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Jamin C, Karam E, Marmouset F, Laure B, Moriniere S, Pare A. Tongue reconstruction after oncological resection: Analysis of the functional outcomes. J Stomatol Oral Maxillofac Surg 2024; 125:101707. [PMID: 38006946 DOI: 10.1016/j.jormas.2023.101707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 11/27/2023]
Abstract
The curative management of oral squamous cell carcinoma can be responsible for swallowing and/or speech impairments. In this study, we analyzed the functional outcomes in patients who underwent an oncological resection and a primary reconstruction of the tongue and/or of the floor of the mouth (TFM). We also investigated the predictive factors for poor functional outcomes. This retrospective study included operated patients from October 2013 to May 2021 at the TOURS University Hospital. We assessed the functional results two years after the completion of the cancer treatment with self-administered questionnaires quantifying swallowing and speech disorders. Thirty-three patients were included and reconstructed with antebrachial free flap (N = 16), local flap (N = 8) or Biodesign ® membrane (N = 9). A higher proportion of pT1 tumor was observed in patient who had a Biodesign-based reconstruction (p = 0.001). There was no significant difference between the groups in terms of postoperative complications or for the duration of enteral feeding. The 21 patients who had an adjuvant radiation therapy had no significant more altered functions. Functional scores were significantly higher in the free flap reconstruction group (DHI =24 and SHI=21) (p = 0.008). No predictive factors for poor outcomes were observed. The repair of TFM defects must be adapted to the resection size. The reconstruction techniques allow to get acceptable functional outcomes even for the greater tumors or in case of radiation therapy. Further research would be required to better identify the predictive factors for poor outcomes.
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Affiliation(s)
- Cerise Jamin
- Department of Maxillofacial and Plastic Surgery, Tours University Hospital, Avenue de la République, Chambray les Tours 37100, France
| | - Elias Karam
- Department of Visceral Surgery, Tours University Hospital, Avenue de la République, Chambray les Tours 37100, France; School of Medicine, University of François Rabelais, 10 bd Tonnellé, Tours 37000, France
| | - Franck Marmouset
- Department of Otorhinolaryngology, Tours University Hospital, 2 bd Tonnellé, Tours 37000, France
| | - Boris Laure
- Department of Maxillofacial and Plastic Surgery, Tours University Hospital, Avenue de la République, Chambray les Tours 37100, France; School of Medicine, University of François Rabelais, 10 bd Tonnellé, Tours 37000, France
| | - Sylvain Moriniere
- Department of Otorhinolaryngology, Tours University Hospital, 2 bd Tonnellé, Tours 37000, France; School of Medicine, University of François Rabelais, 10 bd Tonnellé, Tours 37000, France
| | - Arnaud Pare
- Department of Maxillofacial and Plastic Surgery, Tours University Hospital, Avenue de la République, Chambray les Tours 37100, France; School of Medicine, University of François Rabelais, 10 bd Tonnellé, Tours 37000, France.
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Souza JA, Pasqualoto AS, Cielo CA, Andriollo DB, Moraes DAO. Can We Use the Maximum Phonation Time as a Screening of Pulmonary Forced Vital Capacity in Post-COVID-19 Syndrome Patients? J Voice 2024:S0892-1997(24)00118-8. [PMID: 38649315 DOI: 10.1016/j.jvoice.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To verify the accuracy of the maximum phonation time of the vowel /a/ (MPT/a/), fricative /s/ (MPT/s/), number counting (MPTC), and number reached in this count (CN) to estimate forced vital capacity (FVC) in patients with post-COVID-19 syndrome. METHOD Cross-sectional study involving adult patients, who were admitted to the intensive care unit and referred to the Post-COVID-19 Rehabilitation Outpatient Clinic. Voice function was assessed using a Vocal Handicap Index (VHI) self-assessment questionnaire and MPT tests. To perform the phonatory tests, the patients remained in a standing posture and were instructed to inhale as much air as possible and, during a single exhalation, at usual pitch and loudness, sustain the emission of /a/ and /s/; and in another breath, to perform the ascending numerical count, starting from the number one up to the highest number they could reach. Pulmonary function was assessed by spirometry. The receiver operating characteristic (ROC) curve was plotted, and FVC values lower than the normal limit by Z-score (fifth percentile) were classified as impaired lung function. The predictive values and likelihood ratios were calculated. RESULTS A total of 70 patients participated, with 20-30% having a high VHI. Approximately 24% had an FVC impairment and significantly low values of MPT/a/, MPT/s/, MPTC, and CN. The test results showed overall accuracy of 70% and the cutoff points of 9.69, 6.78, 10.60, and 13, respectively, with high sensitivity, predictive negative value and low specificity, predictive positive value, and positive likelihood ratio. CONCLUSIONS Our results suggest that the MPT has moderate discriminatory power for FVC impairment, indicating that it is not a reliable indicator of pulmonary function in the population studied. Therefore, in patients with an MPT of less than 10.60 seconds, or a CN lower than 13, other criteria should be added to improve the diagnostic accuracy and support the decision to perform more complex investigations.
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Affiliation(s)
- Juliana Alves Souza
- Department of Speech, Hearing and Language Sciences and Postgraduate Program in Human Communication Disorders, Voice Laboratory of he Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil.
| | - Adriane Schmidt Pasqualoto
- Department of Speech, Hearing and Language Sciences and Postgraduate Program in Human Communication Disorders, Voice Laboratory of he Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil; Department of Physiotherapy and Postgraduate Program in Human Communication Disorders at Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil
| | - Carla Aparecida Cielo
- Department of Speech, Hearing and Language Sciences and Postgraduate Program in Human Communication Disorders, Voice Laboratory of he Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil
| | - Débora Bonesso Andriollo
- Department of Speech, Hearing and Language Sciences and Postgraduate Program in Human Communication Disorders, Voice Laboratory of he Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil
| | - Denis Altieri Oliveira Moraes
- Department of Speech, Hearing and Language Sciences and Postgraduate Program in Human Communication Disorders, Voice Laboratory of he Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil; Departament of Statistics and Postgraduate Program in Human Communication Disorders at Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil
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Yiu EML, Cheng LKH, Wang F. Frequency Transmission of Oscillation from External Whole-Body Vibration Platform to the Larynx. J Voice 2024:S0892-1997(24)00093-6. [PMID: 38614894 DOI: 10.1016/j.jvoice.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE This study investigates (1) the presence of frequency transmission of oscillation from an external whole-body vibration (WBV) platform to the larynx; and (2) the factors that influence this frequency transmission. METHODS Thirty participants (mean age=22.3years) with normal voice were exposed to four frequency-intensity levels of WBV (10 Hz-10%, 10 Hz-20%, 20 Hz-10%, 20 Hz-20%) and were instructed to produce the natural vowel /a/ three times during each WBV setting. The frequency was extracted from the middle 1-second of each electroglottographic (EGG) signal after passing through a Hann band filter with a range of 6-24 Hz. Linear mixed-effects models were applied to determine the factors that influenced the absolute deviation of the frequency transmission. RESULTS All participants exhibit an extracted EGG frequency that aligns with the external WBV frequency, deviating by - 0.6 to 1.2 Hz. The absolute deviation of WBV frequency transmission is consistent for both sexes across various WBV settings, except the 10 Hz-10% setting where men tend to exhibit significantly higher deviations (P = 0.018). CONCLUSION Oscillations at a specific frequency are transmitted from an external WBV platform to the larynx. This study proposes the use of a "spring" system to investigate the effect of WBV on the larynx, and recommends further research to explore the potential of WBV in managing voice disorders.
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Affiliation(s)
- E M-L Yiu
- Voice Research Laboratory, The University of Hong Kong, Pokfulam, Hong Kong
| | - L K H Cheng
- Voice Research Laboratory, The University of Hong Kong, Pokfulam, Hong Kong
| | - F Wang
- School of Humanities, Shanghai Normal University, Shanghai, China.
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Tarai SK, Chatterjee I, Pani S. A Comparative Acoustic Analysis of Bangla Folk Song and RabindraSangeet on Long-Term Average Spectrum. J Voice 2024; 38:304-308. [PMID: 34642073 DOI: 10.1016/j.jvoice.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Singing is defined as a sensory-motor phenomenon that requires particular balanced physical skills such as respiration, phonation, resonance, and articulation. The long-term average spectrum (LTAS) is widely accepted as a robust and effective tool for the assessment of voice characteristics. METHOD Eighty female singers within the age range of 18-30 years were considered for the study. Among 80 participants, 40 were asked to perform one traditional song from Bangla Folk representing the Baul style and another 40 were asked to perform a traditional song from Rabindra Sangeet. Recordings were done and then acoustic (LTAS) analyses were done through PRAAT software. Statistical analyses were done for the analyzed data. software package of social sciences (Version 20.0) was used. RESULTS The averaged LTAS curve of Baul style showed a broad peak in the frequency range between 2000 and 3600Hz and its amplitude about 16 dB, Rabindra Sangeet showed a broader peak in the frequency range between 2200 and 3800 Hz and its amplitude about 15 dB. This evidence showed the presence of singer's formants in both singing styles. CONCLUSION It can be concluded from the present study that, there is an acoustical difference between the Bangla Folk and Rabindra Sangeet singing style which can be evidenced using LTAS through PRAAT.
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Affiliation(s)
- Sujit Kumar Tarai
- Department of Speech-Language Pathology, C.C. Saha Ltd., Kolkata, West Bengal, India
| | - Indranil Chatterjee
- Department of Audiology and Speech-Language Pathology, AYJNISHD, RC, Kolkata, West Bengal, India
| | - Susmi Pani
- Department of Speech-Language Pathology and Audiology, iHear, Uttarpara, West Bengal, India.
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Portalete CR, Moraes DADO, Pagliarin KC, Keske-Soares M, Cielo CA. Acoustic and Physiological Voice Assessment And Maximum Phonation Time In Patients With Different Types Of Dysarthria. J Voice 2024; 38:540.e1-540.e11. [PMID: 34895782 DOI: 10.1016/j.jvoice.2021.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/09/2021] [Accepted: 09/16/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare the maximum phonation time of /a/, acoustic glottal source parameters, and physiological measures in patients with dysarthria. METHOD Thirteen patients were classified according to dysarthria type and divided into functional profiles (hypofunctional, hyperfunctional, and mixed). Assessments of maximum phonation time of /a/, glottal source parameters, electroglottography, and nasometry were performed. Results were compared between groups using ANOVA and Tukey posthoc tests. RESULTS The highest fundamental frequency differed significantly between groups, with the hyperfunctional profile showing higher values than the other participant groups. Reductions in the maximum phonation time of /a/ and alterations in acoustic glottal source parameters and electroglottography measures were observed in all groups, with no significant differences between them. The remaining measures did not differ between groups. CONCLUSION The maximum phonation times for /a/ were reduced in all participant groups, suggesting air escape during phonation. The presence of alterations in several glottal source parameters in all participant groups is indicative of noise, tremor, and vocal instability. Lastly, the high fundamental frequency in patients with a hyperfunctional profile reinforces the presence of vocal instability. These findings suggest that, although the characteristics observed in the assessments were consistent with expectations of patients with dysarthria, it is difficult to perform a differential diagnosis of this condition based on acoustic and physiological parameters alone.
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Umashankar A, Ramamoorthy S, Selvaraj JL, Dhandayutham S. Comparative Study on the Acoustic Analysis of Voice in Auditory Brainstem Implantees, Cochlear Implantees, and Normal Hearing Children. Indian J Otolaryngol Head Neck Surg 2024; 76:645-652. [PMID: 38440592 PMCID: PMC10908917 DOI: 10.1007/s12070-023-04236-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/11/2023] [Indexed: 03/06/2024] Open
Abstract
The aim of the study was to compare the acoustic characteristics of voice between Auditory Brainstem Implantees, Cochlear Implantees and normal hearing children. Voice parameters such as fundamental frequency, formant frequencies, perturbation measures, and harmonic to noise ratio were measured in a total of 30 children out of which 10 were Auditory Brainstem Implantees, 10 were Cochlear Implantees and 10 were normal hearing children. Parametric and nonparametric statistics were done to establish the nature of significance between the three groups. Overall deviancies were seen in the implanted group for all acoustic parameters. However abnormal deviations were seen in individuals with Auditory Brainstem Implants indicating the deficit in the feedback loop impacting the voice characteristics. The deviancy in feedback could attribute to the poor performance in ABI and CI. The CI performed comparatively better when compared to the ABI group indicating a slight feedback loop due to the type of Implant. However, there needs to be additional evidence supporting this and there is a need to carry out the same study using a larger sample size and a longitudinal design.
