Acoustic Voice Analysis Research Articles

Vocal outcomes after COVID-19 infection: acoustic voice analyses, durational measurements, self-reported findings, and auditory-perceptual evaluations.

PurposeThe ongoing literature suggests that COVID-19 may have a potential impact on voice characteristics during the infection period. In the current study, we explored how the disease deteriorates different vocal parameters in patients who recovered from COVID-19.MethodsA total of 80 participants, 40 patients with a prior history of COVID-19 (20 male, 20 female) with a mean age of 39.9 ± 8.8 (range, 21–53) and 40 gender and age-matched healthy individuals (mean age, 37.3 ± 8.8; range, 21–54) were included to this study. The data of acoustic voice analyses, durational measurements, patient-reported outcomes, and auditory-perceptual evaluations were compared between the study group and the control group. Correlation analyses were conducted to examine the association between the clinical characteristics of the recovering patients and measured outcomes.ResultsMaximum phonation time (MPT) and the scores of both Voice Handicap Index-10 (VHI-10) and Voice-Related Quality of Life (V-RQOL) questionnaires significantly differed between the groups, which was more evident in female participants. The overall severity score of dysphonia was found to be higher in the study group than the control group (p = 0.023), but gender-based comparisons reached significance only in males (p = 0.032). VHI-10 and V-RQOL revealed significant correlations with the symptom scores of the disease.ConclusionsPatients with a prior history of COVID-19 had significantly lower MPT, increased VHI-10 scores, decreased voice-related quality of life based on the V-RQOL questionnaire, and higher overall severity scores in the auditory-perceptual evaluation. Self-reported voice complaints disclosed close relationships with the symptom scores of COVID-19 disease.

Voice Telerehabilitation in Iatrogenic Unilateral Vocal Fold Paralysis: From Necessity to Opportunity in the COVID-19 Time

To evaluate results of telerehabilitation (TR) during the coronavirus disease 2019 pandemic for the treatment of dysphonia caused by permanent post-thyroidectomy unilateral vocal fold paralysis (UVFP). Forty subjects with post-thyroidectomy UVFP (onset <1 month) underwent TR. Videostrobolaryngoscopy, acoustic and perceptual voice analysis and patient self-assessment were carried out in person before, at the end of TR and 6 months later. Twenty-five subjects spontaneously recovered full vocal fold motility at some time during follow-up, whereas 15 had a permanent UVFP at the end of the follow-up period. These subjects constituted our study group. At the early posttherapy control 10/15 subjects (66.6%) showed a complete glottal closure, while in 5/15 (33.3%) a glottal gap remained (P=0.03). These results did not change 6 months after TR. At the late posttherapy control the maximum phonation time improved significantly (P=0.02). Both post-therapy Voice Handicap Index scores were significantly lower than the pre-therapy ones (P=0.04). Grade, Breathiness, and Asthenia parameters of the Grade-Roughness-Breathiness-Asthenia-Strain scale improved 6 months after TR (P < 0.05). The number of voice signals suitable for acoustic analysis increased significantly after therapy. Finally, 87% of patients were satisfied with TR. With careful patient selection, TR may be considered as a promising method for voice therapy in postthyroidectomy UVFP.

Effect of Educatıon and Socıal Anxıety on Acoustıc, Perceptual and Aerodynamıc Parameters of Adult Females.

In this study, we hypothesized that social anxiety disorder would be more common in women with lower education levels and that this could have a negative effect on acoustic parameters. A total of eighty-eight (88) healthy female volunteers were enrolled into the study. These volunteers were divided into two groups, which were categorized as those with graduation from elementary school or below (Group A, n = 42) and those with graduation from high school or above (Group B, n = 46). Personal anxiety and avoidance for all participants were evaluated using The Liebowitz Social Anxiety Scale. All subjects also underwent acoustic and aerodynamic voice analysis for evaluation of their objective voice quality and function. Additionally, the GRBAS scale was used for perceptual analysis. Social anxiety scores were higher in group A than group B (p < 0.05). In aerodynamic sound analysis, maximal phonation time was lower in group A than group B (p < 0.05). In perceptual sound analysis, the mean values of the GRBAS parameters for group B were lower than group A (p < 0.05). Mean F0 of Group-B was higher than Group-A in acoustic analysis (p < 0.05). However, there was no statistical difference in jitter, shimmer, NHR and HNR between the groups (p > 0.05). In this study, social anxiety and education has been shown to have an effect on voice in women. As the level of education increases, social anxiety decreases, and both maximum phonation time and fundamental frequency increase.

