Amplitude Perturbation Quotient Research Articles

Impact of Vocal Fold Dehydration on Vocal Function and Its Treatment.

The change of vocal function after vocal fold dehydration due to dryness was discussed along with the treatment effect of different atomizing agents. Forty-eight staffs from The Central Hospital of Wuhan were recruited. All volunteers breathed dry air for vocal fold dehydration. After dry air inhalation, the subjects were randomly divided into four groups, with 12 cases each. Three groups were treatment groups, receiving 0.9% normal saline (IS), 5% hypertonic saline (HS) and double-distilled water (SW) atomizing inhalation therapy, respectively, and the last group was the control group without treatment. Voice data were collected for all subjects before and immediately after dry air inhalation using the Multi-Dimensional Voice Program (MDVP) system. Atomizing inhalation therapy was given 10 min after dry air inhalation, and voice data were collected using MDVP system at the following time points after atomizing inhalation treatment: 5 min, 20 min, 35 min, 50 min, 65 min, 80 min, 95 min, 110 min. In the control group, voice data were collected at the same time points and compared with those of treatment groups. The vocal function parameters collected before and after dry air inhalation as well as after treatment were subjected to test using SPSS 16.0 software. In the four groups, jitter (fundamental frequency perturbation), shimmer (amplitude perturbation), and amplitude perturbation quotient (APQ) were significantly increased after dry air inhalation (P<0.05). In IS, HS and SW groups, after atomizing inhalation treatment, there was an obvious reduction in jitter, shimmer and APQ, showing significant differences as compared with those after dry air inhalation (P<0.05). Moreover, these parameters were significantly lower than those in the control group (P<0.05). The jitter, shimmer and APQ in the IS group were significantly lower than those in the HS and SW groups (P<0.05). We are led to a conclusion: Vocal fold dehydration induced by dryness can reduce the stability of voice; such decreased voice stability can be improved by atomizing inhalation therapy; without proper treatment, voice stability caused by vocal fold dehydration cannot heal spontaneously; of three atomizing agents namely, IS, HS and SW, IS had the best treatment effect for decreased voice stability caused by vocal fold dehydration.

Acoustic characteristics of voice in examinees with moderately-severe hearing loss

&amp;lt;p&amp;gt;Introduction.Voice is the result of vocal cord vibrations and resonance effects of the vocal tract, therefore, the instrumental monitoring of the vibrations themselves is one of the essential aspects of objective instrumental assessment of voice. Inadequate height and volume, as well as increased nasality, represent the basic characteristics of voice in hearing-impaired persons. The aim of the study was to perform a detailed analysis of the acoustic structure of vowel /a/ in the hearing-impaired persons and in those with normal hearing and voice. Methods. The sample comprised 40 participants, aged 17 to 20 years (18.50 &amp;amp;plusmn;1.13), both sexes (50% males), divided into two groups. The first group consisted of 20 participants with moderately-severe hearing loss (56-70 dB), while the second group included 20 normal-hearing participants. Members of both groups were equal to each other in sex and age (&amp;amp;plusmn; 3 months). The research was conducted in secondary schools, the Faculty of Medicine in Foča, as well as in Special School with a Student's Dormitory &amp;quot;Bubanj&amp;quot; in Ni&amp;amp;scaron; during May 2018. Results. A statistically significant difference between hearing-impaired and normal-hearing speakers was found in 11 out of 14 tested acoustic parameters of vowel /a/: Standard Deviation of Fundamental Frequency (STD), Absolute Jitter (Jitta), Percentage of Jitter (Jitt), Relative Average Perturbation (RAP), Fundamental Frequency Variation (vFo), Shimmer (Shdb), Percentage of Shimmer (Shim), Amplitude Perturbation Quotient (APQ), Noise-to-Harmonic Ratio (NHR), Soft Phonation Index (SPI) and Frequency Tremor Intensity Index (FTRI) whereby the hearing-impaired participants showed higher values of the above-mentioned parameters. Conclusion: The obtained results show pathological changes in the voice of hearing-impaired persons, as well as the need for voice rehabilitation.&amp;lt;/p&amp;gt;

