Vocal Tract Discomfort and Risk Factors in University Teachers
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Journal of Voice
Summary
Objectives
To characterize the presence of and risk factors for throat pain or irritation among male and female university teachers in private institutions within the city of São Paulo.
Study Design
This is a cross-sectional survey.
Methods
Voice self-evaluation forms prepared by the Brazilian Ministry of Labor were administered to 846 university teachers in a private institution in the city of São Paulo, Brazil.
Results
The prevalence of throat pain or irritation was 50.8% and was higher in the women (62.7%) than in the men (43.5%). The prevalence of throat pain or irritation was higher among professionals ≤60 years old and among those who spent most of their time teaching compared with those who spent most of their time performing other professional activities. Other factors, such as noise and sound competition, air pollution, stress and anxiety, personal habits, and lifestyle/quality of life, were related to the presence of throat pain or irritation.
Conclusions
University teachers demonstrated a high prevalence of throat pain or irritation. Factors such as age ≤60 years, female gender, time-consuming professional activities, noise and sound competition in the work environment, stress and anxiety, air pollution, access to water, personal habits, and lifestyle/quality of life were related to the presence of throat pain or irritation.
Investigating the Effects of Smoking on Young Adult Male Voice by Using Multidimensional Methods
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Journal of Voice
Summary
Objectives
Smoking is one of the most common harmful habits in the world, especially common among young adult male population in Turkey. The purpose of this study was to evaluate the effect of smoking on the young adults' male voice using multidimensional voice assessment methods.
Study Design
This is a case-control study.
Methods
The study included 109 young adult men, 51 nonsmokers and 58 smokers between the ages of 20 and 34 years. The voice evaluation protocol consisted of voice handicap index (VHI), maximum phonation time (MPT), and perceptual, acoustic, and videostroboscopic analyses.
Results
A statistically significant increase for physical, physiological, and total scores of VHI was found in smokers group (P < 0.05). MPT showed significantly lower values among smokers (P < 0.05). There were no significant changes in perceptual analysis of voice samples between smoker and nonsmoker groups. There were no significant changes in any of the acoustic parameters between smoker and nonsmoker groups. Results of videostroboscopic analysis showed significant relationships between smoking and increased vocal fold erythema (P < 0.05). In addition, significantly asymmetry, amplitude, and periodicity abnormality of vocal fold movements were observed in smoker group during phonation (P < 0.05).
Conclusions
The results of this study indicate that observable signs of laryngeal irritation and disturbed phonatory physiology occur even in young adults with relatively brief smoking habits. Subjective symptoms of smoking on voice appear to occur earlier than objective findings.
Spatiotemporal Quantification of Vocal Fold Vibration After Exposure to Superficial Laryngeal Dehydration: A Preliminary Study
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Journal of Voice
Summary
Objectives
The aim of the study was to evaluate the effects of a superficial laryngeal dehydration challenge on vocal fold vibration in young healthy adults using high-speed video imaging.
Subjects and Methods
In this prospective study, the effects of a 60-minute superficial laryngeal dehydration challenge on spatial (speed quotient, amplitude quotient) and temporal measures (jitter percentage, vibratory onset time) of vocal fold vibration and phonation threshold pressure (PTP) were evaluated in 10 (male = 4, female = 6) vocally normal adults (21–29 years). All measures except the vibratory onset time were measured at the 10 (low) and 80 (high) percent level of their pitch range. The vibratory onset time was obtained at habitual pitch and loudness level. Superficial laryngeal dehydration was induced by oral breathing in low ambient humidity. Prechallenge and postchallenge differences were statistically investigated using t tests with Bonferroni correction.
Results
The speed quotient at low-pitch phonation significantly decreased after oral breathing of low ambient humidity. Other spatiotemporal measures and PTP at low and high pitch were not significant after challenge.
Conclusions
Results from this initial study have implications for the use of high-speed video imaging to detect and quantify the subtle changes in vocal fold vibrations after superficial dehydration in healthy individuals. Preliminary findings indicate that superficial dehydration in healthy individuals results in spatial deviations at low pitch. However, further studies are warranted to identify additional spatiotemporal changes in vocal fold vibration after superficial dehydration in normal and disordered populations.
Survey of Voice Acoustic Parameters in Iranian Female Teachers
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Journal of Voice
Summary
Objectives
Teachers are one of the professional voice users. Voice problems are common among them. Female teachers are known to have more voice problems than male ones. Furthermore, there are only few studies on the voice of Iranian female teachers. The present study investigated the acoustic parameters of voice in Iranian female teachers and compares them with nonteachers.
Methods
In this cross-sectional study, 90 Iranian female elementary teachers, 30–50 years old, and 90 Iranian female nonteachers in the same age were assessed between May 2010 and October 2011. Data collection was carried out, using the Dr. Speech software (subprogram: vocal assessment Version 4.0 from Tiger Electronics) at the speech therapy clinic under a comfortable phonation. Normal voice in practitioners was judged by the perceptual evaluation by a voice therapist and indirect laryngoscopy examination by an otorhinolaryngologist. Voice characteristics were assessed with GRBAS scale. The speech sample was sustained /â/ using habitual and constant vocal for 10 seconds. Three tokens from each subject were obtained. Then, each subject was asked to read a standard passage in Farsi. Eventually, the difference measures of F0, jitter, shimmer, harmonic to noise ratio (HNR), and maximum of phonation time (MPT) between two groups were investigated by statistics software SPSS 19.0 (IBM corp.2010).
Results
Results showed that the values of F0 were higher in teachers (210.03 Hz) than in nonteachers (194.11 Hz; P < 0.001). In addition, the values of perturbation measures were greater in teachers (jitter 0.32% and shimmer 4.63%) than those in the control group (jitter 0.22% and shimmer 3.15%; P < 0.001), but in HNR and MPT values, nonteachers showed higher levels (P < 0.001). The value of HNR in teachers was (18.84±1.56) but it was (21.3±1.73) in non-teachers and MPT value in teachers was (16.83±3.65) and in non-teachers was (22.5±5.2).
Conclusions
It can be concluded that vocal overuse, abuse, or misuse during teaching over a period of time result in achievement of inadequate phonatory pattern with excessive musculoskeletal tension, and the possible result is tissue changes in teacher's voice. In addition, acoustic analysis of voice parameters for teachers may significantly contribute to the objective voice examination of this group.
Can Listeners Hear Who Is Singing? The Role of Familiarity
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Journal of Voice
Summary
Objective/Hypothesis
This study sought to determine whether familiarity with voices increases discrimination of voices across pitch intervals.
Study Design
This is a between-group design.
Methods
This study used a forced-choice paradigm where listeners heard two different singers (singer 1 and singer 2) producing /ɑ/ at the identical pitch and an unknown singer (either singer 1 or singer 2) producing /ɑ/ at a different pitch. Listeners had to identify which singer was the unknown singer. Two baritones and two tenors were recorded producing /ɑ/ at the pitches C3, E3, G3, B3, D4, and F4. Two sopranos and two mezzo-sopranos were recorded producing /ɑ/ at the pitches C4, E4, G4, B4, D5, and F5. For each group of stimuli, male and female, all possible pairs of singers were constructed for the lowest pitch (C2 or C3, respectively) and for the highest pitch (F4 or F5, respectively). The unknown singer was varied across the remaining pitches. Participants in group 1 completed a training session where they were familiarized with the voices being tested. Participants in group 2 did not.
Results
Training did not significantly improve the ability to discriminate voices when the voices being compared were of the same voice category. However, training did significantly improve the ability to discriminate voices when the voices being compared were of different voice categories even when training lasted as little as 5 minutes.
Conclusions
Small amount of exposure to human voices results in voice category formation but does not result in the formation of models of individual voices.
Laryngeal Side Effects of Tyrosine Kinase Inhibitors
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Journal of Voice
Summary
Objectives
Tyrosine kinase inhibitors (TKIs) are common targeted drugs, used in the treatment of hematological and solid malignancies. These drugs present a multitude of potential adverse effects. Laryngeal manifestations, including laryngeal edema, secondary to TKIs treatment have not been well studied, despite their potential lethality.
Methods
This cross-sectional study included adult patients (>18 years) treated with TKIs who were followed in a secondary medical center and underwent a voluntary otolaryngological examination, which included laryngeal fiber-optic laryngoscopy (FOL). FOL was independently performed by two senior otolaryngologists, and results were recorded and evaluated by two grading systems, to assess the degree of laryngeal edema. In addition, medical files were reviewed, and data collected included past medical history, signs and symptoms, physical examination, laboratory results, treatment type, and duration.
