High-pitched Phonation Research Articles

Daily Phonotrauma Index: An Objective Indicator of Large Differences in Self-Reported Vocal Status in the Daily Life of Females With Phonotraumatic Vocal Hyperfunction.

The purpose of this study is to evaluate if the Daily Phonotrauma Index (DPI) can quantitatively discriminate large differences in overall vocal status in the daily life of patients with phonotraumatic vocal hyperfunction (PVH). For 1-4 weeks, 23 females with PVH wore an ambulatory voice monitor and answered three vocal status questions (i.e., difficulty producing soft, high-pitched phonation; discomfort; and fatigue) at the beginning, at 5-hr intervals, and the end of each day. DPI values were obtained for each patient's time periods of worst and best self-rated vocal status, and data for the group were analyzed for significant changes using a linear mixed-effects regression model. The DPI was significantly lower during periods self-rated as "best vocal status" compared to during periods self-rated as "worst vocal status" (mean difference in DPI = 0.53) with a medium-to-large effect size (Cohen's d = -0.68). In a group of patients with phonotraumatic lesions, the DPI indicated lower potential for phonotrauma during time periods of better vocal status compared to time periods of worse vocal status. Assuming that a large portion of variance in vocal status for patients with PVH is associated with the extent to which voicing is phonotraumatic, these results support the validity of obtaining estimates of DPI for much shorter time periods (i.e., an estimate every 2 min of voicing) than previous studies (i.e., a single estimate for the entire day or week). Future work can investigate the DPI's use for in-clinic assessment/treatment and ambulatory biofeedback and can gain further insights into phonatory mechanisms that underlie DPI via comparisons with other physiologically relevant measures and computational vocal fold modeling.

Влияние длины голосовых складок на диапазон голоса у начинающих вокалистов

The aim of the study was to determine the effect of vocal cord length on vocal range in aspiring vocalists. On the basis of the Frederic Chopin Irkutsk Regional College of Music. 141 student vocalists (18 ± 3.6 years, 122 girls) underwent indirect laryngoscopy, the length of the vocal folds was measured using an ultrasound scan of the larynx using an Aloka SSD 500 apparatus with a 5 MHz sensor during breathing and during phonation of the lowest and highest tones, measured weight and height, the voice range in Hz and the number of semitones were assessed. Spearman’s correlation coefficient was calculated, the significance of differences according to the U-Mann – Whitney and Wilcoxon criteria was calculated using the Statistica 10.0 software (reliable data at p <0.05*). Results. Spearman’s correlation coefficient was: between the length of the vocal folds and weight + 0.52*, height + 0.43*, gender + 0.45* (female 1, male 2), the lowest tone –0.34*, between height and the lowest tone is –0.23*. The range of the voice in arbitrary units and Hz correlated weakly with the length of the folds during breathing (-0.18/–0.24*, respectively), with the lowest pitch (+ 0.42/+ 0.59 *), but there was a high correlation with the highest (+ 0.88/+ 0.99*). The latter depended on: the length of the vocal folds at rest (–0.32*), weight (–0.25*), gender (–0.45*), the length of the folds during high-pitched phonation (–0.6*). Differences in the length of the vocal folds during breathing in female vocalists with different vocal ranges were not significant, while in males and females (soprano) they were significant. The length of the fold during phonation in all types of voices was shorter than during breathing. The voice range of novice vocalists was increased mainly by high tones in parallel with the shortening of folds during phonation, which could be measured using ultrasound scanning and which is achieved by training.

Brain activity during phonation in healthy female singers with supraglottic compression: an fMRI pilot study

This pilot study evaluated the usability of functional magnetic resonance imaging (fMRI) to detect brain activation during phonation in healthy female singers with supraglottic compression. Four healthy female classical singers (mean age: 26 years) participated in the study. All subjects had normal vocal folds and vocal characteristics and showed supraglottic compression. The fMRI experiment was carried out using a block design paradigm. Brain activation during phonation and exhalation was analyzed using Brain Voyager software (Brain Innovation B.V., Maastricht, The Netherlands). An fMRI data analysis showed a significant effect of phonation control in the bilateral pre/postcentral gyrus, and in the frontal, cingulate, superior and middle temporal gyrus, as well as in the parietal lobe, insula, lingual gyrus, cerebellum, thalamus and brainstem. These activation areas are consistent with previous reports using other fMRI protocols. In addition, a significant effect of phonation compared to exhalation control was found in the bilateral superior temporal gyrus, and the pre/postcentral gyrus. This fMRI pilot study allowed to detect a normal pattern of brain activity during phonation in healthy female singers with supraglottic compression using the proposed protocol. However, the pilot study detected problems with the experimental material/procedures that would necessitate refining the fMRI protocol. The phonation tasks were not capable to show brain activation difference between high-pitched and comfortable phonation. Further fMRI studies manipulating vocal parameters during phonation of the vowels /a/ and /i/ may elicit more distinctive hemodynamic response (HDR) activity patterns relative to voice modulation.