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Affiliation(s)
- Abishek Umashankar
- Department of Translational and Clinical Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Santhoshi Ramamoorthy
- Department of Speech Language Pathology, MERF Institute of Speech and Hearing, Chennai, India
| | - Jasmine Lydia Selvaraj
- Department of Speech-Language Pathology, SRFASLP, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, 116 India
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Peters J, Frank M, Rohloff T. Effects of Cognitive Load on Vocal Fold Vibratory Patterns in Bilingual Speakers of Low and High German. J Voice 2023:S0892-1997(23)00293-X. [PMID: 37925332 DOI: 10.1016/j.jvoice.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVES Increased cognitive load has been observed to correlate with decreased vocal fold perturbation, reduced additive noise, increased periodicity, and a higher rate of vocal fold vibration. The aim of this study was to explore whether vocal fold vibratory patterns can serve as indicators of increased cognitive load in nonbalanced bilingual speakers when they use their weaker language. STUDY DESIGN This is a comparative experimental study with a within-speaker design. METHODS We recorded a total of 95 bilingual speakers of Low German (LG), which is an endangered language spoken in Northern Germany, and Standard High German (HG). Participants completed four tasks in both languages: engaging in free narration, describing a picture story, giving directions, and reading a narrative passage. For the last three tasks, the difficulty levels were varied. Measurements included jitter, shimmer, harmonics-to-noise ratio (HNR), cepstral peak prominence (CPP), the proportion of creak, pitch level, and pitch span. Changes in voice characteristics were examined both in terms of the participants' age and their language dominance. For the latter, we calculated a dominance score derived from age of acquisition, frequency of use, and self-perceived linguistic competence in the two languages. RESULTS Younger speakers showed a higher dominance of HG over LG, which decreased with age. Younger and more HG-dominant speakers exhibited lower jitter and shimmer, along with a higher HNR and a lower creak proportion in LG compared to HG. CPP and pitch level were higher in LG but showed little variation with age or language dominance. No clear effects on pitch span were observed. Overall, age was a slightly more reliable predictor than language dominance. Acoustic differences in voice quality were about equally detectable across the different speech tasks while varying difficulty levels had minimal impact. CONCLUSIONS The variation in vocal fold vibratory patterns suggests that younger and more HG-dominant speakers experienced greater cognitive load when speaking LG. Given that increased cognitive load may negatively impact language usage, voice analysis opens up new possibilities for evaluating the future prospects of endangered languages.
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Affiliation(s)
- Jörg Peters
- Carl von Ossietzky University of Oldenburg, Institute of German Studies, Oldenburg, Lower Saxony, Germany.
| | - Marina Frank
- Carl von Ossietzky University of Oldenburg, Institute of German Studies, Oldenburg, Lower Saxony, Germany
| | - Tio Rohloff
- Carl von Ossietzky University of Oldenburg, Institute of German Studies, Oldenburg, Lower Saxony, Germany
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Cristiano W, Raimondi T, Valente D, De Gregorio C, Torti V, Ferrario V, Carugati F, Miaretsoa L, Mancini L, Gamba M, Giacoma C. Singing more, singing harsher: occurrence of nonlinear phenomena in a primate' song. Anim Cogn 2023; 26:1661-1673. [PMID: 37458893 PMCID: PMC10442282 DOI: 10.1007/s10071-023-01809-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/10/2023] [Accepted: 07/03/2023] [Indexed: 08/22/2023]
Abstract
Nonlinear phenomena (NLP) in animal vocalizations arise from irregularities in the oscillation of the vocal folds. Various non-mutually exclusive hypotheses have been put forward to explain the occurrence of NLP, from adaptive to physiological ones. Non-human primates often display NLP in their vocalizations, yet the communicative role of these features, if any, is still unclear. We here investigate the occurrence of NLP in the song of a singing primate, the indri (Indri indri), testing for the effect of sex, age, season, and duration of the vocal display on their emission. Our results show that NLP occurrence in indri depends on phonation, i.e., the cumulative duration of all the units emitted by an individual, and that NLP have higher probability to be emitted in the later stages of the song, probably due to the fatigue indris may experience while singing. Furthermore, NLP happen earlier in the vocal display of adult females than in that of the adult males, and this is probably due to the fact that fatigue occurs earlier in the former because of a greater contribution within the song. Our findings suggest, therefore, that indris may be subjected to physiological constraints during the singing process which may impair the production of harmonic sounds. However, indris may still benefit from emitting NLP by strengthening the loudness of their signals for better advertising their presence to the neighboring conspecific groups.
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Affiliation(s)
- Walter Cristiano
- Department of Life Sciences and Systems Biology, University of Turin, 10123, Turin, Italy.
- Ecosystems and Health Unit, Environment and Health Department, Italian National Institute of Health, 00161, Rome, Italy.
| | - Teresa Raimondi
- Department of Life Sciences and Systems Biology, University of Turin, 10123, Turin, Italy
| | - Daria Valente
- Department of Life Sciences and Systems Biology, University of Turin, 10123, Turin, Italy
| | - Chiara De Gregorio
- Department of Life Sciences and Systems Biology, University of Turin, 10123, Turin, Italy
| | - Valeria Torti
- Department of Life Sciences and Systems Biology, University of Turin, 10123, Turin, Italy
| | - Valeria Ferrario
- Department of Life Sciences and Systems Biology, University of Turin, 10123, Turin, Italy
| | - Filippo Carugati
- Department of Life Sciences and Systems Biology, University of Turin, 10123, Turin, Italy
| | - Longondraza Miaretsoa
- Groupe d'Étude et de Recherche sur les Primates de Madagascar (GERP), II M 78 BIS Antsakaviro, B.P 779, Antananarivo, Madagascar
| | - Laura Mancini
- Ecosystems and Health Unit, Environment and Health Department, Italian National Institute of Health, 00161, Rome, Italy
| | - Marco Gamba
- Department of Life Sciences and Systems Biology, University of Turin, 10123, Turin, Italy
| | - Cristina Giacoma
- Department of Life Sciences and Systems Biology, University of Turin, 10123, Turin, Italy
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Oh BM, Seok H, Kim SH, Lee SY, Park SJ, Kim BJ, Kim HJ. Correlation Between Articulatory Diadochokinetic Parameters and Dysphagia Parameters in Subacute Stroke Patients. Ann Rehabil Med 2023:arm.23018. [PMID: 37317794 DOI: 10.5535/arm.23018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/14/2023] [Indexed: 06/16/2023] Open
Abstract
Objective To determine correlations of alternation motor rate (AMR), sequential motor rate (SMR), and maximum phonation time (MPT) with the severity of dysphagia in subacute stroke patients. Methods This was a retrospective chart review study. Data of 171 subacute stroke patients were analyzed. Patient's AMR, SMR, and MPT data were collected from their language evaluations. Video fluoroscopic swallowing study (VFSS) was done. Data of dysphagia scales including penetration-aspiration scale (PAS), American Speech-Language-Hearing Association National Outcomes Measurement System (ASHA-NOMS) scale, clinical dysphagia scale (CDS), and videofluoroscopic dysphagia scale (VDS) were obtained. AMR, SMR, and MPT were compared between a non-aspirator group and an aspirator group. Correlations of AMR, SMR, and MPT with dysphagia scales were analyzed. Results AMR ("ka"), SMR, and modified Rankin Scale were significant associated factors between non-aspirator group and aspirator group, while AMR ("pa"), AMR ("ta"), and MPT were not. AMR, SMR, and MPT showed significant correlations with PAS score, ASHA-NOMS scale, CDS, VDS oral, and VDS pharyngeal scores. The cut-off value for distinguishing non-aspirator group and aspiration group was 18.5 for AMR ("ka") (sensitivity of 74.4%, specificity of 70.8%) and 7.5 for SMR (sensitivity of 89.9%, specificity of 61.0%). AMR and SMR were significantly lower in before-swallow aspiration group. Conclusion Articulatory diadochokinetic tasks that can be easily performed at the bedside would be particularly helpful in determining the oral feeding possibility of subacute stroke patients who cannot undergo VFSS, which is the gold standard for dysphagia assessment.
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Affiliation(s)
- Back Min Oh
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hyun Seok
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sang-Hyun Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Seung Yeol Lee
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Su Jung Park
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Beom Jin Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hyun Jung Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Saghiri MA, Vakhnovetsky A, Vakhnovetsky J. Scoping review of the relationship between xerostomia and voice quality. Eur Arch Otorhinolaryngol 2023; 280:3087-3095. [PMID: 36995371 DOI: 10.1007/s00405-023-07941-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 03/25/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE This scoping review aims to synthesize all of the currently available information on how xerostomia correlates with vocal function and the mechanisms that underpin it. METHODS Our scoping review used PubMed, Scopus, Embase, and Web of Science databases to review articles published between January 1999 and July 2022 in accordance with the PRISMA-ScR guidelines. In addition to the academic databases, we also conducted a manual search of Google Scholar. Further investigation was conducted on studies that examined the relationship between xerostomia and vocal function. RESULTS Of the 682 initially identified articles, 21 met our inclusion criteria. Among the included studies, two articles (n = 2) revealed the mechanistic relationship between xerostomia and vocal function. Most studies (n = 12) focused on xerostomia secondary to other underlying conditions or treatments, among which radiotherapy and Sjögren's syndrome were commonly investigated. Seven studies (n = 7) provided details about common vocal parameters measured in studies of xerostomia and the voice. CONCLUSION The literature currently lacks publications regarding the relationship between xerostomia and vocal function. Most of the studies included in this review were about xerostomia secondary to other conditions or medical treatments. Therefore, the impacts on the voice that were observed were very multifaceted and the role of xerostomia alone in phonation could not be ascertained. Nevertheless, it is clear that dryness in the mouth plays some role in vocal function and further research should focus on clarifying and finding the underlying mechanism behind this relationship by incorporating high-speed imaging and cepstral peak prominence analyses.
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Affiliation(s)
- Mohammad Ali Saghiri
- Biomaterial and Prosthodontics Laboratory, Department of Restorative Dentistry, Rutgers School of Dental Medicine, 185 South Orange Avenue, Newark, NJ, 07103, USA.
- Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, CA, USA.
| | | | - Julia Vakhnovetsky
- Sector of Angiogenesis Regenerative Medicine, Dr. Hajar Afsar Lajevardi Research Cluster (DHAL), Hackensack, NJ, USA
- Biomaterial and Prosthodontics Laboratory, Department of Restorative Dentistry, Rutgers School of Dental Medicine, Newark, NJ, USA
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Feltrin TD, Cielo CA, Pasqualoto AS. Relation between Orotracheal Intubation, Inflammatory Markers, Breathing and Voice in Post-COVID-19. J Voice 2023:S0892-1997(23)00070-X. [PMID: 37045738 PMCID: PMC9946891 DOI: 10.1016/j.jvoice.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION COVID-19, an infectious disease with a wide spectrum of clinical manifestations and intensities in the human body, it can cause respiratory and vocal disorders, with fatigue. OBJECTIVE To verify the relation between biological Inflammatory markers D-dimers and C-Reactive Protein, Forced Vital Capacity, Maximum Phonation Time, vocal performance and fatigue, length of hospitalization period and gender of people affected by COVID-19 who were hospitalized, but did not use orotracheal intubation and compare with a group of post-COVID-19 patients with orotracheal intubation. METHODS Data on D-dimers and C-Reactive Protein, spirometry, Maximum Phonation Time, performance and vocal fatigue were collected. The study included 42 adult people affected by COVID-19 who were hospitalized, 22 (52.4%) female and 20 (47.6%) male; 23 (54.8%) critical cases composing the group with orotracheal intubation (average age 48.9 years old) and 19 (45.24%) severe cases in the group without orotracheal intubation (average age 49.9 years old). RESULTS hospital length of stay was significantly longer for the group with orotracheal intubation; D-dimers were significantly altered in all groups; correlations between maximum phonation times were positive and significant; correlations between maximum phonation times, vocal performance and fatigue were both negative and significant. CONCLUSION Patients with orotracheal intubation had longer hospital internment and increased D-dimers and were amazed that, whenever maximum phonation times decreased performance and vocal fatigue increased.
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Affiliation(s)
- Thaís D Feltrin
- Department of Speech Therapy, Federal University of Santa Maria, Santa Maria, RS, Brazil.
| | - Carla A Cielo
- Department of Speech Therapy and Human Communication Disorders, Federal University of Santa Maria, Santa Maria RS, Brazil
| | - Adriane S Pasqualoto
- Department of Physiotherapy and Human Communication Disorders, Federal University of Santa Maria, Santa Maria, RS, Brazil
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12
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Herbst CT, Elemans CPH, Tokuda IT, Chatziioannou V, Švec JG. Dynamic System Coupling in Voice Production. J Voice 2023:S0892-1997(22)00310-1. [PMID: 36737267 DOI: 10.1016/j.jvoice.2022.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/07/2022] [Accepted: 10/07/2022] [Indexed: 02/04/2023]
Abstract
Voice is a major means of communication for humans, non-human mammals and many other vertebrates like birds and anurans. The physical and physiological principles of voice production are described by two theories: the MyoElastic-AeroDynamic (MEAD) theory and the Source-Filter Theory (SFT). While MEAD employs a multiphysics approach to understand the motor control and dynamics of self-sustained vibration of vocal folds or analogous tissues, SFT predominantly uses acoustics to understand spectral changes of the source via linear propagation through the vocal tract. Because the two theories focus on different aspects of voice production, they are often applied distinctly in specific areas of science and engineering. Here, we argue that the MEAD and the SFT are linked integral aspects of a holistic theory of voice production, describing a dynamically coupled system. The aim of this manuscript is to provide a comprehensive review of both the MEAD and the source-filter theory with its nonlinear extension, the latter of which suggests a number of conceptual similarities to sound production in brass instruments. We discuss the application of both theories to voice production of humans as well as of animals. An appraisal of voice production in the light of non-linear dynamics supports the notion that voice production can best be described with a systems view, considering coupled systems rather than isolated contributions of individual sub-systems.