Grade of Dysphonia: Correlation with Patient Self-Assessment Questionnaire and Acoustic Measures

AbstractBackground: The vocal assessment process should con-sider the multidimensionality involved in the demonstration of a voice disorder. Auditory perceptual assessment is the most commonly used clinical voice assessment method (gold standard) for evaluation of voice disorders. However, it has been heavily criticized because it is subjective and classifies severity of vocal disorders but does not address the impact of the vocal disorder has on quality of life which may go beyond the level of perceived voice change. So, it is possible that self-assessment instruments capture a different aspect of the vocal function that cannot be derived from auditory-perceptual or acoustic analysis.Aim of Study: The aim of this work is to investigate the correlation between grade of dysphonia obtained by auditory perceptual assessment, acoustic measures and the degree of handicap a patient experiences (as measured by the Arabic VHI) as a result of their voice disorder.Study Design: This was a descriptive cross-sectional study.Patients and Methods: 70 adult patients with voice com-plaints referred for voice evaluation in the Unite of Phoniatrics, Ain Shams University were included in this study aged 18 years-60 years and 35 normal adult subjects as a control group. Auditory perceptual assessment, acoustic analysis, and appli-cation of Arabic VHI questionnaire were done for all cases.Results: A significant correlation was found between grade of dysphonia and functional subscale of the Arabic VHI. Significant correlation was found between grade of dysphonia and amplitude perturbation quotient (APQ%) and shimmer percent (Shim%).Significant correlation was found between Arabic VHI total score and average fundamental frequency (F0), significant correlation between functional subscale of the Arabic VHI and average fundamental frequency (F0) and jitter percent (Jitt%) and near significant correlation between physical subscale of the Arabic VHI and average fundamental frequency.Conclusion: Auditory perceptual assessment, acoustic analysis and patient's vocal self-assessment measure different aspects of the voice and are not interchangeable. These measures provide complementary rather than redundant infor-mation.

Voice Quality as Therapeutic Outcome in Laryngopharyngeal Reflux Disease: A Prospective Cohort Study

To study the usefulness of voice quality as therapeutic outcome in laryngopharyngeal reflux disease. A total of 80 patients with reflux finding score (RFS) > 7 and reflux symptom index (RSI) > 13 were treated with pantoprazole, diet, and lifestyle recommendations for 3 months. The therapeutic effectiveness was assessed with RSI; RFS; Voice Handicap Index; blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability (GRBASI); aerodynamic and a panel of acoustic measurements before and after treatment. A correlation analysis between symptoms, videolaryngostroboscopic signs, and acoustic measurements was conducted. Compared to baseline, means of RSI, RFS, Voice Handicap Index, perceptual dysphonia, and roughness significantly decreased. Significant improvements of phonatory quotient, percent jitter, percent shimmer, Relative Average Perturbation, Pitch Perturbation Quotient, Phonatory F0 Range, Amplitude Perturbation Quotient, smooth Amplitude Perturbation Quotient, and Peak-to-Peak Amplitude Variation were found at the end of treatment. Studies of correlation did not identify relevant correlation between videolaryngostroboscopic signs, especially vocal folds edema, and objective voice quality evaluations. Voice quality assessments can help to better understand voice disorders and can be used as indicators of the treatment effectiveness in patients with laryngopharyngeal reflux-related symptoms.

Acoustic voice analysis in patients with laryngopharyngeal reflux

Exposure of laryngeal mucosa to gastric juice causes trauma either directly or through a secondary mechanism, which causes chronic cough. Laryngeal mucosal trauma can cause voice problems, which is a frequent complaint in patients with laryngopharyngeal reflux (LPR). Acoustic voice analysis using Multi-Dimensional Voice Program (MDVP) is a relatively convenient and objective method for the assessment of voice disorders. This study assessed the differences between the values of acoustic voice parameters in patients with LPR and those without LPR. A comparative cross-sectional study was conducted in the outpatient Clinic at the Cipto Mangunkusumo Hospital between May and November 2016 (LPR group, n = 40; non-LPR group, n = 20). Some acoustic voice parameters in the LPR group were higher than those in the non-LPR group. Male patients exhibited significantly higher jitter, Pitch Perturbation Quotient (PPQ), and Noise/Harmony noise (NHR) values, whereas female patients exhibited significantly higher shimmer and Amplitude Perturbation Quotient (APQ) values. Significant differences were observed with respect to jitter, PPQ, APQ, and NHR values between male patients in the mild-LPR group and those in the moderate–severe LPR group.