Acoustic voice and spectrographic measures in children with the phonological process of devoicing

IntroductionChildren with speech sound disorders (SSDs) who present the devoicing of plosive and/or fricative sounds may have difficulties with glottal respiratory control. ObjectiveTo analyze acoustic vocal measures, spectrographic aspects and the risk of dysphonia among children with devoicing SDDs and compare the results with those of other groups of children. MethodsTwenty-five boys aged between six and 12 years participated. They were divided into four groups: the SSD-devoicing (PPDG), dysphonia (DG), SSDs other than devoicing (PPOG) and control groups (CG). The vocal tasks were recorded, and perceptual-auditory and acoustic voice analyses were performed. The children's parents answered questions about voice-related aspects (to determine a dysphonia risk score). All data were compared among the groups. ResultsDue to the sample size, an effect size analysis was considered, and the results showed possible differences between the PPDG and the other groups in measures of fundamental frequency (F0), jitter, shimmer, harmonic-to-noise ratio, maximum frequency of harmonic definition and dysphonia risk score. ConclusionsThe PPDG showed a high F0 and abnormal jitter and shimmer values. Although the voices of the children in this group had more harmonics than noise, the maximum frequency for defining the harmonics was very restricted. The PPDG had the lowest dysphonia risk score among all of the groups. Variations in F0, jitter and shimmer may indicate difficulties with controlling vocal adjustments, which appear to be hyperfunctional and not to impact vocal projection or voicing.

Meta Analysis of Clinical Efficacy of Traditional Chinese Medicine Compounds of Huoxue Yangyin in the Treatment of Vocal Cord Polyp after Surgery

<bold>Objective</bold> To evaluate the clinical efficacy and safety of the traditional Chinese medicine compounds "Huoxue Yangyin" for promoting blood circulation and nourishing Yin in the treatment of postoperative discomfort of vocal cord polyp by Metaanalysis. <bold>Methods</bold> Data were searched from the databases of China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP) ,Wanfang Database (Wanfang Data), China Biomedical Literature Database, PubMed, Embase, Web of science,Springer and Cochrane Library,etc. The patients with vocal cord polyp after surgery in the clinical randomized controlled trials (RCTs) were included who were treated with promoting blood circluation and nourishing Yin drugs. The retrieval time for each database was from January 2000 to May 2021. The outcome indicators including clinical efficacy, clinical symptom subsidence time, clinical symptom score, voice acoustic analysis, grade rough breathy asthenic strained (GRBAS), adverse reactions. RevMan 5.4.1 software was used for data analysis, continuous variables were expressed by weighted mean difference (<italic>WMD</italic>) and 95% confidence interval (<italic>CI</italic>); binary variables were expressed by odds ratio (<italic>OR</italic>) and 95% <italic>CI</italic>. If the included studies were homogeneous (<italic>I</italic>²&lt;50%), a fixed effects model would be used; if the included studies were heterogeneous (<italic>I</italic>²≥50%), a random-effects model would be used. <bold>Results</bold> A total of 1 628 patients were included in 15 RCTs, including 813 in the experimental group and 815 in the control group. Meta analysis results showed that the total effective rate of the experimental group was significantly higher than that of the control group [<italic>OR</italic>=4.79, 95% <italic>CI</italic> (3.15, 7.26), <italic>P</italic>&lt;0.000 01]; the symptom subsidence time in the experimental group was significantly lower than that of the control group [<italic>MD</italic>=-2.27, 95% <italic>CI</italic> (-2.48, -2.05), <italic>P</italic>&lt;0.000 01]; the scores of clinical symptoms of the experimental group such as hoarseness,foreign body sensation, pain, cough, and dryness were lower than those of the control group (<italic>P</italic>&lt;0.05); the voice acoustic parameters of the experimental group such as Jitter and Shimmer were significantly lower than those of the control group (<italic>P</italic>&lt;0.05); the GRBAS score of the experimental group after treatment was significantly lower than that of the control group, and the difference was statistically significant [<italic>MD</italic>=-0.64, 95% <italic>CI</italic> (-0.79, -0.49), <italic>P</italic>&lt;0.000 01]. There were no serious adverse reactions in both groups. <bold>Conclusion</bold> The traditional Chinese medicine compounds of promoting blood circulation and nourishing Yin has a good effect in the treatment of vocal cord polyp after surgery, which can effectively improve postoperative hoarseness, foreign body sensation, pain, cough, dryness and other symptoms, and shorten the recovery time of vocal cord function.