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Affiliation(s)
- Christian T Herbst
- Department of Vocal Studies, Mozarteum University, Salzburg, Austria; Janette Ogg Voice Research Center, Shenandoah Conservatory, Winchester, Virginia. http://www.christian-herbst.org
| | - Coen P H Elemans
- Vocal Neuromechanics Lab, Department of Biology, University of Southern Denmark, Odense M, Denmark
| | - Isao T Tokuda
- Department of Mechanical Engineering, Ritsumeikan University, Kusatsu, Shiga, Japan
| | | | - Jan G Švec
- Voice Research Laboratory, Department of Experimental Physics, Faculty of Science, Palacky University Olomouc, Olomouc, Czech Republic
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13
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Rodrigues VN, Andriollo DB, Cielo CA. Respiratory and Sound Pressures, Maximum Phonation Time, Cervical Disability and Voice-Related Quality of Life of Teachers. J Voice 2022:S0892-1997(22)00365-4. [PMID: 36543607 DOI: 10.1016/j.jvoice.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Many teachers report discomfort and a decrease in the quality of aerodynamic, respiratory, and cervical vocal aspects as well as of vocal self-assessment. OBJECTIVE Characterize and correlate measurements of Sound Pressure Levels, Maximum Phonation Time of /a/, Maximum Respiratory Pressures, Voice-Related Quality of Life and cervical pain in teachers with vocal and musculoskeletal complaints and no organic vocal fold lesions, and compare with normative values. METHODS Retrospective study with 56 teachers. Anamnesis, video laryngoscopy, hearing screening, measurements of sound pressure and maximum phonation time, and manovacuometry were performed. Self-assessment protocols for Voice-Related Quality of Life and Neck Disability Index were completed. RESULTS there was significant higher Sound Pressure Levels; significant lower Maximum Phonation Time of /a/, Maximum Expiratory Pressure, and total and physical scores of Voice-Related Quality of Life; most participants had mild cervical disability; there was a negative correlation between Maximum Expiratory Pressure and Neck Disability Index, between Maximum Inspiratory Pressure and Maximum Sound Pressure Level, and between Neck Disability Index and Voice-Related Quality of Life. CONCLUSION The results showed that there are damages and inadequacies in teachers' vocal production which affect their quality of life. Therefore, it is necessary to pay attention to the conditions of use of the voice by professionals, and to their health education.
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Affiliation(s)
- Viviane Nunes Rodrigues
- Departamento de Fonoaudiologia, Laboratório de Voz, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil.
| | - Débora Bonesso Andriollo
- Departamento de Fonoaudiologia, Laboratório de Voz, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Carla Aparecida Cielo
- Departamento de Fonoaudiologia, Laboratório de Voz, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
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14
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Liou HH, Hsieh MHC, Hung DSY, Liu HL, Lee I, Lin YC, Hsiao JR, Huang CC, Ou CY, Chang CC, Lee WT, Tsai ST, Tsai SW. The Additive Effectiveness of Inspiratory Muscle Training on Glottic Closure and Subjective Voice Outcomes of Patients With Benign Lesion After Hyaluronic Acid Laryngoplasty. J Voice 2022:S0892-1997(22)00343-5. [PMID: 36513561 DOI: 10.1016/j.jvoice.2022.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES For patients with glottic insufficiency disease, injection laryngoplasty is a rapid and efficient management option that complements voice therapy. Some studies have indicated that respiratory muscle training may also show promise in patients with voice disorders. However, the effect of respiratory muscle training in patients with glottic insufficiency was reported to be limited, and whether it provides additional benefit after standard management requires further evaluation. We aimed to investigate the effectiveness of inspiratory muscle training on glottis closure and patient-reported voice quality in glottic insufficiency patients who had been treated with hyaluronic acid injection. STUDY DESIGN Retrospective observational study. METHODS We included 46 patients with glottic insufficiency who had undergone hyaluronic acid injection. Twenty of them had undergone inspiratory muscle training during three months. We measured patients' changes in glottic status according to the normalized glottal gap area and bowing index, as well as voice quality of life according to the voice handicap index 10 and the voice outcome survey, before and after training. RESULTS Patients who underwent inspiratory muscle training had higher odds of experiencing better improvement in all scores. The range of odds ratios ranged from 2.5 to 6.3 for changes in scores, and from 3.8 to 22.2 for changes in score percentages. Of note, the effect of training on percentage changes in the normalized glottal gap area score was significant (P= 0.0127) after adjustment for the duration of vocal disease, body mass index and BMI, and history of gastroesophageal reflux disease. CONCLUSIONS Inspiratory muscle training can improve the glottal gap after injection laryngoplasty, and may be applied in clinical practice.
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Affiliation(s)
- Hsin-Hao Liou
- Department of Otolaryngology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Miyuki Hsing-Chun Hsieh
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - David Shang-Yu Hung
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Hui-Ling Liu
- Respiratory treatment room,Department of internal medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ishan Lee
- Respiratory treatment room,Department of internal medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Chih Lin
- Department of Otolaryngology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Jenn-Ren Hsiao
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Cheng-Chih Huang
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Chun-Yen Ou
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Chan-Chi Chang
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Wei-Ting Lee
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Sen-Tien Tsai
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan
| | - Shu-Wei Tsai
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan,Taiwan.
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15
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Bal KK, Alagoz S, Delibas V, Ortoglu F, Ceylan B, Ozdas T, Kuran G, Gorgulu O. Effects of Infertility on Voice in male patients. Indian J Otolaryngol Head Neck Surg 2022; 74:5199-5206. [PMID: 36742516 PMCID: PMC9895568 DOI: 10.1007/s12070-022-03130-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 07/10/2022] [Indexed: 02/07/2023] Open
Abstract
Purpose In this study, we aimed to determine the differences in normospermic, oligospermic and azoospermic infertile men by performing voice analysis and to discuss this in the light of the literature. Methods 71 male patients who applied to the urology clinic due to infertility and were then referred to us were included in the study. Hormone analysis and spermiogram were requested from the patients for routine infertility tests. Testosterone, Follicle stimulating hormone (FSH), Luteinizing hormone (LH), Prolactin levels of the patients were recorded. Age and spermiogram results were recorded. According to the spermiogram results, the patients were categorized as Group 1 (azoospermic), Group 2 (oligospermic), Group 3 (normospermic). Voice Handicap Index-10 Turkish version (VHI-10) was applied to the patients and the results were recorded. Results The age of the infertile patients ranged from 20 to 37. The mean age was 28.23. The distribution of the patients was 21 patients in Group 1, 40 patients in Group 2, and 10 patients in Group 3. The mean Testosterone level of the patients was 2.78; mean FSH level 12.14; mean LH level 7.26; mean Prolactin level was 8.1. The mean VHI-10 scores of the patients were 10.52. The fundamental frequency F0 Hz (mean pitch) values of the patients were 176,468; jitter % (frequency perturbation jitter) values average 0.25; shimmer % (amplitude perturbation shimmer) values average 2,322; HNR dB values averaged 24,862. Conclusions Testosterone is more effective on the voice, especially in male individuals.It would be more logical to think that many hormones, growth factors and local factors are effective instead of a single hormone.
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Affiliation(s)
- Kemal Koray Bal
- Otorhinolaryngology Department,Lecturer Otorhinolaryngology Specialist, University of Mersin, Mersin, Turkey
| | - Sedat Alagoz
- Otorhinolaryngology Department, Specialist Doctor, University of Health Sciences Adana City Training and Research Hospital, Yuregir, Adana, Turkey
| | - Vedat Delibas
- Otorhinolaryngology Department,Research Assistant Doctor, University of Health Sciences Adana City Training and Research Hospital, Yuregir, Adana, Turkey
| | - Ferhat Ortoglu
- Urology Department, Specialist Doctor, University of Health Sciences Adana City Training and Research Hospital, Yuregir, Adana, Turkey
| | - Betul Ceylan
- Speech and Language Therapist, Otorhinolaryngology Department, University of Health Sciences Adana City Training and Research Hospital, Yuregir, Adana, Turkey
| | - Talih Ozdas
- Otorhinolaryngology Department,Associate Professor, University of Health Sciences Adana City Training and Research Hospital, Yuregir, Adana, Turkey
| | - Gokhan Kuran
- Otorhinolaryngology Department,Associate Professor, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Orhan Gorgulu
- Otorhinolaryngology Department,Professor , Ozel Adana Ortadogu Hospital, Adana, Turkey
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16
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Ngo QC, Motin MA, Pah ND, Drotár P, Kempster P, Kumar D. Computerized analysis of speech and voice for Parkinson's disease: A systematic review. Comput Methods Programs Biomed 2022; 226:107133. [PMID: 36183641 DOI: 10.1016/j.cmpb.2022.107133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Speech impairment is an early symptom of Parkinson's disease (PD). This study has summarized the literature related to speech and voice in detecting PD and assessing its severity. METHODS A systematic review of the literature from 2010 to 2021 to investigate analysis methods and signal features. The keywords "Automatic analysis" in conjunction with "PD speech" or "PD voice" were used, and the PubMed and ScienceDirect databases were searched. A total of 838 papers were found on the first run, of which 189 were selected. One hundred and forty-seven were found to be suitable for the review. The different datasets, recording protocols, signal analysis methods and features that were reported are listed. Values of the features that separate PD patients from healthy controls were tabulated. Finally, the barriers that limit the wide use of computerized speech analysis are discussed. RESULTS Speech and voice may be valuable markers for PD. However, large differences between the datasets make it difficult to compare different studies. In addition, speech analytic methods that are not informed by physiological understanding may alienate clinicians. CONCLUSIONS The potential usefulness of speech and voice for the detection and assessment of PD is confirmed by evidence from the classification and correlation results.
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Affiliation(s)
| | - Mohammod Abdul Motin
- Biosignals Lab, RMIT University, Melbourne, Australia; Department of Electrical & Electronic Engineering, Rajshahi University of Engineering & Technology, Rajshahi 6204, Bangladesh
| | - Nemuel Daniel Pah
- Biosignals Lab, RMIT University, Melbourne, Australia; Universitas Surabaya, Indonesia
| | - Peter Drotár
- Intelligent Information Systems Lab, Technical University of Kosice, Letna 9, 42001, Kosice, Slovakia
| | - Peter Kempster
- Neurosciences Department, Monash Health, Clayton, VIC, Australia; Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Dinesh Kumar
- Biosignals Lab, RMIT University, Melbourne, Australia.
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17
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Ishikawa Y, Yanagi Y, Suzuki M, Konomi U. A Questionnaire to Assess Phonation and Problems in Daily Living for Provox ® Voice Prosthesis Users in Japan. Indian J Otolaryngol Head Neck Surg 2022; 74:1780-1789. [PMID: 36452726 PMCID: PMC9702176 DOI: 10.1007/s12070-020-01792-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/08/2020] [Indexed: 10/25/2022] Open
Abstract
The aim of this study was to investigate the problems in daily life of Provox® users in Japan with the use of a questionnaire survey and to consider future guidance methods for these patients. We mailed questionnaires to 190 members of a Japanese laryngectomized patient group. We received 118 questionnaires with valid responses. The total voice handicap index (VHI) score was 44.1. Patients were allocated to two groups based on the type of surgery they underwent-laryngectomy or jejunum reconstruction. The VHI score was significantly lower in the simple laryngectomy group than that in the free jejunum reconstruction group (p < 0.01). Only 55.9% of the patients reported having received voice rehabilitation therapy. For other problems of daily life, many patients answered "bad/very bad" for the "smelling," "eating/drinking hot foodstuffs," "blowing nose," and "quantity of sputum" categories. Based on our results, there is a requirement for an effective rehabilitation therapy and appropriate guidance for patients with the Provox® voice prosthesis.