Impact of Laryngopharyngeal Reflux on Subjective, Aerodynamic, and Acoustic Voice Assessments of Responder and Nonresponder Patients

To investigate the usefulness of voice quality assessment as a treatment outcome in responder and nonresponder patients with laryngopharyngeal reflux (LPR). Eighty clinically diagnosed LPR patients with reflux finding score (RFS) > 7 and reflux symptom index (RSI) > 13 were treated with pantoprazole, lifestyle changes, and diet recommendations for three months. RSI; RFS; Voice Handicap Index; blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability; aerodynamic and acoustic measurements were assessed at baseline and after treatment. These data were analyzed and compared with regard to the clinical evolution of patients (responder versus nonresponder). Patients who significantly improved RSI ≤ 13 and RFS ≤ 7 after treatment were considered as responder. Nonresponders were defined as patients with RSI > 13 and/or RFS > 7 at the end of treatment. Studies of correlation between the adherence to the diet regimen and the evolution of both signs and symptoms and between videolaryngostroboscopic signs; blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability; and acoustic measurements were conducted. Significant improvements in RSI, RFS, Voice Handicap Index, perceptual voice quality (dysphonia and roughness), and some fundamental frequency and intensity perturbation cues (phonatory fundamental frequency range, percent jitter, pitch perturbation quotient, relative average perturbation, percent shimmer, smoothed amplitude perturbation quotient, amplitude perturbation quotient, and peak-to-peak amplitude variation) were mainly identified after treatment in responder patients. The clinical and voice quality improvements of nonresponder patients were lower; highlighting a similar evolution of symptoms, signs, and voice quality. The correlation analysis revealed significant relationships between the adherence to lifestyle changes and diet recommendations and the improvement of symptoms and substantial correlations between breathiness and fundamental frequency perturbation parameters. Voice quality assessments can be used as indicators of the treatment effectiveness in patients with LPR. Voice quality improvement seems to be consistently associated with clinical improvement.

Is insufficient pulmonary air support the cause of dysphonia in chronic obstructive pulmonary disease?

ObjectiveOptimal pulmonary air support is essential pre-requisite for efficient phonation. The objective is to correlate pulmonary and vocal functions in chronic obstructive pulmonary disease (COPD) to find out whether the reduced pulmonary function per se could induce dysphonia. MethodsIn this prospective case-control study, sixty subjects with stable COPD underwent evaluation of pulmonary and vocal functions. The pulmonary functions measured include {Forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC ratio, peak expiratory flow (PEF), maximum mid-expiratory flow (MMEF)}. The vocal functions were {jitter, shimmer, noise-to-harmonic ratio, pitch perturbation quotient, amplitude perturbation quotient, maximum phonation time (MPT), sound pressure level, phonatory efficiency, resistance and power. A control group (n=35) underwent the same measurements. These functions were compared between subjects and controls. Also, correlation of the vocal and pulmonary functions was conducted. ResultsThirty five (58.3%) of COPD subjects have dysphonia. The pulmonary functions were lower in all COPD group than in the control group (P<0.001 for all parameters). Also, the FVC, FEV1, PEF and MMEF % of predicted values were significantly lower in subjects with dysphonia (n=35) than those without dysphonia (n=25) with P values 0.0018, <0.001, 0.0011 and 0.0026 respectively. In addition, the MPT in all subjects showed positive correlations to the 5 pulmonary functions (P=0.004 for FEV1/FVC ratio and P<0.001 for the rest). Also, the phonatory efficiency showed significant positive correlations with the pulmonary functions FVC, FEV1, PEF and MMEF (P=0.001, 0.001, 0.002 and 0.001 respectively). Unlike efficiency, the phonatory resistance revealed significant negative correlations with these pulmonary functions in the same order (P=0.001, 0.003, 0.002, 0.001 respectively). ConclusionDysphonia is a common comorbidity with COPD which attributed to multifactorial etiologies. The lower the pulmonary function in COPD patients is the more likely to have dysphonia. Decreased pulmonary function was associated with reduced MPT and phonatory efficiency but with increased phonatory resistance. The reduced pulmonary functions in COPD can be the underlying cause of the altered vocal function and dysphonia. Great part of this dysphonia is functional, and hence, can be corrected by voice therapy in compensated subjects. Further researches are needed to evaluate the efficacy of voice therapy in these patients.

