immediate Impact of Targeted Exercises on Voice Characteristics in Female Speakers With Phonotraumatic Vocal Fold Lesions

OBJECTIVE

To examine the immediate impact of 30 minutes of targeted voice exercises on measures of vocal function and lesion characteristics in female speakers with phonotraumatic vocal fold lesions (PVFLs).

STUDY DESIGN

Prospective cohort study.

METHOD

Twenty-nine (n = 29) female subjects with PVFLs completed a 30 minutes targeted voice exercise protocol and a multidimensional voice analysis was conducted immediately pre and post-exercise. Analysis included expert perceptual evaluation of connected speech and stroboscopy recordings, instrumental analysis by selected aerodynamic and acoustic parameters, and self-ratings of effort and vocal function by participants. The direction and magnitude of the change from pre- to post-exercise for each individual across parameters was assessed against a Minimal Clinically Important Difference criteria.

RESULTS

Variability was observed among participants in their response to exercise and across parameters. Multidirectional change in function was demonstrated across instrumental parameters, with observations of both improvement and decline. The most consistent change observed was a reduced PTP post-exercises for 38% of participants (n = 11), and the greatest magnitude of change was observed in aerodynamic measures of airflow and pressure, and the acoustic parameter semitone range. Variability in the direction of change across instrumental measures was observed for 24% of participants (n = 7), while consistent improved function was seen for 45% (n = 13), declined function for 17% (n = 5) and no change for 14% (n = 4). Participant's self-reported effort and function post-exercise was also multidirectional, with the greatest number reporting improvement. Comparatively little change was observed in perceptual evaluation of speech and stroboscopy recordings. Findings suggest that individuals with all lesion types, sizes and liabilities have the potential to improve vocal function immediately post-exercises according to instrumental measures, with the greatest magnitude of change observed in participants with large lesions. Although participants' characteristics did not differentiate, those with nodules or polyps tended to report improvement in function and reduced effort post-exercise, whereas those with a diagnosis of pseudocyst/s or a unilateral lesion appeared to report no change or declined function.

CONCLUSION

Change in measures of vocal function was observed in female speakers with PVFLs immediately following a 30 minutes targeted exercises protocol. Many demonstrated improvement but a high degree of variability was observed in the way speakers respond, and it is likely an individual's response is influenced by a range of factors. Self-rating scales, along with key instrumental parameters sensitive to the presence of PVFLs, may prove most useful in tracking initial change in the immediate and short-term duration in this population, and in assessing stimulability and candidacy for therapy. Further exploration is warranted of stimulability for immediate and cumulative change to achieve sustained improvement in function and efficiency across time.

A Novel Dentary Bone Conduction Device Equipped with Laser Communication in DSP

In this study, we designed a dentary bone conduction system that transmits and receives audio by laser. The main objective of this research was to propose a complete hardware design method, including a laser audio transmitter and receiver and digital signal processor (DSP) based digital signal processing system. We also present a digital filter algorithm that can run on a DSP in real time. This experiment used the CMU ARCTIC databases’ human-voice reading audio as the standard audio. We used a piezoelectric sensor to measure the vibration signal of the bone conduction transducer (BCT) and separately calculated the signal-to-noise ratio (SNR) of the digitally filtered audio output and the unfiltered audio output using DSP. The SNR of the former was twice that of the latter, and the BCT output quality significantly improved. From the results, we can conclude that the dentary bone conduction system integrated with a DSP digital filter enhances sound quality.