Self-Ratings of Vocal Status in Daily Life: Reliability and Validity for Patients With Vocal Hyperfunction and a Normative Group.

The aim of this study was to establish reliability and validity for self-ratings of vocal status obtained during the daily activities of patients with vocal hyperfunction (VH) and matched controls. Eight-four patients with VH and 74 participants with normal voices answered 3 vocal status questions-difficulty producing soft, high-pitched phonation (D-SHP); discomfort; and fatigue-on an ambulatory voice monitor at the beginning, 5-hr intervals, and the end of each day (7 total days). Two subsets of the patient group answered the questions during a 2nd week after voice therapy (29 patients) or laryngeal surgery (16 patients). High reliability resulted for patients (Cronbach's α = .88) and controls (α = .95). Patients reported higher D-SHP, discomfort, and fatigue (Cohen's d = 1.62-1.92) compared with controls. Patients posttherapy and postsurgery reported significantly improved self-ratings of vocal status relative to their pretreatment ratings (d = 0.70-1.13). Within-subject changes in self-ratings greater than 20 points were considered clinically meaningful. Ratings of D-SHP, discomfort, and fatigue have adequate reliability and validity for tracking vocal status throughout daily life in patients with VH and vocally healthy individuals. These questions could help investigate the relationship between vocal symptom variability and putative contributing factors (e.g., voice use/rest, emotions).

Functional Magnetic Resonance Imaging Study of Brain Activity Associated With Pitch Adaptation During Phonation in Healthy Women Without Voice Disorders

This functional magnetic resonance imaging (fMRI) study investigated the brain activity associated with pitch adaptation during phonation in healthy women without voice disorders. This is an interventional prospective study. Sixteen healthy women (mean age: 24.3 years) participated in a blocked design fMRI experiment involving two phonation (comfortable phonation and high-pitched phonation) and exhalation (prolonged exhalation) tasks. BrainVoyager QX Version 2.4 software was used for group-level general linear model analysis (q[FDR] < 0.05). Analyses showed a significant main effect of phonation with pitch adaptation compared with rest period in the bilateral precentral gyrus, superior frontal gyrus, posterior cingulate gyrus, superior and middle temporal gyrus, insula and cerebellum, left middle and inferior frontal gyrus, right lingual gyrus, cingulate gyrus, and thalamus. Statistical results also identified a significant main effect of exhalation compared with rest period in the bilateral precentral gyrus, cerebellum, right lingual gyrus, thalamus, and left supramarginal gyrus. In addition, a significant main effect of phonation was found in the bilateral superior temporal gyrus and right insula, as well as in the left midbrain periaqueductal gray for high-pitched phonation only. We demonstrated that a blocked design fMRI is sensitive enough to define a widespread network of activation associated with phonation involving pitch variation. The results of this study will be implemented in our future research on phonation and its disorders.

Cricothyroid Articulation in Elderly Japanese With Special Reference to Morphology of the Synovial and Capsular Tissues

The present study aimed to clarify individual variations in the cricothyroid joint (CT joint). Using 30 specimens of the CT joint obtained from elderly donated cadavers, we examined the composite fibers of the capsular ligament as well as the morphology of the synovial tissue. The capsular ligament consistently contained abundant thick elastic fiber bundles on the anterior side of the joint (anterior band) and an elastic fiber-made mesh on the posterior side (posterior mesh). The synovial membrane, lined by synovial macrophages, was usually restricted to the recesses in the medial or inferior end of the joint cavity. Without the synovial lining, elastic fibers of the capsular ligament were subsequently detached, dispersed, and exposed to the joint cavity. We also observed a folded and thickened synovial membrane and a hypertrophic protrusion of the capsular ligament. In six specimens, the joint cavity was obliterated by debris of synovial folds and elastic fiber-rich tissues continuous with the usual capsular ligament. Notably, with the exception of two specimens, we did not find lymphocyte infiltration in the degenerative synovial tissue. We considered the CT joint degeneration to be a specific, silent form of osteoarthritis from the absence of lymphocyte infiltration. For high-pitched phonation, the elderly CT joint seemed to maintain its anterior gliding and rotation with the aid of elastic fiber-rich tissues compensating for the loss of congruity between the joint cartilage surfaces. Conversely, however, high-pitched phonation may accelerate obliteration of the joint.