Detection of voice changes due to aspiration via acoustic voice analysis

ObjectiveAspiration can occur during swallowing. The present study investigated the feasibility of identifying aspiration risk (AR) via acoustic voice parameters. Materials and methodsIn total, 165 patients scheduled for a videofluoroscopic swallowing study (VFSS) were included. The patients were divided into two groups (AR and non-AR) based on their VFSS results. The AR group, which had ingested materials on or below the vocal folds, included 59 patients (42 males and 17 females). The non-AR group, which showed normal swallowing, included 106 patients (49 males and 57 females). The major cause of swallowing disorders was a stroke. A sustained vowel/a/for at least 3s was recorded before and after swallowing. Eight acoustic voice parameters were measured using PRAAT, including fundamental frequency, standard deviation of F0, jitter, relative average perturbation (RAP), shimmer, amplitude perturbation quotient (APQ), harmonic-to-noise ratio (HNR), and noise-to-harmonic ratio (NHR). Changes in each acoustic voice parameter before and after the VFSS were compared between the two groups with a repeated-measures mixed analysis of variance. ResultsOnly RAP showed a statistically significant interaction between group (non-AR and AR) and time (pre- and post-swallowing; p=0.030). RAP decreased after swallowing in the AR group; however, it increased in the non-AR group. Jitter and NHR increased in the non-AR group but decreased in the AR group after swallowing, but the difference was not statistically significant. ConclusionsOur results suggest that the accumulation of pasty food in the vocal folds may modify vocal fold vibration and change voice quality in patients with penetration/aspiration. Several acoustic voice parameters, especially jitter, RAP, and NHR, were affected by AR. Thus, acoustic voice analysis may be helpful in making a diagnosis of AR as a supplementary tool for standard swallowing study including VFSS or fiberoptic examination.

Acoustic Analysis of Normal Voice Patterns in Pakistani Adults

This study was designed to find out normative acoustic measures of adults in Pakistan. Age and gender differences in these parameters were also studied. The study variables include fundamental frequency, absolute jitter, relative jitter, relative average perturbation, 5-point period perturbation quotient perturbation quotient, jitter average absolute difference between consecutive periods, divided by the average period, shimmer local, shimmer decibel, three-point amplitude perturbation quotient, five-point amplitude perturbation quotient, average absolute difference of consecutive differences between the consecutive periods' amplitudes, and harmonics-to-noise ratio. Participants (N = 71; men = 34; women = 37) were recruited through two-stage sampling; convenience and purposive sampling. Participants were selected from students, staff, and faculty of the University of the Punjab, caretakers of the clients coming for clinical services, and researchers' friends, family, and acquaintances. Gender groups were further divided into three subgroups based on the age bands of 21-30, 31-40, and 41-50 years. After screening for health issues, the voice samples were recorded in a sound-proof acoustic laboratory by using a stand-held microphone and Praat software. Praat was also used for voice analyses. Means and standard deviations were conducted for the participants. Age and gender differences were investigated by using the two-way analysis of variance. Normative values were also measured for men and women between the age bracket of 21 and 50 years. Age differences were not significant for any variable. Gender differences were significant in fundamental frequency, absolute jitter, relative jitter, jitter period perturbation quotient, shimmer five-point amplitude perturbation quotient, and harmonics-to-noise ratio. The interaction between age and gender was significant in all the jitter measures. The interaction showed an increase in all these measures between the ages of 31 and 40 years and a decrease between the ages of 41 and 50 years in women, whereas men showed a reverse effect both in the age ranges of 31-40 and 41-50 years.