A Mandarin Chinese Reading Passage for Eliciting Significant Vocal Range Variations

Purpose There is a lack of standardized Mandarin reading text material that could potentially elicit significant variations in fundamental frequency (F0) and in vocal intensity for clinical voice evaluation. In this study, a phonetically balanced "Three Bears Passage" was developed based on the classical "Goldilocks" story for this purpose. The hypothesis was that the vocal range (F0 range and Intensity range) elicited while reading aloud the passage could be similar to that of the voice range profile (VRP) obtained with sustained vowel production and significantly different from that while reading an existing standard Mandarin passage. Method One hundred twenty young adults (60 men and 60 women, aged 25.22 ± 3.74 years) without vocal pathologies and vocal training participated in the study. Vocal range data, including F0-related measures and intensity-related measures, were obtained with Praat in order to construct VRPs for the sustained /a/ and to construct speech range profiles for passage reading. Results F0 range and intensity range for the new passage were significantly larger than those for the existing Mandarin passage for both male and female participants. In particular, the F0 range for the passage was not significantly different from that of the VRP for male participants. Conclusions These findings suggested that the new passage could allow individuals without vocal training to demonstrate a large vocal range in both F0 and vocal intensity, in a passage reading setting in a relatively short time. Further studies should be pursued with the passage to investigate the vocal range and vocal potential of individuals with voice disorders.

Standardization and Feasibility of Voice Range Profile Measurements in Epidemiological Studies

OBJECTIVES

The voice range profile (VRP) is composed of the speaking VRP (spVRP) and the singing VRP (siVRP). Different examination methods of VRP and effects of interobserver variability were evaluated to define a standard operating procedure (SOP) suitable for the specific use in epidemiological studies. Subsequently the feasibility of the SOP was investigated in a larger number of participants.

STUDY DESIGN

Cross-sectional study.

METHODS

In a first phase both the spVRP and the siVRP of 51 female students were measured by four differently experienced examiners. Using a cross-over study design the effects of two different recording methods (manual vs automatic) and three different types of instructions given by the examiner (none vs before vs during recording) were investigated. In a second phase, the SOP for VRP recording was tested in the framework of a feasibility study in 110 (55 female and 55 male) participants.

RESULTS

The average total investigation time was significantly (P = 0.001) higher for the manual recording method (6.1 minutes ± 1.0) in comparison to the automated (5.5 minutes ± 0.7) recording method. The manual recording method led to significantly lower values of minimum frequency (F0min) (P = 0.013) and minimum intensity (SPLmin) (P < 0.001) and higher values of the maximum frequency (F0max) (P = 0.005) of the siVRP. The maximum phonation time, F0max, SPLmax of the siVRP and the frequency and intensity of the shouting voice (Level IV) of the spVRP showed significantly (P < 0.001) higher values when the examiner was allowed to give instructions and advise during the recording. Voice parameters of the siVRP did not show significant associations with the experience of the examiner.

CONCLUSIONS

Standardization of VRP measurements is important to obtain correct and reproducible data in a reasonable examination time. The SOP proposed here proved to be feasible in the setting of an epidemiological study.

Fundamental Frequency Variations Across the Menstrual Cycle and the Use of an Oral Contraceptive Pill

Purpose Concentrations of sex steroid hormones-estrogens, progesterone, and testosterone-have been associated with premenstrual and menstrual vocal symptoms. However, the extent to which these symptoms may be reflected on acoustical features of the voice is still debated. This study investigates variations in fundamental frequency (f _o) and related parameters in connected speech across phases of the menstrual cycle and during the use of a combined oral contraceptive pill (OCP). Method Electrolaryngographic recordings were made, and blood samples were collected at three different phases of the menstrual cycle-menstrual, follicular, and luteal-for placebo and OCP use. These two conditions were blindly and randomly allocated in the study. Speaking f _o (SFF), SFF standard deviation, SFF rate of change, SFF slope, maximum and minimum f _o, and f _o range were extracted for nine healthy females while reading a phrase from the Rainbow Passage. Concentrations of sex hormones were analyzed in serum. Nonparametric statistical tests were carried out to assess differences between phases and conditions. Results SFF, its standard deviation, and maximum f _o were significantly different between phases of the menstrual cycle for placebo use only. Menstrual phase showed the lowest values. Maximum and minimum f _o were significantly different between placebo and OCP use for menstrual and follicular phases, respectively. Conclusions Fluctuations in sex steroid hormones across the menstrual cycle alter f _o in speech more than a particular hormonal concentration. OCP use seems to have a stabilizing effect on the voice relative to f _o and related parameters in speech.