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Affiliation(s)
- Yukinobu Ishikawa
- Department of Speech and Hearing Sciences at Ookawa, International University of Health and Welfare, 137-1 Enokizu, Ookawa, Fukuoka 831-8501 Japan
| | - Yukiko Yanagi
- Voice and Dizziness Clinic, Futakotamagawa otolaryngology, 2-11-15 Tamagawa Setagaya, Tokyo, 158-0094 Japan
| | - Michi Suzuki
- Department of Speech and Hearing Sciences at Narita, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba 286-8686 Japan
| | - Ujimoto Konomi
- Voice and Dizziness Clinic, Futakotamagawa otolaryngology, 2-11-15 Tamagawa Setagaya, Tokyo, 158-0094 Japan
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18
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Hoffmeister JD, Ulmschneider CL, Ciucci MR, McCulloch TM. Stress Effects on Pharyngeal Air Pressure and Upper Esophageal Sphincter Pressure During Phonation: The Influence of Vocal Tract Semi-Occlusion. J Voice 2022:S0892-1997(22)00222-3. [PMID: 36031506 PMCID: PMC9958265 DOI: 10.1016/j.jvoice.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objective of this study was to determine whether vocal tract semi-occlusion (SOVT) influenced stress effects on pharyngeal air pressure and upper esophageal sphincter (UES) pressure during phonation. Relationships between dysphonia and stress are well recognized but poorly understood. Stress effects act globally on the body, and may be observed beyond intrinsic laryngeal muscles to include pharyngeal muscles and the UES, which contribute to voice modulation. Phonation with SOVT may provide resistance to stress effects on the vocal tract. We hypothesized that stress effects on pharyngeal air pressure and UES pressure would be measurable with a high-resolution, 360° pressure catheter, and that stress effects would be impacted differently by occlusal and non-occlusal phonatory tasks. METHODS Ten healthy adults performed sustained vowel tasks (comfortable /a/, and loud /a/), and SOVT tasks (bilabial fricative and straw phonation). Each task was performed during a baseline condition, and during stress induced through a cold pressor task. Pharyngeal air pressure and UES pressure were measured via high-resolution manometry. Changes in pressure between baseline and stress were compared among phonatory tasks. RESULTS Stress-induced changes to UES pressure differed by phonatory task (P < 0.01). Stress increased UES pressures during vowels, but had no effect during bilabial fricative, and decreased UES pressures during straw phonation. Change in UES pressure with stress was greater for comfortable /a/ and loud /a/ than straw phonation (P = 0.048 and P = 0.019, respectively), and was not significantly different between comfortable /a/ or loud /a/ and bilabial fricative. Stress-induced changes in pharyngeal air pressure were not significantly different among tasks. CONCLUSIONS These findings help identify possible mechanisms underlying the relationship between stress and voice, and point to the utility of SOVT tasks for training vocal tract resistance to stress. This methodology provides a foundation for measuring changes to extra-laryngeal components of the vocal tract during phonation.
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Affiliation(s)
| | | | - Michelle R Ciucci
- University of Wisconsin, Department of Surgery-Otolaryngology; University of Wisconsin, Department of Communication Sciences and Disorders; University of Wisconsin, Neuroscience Training Program
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19
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Peters K, Miller S, Ptok M, Jungheim M. Phonation-induced Upper Esophageal Sphincter Contraction Caused by Different Phonation Types. J Voice 2022:S0892-1997(22)00160-6. [PMID: 35906176 DOI: 10.1016/j.jvoice.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION The upper esophageal sphincter (UES) has been reported to show activity during phonation. As it is still unknown whether the phonation-induced UES contraction represents a reflex or a simultaneous activation phenomenon, i.e. co-innervation, this study aims to investigate and characterize the phonation-induced contraction of the UES in healthy individuals by analyzing the influence of various phonation tasks on pressure parameters of the UES. METHODS Twenty-five healthy volunteers produced the German neutral vowel [ə] in five different phonation tasks (modal voice, whispering, voiceless speech, creaky voice, and whispery voice). Simultaneously, they underwent high resolution manometry and electroglottography for measurement of pressure parameters in the region of the UES and latencies between larynx and UES activation. RESULTS During all types of phonation, the maximum pressures of the UES increased significantly (maximum pressure increases of 72%-132%). With regard to mean pressures this was valid for modal voice and whispering (mean pressure increases of 20%-25%). Differences concerning total pressure changes reached statistical significance when comparing whispering and voiceless speech as well as whispery voice. However, differences concerning the total pressure change between modal voices on the one hand and voiceless speech and whispery voice on the other hand turned out to be small. The averaged time delay between larynx and UES activation ranged from approximately -15 ms (whispery voice) to +15 ms (whispering). CONCLUSION A phonation induced pressure increase of the UES was confirmed in this study and did exist for different types of phonation. The extent of total pressure changes in the UES increases in relation with laryngeal muscle activity necessary for the phonation type. Next to varying effects of different types of phonation on UES activation, very short latencies indicate that a phonation induced contraction of the UES exists most likely due to co-innervation of UES and laryngeal muscles by the vagus nerve.
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Affiliation(s)
- Katharina Peters
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany.
| | - Simone Miller
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| | - Martin Ptok
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
| | - Michael Jungheim
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Hannover, Germany
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20
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Ozawa H, Kawakubo H, Matsuda S, Mayanagi S, Takemura R, Irino T, Fukuda K, Nakamura R, Wada N, Ishikawa A, Wada A, Ando M, Tsuji T, Kitagawa Y. Preoperative maximum phonation time as a predictor of pneumonia in patients undergoing esophagectomy. Surg Today 2022; 52:1299-1306. [PMID: 35133467 DOI: 10.1007/s00595-022-02454-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/05/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Esophagectomy is a highly invasive procedure, associated with several postoperative complications including pneumonia, anastomotic leakage, and sepsis, which may result in multiorgan failure. Pneumonia is considered a major predictor of poor long-term prognosis, so its prevention is important for patients undergoing surgery for esophageal cancer. METHODS The subjects of this study were 137 patients who underwent esophagectomy at Keio University Hospital, Tokyo, Japan, between January, 2012 and December, 2016. Patients who underwent R0 or R1 resection or esophagectomy with organ excision were included. Patients who underwent salvage surgery or resection of recurrent laryngeal nerve, and those with preoperative recurrent laryngeal nerve palsy, were excluded. We investigated the effect of the maximum phonation time on the development of postoperative pneumonia. RESULTS Pneumonia developed more frequently in patients with a long operative time, clinically left recurrent nerve lymph node metastasis, and a short preoperative maximum phonation time (p = 0.074, 0.046, and 0.080, respectively). Pneumonia was also more common in men with an abnormal maximum phonation time (p = 0.010). CONCLUSIONS The maximum phonation time is a significant predictor of postoperative pneumonia after esophagectomy in men.
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Affiliation(s)
- Hiroki Ozawa
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
| | - Satoru Matsuda
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Shuhei Mayanagi
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Ryo Takemura
- Clinical and Translational Research Center, Keio University Hospital, Shinjuku-ku, Tokyo, Japan
| | - Tomoyuki Irino
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kazumasa Fukuda
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Rieko Nakamura
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Norihito Wada
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Aiko Ishikawa
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Ayako Wada
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Makiko Ando
- Department of Rehabilitation Medicine, Keio University Hospital, Shinjuku-ku, Tokyo, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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21
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Gama R, Castro ME, van Lith-Bijl JT, Desuter G. Does the wearing of masks change voice and speech parameters? Eur Arch Otorhinolaryngol 2021. [PMID: 34550454 DOI: 10.1007/s00405-021-07086-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/10/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE The authors aim to review available reports on the potential effects of masks on voice and speech parameters. METHODS A literature search was conducted using MEDLINE and Google Scholar databases through July 2021. Several targeted populations, mask scenarios and methodologies were approached. The assessed voice parameters were divided into self-reported, acoustic and aerodynamic. RESULTS It was observed that the wearing of a face mask has been shown to induce several changes in voice parameters: (1) self-reported-significantly increased vocal effort and fatigue, increased vocal tract discomfort and increased values of voice handicap index (VHI) were observed; (2) acoustics-increased voice intensity, altered formants frequency (F2 and F3) with no changes in fundamental frequency, increased harmonics-to-noise ratio (HNR) and increased mean spectral values in high-frequency levels (1000-8000 Hz), especially with KN95 mask; (3) aerodynamics-maximum phonatory time was assessed in only two reports, and showed no alterations. CONCLUSION Despite the different populations, mask-type scenarios and methodologies described by each study, the results of this review outline the significant changes in voice characteristics with the use of face masks. Wearing a mask shows to increase the perception of vocal effort and an alteration of the vocal tract length and speech articulatory movements, leading to spectral sound changes, impaired communication and perception. Studies analyzing the effect of masks on voice aerodynamics are lacking. Further research is required to study the long-term effects of face masks on the potential development of voice pathology.
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Akkunje PS, Yamini BK, Yadav R, Shivashankar N, Malo PK, Thennarasu K, Hegde S, Pal PK. Phonatory Characteristics of Male Patients with Classic Essential Tremor. J Mov Disord 2021; 14:226-230. [PMID: 34399566 PMCID: PMC10657739 DOI: 10.14802/jmd.21010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/22/2021] [Accepted: 06/08/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Voice tremor (VT) is one of the characteristics of essential tremor (ET). This study was designed to describe the group and phonatory characteristics of classic ET patients with VT. METHODS This retrospective case-control study compared classic ET patients with age and sex-matched controls. The ET population was subgrouped based on auditory perceptual voice analysis. Electroglottography and acoustic voice samples obtained from both groups were analyzed for contact quotient (CQ) and multidimensional voice program parameters, i.e., fundamental frequency (F0), perturbation, noise, and tremor parameters. RESULTS The CQ, F0, perturbation, noise, and tremor characteristics significantly increased from the moderate VT group to the severe VT group. CONCLUSION The CQ, F0, and noise characteristics reflected the vocal folds' functionality. The perturbation and tremor parameters variation were reasoned considering the tremor-related changes occurring in the laryngeal, vocal tract, and expiratory muscles in patients with ET. Thus, phonatory analysis may help in monitoring the progression of ET.
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Affiliation(s)
- Preetie Shetty Akkunje
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Belur Keshavaprasad Yamini
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Nagarajarao Shivashankar
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Palash Kumar Malo
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Kandavel Thennarasu
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Shantala Hegde
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Lin FC, Chien HY, Kao YC, Wang CT. Multi-dimensional investigation of the clinical effectiveness and prognostic factors of voice therapy for benign voice disorders. J Formos Med Assoc 2021:S0929-6646(21)00189-3. [PMID: 34045124 DOI: 10.1016/j.jfma.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/08/2021] [Accepted: 05/02/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND/PURPOSE Voice therapy is frequently recommended as the first-line treatment for benign voice disorders. This study investigated the clinical effectiveness of voice therapy and the prognostic factors of treatment outcomes. METHODS We recruited 103 consecutive patients with voice disorders, namely vocal nodules, polyps, and muscle tension dysphonia (MTD), from September 2014 to July 2016. All the patients received voice therapy as the primary treatment. Treatment outcomes were evaluated using auditory perceptual evaluation, acoustic analysis, maximum phonation time, and 10-item voice handicap index (VHI-10). Clinical effectiveness of voice therapy was defined by either 1) a posttreatment VHI-10 score ≤ 10 points or 2) decline of VHI-10 ≥ 4 points. RESULTS After voice therapy, VHI-10 and perceptual rating of voice quality improved significantly (p < 0.05) in the three disease categories. In patients with nodules, all the outcome parameters improved significantly (p < 0.05). Patients with good adherence to voice therapy (attending more than four sessions) had a significantly higher effectiveness than those with poor adherence (87% vs. 64%, p < 0.05). Patients with high occupational vocal demand also demonstrated a better effectiveness than those with routine vocal demand (90% vs. 70%, p < 0.05). Subsequent multivariate analyses revealed that adherence and vocal demand were independently and significantly correlated with clinical effectiveness (p = 0.03). CONCLUSION Voice therapy is effective for patients with vocal nodules, polyps, and MTD. Adherence to voice therapy and occupational vocal demand are significant prognostic factors for treatment outcomes.
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Abstract
Sound symbolism is a non-arbitrary correspondence between sound and meaning. The majority of studies on sound symbolism have focused on consonants and vowels, and the sound-symbolic properties of suprasegmentals, particularly phonation types, have been largely neglected. This study examines the size and shape symbolism of four phonation types: modal and creaky voices, falsetto, and whisper. Japanese speakers heard 12 novel words (e.g., /íbi/, /ápa/) pronounced with the four types of phonation and rated the size and roundedness/pointedness each of the 48 stimuli seemed to represent on seven-point scales. The results showed that phonation types as well as consonantal and vocalic features influenced the ratings. Creaky voice was associated with larger and more pointed images than modal voice, which was in turn associated with larger and more pointed images than whisper. Falsetto was also associated with roundedness but not with smallness. These results shed new light on the acoustic approaches to sound symbolism and suggest the significance of phonation types and other suprasegmental features in the phenomenon.
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Affiliation(s)
- Kimi Akita
- Department of English Linguistics, Graduate School of Humanities, Nagoya University
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Halliday E, Beswick H, Bunn S, Ahsan SF. Description of a novel technique for creation of a custom-made prosthesis to aid vocalisation following laryngectomy. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138:475-7. [PMID: 33766499 DOI: 10.1016/j.anorl.2020.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/16/2020] [Accepted: 11/11/2020] [Indexed: 11/20/2022]
Abstract
There are various options to restore phonation after laryngectomy; one option involves using tracheo-oesophageal voice by placing a speaking valve through the tracheo-oesophageal wall. Some patients struggle to obtain good fixation of an adhesive base plate to the skin; this can result in air leakage and poor voice. We describe a technique using a custom-made prosthesis to provide a better base plate for fixation of the heat and moisture exchange cassette. This technique involves making an impression of the anterior neck around the laryngectomy stoma to create an anatomically fitted prosthesis, which accurately fills the void around the stoma. The custom-made prosthesis provides a more individualised fit compared to a standard base plate, helping improve vocalisation and communication.