発声時の振幅のゆらぎに見る吃音者と非吃音者( 言語障害(吃音と構音障害)の様相と分析)

発声時の振幅のゆらぎに見る吃音者と非吃音者( 言語障害(吃音と構音障害)の様相と分析)

A comparison of two endoscopic posterior cordotomy techniques: Laser cordotomy vs diathermy-assisted cordotomy.

To compare respiratory function, swallowing and voice quality of bilateral abductor vocal fold paralysis (BAVFP) patients undergoing laser and diathermy-assisted posterior cordotomy. Prospective study. Tertiary academic hospital. Thirty patients were included in the study (groups 1 and 2, 15 patients each). Mean age was 53 ± 14.27 years with a range of 31-78 years (12 [40%] males, 18 [60%] females). Sufficient airway, complications, FEV1, FEV1/FVC, peak expiratory flow rate (PEF), voice quality VAS, fundamental frequency, jitter, shimmer, NHR, amplitude perturbation quotient (APQ) and pitch perturbation quotient (PPQ) scores. A sufficient laryngeal airway was achieved in all patients. Six patients (20%) developed postoperative granulation tissue (2 in group 1 and 4 in group 2). There was a statistically significant improvement in FEV1, FEV1/FVC and PEF measurements at the postoperative sixth month compared to preoperative measurements in both of the groups (P < .05). Preoperative median voice quality VAS scores in groups 1 and 2 were 8 (IQR = 1) and 8 (IQR = 3), respectively. Postoperative sixth-month voice quality VAS scores in groups 1 and 2 were 6 (IQR = 1) and 6 (IQR = 0), respectively. Postoperative VAS scores were significantly lower in both groups (P < .05). The postoperative changes in fundamental frequency, NHR, jitter, shimmer, APQ and PPQ were not statistically significant in both of the groups (P > .05). Laser and diathermy-assisted posterior cordotomy are both minimally invasive, effective techniques with a long-term sufficient laryngeal airway. Despite lower quality of voice VAS scores, objective acoustic outcomes were not significantly lower in both of the groups.

Efeito do tempo de execução do exercício vocal sopro e som agudo na voz de mulheres

To analyze the results of the runtimes of one, three, five, and seven minutes of the high-pitched blowing vocal exercise in women without voice complaints and with dysphonia and vocal nodules. This is an experimental study with a consecutive and convenience sample of 60 women divided into two groups: 30 participants with dysphonia caused by vocal fold nodules (study group - SG) and 30 participants without vocal complaints (control group - CG). All participants performed the high-pitched blowing vocal exercise for one, three, five, and seven minutes. Sustained vowels /a/ and counting from one to ten were recorded before and after each exercise runtime. The recordings were randomized and evaluated by comparison task by four speech-language pathologists using the parameters grade of vocal deviation, roughness, breathiness, asthenia, strain and instability (GRBASI). The acoustic parameters analyzed were fundamental frequency, jitter, shimmer, period perturbation quotient, amplitude perturbation quotient, and harmonics-to-noise ratio. After each vocal exercise runtime, the participants responded whether they had felt vocal discomfort using a visual analogue scale. Auditory-perceptual analysis in the SG showed improved overall severity of dysphonia and breathiness after three minutes and worsening of these acoustic parameters after seven minutes of exercise performance. Participants in the SG reported self-perception of vocal discomfort after seven minutes of exercise performance. The ideal prescription time for the high-pitched blowing vocal exercise in dysphonic women is three minutes; worsening of voice quality and perception of vocal discomfort occurs after seven minutes.