Acoustic Voice Analysis during Phonation Onset, Measured from High-Speed Videoendoscopy in Connected Speech

Adductor spasmodic dysphonia (AdSD) is a neurological voice disorder, which affects the control of intrinsic muscles of the larynx during speech. Our previous research has shown that high-speed videoendoscopy (HSV) can be used to measure the glottal attack time for patients with AdSD during connected speech. This study builds upon that to analyze the acoustic signal during the phonation onset and prephonatory adjustments. The phonation onset events are quantified using the HSV data that were obtained simultaneously with the acoustic data. We analyze the power and energy waveform of the acoustic signal during vocal folds’ first contact, first oscillation, and transitory behaviors, extracted from high-temporal resolution HSV data. The data were obtained from five patients with AdSD and five vocally normal participants. The data were recorded while the participant produced: 2 productions of vowel /i/ at habitual pitch and loudness, 2 with a soft glottal attack and 2 with a hard glottal attack, six CAPE-V sentences, and the “Rainbow Passage.” The HSV system included a monochrome high-speed camera coupled with a flexible nasolaryngoscope. The results of this study could assist for more accurate clinical management of adductor spasmodic dysphonia.

Voice and Swallowing Disorders After Thyroid Surgery

The aim of the study was to evaluate voice and swallowing function following thyroid surgery, to identify dynamic changes during the follow-up period of 12-18 month and to find possible indicative signs of permanent or temporary vocal fold palsy. All participants (N = 110) were prospectively enrolled from the preoperative thyroid surgery patients between September 2013 and December 2016. All subjects underwent preoperatively, first week and 12-18 month postoperatively videolaryngostroboscopy, filled in subjective evaluation of voice (voice handicap index, [VHI]) and swallowing (swallowing impairment score) complaints. Acoustic voice analysis (AVA), maximum phonation time (MPT) measurement and perceptual voice evaluation were conducted. In the presence of laryngeal damage, additional first and sixth-month follow-up visits were planned. Patients, whom we suspected laryngeal nerve damage, underwent laryngeal electromyography 4 weeks after the operation. On first postoperative week evaluation, no objective voice changes within patients with postoperatively intact laryngeal nerves were found. Subjective evaluations showed decline in VHI physical domain and increased strain in postoperative voice. Patients with postoperative nerve damage had a drastic decline in subjective voice quality (VHI all subscales and total score), AVA parameter jitter, MPT and perceptual voice quality. Subjective evaluation of swallowing revealed disturbances in all patients regardless of the nerve damage. We noticed remarkable differences in first week and first month visits between patients with permanent and temporary palsy in VHI total score and physical domain, MPT and perceptual breathiness and asthenia in voice. Regardless of the nerve injury, by the end of the follow-up period all changes had become statistically insignificant with the exception of perceptual evaluation of voice quality. Patients with postoperative laryngeal nerve damage experience substantial deterioration of both subjective and objective voice quality with more extensive impairment in patients with permanent paralysis. Thyroid surgery causes subjective swallowing changes irrespective of laryngeal nerve damage. In patients without laryngeal nerve damage, swallowing function improves following thyroidectomy. Possible indicators for permanent paralysis are delayed recovery in the values of MPT and jitter and persistent perceptual breathiness and asthenia.