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Rudavsky A, Turner T. Novel insight into the coordination between pelvic floor muscles and the glottis through ultrasound imaging: a pilot study. Int Urogynecol J 2020; 31:2645-52. [PMID: 32845397 DOI: 10.1007/s00192-020-04461-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Pelvic floor physical therapists have long utilized breathing cues with exercises and are beginning to incorporate vocalization tasks. To date, there have been no publications describing pelvic floor displacement during vocalization tasks. This study is a preliminary investigation into the changes in bladder shape distortion as a proxy for pelvic floor muscle displacement during respiratory and phonatory tasks. METHODS Bladders were imaged using two-dimensional ultrasound in standing position. Measurement consisted of a diagonal line from the most anterior-superior aspect of the bladder to the most inferior-posterior aspect of the bladder. Length was measured at baseline and maximum distortion for each task. The first two tasks cued pelvic floor muscles to contract and then strain. Subsequent tasks only cued glottis function. A linear regression tested correlation between bladder distortion response to glottis tasks and cued pelvic floor tasks. The hypothesis was that diagonal would shorten with contraction, lengthen with strain, and follow a similar pattern seen in respiration for phonation tasks. RESULTS Ten asymptomatic participants (5 men, 5 women) showed bladder diagonal shortening when cuing pelvic floor contraction for all participants and lengthening for 7 of the 10 participants when cued to strain the pelvic floor. The response of bladder length change was variable for glottis tasks, trending toward lengthening and significantly different in response to contraction. CONCLUSIONS When cuing pelvic floor to contract, healthy individuals showed shortening of bladder length and most lengthened during strain. When cuing phonation and respiration tasks, there was a tendency toward bladder lengthening.
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Al-Yahya SN, Mohamed Akram MHH, Vijaya Kumar K, Mat Amin SNA, Abdul Malik NA, Mohd Zawawi NA, Nik Mahmood NRK, Mustafa N, Azman M, Mat Baki M. Maximum Phonation Time Normative Values Among Malaysians and Its Relation to Body Mass Index. J Voice 2020; 36:457-463. [PMID: 32861567 DOI: 10.1016/j.jvoice.2020.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Maximum phonation time (MPT) is a test to measure glottic efficiency for laryngeal pathology screening and treatment monitoring. The normative value of MPT for South East Asia population has yet to be reported. It is postulated that MPT may be affected by body mass index (BMI) despite the paucity of evidence. Therefore, this study was designed to establish the normative value of MPT for a South East Asia population and investigate its relation to BMI. DESIGN & SETTING This cross-sectional study was conducted in Universiti Kebangsaan Malaysia Medical Center between May and September 2017. PARTICIPANTS AND METHODS Three hundred males and females with mean age of 30.23 (±11.04) years were recruited in equal number for each gender (n = 150) and divided into 3 groups of 50 according to their BMI (n = 50). The three groups are non-obese (BMI≤22.9kg/m2); obese (BMI between 23 and 34.9 kg/m2); and morbidly obese (BMI >35kg/m2). BMI and Voice Handicap Index-10 (VHI-10) were obtained. The average of three readings of MPT was measured using a stopwatch while the participants phonate /a/, /i/ and /u/. Unpaired t-test and ANOVA were used to compare means between and across groups. Spearman correlation assessed the correlation between MPT and BMI. MAIN OUTCOME MEASURES The normative values of MPT of both genders and correlation with BMI were analyzed. RESULTS The MPT normative values for males and females in the non-obese group were of 21.41 (±6.85) seconds and 18.05 (±5.06)seconds respectively for /a/. The MPT for all vowels were significantly higher in males across the BMI groups (P ≤ 0.05). There was low negative correlation between MPT and BMI in both genders. CONCLUSIONS This pioneering study documented the normative values of MPT among Malaysians showed that males had longer MPT than females across the BMI groups. Obesity affects the MPT in that as BMI increases, the MPT decreases.
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Affiliation(s)
- Syarifah Nafisah Al-Yahya
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Muhammad Haffiz Haslam Mohamed Akram
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Kasturi Vijaya Kumar
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Siti Nor Asyrah Mat Amin
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Noor Alifah Abdul Malik
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Nor Ain Mohd Zawawi
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Nik Ritza Kosai Nik Mahmood
- Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Norlaila Mustafa
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Mawaddah Azman
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Marina Mat Baki
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
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Denizoğlu İİ, Başer E. A Novel Surgical Technique for Bilateral Vocal Fold Paralysis: Microlaryngeal Posterior Glottoplasty. J Voice 2020; 36:283-287. [PMID: 32709496 DOI: 10.1016/j.jvoice.2020.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/20/2020] [Accepted: 05/27/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES/HYPOTHESIS Bilateral vocal fold paralysis (BVFP) is a clinical condition that may require emergency intervention that is characterized by airway obstruction. The main aspect to be taken under consideration in treatment is to preserve the vocal functions as much as possible while also ensuring an open airway. This study aims to present the preliminary results of a novel surgical method that we refer to as "posterior glottoplasty," which has been performed on BVFP patients to minimize phonation disorder and achieve a better respiratory function. METHODS Five female patients who developed BVFP-related respiratory distress following total thyroidectomy surgery and underwent "posterior glottoplasty" between 2017 and 2019 were included in our study. Preoperative and postoperative aspiration-swallowing, respiration, and phonation functions were separately evaluated in all patients. RESULTS Five subjects were included in the study. All patients were female and between 31 and 67 years of age (mean 47). The mean duration of dyspnea was 58.4 months (range: 6-120). Mean postoperative follow-up time was 11.6 months (range: 6-18). All patients experienced respiratory relief in the postoperative period. Acoustic voice analysis showed minimal to no phonation loss. Minimal aspiration was observed in the early postoperative period which was supposed to be related to the Botulinum effect and it resolved in 2-4 weeks. CONCLUSIONS The posterior glottoplasty technique aims to increase the posterior (respiratory) glottic space for a better inhalation while keeping the membranous (phonatory) glottic gap to preserve phonation by redirecting the residual or synkinetic muscular vectors. It does not carry major morbidity risks in terms of phonation and aspiration and validates potential spontaneous recovery of the vocal fold paralysis since it preserves the integrity of the cricoarytenoid joints.
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Affiliation(s)
- İsmail İlter Denizoğlu
- Otorhinolaryngology, Head&Neck Surgery Department, İzmir Medical Park Hospital, İzmir, Turkey
| | - Engin Başer
- Otorhinolaryngology, Head&Neck Surgery Department., University of Health Sciences, Izmir Tepecik Training and Research Hospital, İzmir, Turkey.
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Hejná M, Šturm P, Tylečková L, Bořil T. Normophonic Breathiness in Czech and Danish: Are Females Breathier Than Males? J Voice 2020; 35:498.e1-498.e22. [PMID: 31902679 DOI: 10.1016/j.jvoice.2019.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
Abstract
The present study compares the voice quality of female and male speech in two languages: Czech, a Slavic language, and Danish, a Germanic language. For both languages, the results based on a total of 120 vocally healthy speakers are in line with the claim that females are universally breathier than males. This was supported by the Cepstral Peak Prominence (CPP) and H1*-H2* measures, which are generally known as the most robust correlates of breathiness, and also by the H1*-A3* measure. However, the sex distinction was unsupported or even contradictory when using some other measures suggested to reflect breathiness, which provides an incentive to insist on employing a number of acoustic measures in future voice research. The perceptual component of the study nevertheless suggests that these contradictory findings are due to differences in perceived roughness rather than breathiness, and that CPP and H1*-H2* do reflect breathiness differences, and CPP in particular. We therefore conclude that it is indeed the case that female speakers are breathier than male speakers. Finally, in terms of the two robust measures (CPP and H1*-H2*), no language-specific differences in the magnitude of the effect of sex on breathiness were found.
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Affiliation(s)
- Míša Hejná
- Department of English, Aarhus University, Aarhus C, Denmark
| | - Pavel Šturm
- Institute of Phonetics, Charles University, Praha 1, Czech Republic.
| | - Lea Tylečková
- Institute of Phonetics, Charles University, Praha 1, Czech Republic
| | - Tomáš Bořil
- Institute of Phonetics, Charles University, Praha 1, Czech Republic
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Finger LS, Hoffmann CF, Cielo CA. Maximum Phonation Time and Body Mass Index in Nondysphonic Eutrophic Children. J Voice 2019; 35:500.e1-500.e7. [PMID: 31685324 DOI: 10.1016/j.jvoice.2019.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/27/2019] [Accepted: 09/30/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Literature presents controversial maximum phonation time values in children. OBJECTIVE Verify and correlate the maximum phonation time of vowels /a, i, u/ and the body mass index of children. METHOD Evaluation of 484 children, eutrophic and without dysphonia, aged from 4:00 to 7:11 years. SAMPLING questionnaire, audiometric screening, auditory-perceptual evaluation of voice, and assessment of the body mass index. DATA COLLECTION measurement of the maximum phonation time of /a, i, u/. Descriptive statistics, t test, and multiple regression at 5% significance. RESULTS /a:/ = 3.77 seconds at age 4:00 years, 5 seconds at 5:00, 5.85 seconds at 6:00, and 7.5 seconds at 7:00 for boys, and 3.89 seconds, 4.89 seconds, 5.61 seconds, and 6.61 seconds for girls, respectively; /i:/ = 3.49 seconds at age 4:00 years, 4.96 seconds at 5:00, 5.72 seconds at 6:00, and 6.88 seconds at 7:00 for boys, and 3.49 seconds, 4.73 seconds, 5.41 seconds, and 6.63 seconds for girls, respectively; /u:/ = 3.64 seconds at age 4:00 years, 4.85 seconds at 5:00, 5.76 seconds at 6:00, and 7.08 seconds at 7:00 for boys, and 3.54 seconds, 4.73 seconds, 5.64 seconds, and 6.47 seconds for girls, respectively. There were no significant differences between genders, except for /a:/ at age 7:00 years. The correlations were not significant. CONCLUSION Maximum phonation time of /a, i, u/ increased with age and its value in seconds was approximately equal to the age in years. At the age 7:00 years, /a:/ from boys was longer. The body mass index did not show influence on the maximum phonation times.
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Affiliation(s)
- Leila Susana Finger
- Universidade Federal de Santa Maria, Departamento de Fonoaudiologia, Santa Maria, Rio Grande do Sul, Brazil.
| | - Carla Franco Hoffmann
- Universidade Federal de Santa Maria, Departamento de Fonoaudiologia, Santa Maria, Rio Grande do Sul, Brazil
| | - Carla Aparecida Cielo
- Universidade Federal de Santa Maria, Departamento de Fonoaudiologia, Santa Maria, Rio Grande do Sul, Brazil
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Bernardi JMB, de Barros LN, Assunção LDS, de Oliveira RS, Gambirásio YF, Medved DMDS, Fernandes ACN, da Silva EM. Effect of the Finnish Tube on the Voice of a Deaf Musician: A Case Report. J Voice 2019; 35:498.e23-498.e29. [PMID: 31685325 DOI: 10.1016/j.jvoice.2019.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/27/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To verify the auditory-perceptual and acoustic effects of the semioccluded vocal tract exercise with Finnish tube on the vocal quality of a deaf musician. METHODS A seven-day protocol with Finnish tube was performed with guidance for its home replication twice a day. A 46-years-old man with profound bilateral sensorineural hearing loss, musician and composer participated. Before and after the application of the protocol had undergone tonal audiometry, nasofibrolaryngoscopy, acoustic analysis with Praat and auditory-perceptual evaluation of the voice with Voice Profile Analysis Scheme for Brazilian Portuguese. RESULTS The postintervention auditory-perceptual analysis identified reduction of the deviation in lip spreading, extensive labial range, raised tongue body, pharyngeal expansion, nasal resonance, larynx height, larynx and vocal tract tension and irregularity, pitch, speech rate, and a better respiratory support. The maximum phonation time reduced, probably because of elimination of the abrupt vocal attack and tension, articulatory deviations, improvement in voicing and the absence of the use of expiratory reserve air. The fundamental frequency became lower, and the first, second, third, and fourth formants became higher. The jitter increased, and the shimmer reduced. CONCLUSION The use of the Finnish tube might have facilitated the voicing sensations in the deaf musician, by enhancing the tactile-kinesthetic perception of the vocal tract and brought a greater source-filter interaction.
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Reynolds MV, Madden SK, Ryan AB. The influence of premature birth on laryngeal development for phonation. Int J Pediatr Otorhinolaryngol 2019; 122:165-169. [PMID: 31035174 DOI: 10.1016/j.ijporl.2019.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/12/2019] [Accepted: 04/12/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Dysphonia is a known consequence of premature birth, and is usually associated with endotracheal intubation in the neonatal period or surgical ligation of persistent patent ductus arteriosus. Recently, cases of dysphonia, in the absence of these causative factors, have been reported. OBJECTIVES This review seeks to identify literature pertaining to those aspects of laryngeal development that may potentially be disrupted by premature birth. The purpose of the review is to determine whether there is any possible anatomical or physiological explanation for dysphonia to arose solely from premature birth. METHODS This scoping review was conducted in accordance with the guidelines prescribed by Arskey and O'Malley (2005). Fifteen relevant papers were identified. Results were categorized into age-related categories, to identify changes in the developmental trajectory. Based on the results of the literature search, a further category of unphonated larynges was added. RESULTS Potential differences in the laryngeal framework (e.g., the development of the cricoid cartilage and the shape of the glottis) and vocal fold histology, depending on gestational age and post-natal phonation were identified. Much literature focused on the macula flavae, however, the layers of the lamina propria were also discussed. DISCUSSION It is unclear whether the process of differentiation of the layers of the lamina propria, which commences in the second to third months of life in term-born infants, is disrupted by prematurity. Further, development of the macula flavae continues until at least 28 weeks' gestation. Preterm children may not phonate immediately after birth, which may also affect laryngeal development.