Results
Sixteen patients, aged 68.2 ± 13.6 years, were examined during October 2014 to December 2014. Of them, three (19%) were males. Eleven (68%) patients presented with varying degrees of laryngeal edema. A significant correlation was found between gastroesophageal reflux symptoms and laryngeal edema (P = 0.02). TKI treatment was stopped in one patient, because of symptomatic laryngeal edema, which completely resolved within 2 weeks.
Conclusions
Laryngeal edema was common in our study group. This edema was most often not life threatening. Yet, because of the potential severity of this side effect, we propose a routine FOL examination of patients before commencing TKI treatment and a reevaluation performed during treatment.
The Development of Conversation Training Therapy: A Concept Paper
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Journal of Voice
Summary
Objectives
To introduce the conceptual, theoretical, and practical foundations of a novel approach to voice therapy, called conversation training therapy (CTT), which focuses exclusively on voice awareness and efficient voice production in patient-driven conversational narrative, without the use of a traditional therapeutic hierarchy. CTT is grounded in motor learning theory, focused on training target voice goals in spontaneous, conversational speech in the first session and throughout. CTT was developed by a consensus panel of expert clinical voice-specialized speech-language pathologists (SLPs) and patients with voice problems.
Study Design
This is a prospective, clinical consensus design.
Methods
A preliminary CTT approach to voice therapy was developed by the first and last authors (J.G-S. and A.I.G.) and incorporated six interchangeable tenets: clear speech, auditory/kinesthetic awareness, rapport building, negative practice, basic training gestures, and prosody. Five expert voice-specialized clinical SLPs (consensus group) were then presented CTT and a discussion ensued. Later, an informal interview by a neutral third party person occurred for further recommendations for CTT.
Results
The CTT approach was modified to reflect all the consensus groups' recommendations, which included the need for more detail and rationale in the program, troubleshooting suggestions, and the concern for potential challenges for novice clinicians.
Conclusions
CTT is a new therapy approach based on motor learning theory, which exclusively uses patient-driven conversational narrative as the sole therapeutic stimuli. CTT is conceptually innovative because it represents an approach to voice therapy developed without the use of a traditional therapeutic hierarchy. It is also developed using input from patients with voice disorders and expert clinical providers.
Visualization and Estimation of Vibratory Disturbance in Vocal Fold Scar Using High-Speed Digital Imaging
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Journal of Voice
Summary
Objective
To explore the method to visualize and quantify the abnormality of vocal fold vibration in vocal fold scar (VFS) using high-speed digital imaging (HSDI).
Methods
HSDI was performed on 12 patients (2 men and 10 women) with VFS and 46 vocally healthy subjects (17 men and 29 women), and the obtained data were quantitatively evaluated by frame-by-frame analysis, laryngotopography (LTG), single-line and multiline kymography, and glottal area waveform.
Results
Visualization of a scarred area was feasible in 75% of VFS in the present study using LTG. Quantitative HSDI analysis revealed that VFS had poorer glottal closure (eg, larger open quotients, larger minimal glottal area), reduced vibration in a scarred area (eg, smaller mucosal wave magnitude, mucosal wave persistence, lateral peak index), and greater asymmetry (eg, amplitude difference, mucosal wave magnitude difference, lateral phase difference) than the control group. Correlation study revealed moderate correlations between HSDI-derived parameters and conventional acoustic or aerodynamic parameters (eg, period perturbation quotient).
Conclusions
HSDI is considered to be useful in the diagnosis of VFS, visualization of a scarred area, and quantification of vibratory abnormality.
Relationship Between the Electroglottographic Signal and Vocal Fold Contact Area
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Journal of Voice
Summary
Objective
Electroglottography (EGG) is a widely used noninvasive method that purports to measure changes in relative vocal fold contact area (VFCA) during phonation. Despite its broad application, the putative direct relation between the EGG waveform and VFCA has to date only been formally tested in a single study, suggesting an approximately linear relationship. However, in that study, flow-induced vocal fold (VF) vibration was not investigated. A rigorous empirical evaluation of EGG as a measure of VFCA under proper physiological conditions is therefore still needed.
Methods/design
Three red deer larynges were phonated in an excised hemilarynx preparation using a conducting glass plate. The time-varying contact between the VF and the glass plate was assessed by high-speed video recordings at 6000 fps, synchronized to the EGG signal.
Results
The average differences between the normalized [0, 1] VFCA and EGG waveforms for the three larynges were 0.180 (±0.156), 0.075 (±0.115), and 0.168 (±0.184) in the contacting phase and 0.159 (±0.112), −0.003 (±0.029), and 0.004 (±0.032) in the decontacting phase.
Discussions and conclusions
Overall, there was a better agreement between VFCA and the EGG waveform in the decontacting phase than in the contacting phase. Disagreements may be caused by nonuniform tissue conductance properties, electrode placement, and electroglottograph hardware circuitry. Pending further research, the EGG waveform may be a reasonable first approximation to change in medial contact area between the VFs during phonation. However, any quantitative and statistical data derived from EGG should be interpreted cautiously, allowing for potential deviations from true VFCA.
Magnetic Control of the Glottic Opening in an Ex Vivo Sheep Larynx Model: A Preliminary Study
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Journal of Voice
Summary
Objective/Hypothesis
So far, a number of techniques have been described for the treatment of bilateral vocal fold paralysis. These techniques were reported to be successful in maintaining an adequate airway but also found to be associated with an increased risk of aspiration, dysphonia, and granulation tissue formation at the operation site. We aimed to investigate the effectiveness of a novel mucosa-sparing technique based on the generation of a magnetic field within the larynx for the tailored lateralization of the ipsilateral vocal fold.
Study design
This is an ex vivo experimental study.
Methods
Twenty sheep larynges that were procured from the local slaughterhouse were used as a model. For each specimen, two neodymium (Nd) disc magnets with marked poles were used to create a unilateral attractive magnetic force at the glottic level. Following insertion of the magnets, the level of vocal fold lateralization was assessed under an operating microscope. The results were analyzed for their statistical significance.
Results
Before the procedure, the mean value of the glottic openings of all the specimens was 4.985 mm. The postprocedure mean value was 5.640 mm. The mean amount of increase in the glottic openings after the procedure was 0.655 mm. This change was found to be statistically significant (P < 0.05).
Conclusions
A statistically significant increase in the cross-sectional area of the glottic region could be achieved. The mucosal integrity of the laryngeal airway was also preserved. The idea of "magnetic control of the glottic airway" is a novel concept but seems to be a promising option.
Imaging and Analysis of Human Vocal Fold Vibration Using Two-Dimensional (2D) Scanning Videokymography
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Journal of Voice
Summary
Objective
Laryngeal videokymography and high-speed digital kymography are the currently available techniques for studying aperiodic vibration of the vocal folds. However, videokymography has a fundamental limitation that only linear portions of the vocal fold mucosa can be visualized, whereas high-speed digital kymography has the disadvantages of lack of immediate feedback during examination and considerable waiting time before kymographic visualization. We developed a new system, two-dimensional (2D) scanning videokymography, that provides a possible alternative for evaluation of the vibratory pattern of the vocal folds. Herein, we report the application of 2D scanning videokymography for visualization of vocal fold vibration in humans and an analysis of its parameters.
Materials and Methods
Two young healthy volunteers (one man and one woman) took part in this study. The vibratory patterns of their vocal folds were evaluated using 2D scanning videokymography and laryngeal stroboscopy.
Results
Two-dimensional scanning videokymography provided a high-definition image of the vibratory movements of the vocal folds. In analysis of the images acquired by the device, various parameters including fundamental frequency; ratio of the vibratory phases; phase, amplitude, and glottal area symmetry; and cycle-to-cycle variability were extracted.
Conclusions
Our results indicate that 2D scanning videokymography is a useful and promising tool for visualization of the vibratory movement of the vocal folds. This new technique might improve our understanding of the mechanism of vocal fold vibration and contribute to voice research as well as clinical practice.
Refractory Dysphonia Due to Isolated Cricothyroid Muscle Dystonia
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Journal of Voice
Summary
Objective
To demonstrate the utility of electromyography (EMG) in the evaluation and management of treatment-resistant dysphonia.
Method
We report a case of refractory dysphonia in which EMG was used to identify and treat isolated cricothyroid (CT) dystonia.
Results
The patient, a healthy 43-year-old woman, presented with 9 months of progressive hoarseness. Her symptoms were present across vocal tasks but were particularly bothersome while dictating. On presentation, her voice was rated grade 3, roughness 3, breathiness 1, asthenia 0, and strain 3 (G3R3B1A0S3). Videostroboscopy was remarkable for hyperfunction. Voice therapy was not beneficial despite appropriate effort. Microdirect laryngoscopy revealed no evidence of structural pathology. The patient was referred for EMG because of her normal examination and failure to improve with therapy. The CT muscle demonstrated an increased latency of 750 ms in all vocal tasks. One month after CT injection with 3 units of botulinum toxin (BTX), her voice was improved. Perceptual voice evaluation was rated G1R1B0A0S1. Voice Handicap Index improved from 87 to 35.