The cricothyroid joint in elderly Japanese individuals.

Using 15 cricothyroid joint (CT joint) specimens obtained from donated cadavers of elderly individuals, we examined the morphologies of the ceratocricoid ligaments as well as the synovial tissue. The ligaments consistently contained abundant elastic fibers: the fibers tended to be straight on the anterior side in contrast to a mesh-like arrangement on the posterior side. Thick and/or long synovial folds were often evident in the CT joint. The synovial tissue usually contained CD68-positive macrophages, but the positive cells were often restricted to certain parts of the tissue. Factor VIII-positive capillaries were present but few in number, and CD3- or IgM-positive lymphocytes were absent in the synovial tissue. Degenerative changes in the joint cartilage, such as roughness or thinning, were often present, but no cartilage defects were evident. Therefore, in contrast to the small, non-weight-bearing joints of the musculoskeletal system, we considered the degeneration of the CT joint to be a specific, silent form of osteoarthritis. For high-pitched phonation and ossification of the laryngeal cartilage, the CT joint in elderly individuals seemed to maintain its anterior gliding and rotation with the aid of elastic fiber-rich tissues compensating for the loss of congruity between the joint cartilage surfaces.

Analysis of High-Pitched Phonation Using Three-Dimensional Computed Tomography

Our aim was to use three-dimensional computed tomography (3DCT) to examine arytenoid cartilage movement during a high-pitched tone task. This was a prospective study. This study included 14 patients with male-to-female gender identity disorder who had undergone 3DCT imaging for surgical simulation between January 2007 and May 2008. First, to prove that the phonation condition was indeed one of the high-pitched phonation, we confirmed the rotational movement of the thyroid cartilage, horizontal gliding movement of the inferior horn, and vocal fold elongation on a high-pitched tone task. Next, we detected the arytenoid cartilage positions of the joint during a comparison of comfortable and high-pitched phonations. We measured the movement direction and movement distance of the arytenoid cartilage. In all cases, the cricothyroid space became narrower (rotation movement), and we observed anterior gliding movement of the inferior horn. In all cases, elongation of the vocal folds by the high-pitched phonation was confirmed and the arytenoid cartilages were displaced both anteriorly and caudally from the position during comfortable phonation by the high-pitched tone task. The arytenoid cartilages did not move posteriorly to elongate the vocal folds during high-pitched phonation. The arytenoid cartilages were pulled anteriorly and moved caudally because of tension associated with vocal fold elongation because of the task of high-pitched phonation. These results suggest that there are no movements at the cricoarytenoid joint that directly control the length of the vocal folds in accordance with pitch.

頚部・縦隔気腫の増悪にて緊急挿管された喉頭外傷例

A 35-year-old man was involved in an automobile collision and was brought to the emergency room of our hospital by ambulance. He had cuts on his forehead and left knee, and complained of dyspnea and hoarseness. Since swelling and crepitation were palpable on his anterior neck without any other external injury, he was suspected of having sustained a laryngeal trauma caused by the seatbelt pressing on his neck. A CT scan indicated a slight disruption of the lower part of the laryngeal framework, which appeared to cause emphysema extending from the neck to the mediastinum. Examination with a flexible endoscope was tried, resulting in an unexpected exacerbation of the emphysema into a respiratory crisis possibly due to increased subglottic pressure. An immediate oral intubation relieved this crisis.After his general condition was observed for two days in the ICU, we studied his larynx and hypopharynx using endoscopes under general anesthesia by tracheostomal intubation and found a mucosal disruption in the subglottic area. Under sequential open reduction, we also found fractures of the antero-lateral cricoid arch and the lower thyroid cartilage with disruptions of the sternohyoid muscle and the crico-thyroid muscle and ligament. The injuries healed well under repairs by suturing and wiring. We observed no sign of subglottic stenosis without a stent for a period of 5 weeks, and then repaired the tracheostome. Presently, the patient's vocal cords are mobile, and the vibratory patterns observed with a stroboscope appear normal. However, he has continued to demonstrate limitations in high-pitched phonation for 2 months.We discuss in detail the effects of the laryngeal injuries in this case regarding postoperative phonatory function using 3D images reconstructed with a helical CT. In addition, we also discuss the usefulness of so-called endoscopic 3D-CT images in cases of laryngeal trauma with mucosal disruption as a non-invasive examination in place of endoscopy.