Effect of FFP2/3 Masks on Voice Range Profile Measurement and Voice Acoustics in Routine Voice Diagnostics

Introduction: Voice diagnostics including voice range profile (VRP) measurement and acoustic voice analysis is essential in laryngology and phoniatrics. Due to COVID-19 pandemic, wearing of 2 or 3 filtering face piece (FFP2/3) masks is recommended when high-risk aerosol-generating procedures like singing and speaking are being performed. Goal of this study was to compare VRP parameters when performed without and with FFP2/3 masks. Further, formant analysis for sustained vowels, singer’s formant, and analysis of reading standard text samples were performed without/with FFP2/3 masks. Methods: Twenty subjects (6 males and 14 females) were enrolled in this study with an average age of 36 ± 16 years (mean ± SD). Fourteen patients were rated as euphonic/not hoarse and 6 patients as mildly hoarse. All subjects underwent the VRP measurements, vowel, and text recordings without/with FFP2/3 mask using the software DiVAS by XION medical (Berlin, Germany). Voice range of singing voice, equivalent of voice extension measure (eVEM), fundamental frequency (F0), sound pressure level (SPL) of soft speaking and shouting were calculated and analyzed. Maximum phonation time (MPT) and jitter-% were included for Dysphonia Severity Index (DSI) measurement. Analyses of singer’s formant were performed. Spectral analyses of sustained vowels /a:/, /i:/, and /u:/ (first = F1 and second = F2 formants), intensity of long-term average spectrum, and alpha-ratio were calculated using the freeware praat. Results: For all subjects, the mean values of routine voice parameters without/with mask were analyzed: no significant differences were found in results of singing voice range, eVEM, SPL, and frequency of soft speaking/shouting, except significantly lower mean SPL of shouting with FFP2/3 mask, in particular that of the female subjects (p = 0.002). Results of MPT, jitter, and DSI without/with FFP2/3 mask showed no significant differences. Further mean values analyzed without/with mask were ratio singer’s formant/loud singing, with lower ratio with FFP2/3 mask (p = 0.001), and F1 and F2 of /a:/, /i:/, /u:/, with no significant differences of the results, with the exception of F2 of /i:/ with lower value with FFP2/3 mask (p = 0.005). With the exceptions mentioned, the t test revealed no significant differences for each of the routine parameters tested in the recordings without and with wearing a FFP2/3 mask. Conclusion: It can be concluded that VRP measurements including DSI performed with FFP2/3 masks provide reliable data in clinical routine with respect to voice condition/constitution. Spectral analyses of sustained vowel, text, and singer’s formant will be affected by wearing FFP2/3 masks.

Effect of Proton Pump Inhibitor on the Outcome of Laryngeal Microsurgery in Patients With Vocal Fold Mucosal Disease With Reflux Symptoms

To evaluate the effect of proton pump inhibitor (PPI) after laryngeal microsurgery (LMS) in patients with benign vocal fold (VF) mucosal disease and in patients with overt reflux symptom according to subjective and objective voice assessment. The improvement of voice handicap index-10 (VHI-10) score, reflux symptom index (RSI) score, grade, roughness, breathiness, asthenia, and strain (GRBAS) score, Jitter, Shimmer, noise to harmonics ratio (NHR), maximum phonation time of acoustic voice analysis RESULTS: A total of 47 patients (PPI group [n = 24] and non-PPI group [n = 23]) completed the study. The scores for VHI-10, RSI, GRBAS, and acoustic parameters significantly improved in both groups after surgery. In the subgroup analysis of patients with overt reflux symptoms (RSI ≥ 13; non-PPI group [n = 12], PPI group [n = 15]), significant between-group differences were observed in terms of the improvement in NHR and the strain factor. Postoperative PPI administration in patients with VF benign mucosal disease with reflux symptoms might improve subjective and objective voice outcomes after LMS.