Conclusions
In the absence of structural pathology, EMG can be a useful adjunct in the diagnosis of dysphonia that persists despite adequate trials of voice therapy. To our knowledge, this is the only report of laryngeal dystonia due to isolated CT dysfunction successfully treated with BTX.
Normative Values and Interrelationship of MDVP Voice Analysis Parameters Before and After Endotracheal Intubation
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Journal of Voice
Summary
Purpose
The Multi-Dimensional Voice Program (MDVP) is used for assessment of voice quality. A simple procedure for MDVP recordings was used in a randomized clinical trial (RCT) on induced vocal fold trauma due to intubation. This secondary study compares the common MDVP parameters with other normative values for adults and investigates the correlation between these MDVP parameters in relation to the "standardized" trauma of endotracheal intubation.
Methods
Preoperative and postoperative assessments of vocal fold pathology with flexible videolaryngoscopy and voice analysis with MDVP using the best-of-three standardized recording were performed in 121 patients with normal voices included consecutively in the RCT. The procedures of anesthesia were standardized.
Results
The normative MDVP values of this study are consistently lower compared with most normative values presented in other studies. The preoperative to postoperative differences in jitter values (jitter and relative average perturbation) were closely correlated to the shimmer values for patients with postoperative vocal fold edemas. In the patients with edema, the preoperative to postoperative differences in jitter had a correlation coefficient of 0.95 (P < 0.0001) to the difference in shimmer, compared with a correlation coefficient of 0.39 (P < 0.0001) in the patients without edema.
Conclusions
This study supports the use of the "Best-of-Three" procedures for precise and relevant MDVP parameter calculations. The MDVPparameters, with closely correlated changes in jitter and shimmer values, accurately reflect the induced vocal fold edema when using the preoperative to postoperative changes.
Immediate Effect of Stimulability Assessment on Acoustic, Aerodynamic, and Patient-Perceptual Measures of Voice
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Journal of Voice
Summary
Objectives
The purpose of the present study was to determine if patients with voice disorders could achieve immediate improvements in acoustic and aerodynamic parameters and patient's perception of the sound and feel of voice following instructions to use clear speech.
Study Design
This is a retrospective study.
Methods
A total of 114 patients underwent acoustic and aerodynamic analyses of voice before and after instructions to use "clear speech," while reading a standardized passage. The patient's and speech-language pathologist's (SLP) judgments of voice change were also measured.
Results
An increase (improvement) in average vocal intensity (P < 0.001), average airflow (P < 0.001), total breaths taken (P < 0.001), total reading time (P < 0.001), and breaths/second (P < 0.001) was observed as a function of "clear speech" intervention. No change in acoustic analyses was observed. Most patients reported an improvement in the sound or feel of voice immediately after the assessment.
Conclusions
This study is the first to quantify acoustic and aerodynamic parameters and clinician's and patient's perceptions of a standardized stimulability test for voice change in the voice laboratory. These results are potentially paradigm shifting in the role of the SLP in the evaluative clinic setting.
Vocal Attack Time of Different Pitch Levels and Vowels in Mandarin
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Journal of Voice
Summary
The purpose of this study was to investigate how vocal attack time (VAT) varies when young adults articulate the three vertex vowels in Mandarin Chinese at five linguistically unconstrained pitch levels. Sound pressure and electroglottographic signals were recorded simultaneously from 53 male and 53 female subjects saying sustained /A/, /i/, and /u/ at five equally spaced pitch heights, each being higher than the preceding one. Then analyses of means, variance, and correlation were performed to explore the relationships of VAT/pitch levels and VAT/vowels. Findings were As mean STs (semitone) increase linearly from levels 1 to 5, mean VATs decrease nonlinearly in a big group of subjects but increase nonlinearly in a small group of them. Based on the body-cover model of F0 control, data here lead to the guess that different people incline to use different strategies in increasing pitch height. When males, females, and males plus females are considered as a whole, average STs and VATs tend to be positively correlated among the three vertex vowels.
Acoustic Voice Analysis of Young Turkish Speakers
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Journal of Voice
Summary
Objective/Hypothesis
One of the objective assessments of voice is acoustic analysis, particularly, the parameters fundamental frequency (F0), jitter, shimmer, and noise-to-harmonics ratio (NHR). Because the normative data for healthy native Turkish male and female speakers are lacking in the literature, this study aimed to obtainF0, perturbation parameters, and NHR in three sustained vowels (/Λ/, /i/, and /u/) among young Turkish speaking adults.
Methods
The native Turkish speakers with normal voice aged between 18 and 32 years were included in the study (44 women, 39 men). Voice samples were recorded using Computerized Speech Lab, and data were analyzed with the statistics software SPSS Statistics 21.0 (IBM Corp., Armonk, NY, USA).
Results
The F0 values of vowels /Λ/, /i/, and /u/ were greater for women (239.78 Hz, 251.97 Hz, and 250.29 Hz, respectively) than for men (127.11 Hz, 137.23 Hz, and 134.15 Hz, respectively). All shimmer values for all vowels and jitter values for /Λ/ and /u/ were found significantly low in men; however, no difference was found for jitter values of /i/ between genders. There is no effect of gender on NHR. Only in women, NHR of high vowels was found to be lower than that of vowel /Λ/.
Conclusions
There is a significant difference for F0 values between the genders as expected. Comparisons of perturbation values were significantly different for some pairs of vowels. There was no significant difference between NHR values between the genders. These findings can be compared with Turkish speakers who have different voice disorders for the further studies.
A Comparison of Initial and Subsequent Follow-Up Strobovideolaryngoscopic Examinations in Singers
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Journal of Voice
Summary
Objectives
Previous studies have identified abnormal findings in up to 86.1% of singers on initial screening strobovideolaryngoscopy (SVL) examinations. No studies have compared the prevalence of abnormalities in singers on their subsequent follow-up SVL. Our study evaluates the frequency of these findings in both the initial and subsequent examinations.
Methods
Retrospective charts and SVL reports were reviewed on students from an opera conservatory from 1993 to 2014. All students had initial screening SVL, but only students who later returned with acute voice complaints were included in the study (n = 51, 137 follow-up visits). Normal SVL was defined as an examination without structural or functional abnormalities and reflux finding score ≤7. Data were analyzed using the chi-square test.
Results
For initial examinations, 90.2% (including reflux) and 88.2% (excluding reflux) were abnormal. In follow-up examinations, 94.9% (including reflux) and 94.2% (excluding reflux) had abnormal findings, which included muscle tension dysphonia (40.1%), vocal fold (VF) masses (unilateral 48.9%, bilateral 30.7%), vascular abnormalities (unilateral 27.0%, bilateral 5.8%), sulcus (unilateral 17.5%, bilateral 5.1%), VF hypomobility (unilateral 36.3%, bilateral 5.9%), phase (30.6%) and amplitude (44.8%) asymmetries, and glottic insufficiency (49.3%). Follow-up examinations revealed a significant increase in laryngopharyngeal reflux (χ2 = 7.043; P < 0.05).
Conclusions
We found a higher prevalence of abnormal findings compared with previous studies, which we attributed to a more inclusive definition of abnormal pathologies, improvements in SVL technology, and possibly increased experience with SVL interpretation. This high prevalence of abnormal findings in asymptomatic singers further supports the importance of baseline examinations.
Behavior Assessment Battery: A Pilot Study of the Affective, Behavioral, and Cognitive Correlates Surrounding Spasmodic Dysphonia
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Journal of Voice
Summary
Objective/Hypothesis
This study investigates if adults with adductor spasmodic dysphonia (ADSD) report to experience anxiety and voice problems in particular situations, indicate the presence of negative speech-associated attitude, and/or the use of coping behaviors, by means of the Behavior Assessment Battery (BAB) modified for voice.
Methods
Thirty-two participants with ADSD and 32 adults without a voice disorder participated in this study. Each person completed four different BAB-Voice subtests. These standardized self-report tests are adaptations of the original BAB for people who stutter and explore an individual's speech-related belief, negative emotional reaction to and speech problems in particular speech situations, and the use of concomitant behaviors.
Results
Individuals with spasmodic dysphonia (SD) scored statistically significantly higher compared to typical speakers on all BAB subtests, indicating that individuals with SD report being significantly more anxious and experiencing significantly more voice problems in particular speech circumstances. They also reported a significant amount of negative speech-associated attitude and the use of a significant number of coping behaviors. Internal reliability was good for three of the four BAB subtests.