Voice Function in Gender-Diverse People Assigned Female at Birth: Results From a Participant-Centered Mixed-Methods Study and Implications for Clinical Practice

Purpose The purpose of this study was to investigate whether there were indications of restrictions to voice function in our group of gender-diverse people assigned female at birth (GD people^AFAB) and whether the participants would benefit from professional voice support. Method We conducted a descriptive, cross-sectional, mixed-methods study combining qualitative content analyses of semistructured interviews, phoniatric examinations, and acoustical voice analyses. Fourteen German-speaking GD people^AFAB participated. The data were examined for indications of restrictions to voice function according to the results of participant self-evaluation, auditory-perceptual analyses, laryngostroboscopic examinations, and acoustical measurements. Results All participants presented with indications of restrictions to voice function, with vocal power, voice quality, singing voice, laryngeal function, pitch range/variability, and vocal control having found to be most frequently affected (in over 60% of participants). Sixty-four percent of participants expressed an interest in professional voice support, with clinicians and researchers recommending professional voice support for 67% and 71%, respectively. Conclusions GD people^AFAB may experience restrictions to a range of domains of voice function and request or be recommended to participate in professional voice support. Research into this area needs to be intensified so that a more in-depth understanding of the potential voice problems GD people^AFAB might experience can be produced and members of this group can be provided with more comprehensive, evidence-based, and high-quality professional support if and when they need it.

Low-Frequency Pitch Perception in Cochlear Implant Recipients With Normal Hearing in the Contralateral Ear

Purpose Three experiments were carried out to evaluate the low-frequency pitch perception of adults with unilateral hearing loss who received a cochlear implant (CI). Method Participants were recruited from a cohort of CI users with unilateral hearing loss and normal hearing in the contralateral ear. First, low-frequency pitch perception was assessed for the 5 most apical electrodes at 1, 3, 6, and 12 months after CI activation using an adaptive pitch-matching task. Participants listened with a coding strategy that presents low-frequency temporal fine structure (TFS) and compared the pitch to that of an acoustic target presented to the normal hearing ear. Next, participants listened with an envelope-only, continuous interleaved sampling strategy. Pitch perception was compared between coding strategies to assess the influence of TFS cues on low-frequency pitch perception. Finally, participants completed a vocal pitch-matching task to corroborate the results obtained with the adaptive pitch-matching task. Results Pitch matches roughly corresponded to electrode center frequencies (CFs) in the CI map. Adaptive pitch matches exceeded the CF for the most apical electrode, an effect that was larger for continuous interleaved sampling than TFS. Vocal pitch matches were variable but correlated with the CF of the 3 most apical electrodes. There was no evidence that pitch matches changed between the 1- and 12-month intervals. Conclusions Relatively accurate and asymptotic pitch perception was observed at the 1-month interval, indicating either very rapid acclimatization or the provision of familiar place and rate cues. Early availability of appropriate pitch cues could have played a role in the early improvements in localization and masked speech recognition previously observed in this cohort. Supplemental Material https://doi.org/10.23641/asha.8862389.

Voice dissatisfaction in individuals with a disorder of sex development

OBJECTIVE

Changes of sex hormone levels in disorders of sex development (DSD) can affect the body, including the vocal folds, during and after foetal development. The voice is a gender characteristic that may also be affected. There is a lack of knowledge on voice alteration in DSD. To explore this in different forms of DSD, we describe the prevalence of voice alterations and investigate patient satisfaction with voice.

DESIGN

The study is part of dsd-LIFE, a multicentre cross-sectional clinical evaluation project assessing the long-term outcomes of surgical, hormonal and psychological interventions in individuals with DSD.

PATIENTS

The study included 1040 individuals with different forms of DSD, that is Turner and Klinefelter syndromes, different degrees of gonadal dysgenesis and 46 XY DSD. Participants were recruited through patient advocacy groups and health care.

MEASUREMENTS

Satisfaction with voice, Adam's apple, if patient's self-identified gender was mistaken on the phone leading to distress.