Phonetic Approaches of Laryngopharyngeal Reflux Disease: A Prospective Study

The study aimed to explore the impact of the selection of the analyzed time interval on the significance of acoustic measurements used to investigate laryngopharyngeal reflux (LPR) treatment efficacy, and based on these results to develop an alternative statistical approach in data analysis focusing on individual patient vocal behavior. This is a prospective case series. From September 2013 to July 2015, 41 patients with a reflux finding score (RFS) > 7 and a reflux symptom index (RSI) > 13 were enrolled and treated with pantoprazole 20 mg twice daily and diet behavioral changes for 3 months. Voice recordings were performed at baseline and after 3 months of treatment. Most stable time intervals of 1, 2, 3, 4, and 5 seconds, and a 1-second time interval positioned at mid-production, were subjected to acoustic analysis. Based on the latter, we developed an "informativeness coefficient" for each acoustic parameter that aimed at assessing its sensitivity to clinical resolution in the case of LPR disease. Significant clinical improvement (RSI and RFS) was observed after treatment (P < 0.05). The acoustic analysis revealed that acoustic parameters significantly improving from pre- to posttreatment varied across time intervals. The duration and the position of the analyzed time interval in the production yielded considerable differences in the results. Analysis of the informativeness coefficient indicated that jitter, jitter percent, relative average perturbation (RAP), pitch perturbation quotient (PPQ), shimmer (ShdB), shimmer percent (Shim), amplitude perturbation quotient (APQ), and smoothed amplitude perturbation quotient (sAPQ) were the indices most sensitive to medical treatment efficacy, with a coefficient ranging from 75.86% to 86.21%. Depending on the selection of the time interval over which the acoustic parameters are measured, the potential effect of the treatment may or may not be statistically demonstrated. Future studies are needed to establish standardized methodological procedures for acoustic data analysis.

Outcome of regenerative therapy for age-related vocal fold atrophy with basic fibroblast growth factor.

Age-related vocal fold atrophy has become a significant voice disorder as the elderly population grows. However, several therapeutic challenges have limited attempts to improve voice quality. We reported that basic fibroblast growth factor (bFGF) stimulates fibroblasts to produce extracellular matrices such as hyaluronic acid in the lamina propria, leading to a regeneration of pliable vocal folds in animal models. The aim of this study was to determine the efficacy of bFGF for the treatment of age-related vocal fold atrophy. Prospective study. Six patients with age-related vocal fold atrophy underwent injection of bFGF in their vocal folds. Vocal outcomes and stroboscopic examinations were evaluated 1, 3, and 6 months after the injection. The outcome measures included the Voice Handicap Index-10 (VHI-10), GRBAS (grade, roughness, breathiness, asthenia, strain) scale, maximum phonation time (MPT), the amplitude perturbation quotient (APQ), and the pitch perturbation quotient (PPQ). The VHI-10 was significantly improved 6 months after bFGF injection. The GRBAS scale, MPT, APQ, and PPQ were also improved. Stroboscopic examinations showed significant improvement of glottic closure and better mucosal wave. This is the first study to evaluate the regenerative effects of bFGF injection for the treatment of age-related vocal fold atrophy using the VHI-10. Injection of bFGF significantly improved VHI-10 scores and glottal insufficiency for at least 6 months. 4. Laryngoscope, 126:1844-1848, 2016.

Impact of laryngopharyngeal reflux on subjective and objective voice assessments: a prospective study.

BackgroundLaryngopharyngeal reflux is a prevalent, not well-understood disease affecting a high proportion of patients who seek laryngology consultation. The objective of this prospective case series is to explore the subjective and objective voice modifications in Laryngopharyngeal reflux (LPR), especially the usefulness of acoustic parameters as treatment outcomes, and to better understand the pathophysiological mechanisms underlying the development of voice disorder.MethodsForty-one patients with a reflux finding score (RFS) > 7 and a reflux symptom index (RSI) > 13 were enrolled and treated with pantoprazole 20 mg twice daily for three months. RSI, RFS, Voice Handicap Index (VHI), and Grade, Roughness, Breathiness, Asthenia, Strain and Instability (GRBASI) were assessed at baseline and after three months post-therapy. Acoustic parameters were measured by selecting the most stable interval of the vowel /a/. A study of correlations between acoustic measurements and laryngoscopic signs was conducted in patients with roughness. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS).ResultsSignificant improvement in RSI, RFS, VHI, jitter, percent jitter, relative average perturbation (RAP), shimmer, percent shimmer, and amplitude perturbation quotient (APQ) was found at 3 months of treatment (p < .05). A correlation analysis revealed significant correlations between the grade of dysphonia, breathiness, asthenia, instability and jitter, percent jitter, RAP, shimmer, percent shimmer and APQ. In dividing our cohort into two groups of patients according to the presence of roughness, shimmer, percent shimmer and APQ significantly improved in patients with roughness, but no positive correlation was found between acoustic parameters and laryngoscopic signs.ConclusionAcoustic parameters can help to better understand voice disorders in LPR and can be used as treatment outcomes in patients with roughness.