The Effect of An Indirect Voice Therapy Approach on the Voice of Children With Vocal Fold Nodules: A Prospective Cohort Study

To investigate the effect of a combination indirect voice therapy approach on the management of vocal nodules in the pediatric population. A prospective cohort study with thirty children (24 males and 6 females; mean age 8.8 ± 2.2) with a diagnosis of vocal fold nodule (VFN) was conducted. All participants were included in an 8-week voice therapy program consisting of vocal hygiene education and parental rule-setting. Videolaryngoscopic examination, auditory-perceptual evaluation, and acoustic voice analysis were performed immediately before and after the intervention. The comparison of videolaryngoscopic findings before and after the therapy revealed that the size of the nodules decreased significantly (P < 0.001). Findings from the laryngeal examination showed that the vast majority of children 73.3% (n = 22) had no VFN anymore after the intervention. The auditory-perceptual evaluation showed that overall severity of dysphonia decreased significantly [from 50 (40-70) to 38 (30-45), P < 0.001]. Jitter local (P = 0.031) and Jitter local abs (P = 0.043) parameters statistically differed after the therapy. There were not any statistically significant differences for mean F0, shimmer local (%), shimmer local (dB), and mean HNR. The voice therapy method in this study has a clear benefit on the voice of children with VFN and can be used in clinical practice. Specifically, clinicians should consider the parents as a core component of voice therapies and pay attention to vocal hygiene education for optimal management of VFN related childhood dysphonia.

Comprehensive Evaluation of Vocal Outcomes and Quality of Life after Total Laryngectomy and Voice Restoration with J-Flap and Tracheoesophageal Puncture.

Simple SummaryLaryngopharyngectomy is still the treatment of choice in locally advanced pharyngolaryngeal tumors not eligible for organ preservation protocols. Loss of speech capacity has been reported as one of the factors that most affect the patient-reported quality of life. Thus, the reconstructive goals are restoring the pharynx and possibly the voice in such a scenario. For decades, tracheoesophageal puncture (TEP) has allowed proper voice rehabilitation; however, TEP has a non-neglectable financial expenditure and complication rate. Therefore, we recently reported a novel flap design and surgical technique that shares the same principles of TEP, without the need to change any device over time, named J-flap. This study aimed to analyze both techniques’ subjective and objective vocal outcomes and their impact on overall and voice-related quality of life.Background: Tracheoesophageal puncture with a voice prosthesis is the gold standard for speech rehabilitation in patients that receive a laryngopharyngectomy. However, a novel surgical technique, using a tubularized anterolateral tight flap, named “J-flap,” has been demonstrated to produce adequate voice restoration. We aimed to compare the outcomes and the quality of life of patients who underwent voice rehabilitation with both techniques. Methods: We enrolled patients that underwent laryngopharyngectomy and voice restoration surgery. The control group received a tracheoesophageal puncture with a voice prosthesis, while the study group received J-flap reconstruction. A total of 20 patients received voice prosthesis rehabilitation, while 18 received J-flap reconstruction. Speech and vocal outcomes and quality of life metrics were collected. Results: The objective phonatory performances and the acoustic voice analysis did not outline a significant difference. Speech pathologists judged the consonant pronunciation in the J-flap group as less accurate (p < 0.001). The voice handicap index revealed a moderate impairment for the J-flap group (p < 0.001). Quality of life scores were higher for the voice prosthesis group. Conclusion: Voice prostheses and J-flaps share similar objective phonatory outcomes. Quality of life was more impaired in the J-flap group. In our view, these two techniques possess complementary characteristics in clinical practice, taking into account health care system regulations and patients’ social background.

Acoustic characteristics of voice and speech in Arabic-speaking stuttering children

BackgroundUsing different methodologies, several researchers have reported certain acoustical and physiological differences between fluent utterances of stutterers and normally fluent speakers. The aim of this study was to determine acoustic characteristics of voice and speech in Arabic-speaking stuttering children in comparison to normal children and correlate these characteristics with stuttering severity. A sample of 80 Arabic-speaking Egyptian children (including 40 typically developing children and 40 stuttering children) in the age range 5–8 years were subjected to acoustic analysis of voice and speech using the Praat software.ResultsThe stuttering children showed significantly higher values of jitter and shimmer in prolonged /a/ vowel sample, as compared to the normal group. This may reflect the subtle differences in laryngeal functioning or in the complex interaction among the laryngeal, respiratory, and the vocal tract systems in stuttering children. Both jitter and shimmer of prolonged /a/ vowel demonstrated significant positive moderate correlation with stuttering severity as assessed by SSI3. F0 was significantly higher in females than in males, both in normal and stuttering children.ConclusionsThe present study revealed significant differences in the acoustic parameters of voice and speech between Arabic-speaking stuttering children and normal children. Some of these acoustic parameters were significantly correlated with stuttering severity. Acoustic analysis can be used as simple, quick, and cheap tool for assessment of stuttering in children and might be a valuable addition to the diagnostic set for assessment of stuttering severity.