RESULTS

A vast majority of the participants with DSD (between 58.3% to 82% in various groups) were not satisfied with their voice, and approximately 15% (n = 147) were mistaken on the phone in accordance with self-identified gender. For 102 participants, this caused distress.

CONCLUSIONS

We have identified that voice problems are a cause of distress in all forms of DSD. This result needs to be confirmed and compared with controls. We recommend that evaluation of the voice should be included in future international guidelines for management of DSD.

Gender-specific reference ranges of the vocal extent measure in young and healthy adults

Objective: The recently developed vocal extent measure (VEM) quantifies a patient's vocal capacity as documented in the voice range profile (VRP). This study presents the first reference ranges of the VEM for young subjects without voice complaints. Furthermore, this study investigates the influence of gender on the VEM as well as the correlation of the VEM with the dysphonia severity index (DSI).Patients and methods: Reference ranges were captured by combining a retrospective analysis of subjects who received a medical fitness certificate of a healthy voice (n = 135) and a prospective analysis of adult volunteers without voice complaints (n = 67). Every participant obtained a standardized voice assessment comprising videolaryngostroboscopy, auditory-perceptual analysis, acoustic analysis, VRP, and the Voice Handicap Index (VHI-9i).Results: A total of 202 subjects were recruited and investigated. Due to our stringent selection criteria, 51 participants had to be excluded from further analysis. The remaining data of 151 participants (52 males, 99 females), aged 18-39 years (mean 24, SD 5), were analysed in more detail. The mean of the VEM amounted to 123.7 (SD 12.6) for males and 114.4 (SD 13.3) for females. The values differed significantly between both sexes and correlated significantly with the corresponding DSI values.Conclusion: By introducing the first reference values, this study represents the next step of implementing the VEM in daily phoniatric diagnostics. These values serve as a basis to interpret the VEM regarding the degree of severity of voice disorders and to evaluate treatment success.

Intelligibility Enhancement Assessment and Intervention: a single-case experimental design with two multilingual university students

Speech-language pathologists (SLPs) may be approached by multilingual speakers wishing to improve their intelligibility in English. Intelligibility is an essential element of spoken language proficiency and is particularly important for multilingual international students given their need to express complex ideas in an additional language. Intelligibility Enhancement aims to improve the intelligibility and acceptability of consonants, vowels and prosody with multilingual speakers who are learning to speak English. This study aimed to describe the Intelligibility Enhancement Assessment and Intervention Protocols and determine whether the intervention changed multilingual university students' English intelligibility. A multiple-baseline single-case experimental design was applied with direct inter-subject replication across two female participants whose home languages were Vietnamese and Putonghua (Mandarin). English intelligibility was assessed at multiple intervals pre, post and during intervention. The intervention protocol consisted of 11 weekly 1-h sessions with an SLP targeting English consonants, vowels and prosody. Following intervention, both participants displayed increased performance across most measures. For example, the Vietnamese participant's percentage of consonants correct (PCC) increased from 62.5% to 85.0% in probe keywords. Effect sizes, when comparing baseline and withdrawal phases, were 5.5 for PCC, 4.6 for final consonants, 2.3 for consonant clusters and 1.6 for syllables indicating improvements in all variables measured. Her speech rate reduced, word stress increased in accuracy and she perceived less difficulty communicating in English. These promising results suggest further testing of the Intelligibility Enhancement Protocols is warranted to determine effectiveness as an intervention for multilingual speakers.

Speech-language pathologists' support for multilingual speakers' English intelligibility and participation informed by the ICF

PURPOSE

To use the ICF to classify characteristics and aspirations of multilingual university students and faculty who seek speech-language pathologists' support for intelligibility in English and to identify activities, facilitators, and barriers that impact participation in society.

METHOD

A retrospective record review was conducted on files of 175 clients attending a university clinic for intelligibility enhancement (accent modification). Participants came from 35 countries and spoke 28 different home languages.