Does Cervical Muscular Contraction Affect the Measurement for Electroglottographic Perturbation Parameters?

The purpose was to assess whether cervical muscular contraction during phonation influences the period and amplitude perturbation quotients (PPQ and APQ, respectively) of electroglottographic (EGG) signals,and whether high-pass filtering can attenuate these effects. Prospective. We included 19 nondysphonic speakers and 21 patients with muscle tension dysphonia. During the recording of acoustic and EGG signals, each participant was instructed to naturally phonate sustained vowels /i:/ and/a:/ (NP tasks), and additionally, each nondysphonic participant was asked to phonate the same vowels in a nondysphonic voice quality while contracting the cervical muscles (muscular contracted phonation [MCP] tasks). To confirm the contraction, surface and needle electromyography (EMG) was performed. The EGG signals were high-pass filtered at different cutoff frequencies from 0 to 90Hz and were subsequently analyzed for the PPQ and APQ. Compared with the NP tasks, the MCP tasks enhanced the cervical EMG activities ranging from 0 to more than 1000Hz, but conferred only low-frequency noise to the EGG signals under 50Hz and increased the values for EGG-APQ, but not EGG-PPQ. These EGG-APQ values exhibited gradual decreases after high-pass filtering with an increase in the cutoff frequency ranging from 0 to 50Hz in both groups, followed by plateaus during the MCP tasks in the nondysphonic group. The present results demonstrate that cervical muscular contraction seriously affects the EGG-APQ values for unfiltered EGG signals independent of the EMG activities and that appropriate high-pass filtering over 50Hz can attenuate these effects.

The association between health-related quality of life and voice as evaluated by an acoustic analysis in elderly Japanese nursing home residents

We carried out a cross-sectional study investigating the association between health-related quality of life (HRQOL) and voice, as evaluated by an acoustic analysis, in elderly residents of a nursing home. The HRQOL of 61 elderly nursing home residents (mean age: 82.1±8.3 years) was assessed via the SF-8 Health Survey questionnaire, Japanese version (SF-8). The subjects' voices were recorded and analyzed by a voice assessment software program, which calculated the pitch period perturbation quotient (PPQ), amplitude perturbation quotient (APQ), and noise-to-harmonic ratio (NHR). Subjects who scored under the 25th percentile on general health (GH), vitality (VT), or physical summary (PCS) in the SF-8 showed significantly higher PPQ, APQ, and NHR scores in comparison to their counterparts (p<0.05). After adjustment for age, lower GH scores were found to be associated with higher PPQ, APQ, and NHR scores; lower VT scores were associated with higher APQ and NHR scores; and lower PCS scores were associated with higher APQ and NHR scores (p<0.05). The results of the acoustic analysis indicated that voice was associated with HRQOL in the elderly nursing home residents of the present study. Among the acoustic parameters that were analyzed, PPQ, APQ, and NHR may be an influential factor that can be used to assess HRQOL, independently of the effects of age, in elderly individuals.