Speech capacity in patients with voice disorders before and after surgical treatment of vocal fold tumors

Inroduction. Pathological characteristics of voice and speech in persons with benign and malignant vocal fold tumors present as different variations in the voice pitch, intensity and quality. The aim of the study was to determine the speech capacity of persons with malignant and benign vocal fold tumors before and after surgical treatment and to establish if there are differences in the speech capacity in relation to the type of tumor. Material and Methods. The sample included 67 subjects who were divided into two groups: group I - subjects with benign tumors, vocal cord lesions (polyps, cysts) and Reinke?s edema and group II - subjects with malignant tumors, aged 23 to 74 years (mean age 55.43; standard deviation 11.95). Acoustic voice analysis, maximum phonation time of the vowel /a/, analysis of temporal speech organization, and sentence melody analysis were used for measuring the speech capacity. Results. Before surgery, the speech capacity in both groups of patients was almost equal, without statistical significance between the compared groups. After surgery, there was a statistically significant difference between the speech capacity in the examined groups, with better speech capacity observed in group I (t = -3.807, p &lt; 0.001). The study did not show an isolated effect of time or tumor type on the speech capacity, but showed a combined effect (F = 10.079, p = 0.002). Conclusion. The proposed method for the assessment of the speech capacity before and after surgical treatment of vocal fold tumors is a useful tool for the prediction of the voice outcome and in planning rehabilitation procedures.

Результаты хирургического лечения с использованием СО2-лазера у больных с двусторонним параличом гортани

Introduction. Despite advances in modern surgery, the percentage of patients with bilateral paralysis of the larynx is not decreasing. There are many author’s methods of treatment, but there is no single algorithm. This problem remains relevant, especially among people of working age. Research objective: Optimization of surgical treatment of patients with bilateral paralysis of the larynx using a CO2-laser. Materials and methods. For 2014–2018, 143 patients diagnosed with bilateral paralysis of the larynx were treated. The patients underwent a general clinical examination, video endolaryngoscopy, video stroboscopy, spirometry, acoustic voice analysis. For a subjective assessment of the condition, patients filled out the VOICE HANDICAP INDEX (VHI) voice questionnaire, the 36-Item Short Form Survey (SF-36) quality of life questionnaire. Depending on the degree of stenosis, age, body mass index, the presence of a tracheostomy, comorbidities, the following operations were performed using a CO2-laser: posterior partial chordotomy, posterior vestibulo-chordotomy, posterior chordotomy with wound defect plasty. Results and discussion: The patients followed up for 6 to 12 months in the postoperative period. A positive outcome achieved in 128 patients (90%). 15 patients needed a second operation. Tracheostomy patients were decannulated on days 3 to 5. Conclusion. Restoration of respiratory function was achieved by expanding the lumen of the glottis in the posterior parts of the larynx, while maintaining a socially adapted voice was achieved due to intact anterior two-thirds of the vocal folds. These methods are among the most effective and minimally invasive methods for the treatment of bilateral paralysis of the larynx.

Electromyographic Assessment of the External Laryngeal Muscles of Opera Singers During Phonation and Non-Phonation Tasks