Vocal fold vibration viewed from the tracheal side in living human beings

The mucosal upheaval where the mucosal wave starts and propagates upward appears on the lower surface of the canine vocal fold during vibration. We investigated the vibratory behavior of the in vivo human vocal fold viewed from the tracheal side. Subjects consisted of 14 men and 6 women who had undergone tracheostomy for various head and neck diseases; their ages ranged from 22 to 70 years, with a mean of 53.9 years. The inferior aspect of the vocal fold during phonation was observed with the aid of a rigid oblique-view endoscope inserted through a tracheostoma (inferior glottoscopy). Each subject was asked to sustain the vowel /a/ at a comfortable pitch and loudness (easy phonation) and then at a higher pitch. Inferior glottoscopy could be performed during easy phonation in 19 subjects and during high-pitched phonation in 10 subjects. During easy phonation, the mucosal upheaval appeared on the lower surface of the vocal fold between the anterior commissure and the vocal process in all 19 subjects. During high-pitched phonation, the vocal fold became longer, and the subglottic vault surrounded by the bilateral mucosal upheavals became narrower compared with those during easy phonation. Use of a dilated blood vessel as a landmark in one subject showed the location of the mucosal upheaval on the vocal fold mucosa to actually shift medially toward the oral side during high-pitched phonation. Despite structural differences between the human and canine vocal folds, the infraglottic aspect of the vocal fold vibration observed in the living human larynx was quite similar to that observed in the excised canine larynx (Otolaryngol Head Neck Surg 1996;115:329-34.)

Laryngeal behavior in unilateral superior laryngeal nerve paralysis.

Laryngeal behavior in unilateral superior laryngeal nerve (SLN) paralysis was investigated in animal models and clinical cases. The occurrence of an oblique glottis caused by rotation of the posterior glottis to the paralytic side was the main focus of this study. The animal model study employed live dogs. When the SLN on one side was sectioned, spontaneous phonation did not cause a significantly oblique glottis. When the unaffected SLN was electrically stimulated during spontaneous phonation, an oblique glottis occurred. When the SLN was unilaterally stimulated during spontaneous phonation with both SLNs sectioned, a markedly oblique glottis occurred. In the clinical study, larynges of 17 patients with SLN paralysis were examined during a test task in which a low-pitched phonation was followed by a high-pitched phonation. The purpose of this task was to activate the unaffected cricothyroid muscle during the test phonation. Five patients could not perform the test task. The glottis obviously rotated in 9 patients, whereas no significant rotation of the glottis occurred in 3. One of the latter 3 had an incomplete paralysis, and the other 2 had marked scarring around the laryngeal framework. We conclude that a unilateral SLN paralysis causes a rotation of the posterior glottis to the paralytic side when the unaffected cricothyroid muscle is markedly activated. The test consisting of low-pitched phonation followed by high-pitched phonation is a relatively simple and accurate diagnostic procedure for unilateral SLN paralysis.

Pitch in esophageal speech

Most reports on pitch in esophageal speech emphasize that it is low-pitched with a measured fundamental frequency rarely higher than 100 cps. Our investigations show, however, that much esophageal 'phonation' lacks periodicity and, therefore, a fundamental frequency (i.e. pitch in the accepted sense). An auditory impression of pitch modulation can, nevertheless, be created by physical properties other than a varying harmonic structure. Our sample includes a rare case of truly high-pitched esophageal phonation with a fundamental frequency in the upper limit of the voice an octave higher than the highest reported in the literature. High-pitched phonation apparently requires a vibratory source in a 'mode' different from that of low-pitched phonation and should therefore be distinguished from it in discussing pitch in esophageal voice.