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Affiliation(s)
| | - Shayla K Madden
- State University New York College at Plattsburgh, United States
| | - Amy B Ryan
- State University New York College at Plattsburgh, United States
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Mattheus W, Brücker C. Characteristics of the pulsating jet flow through a dynamic glottal model with a lens-like constriction. Biomed Eng Lett 2019; 8:309-320. [PMID: 30603215 DOI: 10.1007/s13534-018-0075-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/09/2018] [Accepted: 05/14/2018] [Indexed: 11/28/2022] Open
Abstract
A computational study of the pulsating jet in a squared channel with a dynamic glottal-shaped constriction is presented. It follows the model experiments of Triep and Brücker (J Acoust Soc Am 127(2):1537-1547, 2010) with the cam-driven model that replicates the dynamic glottal motion in the process of human phonation. The boundary conditions are mapped from the model experiment onto the computational model and the three dimensional time resolved velocity and pressure fields are numerically calculated. This study aims to provide more details of flow separation and pressure distribution in the glottal gap and in the supraglottal flow field. Within the glottal gap a 'vena contracta' effect is generated in the mid-sagittal plane. The flow separation in the mid-coronal plane is therefore delayed to larger diffuser angles which leads to an 'axis-switching' effect from mid-sagittal to mid-coronal plane. The location of flow separation in mid-sagittal cross section moves up- and downwards along the vocal folds surface in streamwise direction. The generated jet shear layer forms a chain of coherent vortex structures within each glottal cycle. These vortices cause characteristic velocity and pressure fluctuations in the supraglottal region, that are in the range of 10-30 times of the fundamental frequency.
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Affiliation(s)
- Willy Mattheus
- 1Division of Phoniatrics and Audiology, Department of Otorhinolaryngology, Faculty of Medicine "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Christoph Brücker
- 2Department of Mechanical Engineering and Aeronautics, City University London, Northampton Square, London, UK
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Vásquez-Correa JC, Orozco-Arroyave JR, Bocklet T, Nöth E. Towards an automatic evaluation of the dysarthria level of patients with Parkinson's disease. J Commun Disord 2018; 76:21-36. [PMID: 30149241 DOI: 10.1016/j.jcomdis.2018.08.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/29/2018] [Accepted: 08/07/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Parkinson's disease (PD) is a neurological disorder that produces motor and non-motor impairments. The evaluation of motor symptoms is currently performed following the third section of the Movement Disorder Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRS-III); however, only one item of that scale is related to speech impairments. It is necessary to develop a specific scale such that considers those aspects related to speech impairments of the patients. AIMS (i) To introduce and evaluate the suitability of a modified version of the Frenchay Dysarthria Assessment (m-FDA) scale to quantify the dysarthria level of PD patients; (ii) to objectively model dysarthric speech signals considering four speech dimensions; (iii) to develop a methodology, based on speech processing and machine learning methods, to automatically quantify/predict the dysarthria level of patients with PD. METHODS The speech recordings are modeled using features extracted from several dimensions of speech: phonation, articulation, prosody, and intelligibility. The dysarthria level is quantified using linear and non-linear regression models. Speaker models based on i-vectors are also explored. RESULTS AND CONCLUSIONS The m-FDA scale was introduced to assess the dysarthria level of patients with PD. Articulation features extracted from continuous speech signals to create i-vectors were the most accurate to quantify the dysarthria level, with correlations of up to 0.69 between the predicted m-FDA scores and those assigned by the phoniatricians. When the dysarthria levels were estimated considering dedicated speech exercises such as rapid repetition of syllables (DDKs) and read texts, the correlations were 0.64 and 0.57, respectively. In addition, the combination of several feature sets and speech tasks improved the results, which validates the hypothesis about the contribution of information from different tasks and feature sets when assessing dysarthric speech signals. The speaker models seem to be promising to perform individual modeling for monitoring the dysarthria level of PD patients. The proposed approach may help clinicians to make more accurate and timely decisions about the evaluation and therapy associated to the dysarthria level of patients. The proposed approach is a great step towards unobtrusive/ecological evaluations of patients with dysarthric speech without the need of attending medical appointments.
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Affiliation(s)
- J C Vásquez-Correa
- Faculty of Engineering, University of Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia; Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.
| | - J R Orozco-Arroyave
- Faculty of Engineering, University of Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia; Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.
| | | | - E Nöth
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.
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Ternström S, D'Amario S, Selamtzis A. Effects of the Lung Volume on the Electroglottographic Waveform in Trained Female Singers. J Voice 2018; 34:485.e1-485.e21. [PMID: 30337119 DOI: 10.1016/j.jvoice.2018.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 09/04/2018] [Accepted: 09/06/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine if in singing there is an effect of lung volume on the electroglottographic waveform, and if so, how it varies over the voice range. STUDY DESIGN Eight trained female singers sang the tune "Frère Jacques" in 18 conditions: three phonetic contexts, three dynamic levels, and high or low lung volume. Conditions were randomized and replicated. METHODS The audio and EGG signals were recorded in synchrony with signals tracking respiration and vertical larynx position. The first 10 Fourier descriptors of every EGG cycle were computed. These spectral data were clustered statistically, and the clusters were mapped by color into a voice range profile display, thus visualizing the EGG waveform changes under the influence of fo and SPL. The rank correlations and effect sizes of the relationships between relative lung volume and several adduction-related EGG wave shape metrics were similarly rendered on a color scale, in voice range profile-style 'voice maps.' RESULTS In most subjects, EGG waveforms varied considerably over the voice range. Within subjects, reproducibility was high, not only across the replications, but also across the phonetic contexts. The EGG waveforms were quite individual, as was the nature of the EGG shape variation across the range. EGG metrics were significantly correlated to changes in lung volume, in parts of the range of the song, and in most subjects. However, the effect sizes of the relative lung volume were generally much smaller than the effects of fo and SPL, and the relationships always varied, even changing polarity from one part of the range to another. CONCLUSIONS Most subjects exhibited small, reproducible effects of the relative lung volume on the EGG waveform. Some hypothesized influences of tracheal pull were seen, mostly at the lowest SPLs. The effects were however highly variable, both across the moderately wide fo-SPL range and across subjects. Different singers may be applying different techniques and compensatory behaviors with changing lung volume. The outcomes emphasize the importance of making observations over a substantial part of the voice range, and not only of phonations sustained at a few fundamental frequencies and sound levels.
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Affiliation(s)
- Sten Ternström
- Department of Speech, Music and Hearing, School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden.
| | - Sara D'Amario
- Department of Speech, Music and Hearing, School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden; Audio Lab, Department of Electronic Engineering, University of York, Heslington, United Kingdom
| | - Andreas Selamtzis
- Department of Speech, Music and Hearing, School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden
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Abstract
The larynx is a complex organ which has a role in a variety of functions such as phonation, breathing, and swallowing. To research these functions, it is widely accepted that in vivo studies provide more anatomically and physiologically relevant findings. However, invasive procedures are generally needed to measure variables such a subglottal pressure, vocal fold tension and stiffness, and cricothyroid muscle stretch. Performing studies using excised larynges is a useful technique which makes it possible to not only measure phonation parameters but control them as well. Early studies using excised larynges mainly focused on controlling specific parameters and mathematical modeling simulations. The use of these studies has helped further research in laryngeal anatomy, imaging techniques, as well as aerodynamic, acoustic, and biomechanical properties. Here, we describe the progress of this research over the past 5 years. The number of accepted animal models has increased and ideas from excised larynx studies are starting to be applied to treatment methods for laryngeal disorders. These experiments are only valid for an excised situation and must continue to be combined with animal experimentation and clinical observations.
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Affiliation(s)
- Rong Luo
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weijia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Wei
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jim Lamb
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Madison, Wisconsin
| | - Jack J Jiang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; University of Wisconsin-Madison, School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Madison, Wisconsin.
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Ko EJ, Chae M, Cho SR. Relationship Between Swallowing Function and Maximum Phonation Time in Patients With Parkinsonism. Ann Rehabil Med 2018; 42:425-432. [PMID: 29961740 PMCID: PMC6058589 DOI: 10.5535/arm.2018.42.3.425] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/18/2017] [Indexed: 11/29/2022] Open
Abstract
Objective To identify the relationship between maximum phonation time (MPT) and swallowing function, as well as the elements of swallowing, in order to provide a rationale for speech therapy in patients with Parkinsonism manifesting dysphagia. Methods Thirty patients with Parkinsonism who underwent speech evaluation and videofluoroscopic swallowing study (VFSS) were recruited. The MPT, the longest periods of sustained pronunciation of /aa/, was evaluated. The VFSS was evaluated using Penetration Aspiration Scale (PAS), National Institutes of Health-Swallowing Safety Scale (NIH-SSS), and Videofluoroscopic Dysphagia Scale (VDS). The relationship between dysphagia scales and MPT was analyzed using Pearson correlation. The difference in VDS variables between subgroups (Parkinson disease or Parkinsonian syndrome, independent or dependent ambulation, and normal or abnormal MPT) and the difference in MPT between subgroups based on the VDS variables were analyzed using the independent t-test. Results Bolus formation and laryngeal elevation functions were significantly higher in the normal MPT group compared with the impaired group. In the VDS variables, patients with intact bolus formation, oral transit time, pharyngeal swallow triggering, and laryngeal elevation showed significantly longer MPTs compared with the impaired groups. In addition, MPT was significantly correlated with the VDS and modestly correlated with the NIH-SSS, but not the PAS, suggesting that phonatory function is related to the oropharyngeal swallowing function, but not directly to the aspiration itself. Conclusion The correlation between MPT and several swallowing-related elements was identified, indicating an interactive correlation between swallowing and phonation. This result justifies voice therapy as a treatment for dysphagia in patients with Parkinsonism.
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Affiliation(s)
- Eu Jeong Ko
- Department of Rehabilitation Medicine and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Minji Chae
- Department of Rehabilitation Medicine and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Rae Cho
- Department of Rehabilitation Medicine and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea.,Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.,Avison Biomedical Research Center, Yonsei University College of Medicine, Seoul, Korea.,Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
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Zhang C, Paddock K, Chou A, Scholp A, Gong T, Jiang JJ. Prolonged phonation impairs the integrity and barrier function of porcine vocal fold epithelium: a preliminary study. Eur Arch Otorhinolaryngol 2018; 275:1547-1556. [PMID: 29671091 DOI: 10.1007/s00405-018-4973-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 04/11/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Voice abuse is known to be a common risk factor of voice disorders and prolonged; high-intensity phonation has been shown to damage the vocal fold epithelium. We aim to evaluate the effects of phonation on the integrity and barrier function of vocal fold epithelium using a porcine laryngeal model. METHODS Ex vivo porcine larynges were phonated at low intensity or high intensity for 15, 30, or 60 min within 4 h after harvest. Vocal fold epithelium was visualized using transmission electron microscopy (TEM). The barrier function of vocal fold epithelium was evaluated by measuring the permeability to model molecules, fluorescein (376 Da), and fluorescein isothiocyanate (FITC)-dextrans of 4000 and 10,000 Da (FD4, FD10), in a Franz diffusing cell. RESULTS Cell death and dilated intercellular space after phonation were observed using TEM. Thickness of vocal fold epithelium was significantly reduced after low-intensity phonation for 30 and 60 min and high-intensity phonation for 15, 30, and 60 min. Epithelial permeability to fluorescein was significantly increased after low-intensity phonation for 30 and 60 min, and high-intensity phonation. Permeability to FD4 was significantly increased after high-intensity phonation for 30 and 60 min. Phonation did not alter the permeability to FD10 significantly. CONCLUSION Long-duration phonation destroys the integrity and barrier function of vocal fold epithelium. These effects likely make vocal folds more vulnerable to other environmental irritants, such as tobacco smoke, reflux components, allergens, and inhaled pollutants. Destroyed barrier function may be an important factor in the pathogenesis of voice lesions related to voice abuse.
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Affiliation(s)
- Chi Zhang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Kieran Paddock
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, 53792, USA
| | - Adriana Chou
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, 53792, USA
| | - Austin Scholp
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, 53792, USA
| | - Ting Gong
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Jack J Jiang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, 53792, USA.