RESULTS

Assessment and intervention for intelligibility enhancement involved consideration of ICF components of Body Functions and Structures (e.g., articulating phonemes, rate, prosody), Environmental Factors (e.g., support), and Personal Factors (e.g., motivation). Consonant substitutions and deletions were common, although participants were often unaware of these. For example, only 25.6% of participants reported English dental fricatives (/θ/ and /ð/) were difficult to pronounce; however, 94.9% substituted them with other phonemes such as [t] and [d]. The combination of substitutions/deletions, fast speech rate, low speaking volume, and differences in word stress exacerbated poor intelligibility. More time conversing in English was associated with greater confidence and less difficulty communicating in English, although more time knowing English was not. Difficult communication situations were reported to be conversing over the phone, talking to strangers, and communicating in English on professional fieldwork placements. Participants were motivated to seek intelligibility enhancement for academic, employment, and social reasons.

CONCLUSIONS

To ensure multilingual speakers are able to participate fully in society, intelligibility enhancement requires a multi-pronged approach where speech and environmental characteristics interweave.

Elicitation of Minimum and Maximum Fundamental Frequency and Vocal Intensity: Discrete Half Steps Versus Glissando

PURPOSE

To investigate the effect of elicitation method, either discrete half steps or glissando, on the minimum fundamental frequency, maximum fundamental frequency, minimum vocal intensity, and maximum vocal intensity.

METHOD

Fifty-six healthy-voice participants (28 males and 28 females) ranging from 18 to 25 years of age participated in the study. Each participant performed both the discrete half steps and the glissando procedure. The minimum frequency, maximum frequency, minimum intensity, and maximum intensity values elicited by each task were analyzed. A portion of participants (five males and five females) returned within 3 weeks to repeat the whole procedure to determine test-retest reliability.

RESULT

The results of Pearson's correlation demonstrated all measures were positively significantly correlated. However, the results of paired t tests showed significant difference between elicitation methods, where discrete half steps could elicit maximal vocal performance better than glissando in terms of minimum frequency, maximum frequency, and minimum intensity. Discrete half steps could elicit higher maximum intensity than glissando in males to a greater extent than in females.

CONCLUSION

The difference in performance elicited by the two procedures may be considered acceptable under some situations (eg, time constraint, patient fatigue). In the clinical setting, the clinician should select the appropriate procedure with the consideration of time and assessment purpose.

Effects of Gender-confirming Pitch-raising Surgery in Transgender Women a Long-term Follow-up Study of Acoustic and Patient-reported Data

OBJECTIVES

Transgender women often seek to feminize their voice so that it becomes congruent with their gender identity. Many receive voice therapy (VT) with good results. Some also need pitch-raising surgery. The purpose of this study was to investigate long-term effects and to compare outcomes between cricothyroid approximation (CTA) and glottoplasty (GP).

METHODS

This study included retrospective data from 24 patients (35-67 years). Eleven patients had undergone CTA and 13 had undergone GP. Audio recordings were performed in a sound-treated booth and patients answered questionnaires before and after VT, post surgery, and at 1-year follow-up. Fundamental frequency (f_o) measures were extracted from voice range profiles (VRPs) and speech range profiles (SRPs) and were compared with cisgender data.

RESULTS

Minimum f_o in VRP increased significantly only after CTA (95 to 123 Hz). Maximum f_o in VRP was significantly lowered after GP (765 to 652 Hz), even more after CTA (677 to 475 Hz). Speaking mean f_o increased significantly after VT and post surgery, and was thereafter stable (CTA 167 Hz, GP 169 Hz). The maximum f_o in the SRP increased only after VT. The frequency ranges were strongly reduced after CTA. Patients were in general satisfied at follow-up and rated the GP outcomes more favorably than CTA.

CONCLUSIONS

Both surgical methods have advantages and disadvantages. The very restricted speaking and physiological frequency ranges, which do not favor an optimal female voice, were mainly found after the irreversible CTA. Thus, CTA is no longer performed at our hospital, whereas surgical techniques based on GP are being developed further. We strongly recommend the use of VRPs to evaluate treatment effects.

