Hoarse Voice Quality Research Articles

Hypokinetic Dysarthria in Parkinson's Disease: A Narrative Review.

Numerous disabling motor and non-motor symptoms occur during Parkinson's disease (PD), including speech disorders, often referred to as hypokinetic dysarthria. PD is the most common cause of this type of dysarthria. About 90% of PD patients experience hypokinetic dysarthria, which is exacerbated as the disease progresses and makes it very difficult for other people to understand the person with PD. This disorder is characterized by a monotonous speech pattern, reduced and monotonous loudness, decreased stress, a breathy or hoarse voice quality, an increase in speech rate, rapid repetition of phonemes, and impreciseness in consonant production. However, patients may also have sensory symptoms including inaccurate perceptions of their own loudness and decreased awareness of speech problems. Hypokinetic dysarthria in PD may not only result from dopamine degeneration in the nigrostriatal pathway but also from disturbances in the motor and somatosensory systems. All speech components, such as phonation, articulation, respiration, resonance, and prosody should be assessed carefully in PD patients with hypokinetic dysarthria. Taking medical history, an oral motor assessment, a perceptual evaluation of speech characteristics, intelligibility, efficiency, and participation in communication all need to be a part of the assessment. The tasks of maximum phonation time, diadochokinetic rate, reading sentences, words, and passages, describing pictures, and spontaneous speech are used to assess the features of speech components and intelligibility. The evaluation should include physiological, acoustic, or imaging modalities as well. Speech therapy is typically the main treatment of speech problems in PD. The management of PD-related hypokinetic dysarthria basically focuses on speaker-oriented and communication-oriented strategies. In addition to these strategies, Augmentative Alternative Communication (AAC) should be considered in patients with severe dysarthria. Loudness, intelligibility, and sound perception may all significantly improve with the Lee Silverman Voice Therapy LOUD (LSVT LOUD) program which is an evidence-based program. The beneficial effect of pharmacological and surgical treatment approaches has not been proven in improving speech. Deep brain stimulation may carry the risk of the deterioration of speech as the illness progresses.

Diagnostic Accuracy of Acoustic Voice Quality Index Version 02.03 in Discriminating across the Perceptual Degrees of Dysphonia Severity in Kannada Language

Acoustic Voice Quality Index (AVQI) has been reported to be a sensitive tool for discriminating between the normal and dysphonic voices, however, there is a dearth of research focused on investigating the diagnostic accuracy of AVQI in discriminating across the perceptual categories of dysphonia severity ie, slight, moderate, and severe. Hence, the present study is a preliminary attempt to document the AVQI across the degrees of dysphonia severity and to verify whether the AVQI can discriminate across these degrees of perceptual dysphonia severity. A total of 71 dysphonic samples extracted from the clinical database of the institute and 19 prospectively recorded normophonic samples consisting of sustained vowel /a/ and a sentence from a standardized Kannada passage served as input data. These 90 samples were categorized into four categories based on the overall grade of perceptual dysphonia (G) as normal, slight, moderate, or severe by three experienced speech language pathologists in a randomized and double-blinded manner, which served as the ground truth. The AVQI was calculated from the samples using Praat version 6.0.40 and the AVQI script version 2.03. The Spearman's correlation test revealed a positive correlation between the G and the AVQI (r = 0.67; P < 0.001). The Receiver Operating Characteristics analysis revealed that the AVQI could accurately discriminate across the perceptual subcategories of dysphonia. The results of the present study revealed that AVQI is a robust multiparametric measure which can accurately discriminate across the subcategories of the perceptual dysphonia severity with reasonable precision. Further, the AVQI is also shown to be promising in evaluating the signals with higher levels of aperiodicity such as severe hoarse voice quality.

Developing a large scale population screening tool for the assessment of Parkinson's disease using telephone-quality voice.

Recent studies have demonstrated that analysis of laboratory-quality voice recordings can be used to accurately differentiate people diagnosed with Parkinson's disease (PD) from healthy controls (HCs). These findings could help facilitate the development of remote screening and monitoring tools for PD. In this study, 2759 telephone-quality voice recordings from 1483 PD and 15 321 recordings from 8300 HC participants were analyzed. To account for variations in phonetic backgrounds, data were acquired from seven countries. A statistical framework for analyzing voice was developed, whereby 307 dysphonia measures that quantify different properties of voice impairment, such as breathiness, roughness, monopitch, hoarse voice quality, and exaggerated vocal tremor, were computed. Feature selection algorithms were used to identify robust parsimonious feature subsets, which were used in combination with a random forests (RFs) classifier to accurately distinguish PD from HC. The best tenfold cross-validation performance was obtained using Gram-Schmidt orthogonalization and RF, leading to mean sensitivity of 64.90% (standard deviation, SD, 2.90%) and mean specificity of 67.96% (SD 2.90%). This large scale study is a step forward toward assessing the development of a reliable, cost-effective, and practical clinical decision support tool for screening the population at large for PD using telephone-quality voice.