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Echternach M, Burk F, Rose F, Herbst CT, Burdumy M, Döllinger M, Richter B. [Impact of functional mass lesions in professional female singers : Biomechanics of vocal fold oscillation in the register transition regions]. HNO 2017; 66:308-320. [PMID: 29247438 DOI: 10.1007/s00106-017-0447-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The influence of functional mass lesions on vocal fold oscillation patterns in vocally challenging tasks is not yet understood in detail. MATERIALS UND METHODS Glissandi on the vowel [a:] from 220 to 440 Hz and 440 to 880 Hz were analyzed in three groups of four professional female singers: without a mass lesion or dysphony (group A), with a functional mass lesion (swellings without a great impact on oscillation patterns during stroboscopy; group B), and with organic dysphony (group C). High-speed digital imaging (HSDI; 20,000 fps), and acoustic and electroglottographic (EGG) signals were used for analysis. Based on the EGG sample entropy, time windows for analysis of register transition phenomena were constructed. The voice signals (glottal area waveform, GAW; acoustic and EGG signals) were perceptually rated in terms of the noticeability of registration events. RESULTS The absolute sample entropy revealed maxima in fundamental frequency regions where register transitions typically occur. Groups A and B could be distinguished neither by perceptual rating nor based on sample entropy values. In comparison to the other two groups, the absolute sample entropy values of group C were greater in the lower glissando. However, the larger vocal fold oscillatory irregularities were observable for the upper glissando in this group. CONCLUSION Functional mass lesions do not influence biomechanics adversely in vocally challenging tasks such as register transitions. The use of sample entropy as a criterion for detection of register transitions is promising, but needs further validation.
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Affiliation(s)
- M Echternach
- Freiburger Institut für Musikermedizin, Medizinische Fakultät, Albert-Ludwigs-Universität und Universitätsklinikum Freiburg, Breisacher Str. 60, 79106, Freiburg i.Br., Deutschland.
| | - F Burk
- Freiburger Institut für Musikermedizin, Medizinische Fakultät, Albert-Ludwigs-Universität und Universitätsklinikum Freiburg, Breisacher Str. 60, 79106, Freiburg i.Br., Deutschland
| | - F Rose
- Freiburger Institut für Musikermedizin, Medizinische Fakultät, Albert-Ludwigs-Universität und Universitätsklinikum Freiburg, Breisacher Str. 60, 79106, Freiburg i.Br., Deutschland
| | - C T Herbst
- Department für Musikwissenschaft, Universität Mozarteum Salzburg, Salzburg, Österreich
| | - M Burdumy
- Medizin Physik, Medizinische Fakultät, Albert-Ludwigs-Universität und Universitätsklinikum Freiburg, Breisacher Str. 60a, 79106, Freiburg, Deutschland
| | - M Döllinger
- Abteilung für Phoniatrie und Pädaudiologie an der HNO Klinik Erlangen, Universitätsklinikum Erlangen, Bohlenplatz 21, 91054, Erlangen, Deutschland
| | - B Richter
- Freiburger Institut für Musikermedizin, Medizinische Fakultät, Albert-Ludwigs-Universität und Universitätsklinikum Freiburg, Breisacher Str. 60, 79106, Freiburg i.Br., Deutschland
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Sakuma T, Kurose M, Okamoto K, Hasegawa M, Fujii N, Nakatani Y, Takagi R, Sato T, Kodama Y, Ominato R, Yamamura K, Yamada Y. Use of a Novel Device to Assess Intraoral and Intrapharyngeal Baropressure during Sound Production. Folia Phoniatr Logop 2017; 68:274-281. [PMID: 29232672 DOI: 10.1159/000481530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 09/12/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We developed a novel device that simultaneously measures oral and intrapharyngeal baropressure. The transducer has the advantage that it can be placed in any region. We determined the effect of different speech samples on baropressure in these regions. PATIENTS AND METHODS Seven healthy individuals produced speech samples comprising vowels and consonants (e.g., /aka/, /apa/, and /ash/). Two transducers were installed into the experimental plate at the incisive papillae and center of the Ah-line; a third transducer was placed in the mid-pharyngeal cavity. During each task, 3 parameters were analyzed: peak pressure, mean pressure, and the temporal relationship between sound signals and pressure changes. RESULTS The mean pressure did not change during the production of a single vowel; however, the pressure transiently increased during the production of the speech samples, depending on the place of articulation. Moreover, the place of articulation affected the onset and peak timing of pressure changes. CONCLUSIONS These findings indicate that pressure changes during the production of speech samples reflect the functional aspects of speech production. In particular, simultaneous pressure recordings at multiple locations would provide precise information about speech production, compared to pressure studies that used a single pressure transducer.
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Affiliation(s)
- Toshiki Sakuma
- Division of Oral Physiology, Department of Oral Biological Sciences, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan.,Shinei-cho Dental Clinic, Tainai, Japan
| | - Masayuki Kurose
- Division of Oral Physiology, Department of Oral Biological Sciences, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Keiichiro Okamoto
- Division of Oral Physiology, Department of Oral Biological Sciences, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Mana Hasegawa
- Division of Oral Physiology, Department of Oral Biological Sciences, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan.,General Dentistry and Clinical Education Unit, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Noritaka Fujii
- General Dentistry and Clinical Education Unit, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yousuke Nakatani
- Division of Oral Physiology, Department of Oral Biological Sciences, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan.,Division of Oral and Maxillofacial Surgery, Department of Oral Biological Sciences, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ritsuo Takagi
- Division of Oral and Maxillofacial Surgery, Department of Oral Biological Sciences, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Taisuke Sato
- Center for Transdisciplinary Research, Niigata University, Niigata, Japan
| | - Yasumitsu Kodama
- Division of Oral and Maxillofacial Surgery, Department of Oral Biological Sciences, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Rei Ominato
- Division of Oral and Maxillofacial Surgery, Department of Oral Biological Sciences, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kensuke Yamamura
- Division of Oral Physiology, Department of Oral Biological Sciences, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan
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Kryshtopava M, Van Lierde K, Defrancq C, De Moor M, Thijs Z, D'Haeseleer E, Meerschman I, Vandemaele P, Vingerhoets G, Claeys S. Brain activity during phonation in healthy female singers with supraglottic compression: an fMRI pilot study. LOGOP PHONIATR VOCO 2017; 44:95-104. [PMID: 29219633 DOI: 10.1080/14015439.2017.1408853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This pilot study evaluated the usability of functional magnetic resonance imaging (fMRI) to detect brain activation during phonation in healthy female singers with supraglottic compression. Four healthy female classical singers (mean age: 26 years) participated in the study. All subjects had normal vocal folds and vocal characteristics and showed supraglottic compression. The fMRI experiment was carried out using a block design paradigm. Brain activation during phonation and exhalation was analyzed using Brain Voyager software (Brain Innovation B.V., Maastricht, The Netherlands). An fMRI data analysis showed a significant effect of phonation control in the bilateral pre/postcentral gyrus, and in the frontal, cingulate, superior and middle temporal gyrus, as well as in the parietal lobe, insula, lingual gyrus, cerebellum, thalamus and brainstem. These activation areas are consistent with previous reports using other fMRI protocols. In addition, a significant effect of phonation compared to exhalation control was found in the bilateral superior temporal gyrus, and the pre/postcentral gyrus. This fMRI pilot study allowed to detect a normal pattern of brain activity during phonation in healthy female singers with supraglottic compression using the proposed protocol. However, the pilot study detected problems with the experimental material/procedures that would necessitate refining the fMRI protocol. The phonation tasks were not capable to show brain activation difference between high-pitched and comfortable phonation. Further fMRI studies manipulating vocal parameters during phonation of the vowels /a/ and /i/ may elicit more distinctive hemodynamic response (HDR) activity patterns relative to voice modulation.
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Affiliation(s)
- Maryna Kryshtopava
- a Department of Otorhinolaryngology , University Hospital Ghent , Ghent , Belgium
| | - Kristiane Van Lierde
- b Department of Speech , Language and Hearing Sciences, University Ghent , Ghent , Belgium
| | - Charlotte Defrancq
- a Department of Otorhinolaryngology , University Hospital Ghent , Ghent , Belgium
| | - Michiel De Moor
- a Department of Otorhinolaryngology , University Hospital Ghent , Ghent , Belgium
| | - Zoë Thijs
- a Department of Otorhinolaryngology , University Hospital Ghent , Ghent , Belgium
| | - Evelien D'Haeseleer
- b Department of Speech , Language and Hearing Sciences, University Ghent , Ghent , Belgium
| | - Iris Meerschman
- b Department of Speech , Language and Hearing Sciences, University Ghent , Ghent , Belgium
| | - Pieter Vandemaele
- c Department of Radiology and Nuclear Medicine , University Hospital Ghent , Ghent , Belgium
| | - Guy Vingerhoets
- d Department of Experimental Psychology , Faculty of Psychology and Educational Sciences, Ghent University , Ghent , Belgium.,e Ghent Institute for functional and Metabolic Imaging (GIfMI) , University Hospital Ghent , Ghent , Belgium
| | - Sofie Claeys
- a Department of Otorhinolaryngology , University Hospital Ghent , Ghent , Belgium
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Hamdan AL, Ziade G, Tabet G, Btaiche R, Fakhri G, Yatim F, Sarieddine D, Seoud M. Vocal Symptoms and Acoustic Findings in Menopausal Women in Comparison to Pre-menopause Women with Body Mass Index as a Confounding Variable. J Menopausal Med 2017; 23:117-123. [PMID: 28951860 PMCID: PMC5606909 DOI: 10.6118/jmm.2017.23.2.117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/23/2017] [Accepted: 07/23/2017] [Indexed: 01/17/2023] Open
Abstract
Objectives To compare the prevalence of phonatory symptoms in menopausal women compared to pre-menopause women with body mass index (BMI) as a confounding variable. Methods A total of 69 women, 34 menopausal and 35 pre-menopausal were invited to participate in this study. Demographic variables included age, smoking, and BMI. All subjects were asked about the presence hoarseness, loss of high or low frequencies, pitch breaks, throat clearing, dryness in the throat and vocal fatigue. Acoustic analysis was performed and the Voice Handicap Index (VHI)-10 was filled by all the subjects. Results There was a significantly higher prevalence of throat clearing and dryness in the menopausal group compared to the pre-menopause group with a P value of 0.035 and 0.032 respectively. When BMI was taken into account, there was no statistically significant difference in the prevalence of any of the phonatory symptoms in menopausal women with high BMI and pre-menopause. There was no statistically significant difference in the means of any of the acoustic parameters between the menopausal group and pre-menopausal group. There was no significant difference in the mean VHI-10 between the menopause group and the pre-menopause (P = 0.652). Conclusions The results of this investigation substantiate the importance of fat as an alternative source of estrogen which can mask some of the phonatory symptoms.
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Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Georges Ziade
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Georges Tabet
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Rachel Btaiche
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Ghina Fakhri
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Firas Yatim
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Doja Sarieddine
- Department of Otolaryngology and Head & Neck Surgery, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Muhieddine Seoud
- Department of Obstetrics & Gynecology, American University of Beirut-Medical Center, Beirut, Lebanon
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Mao YT, Chen ZM, Xu L. [The application of artificial neural network on the assessment of lexical tone production of pediatric cochlear implant users]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2017; 52:573-579. [PMID: 28822408 DOI: 10.3760/cma.j.issn.1673-0860.2017.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: The present study was carried out to explore the tone production ability of the Mandarin-speaking children with cochlear implants (CI) by using an artificial neural network model and to examine the potential contributing factors underlining their tone production performance. The results of this study might provide useful guidelines for post-operative rehabilitation processes of pediatric CI users. Methods: Two hundred and seventy-eight prelingually deafened children who received unilateral CI participated in this study. As controls, 170 similarly-aged children with normal hearing (NH) were recruited. A total of 36 Chinese monosyllabic words were selected as the tone production targets. Vocal production samples were recorded and the fundamental frequency (F0) contour of each syllable was extracted using an auto-correlation algorithm followed by manual correction. An artificial neural network was created in MATLAB to classify the tone production. The relationships between tone production and several demographic factors were evaluated. Results: Pediatric CI users produced Mandarin tones much less accurately than did the NH children (58.8% vs. 91.5% correct). Tremendous variability in tone production performance existed among the CI children. Tones 2 and 3 were produced less accurately than tones 1 and 4 for both groups. For the CI group, all tones when in error tended to be judged as tone 1. The tone production accuracy was negatively correlated with age at implantation and positively correlated with CI use duration with correlation coefficients (r) of -0.215 (P=0.003) and 0.203 (P=0.005), respectively. Age was one of the determinants of tonal ability for NH children. Conclusions: For children with severe to profound hearing loss, early implantation and persistent use of CI are beneficial to their tone production development. Artificial neural network is a convenient and reliable assessment tool for the development of tonal ability of hearing-impaired children who are in the rehabilitation processes that focus on speech and language expression.
