Abstract
PurposePrevious ambulatory voice monitoring studies have included many singers and have combined speech and singing in the analyses. This study applied a singing classifier to the ambulatory recordings of singers with phonotrauma and healthy controls to determine if analyzing speech and singing separately would reveal voice use differences that could provide new insights into the etiology and pathophysiology of phonotrauma in this at-risk population.MethodForty-two female singers with phonotrauma (vocal fold nodules or polyps) and 42 healthy matched controls were monitored using an ambulatory voice monitor. Weeklong statistics (average, standard deviation, skewness, kurtosis) for sound pressure level (SPL), fundamental frequency, cepstral peak prominence, the magnitude ratio of the first two harmonics (H1–H2 ), and three vocal dose measures were computed from the neck surface acceleration signal and separated into singing and speech using a singing classifier.ResultsMixed analysis of variance models found expected differences between singing and speech in each voice parameter, except SPL kurtosis. SPL skewness, SPL kurtosis, and all H1–H2 distributional parameters differentiated patients and controls when singing and speech were combined. Interaction effects were found in H1–H2 kurtosis and all vocal dose measures. Patients had significantly higher vocal doses in speech compared to controls.ConclusionsConsistent with prior work, the pathophysiology of phonotrauma in singers is characterized by more abrupt/complete glottal closure (decreased mean and variation for H1–H2 ) and increased laryngeal forces (negatively skewed SPL distribution) during phonation. Application of a singing classifier to weeklong data revealed that singers with phonotrauma spent more time speaking on a weekly basis, but not more time singing, compared to controls. Results are used as a basis for hypothesizing about the role of speaking voice in the etiology of phonotraumatic vocal hyperfunction in singers.
Highlights
We found that cepstral peak prominence (CPP) was significantly higher, and H1–H2 values were significantly lower in speech than singing
While it is universally acknowledged that the act of singing is typically more vocally demanding than everyday speaking, the findings in this study suggest that speaking has the potential to play a larger role in perpetuating phonotrauma in singers than is reflected in current views that place the onus on singing voice use, especially when accompanied by the fact that the students used their voices for speaking 3 times more than for singing
Participants spent significantly more time speaking than singing, and singing was produced with higher average values and more variation of sound pressure level (SPL) and f0, lower mean and variation for CPP, and higher mean and variation for H1–H2
Summary
Forty-two female patients with a diagnosis of bilateral vocal fold nodules (n = 39) or unilateral vocal fold polyp (n = 3) who self-identified as professional, semiprofessional, or student singers were recruited through sequential convenience sampling at the Massachusetts General Hospital Voice Center. Diagnoses were based on a comprehensive team evaluation (laryngologist and speech-language pathologist [SLP]) at the Massachusetts General Hospital Voice Center that included (a) the collection of a complete case history, (b) stroboscopic imaging of the larynx, (c) an auditory-perceptual evaluation using the Consensus AuditoryPerceptual Evaluation of Voice (Kempster et al, 2009), and (d) aerodynamic and acoustic assessment of vocal function. Potential control subjects were excluded from the study if they (a) indicated present or past vocal difficulties, (b) participated in previous voice therapy or laryngeal surgery, (c) demonstrated an abnormal voice quality during an auditory-perceptual evaluation by the SLP, or (d) demonstrated structural abnormalities on the laryngeal stroboscopic examination
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