IntroductionThe surface EMG technique (sEMG) gives valuable assessment of vocal tract as well as diagnosis or outcome assessment in dysphonia. There are very few papers on the use of sEMG in vocal professionalists. AimThe aim of this study was to evaluate the electromyographic characteristics of selected external laryngeal and neck muscles in professional opera singers. MaterialThe study material consisted of 50 subjects. Twenty-six opera professional singers and 24 healthy non-singers. MethodEach person underwent otolaryngologic and phoniatric examination, laryngeal videostroboscopy, hearing testing, multiparametric acoustic voice analysis (multidimensional voice program) and sEMG of submentalis, cricothyroid and sternocleidomastoid muscles. ResultsStatistical analysis of the values of the amplitudes of the submentalis and the cricothyroid muscles showed significant differences between the vocalists and the control group. Moreover, during vowel phonation and glissando, significantly greater differences in the asymmetry of sternocleidomastoid muscles amplitudes were observed in singers compared to the control group. In most subjects, the studied muscles did not show asymmetry during saliva swallowing. ConclusionsLaryngeal muscle function should be assessed during different phonation and non-phonation tasks. Singers have different SEMG characteristics than non-singers. Knowledge of the patient's history and endoscopic studies is needed to interpret EMG recordings.

Early Cochlear Implantation Allows Deaf Children to Control Voice Pitch and Loudness independently.

Congenitally deaf children with a cochlear implant (CI) improve their speech production intelligibility, but their prosody, including stress and intonation produced by voice pitch and loudness changes, often differs from normal hearing people, which affects their fluent oral communication. This study is aimed to clarify abnormal characteristics of voice pitch and loudness control in CI recipients using a newly developed visually guided pitch change task. We included 13 normal hearing volunteers (NH group) and 17 congenitally deaf CI users who showed good speech intelligibility. The 17 CI users were divided into Early-CI and Late-CI groups, based on their age at implantation of 2.5 years. Using the visually guided pitch change task and acoustic voice analysis of sustained vowels, we assessed their vocal skills to maintain constant pitch and loudness and intentionally change the voice pitch independent from loudness. At the time of examination, the mean age was 24.1, 12.7, and 18.9 years in the NH, Early-CI, and Late-CI groups. During constant vowel production, Early-CI and Late-CI groups showed more significant fluctuations in pitch and loudness than the NH group. However, when focusing on intentionally changing only the pitch of the voice, the Early-CI group was significantly better than the Late-CI group and comparable to the NH group in terms of their ability to change vocal pitch independently from loudness. Among congenitally deaf patients, age at implantation was associated with the development of voice skills to control voice pitch and loudness separately, which may influence their fluent prosody production.

Perceptual, Aerodynamic and Acoustic Evaluation of Vocal Characteristics in Subjects With Obesity

Obesity has tripled since 1975 and affects health across many domains. Increasing body mass index increases the risk to the obese subject of many non-communicable diseases. The study evaluated the perceptive, aerodynamic, and acoustic parameters that characterize the voice of the obese population. Eighty adult subjects (40 participants in each obese and control group) aged 18-50 years were enrolled. The perceptual voice analysis was performed using the Consensus Auditory Perceptual Evaluation of Voice. The aerodynamic and acoustic voice analyses were performed using the MIR Spiro lab instrument and Doctor's Speech software. A digital stopwatch was also used to measure maximum phonation time. Statistical analysis revealed a significant difference (P-value <0.05 and t value >2) between two groups on acoustic parameters, specifically Normalized noise energy and fundamental frequency tremor (F0 tremor). Normalized noise energy and fundamental frequency tremor were greater in the obese group. Moreover, maximum phonation time and expiratory reserve volume were significantly reduced in the obese group. Results of the present study showed poor voice quality and reduced expiratory reserve volume in obese individuals. This could be credited to the adverse effects of accrued adipose on the functioning of the laryngeal and respiratory systems. Increasing body mass index escalates the risk to the obese subjects of many non-communicable diseases.

Prethyroidectomy voice and swallowing disorders and the possible role of laryngopharyngeal reflux disease