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Affiliation(s)
- Y T Mao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, China; School of Rehabilitation and Communication Sciences, Ohio University, Athens, OH 45701, USA
| | - Z M Chen
- Department of Rehabilitation Medicine, Language Disorder Center, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China
| | - L Xu
- School of Rehabilitation and Communication Sciences, Ohio University, Athens, OH 45701, USA
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Yoon JH, Ahn Y, Kim SH, Chin J, Park S, Na DL. Neuroanatomical Correlates of Hypophonia in Subcortical Vascular Cognitive Impairment. Eur Neurol 2017; 78:93-104. [PMID: 28738366 DOI: 10.1159/000479023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 06/26/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Early detection and intervention may alter the disease course of subcortical vascular cognitive impairment (SVCI). Patients with SVCI have white matter ischemia that disrupts connections between the cortex and subcortical gray matter and therefore manifest various symptoms such as motor disturbances and behavioral/cognitive dysfunction. Reduced vocal loudness, or hypophonia, is one of the common motor symptoms of SVCI, but few studies have systematically investigated it in this patient population. The main purpose of this investigation was to identify neural pathways underlying hypophonia in patients with SVCI. METHODS Eighty-eight patients with SVCI and 21 normal controls performed phonation tasks. Diffusion tensor imaging data from 73 patients were utilized to measure white matter changes associated with hypophonia. RESULTS Correlational analyses between white matter fractional anisotropy values and the decibel level of the "sustained phonation" task identified the left midbrain cerebral peduncle (corticobulbar tract), external capsule, corona radiata/internal capsule, and bilateral frontal white matter as possible neural correlates for hypophonia. CONCLUSION Our results support the notion that hypophonia in SVCI patients might be caused by the impairment of the pyramidal and extrapyramidal systems. This study provides a unique contribution towards understanding the neuropathology of hypophonic features in this population.
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Affiliation(s)
- Ji Hye Yoon
- Department of Speech Pathology and Audiology, Audiology and Speech Pathology Research Institute, College of Natural Sciences, Hallym University, Chuncheon, Republic of Korea
| | - Yisuh Ahn
- The BOM Neuropsychology Center and Cognitive Rehabilitation Research Institute, Seoul, Republic of Korea
| | | | - Juhee Chin
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seongbeom Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University Seoul, Seoul, Republic of Korea.,Stem Cell and Regenerative Medicine Institute, Samsung Medical Center, Seoul, Republic of Korea
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Goodyer E, Müller F, Hess M, Kandan K, Farukh F. Biomechanical Flow Amplification Arising From the Variable Deformation of the Subglottic Mucosa. J Voice 2017; 31:669-674. [PMID: 28433346 DOI: 10.1016/j.jvoice.2017.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/18/2017] [Accepted: 03/22/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study mapped the variation in tissue elasticity of the subglottic mucosa, applied these data to provide initial models of the likely deformation of the mucosa during the myoelastic cycle, and hypothesized as to the impact on the process of phonation. STUDY DESIGN Six donor human larynges were dissected along the sagittal plane to expose the vocal folds and subglottic mucosa. A linear skin rheometer was used to apply a controlled shear force, and the resultant displacement was measured. These data provided a measure of the stress/strain characteristics of the tissue at each anatomic point. A series of measurements were taken at 2-mm interval inferior of the vocal folds, and the change in elasticity was determined. RESULTS It was found that the elasticity of the mucosa in the subglottic region increased linearly with distance from the vocal folds in all 12 samples. A simple deformation model indicated that under low pressure conditions the subglottic mucosa will deform to form a cone, which could result in a higher velocity, thus amplifying the low pressure effect resulting from the Venturi principle, and could assist in maintaining laminar flow. CONCLUSIONS This study indicated that the deformation of the subglottic mucosa could play a significant role in the delivery of a low pressure airflow over the vocal folds. A large scale study will now be undertaken to secure more data to evaluate this hypothesis, and using computational fluid dynamics based on actual three-dimensional structure obtained from computed tomography scans the aerodynamics of this region will be investigated.
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Affiliation(s)
- Eric Goodyer
- De Montfort University, Bio-Informatics Research Group, Leicester, UK.
| | | | - Markus Hess
- Universitat Klinic, Eppendorf, Hamburg, Germany
| | | | - Farukh Farukh
- De Montfort University, Bio-Informatics Research Group, Leicester, UK
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Konnai R, Scherer RC, Peplinski A, Ryan K. Whisper and Phonation: Aerodynamic Comparisons Across Adduction and Loudness. J Voice 2017; 31:773.e11-773.e20. [PMID: 28366247 DOI: 10.1016/j.jvoice.2017.02.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/13/2017] [Accepted: 02/24/2017] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Whisper is known to be produced by different speakers differently, especially with respect to glottal configuration that influences glottal aerodynamics. Differences in whisper production and phonation types imply important linguistic information in many languages, are identified in vocal pathologies, are used to communicate mood and emotion, and are used in vocal performance. OBJECTIVE The present study focused on investigating the aerodynamic differences between whisper and phonation at different loudness and adduction levels. METHODS Three men and five women between 20 and 40 years of age participated in the study. Smooth syllable strings of the syllable /baep:/ were whispered and phonated at three different loudness levels (soft, medium, and loud) and three voice qualities (breathy, normal, and pressed). The voice qualities are associated with different adduction levels. This resulted in 18 treatment combinations (three adduction levels × three loudness levels × two sexes). RESULTS A regression analysis was performed using a PROC MIXED procedure with SAS statistical software. Under similar production conditions, subglottal pressure was significantly lower in whisper than in phonation in 10 of 18 combinations, mean glottal airflow was significantly higher in whisper than in phonation in 13 of 18 combinations, and flow resistance was significantly lower in whisper than in phonation in 14 of 18 combinations, with the female subjects demonstrating these trends more frequently than the male subjects do. Of importance, in general, compared with phonation under similar production conditions, whisper is not always accompanied by lower subglottal pressure and higher airflows. CONCLUSION Results from this study suggest that the typical finding of lower subglottal pressure, higher glottal airflow, and decreased flow resistance in whisper compared with phonation cannot be generalized to all individuals and depends on the "whisper type." The nine basic production conditions (three loudness levels and three adduction levels) resulted in data that may help explain the wide range of variation of whisper production reported in earlier studies.
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Affiliation(s)
- Ramya Konnai
- Department of Neurology, Henry Ford West Bloomfield Hospital, West Bloomfield, Michigan.
| | - Ronald C Scherer
- Department of Communication Sciences and Disorders, Bowling Green State University, Bowling Green, Ohio
| | | | - Kenneth Ryan
- Department of Statistics, West Virginia University, Morgantown, Virginia
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Meerschman I, D'haeseleer E, Catry T, Ruigrok B, Claeys S, Van Lierde K. Effect of two isolated vocal facilitating techniques glottal fry and yawn-sigh on the phonation of female speech-language pathology students: A pilot study. J Commun Disord 2017; 66:40-50. [PMID: 28412598 DOI: 10.1016/j.jcomdis.2017.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/16/2017] [Accepted: 03/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the effect of two isolated vocal facilitating techniques, glottal fry and yawn-sigh, on the phonation of vocally healthy female speech-language pathology (SLP) students. STUDY DESIGN A multigroup pretest-posttest design was used. METHODS A group of thirty-six healthy female SLP students with a mean age of 18.1 years were assigned into three groups: a glottal fry group (practicing the facilitating technique glottal fry across 18 weeks, n=12), a yawn-sigh group (practicing the facilitating technique yawn-sigh across 18 weeks, n=12) and a control group (receiving no facilitating techniques, n=12). To compare vocal measures before and after this training period, an identical objective voice assessment protocol (maximum performance task, acoustic analysis, voice range profile and Dysphonia Severity Index) was performed in the three groups. Groups were compared over time using linear mixed models. Within-group effects of time were determined using post hoc pairwise comparisons. RESULTS Glottal fry resulted in a significant decrease in lowest and highest intensity. Yawn-sigh resulted in a significant increase in fundamental frequency, a significant decrease in shimmer and noise-to-harmonic ratio, and a significant increase in highest intensity. CONCLUSIONS Yawn-sigh may have a positive effect on the phonation of female vocally healthy future SLPs, whereas results are less supportive for using glottal fry in training this population's voice.
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Affiliation(s)
- I Meerschman
- Department of Speech Language and Hearing Sciences, Ghent University, Belgium.
| | - E D'haeseleer
- Department of Speech Language and Hearing Sciences, Ghent University, Belgium
| | - T Catry
- Department of Speech Language and Hearing Sciences, Ghent University, Belgium
| | - B Ruigrok
- Department of Speech Language and Hearing Sciences, Ghent University, Belgium
| | - S Claeys
- Department of Otorhinolaryngology, Ghent University, Belgium
| | - K Van Lierde
- Department of Speech Language and Hearing Sciences, Ghent University, Belgium; Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
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Traser L, Knab J, Echternach M, Fuhrer H, Richter B, Buerkle H, Schumann S. Regional ventilation during phonation in professional male and female singers. Respir Physiol Neurobiol 2017; 239:26-33. [PMID: 28109943 DOI: 10.1016/j.resp.2017.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/05/2017] [Accepted: 01/11/2017] [Indexed: 01/08/2023]
Abstract
The respiratory system is a central part of voice production, but details in breath control during phonation are not yet fully understood. This study therefore aims to investigate regional ventilation of the lungs during phonation. It was analyzed in 11 professional singers using electrical impedance tomography during breathing and phonation with maximum phonation time. Our results show differences in impedance changes between phonation and exhalation in the courses of time and amplitude normalized curves. Furthermore, differences related to gender and professionalism were found in the temporal and spatial profiles of regional ventilation. For female singers (sopranos and mezzo-sopranos) the anterior region participated less at the start of ventilation, and was more stable at the midpoint compared to male singers (tenors). This might be an expression of a smaller relative movement in rib cage and anterior diaphragm, primarily in early phonation.
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Affiliation(s)
- Louisa Traser
- Institute of Musicians' Medicine, Medical Center-University of Freiburg, Germany; Department of Otolaryngology, Medical Center-University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany.
| | - Jana Knab
- Faculty of Medicine, University of Freiburg, Germany; Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Germany
| | - Matthias Echternach
- Institute of Musicians' Medicine, Medical Center-University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany
| | - Hannah Fuhrer
- Faculty of Medicine, University of Freiburg, Germany; Department of Neurology, Medical Center-University of Freiburg, Germany
| | - Bernhard Richter
- Institute of Musicians' Medicine, Medical Center-University of Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany
| | - Hartmut Buerkle
- Faculty of Medicine, University of Freiburg, Germany; Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Germany
| | - Stefan Schumann
- Faculty of Medicine, University of Freiburg, Germany; Department of Anesthesiology and Critical Care, Medical Center-University of Freiburg, Germany
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Jing B, Tang S, Wu L, Wang S, Wan M. Visualizing the Vibration of Laryngeal Tissue during Phonation Using Ultrafast Plane Wave Ultrasonography. Ultrasound Med Biol 2016; 42:2812-2825. [PMID: 27633284 DOI: 10.1016/j.ultrasmedbio.2016.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/12/2016] [Accepted: 07/22/2016] [Indexed: 06/06/2023]
Abstract
Ultrafast plane wave ultrasonography is employed in this study to visualize the vibration of the larynx and quantify the vibration phase as well as the vibration amplitude of the laryngeal tissue. Ultrasonic images were obtained at 5000 to 10,000 frames/s in the coronal plane at the level of the glottis. Although the image quality degraded when the imaging mode was switched from conventional ultrasonography to ultrafast plane wave ultrasonography, certain anatomic structures such as the vocal folds, as well as the sub- and supraglottic structures, including the false vocal folds, can be identified in the ultrafast plane wave ultrasonic image. The periodic vibration of the vocal fold edge could be visualized in the recorded image sequence during phonation. Furthermore, a motion estimation method was used to quantify the displacement of laryngeal tissue from hundreds of frames of ultrasonic data acquired. Vibratory displacement waveforms of the sub- and supraglottic structures were successfully obtained at a high level of ultrasonic signal correlation. Moreover, statistically significant differences in vibration pattern between the sub- and supraglottic structures were found. Variation of vibration amplitude along the subglottic mucosal surface is significantly smaller than that along the supraglottic mucosal surface. Phase delay of vibration along the subglottic mucosal surface is significantly smaller than that along the supraglottic mucosal surface.
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Affiliation(s)
- Bowen Jing
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Shanshan Tang
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Liang Wu
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Supin Wang
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Mingxi Wan
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China.
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Einspieler C, Freilinger M, Marschik PB. Behavioural biomarkers of typical Rett syndrome: moving towards early identification. Wien Med Wochenschr 2016; 166:333-7. [PMID: 27514944 PMCID: PMC5005386 DOI: 10.1007/s10354-016-0498-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 11/30/2022]
Abstract
The dynamic course of Rett syndrome (RTT) is still said to begin with a period of apparently normal development although there is mounting evidence that individuals with RTT show behavioural peculiarities and abnormalities during their infancy. Their spontaneous general movements are abnormal from birth onwards. Normal cooing vocalisation and canonical babbling (if at all required) are interspersed with abnormalities such as proto-vowel and proto-consonant alternations produced on ingressive airstream, breathy voice characteristics, and pressed or high-pitched vocalisations. The gestural repertoire is limited. Certain developmental motor and speech-language milestones are not at all acquired or show a significant delay. Besides abnormal blinking, repetitive and/or long lasting tongue protrusion, and bizarre smiling, there are already the first body and/or hand stereotypies during the first year of life. We are currently on a promising way to define a specific set of behavioural biomarkers pinpointing RTT.
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Affiliation(s)
- Christa Einspieler
- Research Unit iDN, interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Harrachgasse 21/5, 8010, Graz, Austria.
| | - Michael Freilinger
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter B Marschik
- Research Unit iDN, interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Harrachgasse 21/5, 8010, Graz, Austria
- Center for Neurodevelopmental Disorders, Department of Women's and Children's Health (KIND), Karolinska Institutet, Stockholm, Sweden
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