Conclusions
The BAB is capable of reflecting the dimensions that surround the disorder of SD. The self-report measures have the potential to augment the observations made by the clinician and may lead to a more diverse and all-encompassing therapy for the person suffering from SD. Future research with a revised version of the BAB-Voice will continue to explore the validity, reliability, and replicability of the initial data.
First Passaggio Transition Gestures in Classically Trained Female Singers
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Journal of Voice
Summary
Objectives/hypothesis
The purpose of this project was to determine the spectral and electroglottograph (EGG) differences exhibited by classically trained female singers when singing through their primo passaggio. The hypotheses were that the singers would exhibit relatively steady EGG levels and minimal changes in speech spectra when singing through their primo passaggio. It also was hypothesized that EGG and spectral measurements at the crest and trough of the vibrato cycles would be similar to each other.
Study Design
The study is an observational case-control study.
Methods
Singers at training levels from undergraduate university students through professionals sang an A3-A4 scale using an /ɑ:/ vowel while standing. Contact quotient (CQEGG), amplitudes of the first five harmonics (H1–H5), and the number of the harmonics with greatest energy in the frequency region around 3000 Hz were measured at vibrato crests and troughs for each note.
Results
The data at the vibrato crests and troughs exhibited similar patterns across the notes that differed in the percentage CQEGG and harmonic amplitude. The mean CQEGG exhibited a slight decline from the lowest note to the highest, with a few of the singers exhibiting different patterns. The strongest harmonic for the four lowest notes was H3 with a transition to H2 being strongest for the four highest notes.
Conclusions
The patterns of all the singers' averaged glottal and vocal tract adjustments through their primo passaggio generally followed what was hypothesized for the CQEGG, harmonic amplitudes, and harmonic of the frequency region around 3000 Hz. However, differences occurred between the measurements at the vibrato peaks and troughs.
Effect of Training and Level of External Auditory Feedback on the Singing Voice: Volume and Quality
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Journal of Voice
Summary
Background
Previous research suggests that classically trained professional singers rely not only on external auditory feedback but also on proprioceptive feedback associated with internal voice sensitivities.
Objectives
The Lombard effect and the relationship between sound pressure level (SPL) and external auditory feedback were evaluated for professional and nonprofessional singers. Additionally, the relationship between voice quality, evaluated in terms of singing power ratio (SPR), and external auditory feedback, level of accompaniment, voice register, and singer gender was analyzed.
Methods
The subjects were 10 amateur or beginner singers and 10 classically trained professional or semiprofessional singers (10 men and 10 women). Subjects sang an excerpt from the Star-Spangled Banner with three different levels of the accompaniment, 70, 80, and 90 dBA and with three different levels of external auditory feedback. SPL and SPR were analyzed.
Results
The Lombard effect was stronger for nonprofessional singers than professional singers. Higher levels of external auditory feedback were associated with a reduction in SPL. As predicted, the mean SPR was higher for professional singers than nonprofessional singers. Better voice quality was detected in the presence of higher levels of external auditory feedback.
Conclusions
With an increase in training, the singer's reliance on external auditory feedback decreases.
A Review of Measures of Vocal Effort With a Preliminary Study on the Establishment of a Vocal Effort Measure
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Journal of Voice
Summary
Objectives/Hypothesis
Vocal effort is the perceived exertion of voicing. Patients with voice disorders (VDs) frequently complain of increased effort, but currently there exists no empirically validated scale for the measurement of vocal effort.
This article reviews the extant literature on vocal effort and its various definitions. It also presents a preliminary investigation on the use of a psychophysical scale, the Borg Category Ratio (CR-10), for vocal effort ratings.
Study Design
A total of 28 participants with VDs and 28 healthy controls (HCs) underwent acoustic and aerodynamic voice measures in this prospective quasi-experimental group design.
Methods
Vocal effort ratings using the Borg CR-10 gathered on vowels, standard sentences, and conversation were correlated with auditory-perceptual ratings, Voice Handicap Index scores, and phonation threshold pressure (PTP).
Results
Results indicate that the Borg CR-10 is not sensitive to the presence of a VD but does correlate moderately well with other measures of VD severity, and may be clinically indicated for such use.
Conclusions
Future research directions include task choice for vocal effort ratings, considerations during PTP protocols, intensive examiner and examinee training, and use of the Borg CR-10 for within-group separation of VD diagnosis.
Features of Vocal Fold Adductor Paralysis and the Management of Posterior Muscle in Thyroplasty
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Journal of Voice
Summary
Objective
To present the pathologic characteristics of unilateral recurrent nerve adductor branch paralysis (AdBP), and to investigate the management of posterior cricoarytenoid (PCA) muscle on the basis of our experience of surgical treatment for AdBP.
Study Design
This is a retrospective review of clinical records
Methods
Four cases of AdBP, in which surgical treatment was performed, are presented. AdBP shows disorders of vocal fold adduction because of paralysis of the thyroarytenoid and lateral cricoarytenoid muscles. The PCA muscle, dominated by the recurrent nerve PCA muscle branch, does not show paralysis. Thus, this type of partial recurrent nerve paresis retains the abductive function and is difficult to distinguish from arytenoid cartilage dislocation because of their similar endoscopic findings. The features include acute onset, and all cases were idiopathic etiology. Thyroarytenoid muscle paralysis was determined by electromyography and stroboscopic findings. The adduction and abduction of paralytic arytenoids were evaluated from 3 dimensional computed tomography (3DCT).
Results
In all cases, surgical treatments were arytenoid adduction combined with thyroplasty. When we adducted the arytenoid cartilage during inspiration, strong resistance was observed. In the two cases where we could cut the PCA muscle sufficiently, the maximum phonation time was improved to ≥30 seconds after surgery, from 2 to 3 seconds preoperatively, providing good postoperative voices. In contrast, in the two cases of insufficient resection, the surgical outcomes were poorer.
Conclusions
Because the preoperative voice in AdBP patients is typically very coarse, surgical treatment is needed, as well as ordinary recurrent nerve paralysis. In our experience, adequate PCA muscle resection might be helpful in surgical treatment of AdBP.
Efficiency and Cutoff Values of Self-Assessment Instruments on the Impact of a Voice Problem
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Journal of Voice
Summary
Objectives
To evaluate the efficiency of four self-assessment questionnaires that rate the impact of a voice problem on the individual's life: Voice-Related Quality of Life (V-RQOL), the original and reduced versions of the Voice Handicap Index (VHI) and VHI-10, Vocal Performance Questionnaire (VPQ), and Voice Symptom Scale (VoiSS).
Methods
Data from 975 subjects, 486 with a diagnosis of dysphonia and 489 vocally healthy individuals, were submitted to the receiver operating characteristic (ROC) curve analysis to obtain the cutoff values that determine the discriminating power of these instruments (presence of dysphonia vs healthy voice).
Results
The ROC curve analysis showed that the most efficient questionnaires were the VoiSS and the VHI. Results showed that they presented as a perfect classification based on their efficiency, specificity, and sensitivity values (all three of them = 1). The VHI-10 and the V-RQOL showed excellent classification (VHI-10: efficiency = 0.991; specificity = 1; sensitivity = 0.981; V-RQOL: efficiency = 0.914; specificity = 0.860; sensitivity = 0.967). Finally, the VPQ showed a good level of classification (efficiency = 0.828; specificity = 0.824; sensitivity = 0.831). The cutoff values for the instruments are as follows: VoiSS = 16 points, VHI = 19 points, VHI-10 = 7.5 points, V-RQOL = 91.25, and VPQ = 20.5 points. These values are important for screening large populations as well as for helping in the decision-making process of clinical management. The cutoff values for maximum sensitivity and specificity of the instruments that did not produce perfect classification are as follows: VHI-10: sensitivity = 5; specificity = 7.5, V-RQOL: sensitivity = 86.25; specificity = 98.75, and VPQ: sensitivity = 15.5; specificity = 31.5.
Conclusions
Both the VoiSS and the VHI are perfect classifiers. The VHI-10 and the V-RQOL are excellent classifiers, and the VPQ is good at discriminating individuals with dysphonia from the ones without dysphonia.
Motor-Learning-Based Adjustment of Ambulatory Feedback on Vocal Loudness for Patients With Parkinson's Disease
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Journal of Voice
Summary
Objectives
To investigate how the direct biofeedback on vocal loudness administered with a portable voice accumulator (VoxLog) should be configured, to facilitate an optimal learning outcome for individuals with Parkinson's disease (PD), on the basis of principles of motor learning.
Study Design
Methodologic development in an experimental study.