Tutorial and Guidelines on Measurement of Sound Pressure Level in Voice and Speech

PURPOSE

Sound pressure level (SPL) measurement of voice and speech is often considered a trivial matter, but the measured levels are often reported incorrectly or incompletely, making them difficult to compare among various studies. This article aims at explaining the fundamental principles behind these measurements and providing guidelines to improve their accuracy and reproducibility.

METHOD

Basic information is put together from standards, technical, voice and speech literature, and practical experience of the authors and is explained for nontechnical readers.

RESULTS

Variation of SPL with distance, sound level meters and their accuracy, frequency and time weightings, and background noise topics are reviewed. Several calibration procedures for SPL measurements are described for stand-mounted and head-mounted microphones.

CONCLUSIONS

SPL of voice and speech should be reported together with the mouth-to-microphone distance so that the levels can be related to vocal power. Sound level measurement settings (i.e., frequency weighting and time weighting/averaging) should always be specified. Classified sound level meters should be used to assure measurement accuracy. Head-mounted microphones placed at the proximity of the mouth improve signal-to-noise ratio and can be taken advantage of for voice SPL measurements when calibrated. Background noise levels should be reported besides the sound levels of voice and speech.

Transmasculine People's Voice Function: A Review of the Currently Available Evidence

OBJECTIVES

This study aims to evaluate the currently available discursive and empirical data relating to those aspects of transmasculine people's vocal situations that are not primarily gender-related, to identify restrictions to voice function that have been observed in this population, and to make suggestions for future voice research and clinical practice.

METHODS

We conducted a comprehensive review of the voice literature. Publications were identified by searching six electronic databases and bibliographies of relevant articles. Twenty-two publications met inclusion criteria. Discourses and empirical data were analyzed for factors and practices that impact on voice function and for indications of voice function-related problems in transmasculine people. The quality of the evidence was appraised.

RESULTS

The extent and quality of studies investigating transmasculine people's voice function was found to be limited. There was mixed evidence to suggest that transmasculine people might experience restrictions to a range of domains of voice function, including vocal power, vocal control/stability, glottal function, pitch range/variability, vocal endurance, and voice quality.

CONCLUSIONS

More research into the different factors and practices affecting transmasculine people's voice function that takes account of a range of parameters of voice function and considers participants' self-evaluations is needed to establish how functional voice production can be best supported in this population.

A novel approach for measuring social participation in adults who stutter

This paper reports a preliminary study which trialled a novel approach for measuring speech output and social participation. The amount of phonation was accumulated via an objective measure called an Ambulatory Phonation Monitor (APM).

PURPOSE

(1) To establish whether adults who stutter will tolerate wearing an APM for an extended period of time (three days), (2) to test whether the APM can accumulate useful data about the amount of phonation adults who stutter produce in the course of a normal day and (3) to examine a possible relationship between stuttering severity and amount of phonation.

METHOD

Three adults who stutter wore an APM for three consecutive days during their waking hours. Each completed a questionnaire regarding the device and kept a speech diary outlining daily speaking activities and self-reported stuttering severity. APM data regarding amount of phonation was collected, analysed and compared with the participants' speech diaries.

RESULTS

Each adult tolerated wearing the APM and while they felt comfortable speaking wearing the device, it was somewhat cumbersome. Variations in the amount of speaking across each day and in different speaking situations were evident. For two participants there was a positive correlation between phonation time and severity rating.

CONCLUSIONS

Preliminary data suggests that the APM can provide valuable information about the amount adults who stutter speak. The APM is sufficiently sensitive to differentiate variations in the amount of phonation during different speaking situations. These favourable preliminary results suggest the value of a larger scale study.

EDUCATIONAL OBJECTIVES

The reader will be able to: (a) describe the different aspects of stuttering currently routinely measured in clinical practice; (b) discuss the limitations of current measurement procedures; (c) discuss the advantages of speech measures obtained by an Ambulatory Phonation Monitor APM); (d) describe the perspectives of adults who stutter who have worn an APM to measure phonation time.

The softest sound levels of the human voice in normal subjects

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