Objectives The aim of the study was to evaluate voice and swallowing function before thyroid surgery and to explore the possible role of thyroid enlargement and laryngopharyngeal reflux (LPR). Methods We conducted a prospective study of patients who underwent hemi- or total thyroidectomy (n = 118) and compared the results with patients of laparoscopic cholecystectomy (n = 110). All subjects underwent videolaryngostroboscopy, filled in subjective evaluations of voice, swallowing and reflux complaints. Acoustic voice analysis (AVA), maximum phonation time (MPT) and perceptual voice evaluation were conducted. Results We found no difference in voice quality between study and control group, neither in subjective complaints nor in AVA or perceptual evaluation. We did find indicative signs of minor laryngeal changes in thyroid group. Swallowing Impairment Score (SIS) revealed worse swallowing function in thyroid patients (p = 0.0006). Comparison of Reflux Symptom Index (RSI) scores revealed that thyroid group patients have higher values compared to control group (p = 0.006). Nevertheless, Reflux Finding Score (RFS) showed identical scores in both groups (p = 0.220). In thyroid group there was a strong positive correlation between RSI and SIS (ρ = 0.641), but no correlation between RFS and SIS (ρ = −0.002). In addition, we found a weak positive correlation between thyroid weight and RFS (ρ = 0.379). Conclusions Changes in laryngeal area caused by thyroid disorders do not lead to subjective but indicate slight objective disturbances in voice quality. We detected a decline in swallowing quality within thyroid patients. Higher RSI scores and a positive correlation between RFS and thyroid weight, indicate a possible role of thyroid gland in LPR.

Scientific research with cancer patients during the COVID-19 pandemic: an experience report

Scientific research brings resolutions to several problems in society, supporting clinical performance in health. Work with cancer patients needs to be even more careful. During the COVID-19 pandemic, cancer patients enter the risk group for exposure to the virus, limiting the monitoring of the disease, impairing treatment. New health technologies and telemedicine have been on the rise in recent years, changing the course of medicine, research and health care. Its implementation and validation have been widely discussed in recent years, and it was greatly encouraged by the COVID-19 pandemic. To report the development, adaptations and the six-month longitudinal follow-up of 20 individuals who underwent thyroidectomy at a university hospital. The research flowchart initially persisted in evaluating symptoms and vocal fatigue in individuals undergoing thyroidectomy due to thyroid cancer at three times: pre-surgical (M1), immediate post-surgical (M2) and late post-surgical (M3) in three to six months. The individuals were submitted to videolaryngoscopy, voice recording, voice acoustic analysis and completion of self-assessment protocols along with the medical consultation. All assessments were performed on an outpatient basis at the three times described. The research began in October 2019, and was interrupted at the beginning of the pandemic. In February 2020 we obtained eight cases with the two initial assessments, and only two cases with M3. Due to the pandemic, the surgeries were suspended and the continuity of the study was impaired, requiring modifications. The initial goal was to last nine months with 30 individuals in the sample. New cases were followed up from October 2020 until May 2021 when there was a reduction in cases. At the end, all data from 20 individuals in this period of the research were collected. The completion time increased from nine months to 20 months. None of the patients were infected by COVID-19 during the research period. Therefore, the treatment of cancer patients encompasses several aspects that have been hampered by its continuity, delaying deadlines and making access difficult by COVID-19. As well as, scientific research in this population has undergone several adaptations to preserve the health of individuals, not unnecessarily exposing them to contamination with the virus. Monitoring by telemedicine proved to be effective for the initial objectives of this study, but it may limit it depending on the type of proposed intervention. Despite the existing pandemic, scientific production should not be stopped because it brings discoveries that aim to improve the health of the population.

Interprofessional Approaches to Acoustic Voice Analysis

ABSTRACT When teaching voice for actors, much of the teacher’s work dwells in the realm of perceptual skills and assessment. Acting voice pedagogy often requires students to imagine physiological processes using the teacher’s descriptive imagery. Students’ progress may benefit from the incorporation of technology to teach and envision aspects of the voice that cannot be seen or are difficult to imagine. Acoustic assessment using computer software offers potential opportunities for making the intangible or imperceptible more precise and perceivable. Acoustic measures provide objective information to correlate with auditory perceptual judgments of vocal quality, discriminate between normal and disordered vocal quality, and are sufficiently stable to assess change in performance across time. For the acting voice teacher interested in exploring acoustic assessment, this paper introduces the parameters of acoustic analysis and envisions its potential uses in the studio or classroom. The teacher who explores acoustic assessment may discover new ways to discuss voice production and new tools to describe and vivify voice work using an unexpected artistic source: data. In concert with clinicians on the actor’s voice care team, the acting voice teacher versed in acoustic voice analysis may offer their students an enhanced approach to acting and speaking voice habilitation.