Methods
The portable voice accumulator VoxLog was worn by 20 participants with PD during habitual speech during semistructured conversations. Six different biofeedback configurations were used, in random order, to study which configuration resulted in a feedback frequency closest to 20% as recommended on the basis of previous studies.
Results
Activation of feedback when the wearer speaks below a threshold level of 3 dB below the speaker's mean voice sound level in habitual speech combined with an activation time of 500 ms resulted in a mean feedback frequency of 21.2%.
Conclusions
Settings regarding threshold and activation time based on the results from this study are recommended to achieve an optimal learning outcome when administering biofeedback on vocal loudness for individuals with PD using portable voice accumulators.
An Oral Pressure Conversion Ratio as a Predictor of Vocal Efficiency
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Journal of Voice
Summary
Voice production is an inefficient process in terms of energy expended versus acoustic energy produced. A traditional efficiency measure, glottal efficiency, relates acoustic power radiated from the mouth to aerodynamic power produced in the trachea. This efficiency ranges between 0.0001% and 1.0%. It involves lung pressure and hence would appear to be a useful effort measure for a given acoustic output. Difficulty in the combined measurement of lung pressure and tracheal airflow, however, has impeded clinical application of glottal efficiency. This article uses the large data base from Schutte (1980) and a few new measurements to validate a pressure conversion ratio (PCR) as a substitute for glottal efficiency. PCR has the potential for wide application because of low cost and ease of use in clinics and vocal studios.
Effect of Spinal Manipulative Therapy on the Singing Voice
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Journal of Voice
Summary
Objective
This study investigated the effect of spinal manipulative therapy (SMT) on the singing voice of male individuals.
Study Design
Randomized, controlled, case-crossover trial.
Methods
Twenty-nine subjects were selected among male members of the Heralds of the Gospel. This association was chosen because it is a group of persons with similar singing activities. Participants were randomly assigned to two groups: (A) chiropractic SMT procedure and (B) nontherapeutic transcutaneous electrical nerve stimulation (TENS) procedure. Recordings of the singing voice of each participant were taken immediately before and after the procedures. After a 14-day period, procedures were switched between groups: participants who underwent SMT on the first day were subjected to TENS and vice versa. Recordings were subjected to perceptual audio and acoustic evaluations. The same recording segment of each participant was selected. Perceptual audio evaluation was performed by a specialist panel (SP). Recordings of each participant were randomly presented thus making the SP blind to intervention type and recording session (before/after intervention). Recordings compiled in a randomized order were also subjected to acoustic evaluation.
Results
No differences in the quality of the singing on perceptual audio evaluation were observed between TENS and SMT.
Conclusions
No differences in the quality of the singing voice of asymptomatic male singers were observed on perceptual audio evaluation or acoustic evaluation after a single spinal manipulative intervention of the thoracic and cervical spine.
Computerized Analysis of Vocal Folds Vibration From Laryngeal Videostroboscopy
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Journal of Voice
Summary
Objectives
To develop an objective analysis of laryngeal videostroboscopy (VSS) movies in the space-time domain for quantitative determination of the true vocal folds (TVFs) vibratory pattern to allow for detection of local pathologies at early stages of development.
Methods
Contours of the TVF and false vocal folds (FVFs) were tracked on each frame of a VSS movie. A registration algorithm was used with respect to the centerline of the FVF to eliminate movements not related to TVF vibration. The registered contours of the TVF were analyzed in time and frequency domains.
Results
The TVF vibration demonstrated a sinusoidal pattern with the same fundamental frequency at every section along the folds of healthy subjects, as well as detection of an abnormal area with a different fundamental frequency in TVF with local pathologies. Analysis of the TVF vibration time delay of healthy subject revealed a posterior-to-anterior longitudinal wave that was not detected by visual observation.
Conclusions
An objective analysis of laryngeal VSS movies was developed for quantitative determination of the TVF vibration. This analysis was able to detect and quantify TVF characteristics in normal subjects as well as in patients with pathologies beyond the ability of examinee's naked eyes.
Switching of the Laryngeal Cavity From the Respiratory Diverticulum to the Vestibular Recess: A Study Using Serial Sagittal Sections of Human Embryos and Fetuses
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Journal of Voice
Summary
A cecum-like protrusion of the pharynx (the laryngeal cecum or vestibular recess [VR]) develops immediately anterior to the laryngeal part of the respiratory diverticulum. An expansion of the VR has been well described, whereas the fate of the diverticulum is still obscure, although its pharyngeal opening corresponds to the glottis. We observed sagittal sections of 10 embryos (five specimens at 5–6 weeks and another five at 7–8 weeks) and eight fetuses at 25–30 weeks. At 5–6 weeks, a lumen of the laryngeal part of the respiratory diverticulum appeared, and subsequently, the VR opened into the epithelial lamina. Because of this discrete separation, it seemed unlikely that the pharyngeal pouches contributed to the laryngeal epithelium. At 6–7 weeks, the VR exhibited a high boot-shaped lumen with canalization to the diverticular lumen at the level of the cricoid cartilage. Thus, in a midline area between the bilateral arytenoid cartilages, double laryngeal lumina were evident, separated by the thick midline epithelial lamina. At 25–30 weeks, the inferior part of the VR lumen had become enlarged because of the destruction of the epithelial lamina along the arytenoid and corniculate cartilages. In contrast, candidates for the initial diverticular lumen remained as epithelial slits in the anterosuperior side of the transverse arytenoid muscle. Therefore, the final anterior and lateral laryngeal walls seemed to originate from the VR with canalization, in contrast to the part of the posterior wall derived from the initial diverticular wall.
A Preliminary Quantitative Comparison of Vibratory Amplitude Using Rigid and Flexible Stroboscopic Assessment
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Journal of Voice
Summary
Study Objective
The purpose of this study was to establish preliminary, quantitative data on amplitude of vibration during stroboscopic assessment in healthy speakers with normal voice characteristics. Amplitude of vocal fold vibration is a core physiological parameter used in diagnosing voice disorders, yet quantitative data are lacking to guide the determination of what constitutes normal vibratory amplitude.
Methods/Study Design
Eleven participants were assessed during sustained vowel production using rigid and flexible endoscopy with stroboscopy. Still images were extracted from digital recordings of a sustained /i/ produced at a comfortable pitch and loudness, with F0 controlled so that levels were within ±15% of each participant's comfortable mean level as determined from connected speech. Glottal width (GW), true vocal fold (TVF) length, and TVF width were measured from still frames representing the maximum open phase of the vibratory cycle. To control for anatomic and magnification differences across participants, GW was normalized to TVF length. GW as a ratio of TVF width was also computed for comparison with prior studies.
Results
Mean values and standard deviations were computed for the normalized measures. Paired t tests showed no significant differences between rigid and flexible endoscopy methods. Interrater and intrarater reliability values for raw measurements were found to be high (0.89–0.99).
Conclusions
These preliminary quantitative data may be helpful in determining normality or abnormality of vocal fold vibration. Results indicatethat quantified amplitude of vibration is similar between endoscopic methods, a clinically relevant finding for individuals performing and interpreting stroboscopic assessments.
Behavioral Dysphonia and Depression in Elementary School Teachers
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Journal of Voice
Summary
Objective/Hypothesis
To verify the relationship between behavioral dysphonia and current depressive episodes in municipal elementary school teachers. We hypothesize that teachers with behavioral dysphonia will be more susceptible to psychiatric disorders.
Design
Cross-sectional study, quantitative, conducted across municipal schools in both rural and urban regions of Pelotas.
Method
Five-hundred seventy-five teachers from urban and rural areas of the same Brazilian state were included. The full version of the Voice Handicap Index validated into Brazilian Portuguese was used to determine the presence of behavioral dysphonia. A profile of vocal behaviors was also used to quantify the number of phonotraumatic events. In addition, the Mini-International Neuropsychiatric Interview was used to determine current episodes of depression. Data were analyzed via correlative studies using chi-square and Poisson regression analyses.
Results
Across all teachers, the prevalence of dysphonia was 33.9% and 55% reported that they had already taken a leave because of their voice. Those teachers with a current depressive episode had a higher rate of dysphonia compared with those without depression (prevalence ratio [PR] 1.66; P < 0.000). Teachers who presented with a risk of serious vocal problems had a prevalence ratio of 2.58, indicating a greater proportion of dysphonia, whereas teachers classified as champions of abuse were five times more likely compared with those teachers with behaved or candidates for voice problems.
Conclusions
There is an association between behavioral dysphonia and current depressive episodes in elementary school teachers.