Acoustic and Perceptual Characteristics of the Voice in Patients With Vocal Polyps After Surgery and Voice Therapy

The aim of the study was to assess the effect of endolaryngeal phonomicrosurgery (EPM) and voice therapy in patients with vocal fold polyps using perceptual and acoustic analysis before and after both therapies. The acoustic tests and perceptual evaluation of voice were carried out on 41 female patients with vocal fold polyp before and after EPM and voice therapy. Both therapy strategies were performed. Used acoustic parameters were Jitter percent (Jitt), pitch perturbation quotient (PPQ), shimmer percent (Shim), amplitude perturbation quotient (APQ), fundamental frequency variation (vF0), noise-to-harmonic ratio (NHR), Voice Turbulence Index (VTI). For perceptual evaluation, GRB scale was used. Results indicated higher values of investigated parameters in patients' group than in the control group (P<0.01). Good correlation between the perceptual hoarseness factors of GRB scale and objective acoustic voice parameters were observed. All analyzed acoustic parameters improved after the phonomicrosurgery and voice therapy and tend to approach to values of the control group. For Jitt percent, Shim percent, vF0, VTI, and NHR, there were statistically significant differences. Perceptual voice evaluation revealed statistically significantly (P<0.01) decreased rating of G (grade), R (rough) and B (breathy) after surgery and voice therapy. Our data indicated that both acoustic and perceptual characteristic of voice in patients with vocal polyps significantly improved after phonomicrosurgical and voice treatment.

A Study of Injection Therapy Using bFGF by High‐Speed Imaging and Acoustic Analysis

Objectives: Some authors have reported effects of some materials used for injection. Their effects that reduce the size of glottal gap do not last because the materials are usually absorbed. Thus, patients with deficient glottal closure must be repeatedly injected. To reduce the number of treatments, we injected basic fibroblast growth factor (bFGF) into our patients. The purpose of this study was to examine the effect of bFGF injection by high-speed imaging and acoustic analysis. Methods: Fifteen patients (8 men and 7 women, mean age 65 years) were enrolled in this study. Four or 8 µg of bFGF were injected into each treated vocal cord. The injection was made into the unilateral or bilateral vocal cord according to the size of glottal gap. All patients were followed up every 3 months. Using high-speed imaging and PS77E, we analyzed the following factors: KEA (kimograph edge analysis), GAW (glottal area wave form), phase shift analysis, PPQ (period pertubation quotient), APQ (amplitude perturbation quotient), MFR (mean flow rates). The effect of the treatment was assessed by high-speed imaging and acoustic analysis. Results: Data both from the imaging analysis and acoustic analysis showed significant improvement in all subjects after 6 months. No allergic or long-term adverse effects were noted. Conclusions: The result of this study suggests bFGF may be effective long-term and safe as a regenerative agent for aged vocal folds.

Voice, Speech, and Laryngeal Features of Primary Sjögren’s Syndrome

This study examined voice, speech, and laryngeal characteristics in primary Sjögren's syndrome (pSS). Eleven patients (10 female, 1 male; mean [SD] age = 57 [14] years) from The University of Utah Division of Rheumatology provided connected speech and sustained vowel samples. Analyses included the Multi-Dimensional Voice Profile, the Analysis of Dysphonia in Speech and Voice, and dysphonia severity, speech clarity, and videolaryngostroboscopy ratings. Shimmer, amplitude perturbation quotient, and average fundamental frequency differed significantly from normative values (P < .01). Cepstral Spectral Index of Dysphonia values indicated mild-to-moderate dysphonia in connected speech (mean [SD] = 20.26 [8.36]) and sustained vowels (mean [SD] = 16.91 [11.08]). Ratings of dysphonia severity and speech clarity using 10-cm visual analog scales suggested mild-to-moderate dysphonia in connected speech (mean [SD] = 2.11 [1.72]) and sustained vowels (mean [SD] = 3.13 [2.20]) and mildly reduced speech clarity (mean [SD] = 1.46 [1.36]). Videolaryngostroboscopic ratings indicated mild-to-moderate dryness and mild reductions in overall laryngeal function. Voice Handicap Index scores indicated mild-to-moderate voice symptoms (mean [SD] = 43 [23]). Individuals with pSS may experience dysphonia and articulatory imprecision, typically in the mild-to-moderate range. These findings have implications for diagnostic and referral practices in pSS.