Vocal Tract Morphology in Inhaling Singing: An MRI-Based Study
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Journal of Voice
Summary
Objectives/Hypothesis
Inhaling singing is a recently developed singing technique explored by the soprano singer Françoise Vanhecke. It is based on an inspiratory airflow instead of an expiratory airflow. This article describes the anatomical structural differences of the vocal tract between inhaling and exhaling singing. We hypothesize that the vocal tract alters significantly in inhaling singing, especially concerning the configuration of the anatomical structures in the oral cavity and the subglottal region.
Study Design
This is a prospective study.
Methods
A professional singer (F.V.) performed sustained tones from F5 chromatically rising up to Bb5 on the vowel /a/. Vocal tract anatomy is assessed by magnetic resonance imaging.
Results
Wilcoxon directional testing demonstrates (1) that the vocal tract volume above the glottal region does not differ statistically in contrast to the subglottal region and (2) significant changes in the configuration of the tongue, the upright position of the epiglottis, the length of the floor of mouth, and the distance between the teeth.
Conclusions
The narrowing of the subglottis is considered to be secondary to suction forces used in the inhaling singing technique. The changes in the anatomical structures above the vocal folds possibly suggest a valve-like function controlling the air inlet together with the regulator function of the resonator capacities of the vocal tract.
The Reliability of the Reflux Finding Score Among General Otolaryngologists
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Journal of Voice
Summary
Background
The reflux finding score (RFS) is a validated clinical severity scale for findings of laryngopharyngeal reflux (LPR) on fiberoptic laryngoscopy. To our knowledge, there have been no studies to determine whether severity of patient symptoms influence the RFS; in addition, the reliability of the RFS has not been tested for general otolaryngologists.
Objectives
The objectives of this study were (1) to determine whether the RFS for LPR is influenced by symptoms of reflux and (2) to determine the inter-rater reliability for general otolaryngologists in diagnosing LPR using the RFS.
Methods
Ten general otolaryngologists were selected to participate. Participants were asked to complete an Internet survey consisting of flexible endoscopic videos of larynges with varying physical findings of reflux and grade the severity of reflux using the RFS. The videos were randomly shown with and without accompanying patient symptoms.
Results
Our data suggest that patient symptoms influence the RFS. Inter-rater reliability for general otolaryngologists using the RFS is fair.
Conclusions
Among general otolaryngologists in our study, the reliability and objectivity of the RFS in diagnosing reflux cannot be demonstrated.
Emirati Teachers' Perceptions of Voice Handicap
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Journal of Voice
Summary
Objectives
The purpose of the study was to explore Emirati teachers' perceptions of voice handicap and to analyze their acoustic characteristics to determine whether acoustic measures of teachers' voice would verify their perceptions of voice handicap.
Methods
Sixty-six Emirati school teachers (33 men and 33 women), with different years of teaching experience and age, and 100 control participants (50 men and 50 women) underwent vocal assessment that included the Voice Handicap Index (VHI-Arab) and acoustic measures (F0, jitter%, shimmer%, signal to noise ratio [SNR]).
Results
Significant differences between the teachers' group scores and the control group scores on the following subscales of VHI-Arab: physical (P = 0.006), emotional (P = 0.004), and total score of the test (P = 0.002). No significant differences were found among teachers in the three VHI subscales, and the total score regarding gender (functional P = 0.307; physical P = 0.341; emotional P = 0.126; and totalP = 0.184), age (functional P = 0.972; physical P = 0.525; emotional P = 0.772; and total P = 0.848), and years of teaching experience (functional P = 0.319; physical P = 0.619; emotional P = 0.926; and total P = 0.638). The significant differences between the teacher's group and the control group in three acoustic measures: F0 (P = 0.000), shimmer% (P = 0.000), and SNR (P = 0.000) were further investigated. Significant differences were found among female and male teachers in F0 (P = 0.00) and SNR (P = 0.007). As for teachers' age, significant differences were found in SNR (P = 0.028). Teachers' years of experience did not show significant differences in any of the acoustic measures.
Conclusions
Teachers have a higher perception of voice handicap. However, they were able to produce better voice quality than control participants were, as expressed in better SNRs. This might have been caused either by manipulation of vocal properties or abusive overloading the vocal system to produce a procedurally acceptable voice quality.
Comparison of Two Perceptual Methods for the Evaluation of Vowel Perturbation Produced by Jitter
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Journal of Voice
Summary
Objectives
To explore perceptual evaluation of jitter produced by fundamental frequency (F0) variation in a sustained vowel /a/, using two different methods. One is based on listener's internal references and the other is based on external references provided by the experimenter.
Methods
We used two methods: one is magnitude estimation-converging limits (ME-CL), which is close to the standard approach used by speech therapists when they use numerical estimations and their own standards, and other is intramodal matching procedure (IMP), where each matched stimulus is to be compared with a fixed-set matching stimuli. Systematic variations were introduced in vowel /a/ by Linear Prediction Coding synthesis using an F0 contour function obtained from a statistical jitter model. Six jitter values were used for each of two reference F0 values. Three groups of listeners were tested: expert speech therapists, speech therapy students, and naïve listeners.
Results
Perceptual functions appear to be similar and linear for both methods as the theory predicts. The answers of all groups of listeners tested with ME-CL present higher standard deviations than for IMP. When subjects were tested with IMP, intrareliability and interreliability measurements show a significant improvement for both expert and naïve listeners.
Conclusions
Both intraindividual and interindividual differences for expert speech therapists could be better managed when tested with an IMP than when they use numerical estimations and internal standards to evaluate vowel perturbation produced by jitter. This procedure could be the basis for the development of a clinical evaluation tool.
Effect of Noise on Vocal Loudness and Pitch in Natural Environments: An Accelerometer (Ambulatory Phonation Monitor) Study
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Journal of Voice
Summary
Purpose
This study investigated the effects of environmental noise on the production of vocal intensity and fundamental frequency using an accelerometer.
Methods
Twenty-four vocally healthy young adults (12 men and 12 women, aged 19–22 years) recorded a monologue passage using KayPENTAX (Montvale, NJ, USA) Ambulatory Phonation Monitor (model 3200) under three natural environmental conditions in a randomized order: a quiet room (mean noise, 35.5 dBA), room with moderate level of noise (mean noise, 54.5 dBA), and a room with high noise (mean noise, 67.5 dBA).
Results
Both gender groups showed significant increases in the mean vocal intensity, fundamental frequency, and perceived vocal effort in the high-noise environment than in the other two conditions. No significant difference was found in the vocal intensity between the quiet and moderately noisy environment except in the fundamental frequency in the female group.
Conclusions
This study showed that the use of accelerometer for laryngeal signal recordings could be a useful tool for measuring phonation without being affected by the background noise. The findings also support the recommendation that noise levels for conversation should be kept <50–55 dB to maintain speech intelligibility.
Speech Range Profile (SRP) Findings Before and After Mutational Falsetto (Puberphonia)
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Journal of Voice
Summary
Introduction
Mutational falsetto is a temporary adolescent voice. Voice therapy support in mutational falsetto helps the individual to regain a healthy voice. Speech Range Profile (SRP) is considered to be a method requiring less time in the pretherapy and posttherapy evaluations of voice patients.
Objective
The purpose of this study was to determine the differences between the SRP results of male subjects experiencing mutational falsetto before and after therapy.
Methods
Sixteen male participants have been included in this study. F0, MinF0, MaxF0, F0Range, F0Range (st), MindB SPL, and MaxdB SPL have been taken to evaluation. SRP recordings of all subjects have been performed. All the recordings have been repeated before and after therapy.
Results
A statistically significant difference has been observed between the F0 and MinF0 values before and after therapy (P < 0.001).
Conclusions
SRP provides important information about frequency and intensity. In mutational falsetto, SRP is a useful technique in terms of evaluating success in therapy.
Evaluation of the Distance Between Anterior Commissure of True Vocal Folds and the First Tracheal Ring and Related Laryngeal Indices in 40 Human Cadavers
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Journal of Voice
Summary
Objective
Distorted anatomy in laryngotracheal pathologies expresses the need to determine a quantitative mean of the distance between the anterior commissure of true vocal folds and the first tracheal ring to better define whether a lesion is in the subglottis or has extended toward the trachea.
Study Design
This is a descriptive cross-sectional study.
Methods
In 40 cadavers, the larynx was exposed with an apron cut. The laryngofissure cut opened the larynx via the lateral aspect so that the anterior commissure was exposed. A needle was passed through the thyroid cartilage to reach the anterior commissure. The second needle was crossed over the first tracheal ring. The distance between the two needles was measured.
Results
The mean distance between the anterior commissure of true vocal folds and the first tracheal ring was 26.82 ± 4.28 mm (21.3–42.5 mm) in our subjects. This distance was 27.27 ± 4.45 and 25.05 ± 3.2 mm, in men and women, respectively. There was no statistically significant correlation between this distance with body mass index (BMI), age, and sex.
Conclusions
The distance between the anterior commissure and the first tracheal ring in patients with laryngotracheal pathologies helps in determining the best therapeutic plan for patients.
Correlation Between Acoustic Measurements and Self-Reported Voice Disorders Among Female Teachers
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Journal of Voice
Summary
Objective
Many studies focused on teachers' voice problems and most of them were conducted using questionnaires, whereas little research has investigated the relationship between self-reported voice disorders and objective quantification of voice. This study intends to explore the relationship of acoustic measurements according to self-reported symptoms and its predictive value of future dysphonia.
Study Design
This is a case-control study.
Methods
Voice samples of 80 female teachers were analyzed, including 40 self-reported voice disorders (VD) and 40 self-reported normal voice (NVD) subjects. The acoustic measurements included jitter, shimmer, and noise-to-harmonics ratio (NHR). Levene's t test and logistic regression were used to analyze the differences between VD and NVD and the relationship between self-reported voice conditions and the acoustic measurements. To examine whether acoustic measurements can be used to predict further voice disorders, we applied a receiver operating characteristic (ROC) curve to determine the cutoff values and the associated sensitivity and specificity.
Results
The results showed that jitter, shimmer, and the NHR of VD were significantly higher than those of NVD. Among the parameters, the NHR and shimmer demonstrated the highest correlation with self-reported voice disorders. By using the NHR ≥0.138 and shimmer ≥0.470 dB as the cutoff values, the ROC curve displayed 72.5% of sensitivity and 75% of specificity, and the overall positive predictive value for subsequent dysphonia achieved 60%.
Conclusions
This study demonstrated a significant correlation between acoustic measurements and self-reported dysphonic symptoms. NHR and ShdB are two acoustic parameters that are more able to reflect vocal abnormalities and, probably, to predict subsequent subjective voice disorder. Future research recruiting more subjects in other occupations and genders shall validate the preliminary results revealed in this study.
The Effect of Timbre, Pitch, and Vibrato on Vocal Pitch-Matching Accuracy
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Journal of Voice
Summary
Objective/hypothesis
This study seeks to examine how target stimulus timbre, vibrato, pitch, and singer classification affect pitch-matching accuracy.
Study design
This is a repeated-measures factorial design.
Methods
Source signals were synthesized with a source slope of −12 dB/octave with and without vibrato at each of the pitches, C4, B4, and F5. These source signals were filtered using five formant patterns (A–E) constituting a total of 30 stimuli (5 formant patterns × 3 pitches × 2 vibrato conditions). Twelve sopranos and 11 mezzo-sopranos with at least 3 years of individual voice training were recruited from the University Of Tennessee, Knoxville, School of Music and the Knoxville Opera Company. Each singer attempted to match the pitch of all 30 stimuli presented twice in a random order.
Results
Results indicated that there was no significant effect of formant pattern on pitch-matching accuracy. With increasing pitch from C4 to F5, pitch-matching accuracy increased in midpoint of the vowel condition but not in prephonatory set condition. Mezzo-sopranos moved toward being in tune from prephonatory to midpoint of the vowel. However, sopranos at C4 sang closer to being in tune at prephonatory but lowered the pitch at the midpoint of the vowel. Presence or absence of vibrato did not affect the pitch-matching accuracy. However, the interesting finding of the study was that singers attempted to match the timbre of stimuli with vibrato.
Conclusions
The results of this study show that pitch matching is a complex process affected by many parameters.
Fracture Toughness of Vocal Fold Tissue: A Preliminary Study
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Journal of Voice
Summary
A customized mechanical tester that slices thin, soft samples was used to measure the fracture toughness of vocal fold tissue. Porcine vocal fold lamina propria was subjected to quasi-static, guillotine-like tests at three equally distanced regions along the anterior-posterior direction. The central one-third where high-velocity collisions between vocal folds occur was found to have the maximum fracture toughness. In contrast, the anterior one-third featured a lower toughness. Fracture toughness can be indicative of the risk of benign and malignant lesions in vocal fold tissue.
Natural Voice Use in Patients With Voice Disorders and Vocally Healthy Speakers Based on 2 Days Voice Accumulator Information From a Database
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Journal of Voice
Summary
Objectives and Study Design
Information about how patients with voice disorders use their voices in natural communicative situations is scarce. Such long-term data have for the first time been uploaded to a central database from different hospitals in Sweden. The purpose was to investigate the potential use of a large set of long-term data for establishing reference values regarding voice use in natural situations.
Methods
VoxLog (Sonvox AB, Umeå, Sweden) was tested for deployment in clinical practice by speech-language pathologists working at nine hospitals in Sweden. Files from 20 patients (16 females and 4 males) with functional, organic, or neurological voice disorders and 10 vocally healthy individuals (eight females and two males) were uploaded to a remote central database. All participants had vocally demanding occupations and had been monitored for more than 2 days. The total recording time was 681 hours and 50 minutes. Data on fundamental frequency (F0, Hz), phonation time (seconds and percentage), voice sound pressure level (SPL, dB), and background noise level (dB) were analyzed for each recorded day and compared between the 2 days. Variations across each day were measured using coefficients of variation.
Results
Average F0, voice SPL, and especially the level of background noise varied considerably for all participants across each day. Average F0 and voice SPL were considerably higher than reference values from laboratory recordings.
Conclusions
The use of a remote central database and strict protocols can accelerate data collection from larger groups of participants and contribute to establishing reference values regarding voice use in natural situations and from patients with voice disorders. Information about activities and voice symptoms would supplement the objective data and is recommended in future studies.
Effectiveness of a Voice Training Program for Student Teachers on Vocal Health
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Journal of Voice
Summary
Objectives
The effectiveness of a preventive training program on vocal health for German student teachers was investigated on specific vocal parameters.
Methods
The voice quality as described by the Dysphonia Severity Index of 204 student teachers (training group: n = 123; control group: n = 81) was measured at the beginning and at the end of the student teachers training period (duration 1.5 years). Additionally, for investigating the voice-carrying capacity, a vocal loading test (VLT) was performed. Finally, participants had to provide a subjective judgment of a possible Voice Handicap Index.
Results
The training program improved the voice quality of the trained group compared with that of the control group, whose voice quality declined. The trained group was also able to better sustain their voice quality across the VLT than the control group. Both groups, however, reported a similar increase in subjective vocal strain.
Conclusions
The presented training program clearly showed a positive impact on the voice quality and the vocal capacity. The results maintain the importance of such a training program to be integrated in the education and occupational routine of teachers.
Quantitative Analysis of the Visor-Like Vertical Motion of the Cricoarytenoid Joint in the Living Subject
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Journal of Voice
Summary
Objectives
The cricoarytenoid joint has a loose capsule and large cavity and may allow the arytenoid distanced from the cricoid cartilage. The objective was to quantify vertical motion of the arytenoid cartilage in the living subject.
Study Design
This is a prospective study.
Methods
Axial computed tomography images from 35 healthy subjects and seven patients with unilateral vocal fold paralysis were collected at inspiration and phonation. The perpendicular distance from the arytenoid vocal process (VP) or muscular process (MP) to the cricoid plane was measured and analyzed.
Results
During phonation, the range of the vertical movement of the VP was significantly wider than that of the MP. The vertical motion varies in sides, sexes, and ages. The vertical gaps of the VP and MP between the paralyzed and contralateral sides were about 0.8 mm and 1.5 mm, respectively.
Conclusions
This study confirms a visor-like downward vertical motion of the arytenoid cartilage during phonation.
Bilateral In-Office Injection Laryngoplasty as an Adjunctive Treatment for Recalcitrant Puberphonia: A Case Report and Review of the Literature
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Journal of Voice
Summary
Puberphonia or mutational falsetto is a voice disorder seen in male adolescents. It is defined as the failure of the voice to change from the high pitch of early childhood to the low pitch of adulthood. Puberphonia is usually treated with voice therapy (with or without adjunctive laryngeal manipulation) and psychological counseling. Small series of surgical treatments have also been described. We present the first report of bilateral in-office injection laryngoplasty with hyaluronic acid with voice therapy to treat a 22-year-old male with puberphonia that had not responded to voice therapy. The subject presented with a speaking fundamental frequency of 152 Hz, which decreased to 102 Hz immediately after bilateral injection laryngoplasty and has been maintained at 108 Hz after 24 months.
A Survey of Equipment in the Singing Voice Studio and Its Perceived Effectiveness by Vocologists and Student Singers
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Journal of Voice
Summary
Objectives
Speech-language pathologists have long used technology for the clinical measurement of the speaking voice, but present research shows that vocal pedagogues and voice students are becoming more accepting of technology in the studio. As a result, the equipment and technology used in singing voice studios by speech-language pathologists and vocal pedagogues are changing. Although guides exist regarding equipment and technology necessary for developing a voice laboratory and private voice studio, there are no data documenting the current implementation of these items and their perceived effectiveness. This study seeks to document current trends in equipment used in voice laboratories and studios.
Methods
Two separate surveys were distributed to 60 vocologists and approximately 300 student singers representative of the general singing student population. The surveys contained questions about the inventory of items found in voice studios and perceived effectiveness of these items. Data were analyzed using descriptive analyses and statistical analyses when applicable.
Results/conclusions
Twenty-six of 60 potential vocologists responded, and 66 student singers responded. The vocologists reported highly uniform inventories and ratings of studio items. There were wide-ranging differences between the inventories reported by the vocologist and student singer groups. Statistically significant differences between ratings of effectiveness of studio items were found for 11 of the 17 items. In all significant cases, vocologists rated usefulness to be higher than student singers. Although the order of rankings of vocologists and student singers was similar, a much higher percentage of vocologists report the items as being efficient and effective than students. The historically typical studio items, including the keyboard and mirror, were ranked as most effective by both vocologists and student singers.
Effects of Adventitious Acute Vocal Trauma: Relative Fundamental Frequency and Listener Perception
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Journal of Voice
Summary
Objective
High voice users (individuals who demonstrate excessive or loud vocal use) are at risk for developing voice disorders. The objective of this study was to examine, both acoustically and perceptually, vocal changes in healthy speakers after an acute period of high voice use.
Methods
Members of a university women's volleyball team (n = 12) were recorded a week before (pre) and week after (post) the 10-week spring season; n = 6 control speakers were recorded over the same time period for comparison. Speakers read four sentences, which were analyzed for relative fundamental frequency (RFF). Eight naïve listeners participated in an auditory-perceptual visual sort and rate (VSR) task, in which they rated each voice sample's overall severity and strain.
Results
No significant differences were found as a function of time point in the VSR ratings for the volleyball group. Onset cycle 1 RFF values were significantly lower (P = 0.04) in the postrecordings of the volleyball participants compared with prerecordings, but there was no significant difference (P = 0.20) in offset cycle 10 RFF values. Receiver operating characteristic analyses indicated moderate sensitivity and specificity of onset cycle 1 RFF for discrimination between the volleyball and control participants. Changes were not apparent in the control group as a function of time for either, onset cycle 1 RFF, offset cycle 10 RFF, or either vocal attribute.
Conclusions
Onset cycle 1 RFF may be an effective marker for detecting vocal changes over an acute high voice use period of time before perceptual changes are noted.
Vocal Effects in Military Students Submitted to an Intense Recruit Training: A Pilot Study
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Journal of Voice
Summary
Objectives
This study aims at evaluating the vocal parameters of military officers before and after an Intense Recruit Training (IRT), consisting of a 48-hour exercise protocol involving high vocal demand combined with physical effort, lower body hydration levels, and fewer hours of sleep.
Study Design
Eighty-three young male military officers (aged between 18 and 22 years) were recorded on three occasions: before, immediately after, and 2 weeks after the IRT.
Methods
Maximum phonation times (MPTs) using vocalization of the vowel /a/, the fricative consonants /s/ and /z/, and connected speech samples were collected. A number of acoustic parameters were analyzed: mean fundamental frequency, mean intensity, jitter, shimmer, harmonics-to-noise ratio, spectral emphasis (acoustic correlate of vocal effort), H1−H2 (difference between the amplitude of the first and the second harmonic), and the frequency and intensity ranges. For the immediate effects, statistical analyses were conducted using a paired sample t test (P = 0.05) to compare two moments: before and after the IRT. For the long-lasting effect, statistical analyses were conducted using a one-way analysis of variance (ANOVA) test (P = 0.05) to compare between all three moments (before, immediately after, and 2 weeks after the IRT).
Results
The MPTs of /a/, /s/, and /z/, the acoustic parameters as spectral emphasis, and the mean of intensity showed statistically significant changes between the data from before and immediately after training took place. The MPT of /a/ and the intensity range showed statistically significant changes between the measurements taken immediately after training and the ones taken 2 weeks after training; there were significant differences in the comparisons between the three groups of data acquired.
Conclusions
Some of the acoustic parameters were able to identify changes in the vocal conditions of the military students as consequence of high intensity voice and physical military training. The changes in the vocal intensity and MPT parameters seem to be related to general fatigue and lower hydration. The absence of impact in some parameters, specially 2 weeks after the IRT, may reveal that the students' voice is getting used to the military activities.
Vocal Fold Vibratory Changes Following Surgical Intervention
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Journal of Voice
Summary
High-speed videoendoscopy (HSV) captures direct cycle-to-cycle visualization of vocal fold movement in real time. This ultrafast recording rate is capable of visualizing the vibratory motion of the vocal folds in severely disordered phonation and provides a direct method for examining vibratory changes after vocal fold surgery. The purpose of this study was to examine the vibratory motion before and after surgical intervention. HSV was captured from two subjects with identifiable midvocal fold benign lesions and six subjects with highly aperiodic vocal fold vibration before and after phonosurgery. Digital kymography (DKG) was used to extract high-speed kymographic vocal fold images sampled at the midmembranous, anterior 1/3, and posterior 1/3 region. Spectral analysis was subsequently applied to the DKG to quantify the cycle-to-cycle movements of the left and the right vocal fold, expressed as a spectrum. Before intervention, the vibratory spectrum consisted of decreased and flat-like spectral peaks with robust power asymmetry. After intervention, increases in spectral power and decreases in power symmetry were noted. Spectral power increases were most remarkable in the midmembranous region of the vocal fold. Surgical modification resulted in improved lateral excursion of the vocal folds, vibratory function, and perceptual measures of Voice Handicap Index-10. These changes in vibratory behavior trended toward normal vocal fold vibration.
Prevalence of Vocal Tract Discomfort in the Flemish Population Without Self-Perceived Voice Disorders
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Journal of Voice
Summary
Objectives
The main aim of this study was to assess the prevalence of Vocal Tract Discomfort (VTD) in the Flemish population without self-perceived voice disorders using the VTD scale and to examine the relationship between vocal load and VTD symptoms. In addition, consistency between the VTD scale and the Voice Handicap Index (VHI) and the Corporal Pain scale was evaluated.
Methods
A total of 333 participants completed the VTD scale, the VHI, and the Corporal Pain scale. Patient information about study and voice-related hobbies (for students), state of (non)professional voice user (for employees), smoking, shouting, allergy, and voice therapy was taken into account.
Results
A median number of three VTD symptoms was reported, and 88% of the participants showed at least one symptom of VTD. Dryness (70%), tickling (62%), and lump in the throat (54%) were the most frequently occurring symptoms. The frequency and severity of VTD were significantly higher in participants who followed voice-related studies, played a team sport, were part of a youth movement, shouted frequently, and received voice therapy in the past (P < 0.05). Finally, low correlations were obtained between frequency and severity of the VTD scale and total VHI score (r = 0.226–0.411) or frequency and intensity of the Corporal Pain scale (r = 0.016–0.408).
Conclusions
The prevalence of VTD is relatively high in the Flemish population without self-perceived voice disorders, although the frequency and severity of the symptoms are rather low. Vocal load seems to influence the frequency and severity of VTD. Finally, the VTD scale seems to reveal clinically important information that cannot be gathered from any other protocol.
A Review of Training Opportunities for Singing Voice Rehabilitation Specialists
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Journal of Voice
Summary
Objectives
Training opportunities for singing voice rehabilitation specialists are growing and changing. This is happening despite a lack of agreed-on guidelines or an accredited certification acknowledged by the governing bodies in the fields of speech-language pathology and vocal pedagogy, the American Speech-Language Hearing Association and the National Association of Teachers of Singing, respectively. The roles of the speech-language pathologist, the singing teacher, and the person who bridges this gap, the singing voice rehabilitation specialist, are now becoming better defined and more common among the voice care community. To that end, this article aims to review the current opportunities for training in the field of singing voice rehabilitation.
Methods
A review of available university training programs, private training programs and mentorships, clinical fellowships, professional organizations, conferences, vocal training across genres, and self-study opportunities was conducted. All institutional listings are with permission from program leaders.
Results/Conclusions
Although many avenues are available for training of singing voice rehabilitation specialists, there is no accredited comprehensive training program at this point. This review gathers information on current training opportunities from across various modalities. The listings are not intended to be comprehensive but rather representative of possibilities for interested practitioners.
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