Respiratory Tract Infections and Voice Quality in 4-Year-old Children in the STEPS Study

Health-related factors are part of the multifactorial background of dysphonia in children. Respiratory tract infections affect the same systems and structures that are used for voice production. The purpose of this study was to investigate if the number of respiratory tract infections or the viral etiology were significant predictors for a more hoarse voice quality. The participants were 4-year-old children who participated in the multidisciplinary STEPS study (Steps to the Healthy Development and Well-being of Children) where they were followed up from pregnancy or birth to 4 years of age. Data were collected through questionnaires and a health diary filled in by the parents. Some of the children were followed up more intensively for respiratory tract infections during the first 2 years of life, and nasal swab samples were taken at the onset of respiratory symptoms. Our participants were 489 of these children who had participated in the follow-up for at least 1 year and for whom data on respiratory tract infections and data on voice quality were available. The number of hospitalizations due to respiratory tract infections was a significant predictor for a more hoarse voice quality. Neither the number of rhinovirus infections nor the number of respiratory syncytial virus infections was statistically significant predictors for a more hoarse voice quality. Based on our results, we would suggest including questions on the presence of respiratory tract infections that have led to hospitalization in the pediatric voice anamnesis. Whether the viral etiology of respiratory tract infections is of importance or not requires further research.

Acoustical and Perceptual Voice Profiling of Children With Recurrent Respiratory Papillomatosis

Respiratory papillomatosis is a condition characterized by benign papillomatous (wart-like) growths in the respiratory tract. The condition tends to recur after treatment, requiring multiple procedures to control growth of the lesions. In such cases, the condition is known as recurrent respiratory papillomatosis (RRP). This study aims at providing comparative measures of acoustic as well as perceptual voice analysis of children with RRP. Ten children with a history of RRP for a minimum of 3years were selected under purposive sampling. A detailed case history, Clinical Assessment Scale of RRP, and laryngostroboscopy findings were done. This was followed by perceptual voice assessment using Buffalo III Voice Screening Profile, and acoustical voice assessment using Dr. Speech software (by Tiger DRS, Inc.). Group statistics and t test were used at a significance level of 0.05 (SPSS package Version 12.0 is used which is manufactured by IBM Corporation). Both groups with RRP showed substantial difference in habitual F0, S/Z ratio, Signal to Noise Ratio (SNR), Harmonic to Noise Ratio (HNR), and Maximum Phonation Time (MPT) voice parameters. On perceptual analysis, all children with RRP had hoarse voice quality, and stridors are present. All children with RRP have affected voice parameters in some extent which depend on the period and area of lesion.

Assessment of disordered voice via the first rahmonic

A number of studies have shown that the amplitude of the first rahmonic peak (R1) in the cepstrum can be usefully employed to indicate hoarse voice quality. The cepstrum is obtained by taking the inverse Fourier transform of the log-magnitude spectrum. In the present study, a number of spectral pre-processing steps are investigated prior to computing the cepstrum; the pre-processing steps include period-synchronous, period-asynchronous, harmonic-synchronous and harmonic-asynchronous spectral band-limitation analysis. The analysis is applied on both sustained vowels [a] and connected speech signals. The correlation between R1 (the amplitude of the first rahmonic) and perceptual ratings is examined for a corpus comprising 251 speakers. It is observed that the correlation between R1 and perceptual ratings increases when the spectrum is band-limited prior to computing the cepstrum. In addition, comparisons are made with a previously reported cepstral cue, cepstral peak prominence (CPP).

Current Perspectives on the Lee Silverman Voice Treatment (LSVT) for Individuals With Idiopathic Parkinson Disease

Successful treatment of speech disorders in individuals with progressive neuro logical diseases can be challenging. Hillman, Gress, Haugraf, Walsh, and Bunting (1990) stated that “voice treatment for disorders that are degenerative is controversial since there is no expectation for recovery of function or that any improvement secondary to speech language pathology intervention will be maintained in the long term” (p. 308). Individuals with idiopathic Parkinson disease (IPD) have been particularly resistant to speech treatment, with the conventional wisdom being summarized by the statement that changes observed in the treatment room disappear on the way to the parking lot (Allan, 1970; Aronson, 1985; Greene, 1980; Sarno, 1968; Weiner & Singer, 1989). The consensus that speech treatment has not been effective for individuals with IPD is, perhaps, the basis for the report that of the 75%–89% of these individuals with voice and speech disorders, only 3%–4% receive speech treatment (Hartelius & Svensson, 1994; Oxtoby, 1982). The reduced ability to communicate is considered to be one of the most difficult aspects of IPD by many patients and their families. Soft voice, monotone, breathy, hoarse voice quality, and imprecise articulation (Darley, Aronson, & Brown, 1969a, 1969b; Logemann, Fisher, Boshes, & Blonsky, 1978), together with lessened facial expression (masked facies), contribute to limitations in communication in the vast majority of individuals with IPD (Pitcairn, Clemie, Gray, & Pentland, 1990a, 1990b). Although medical treatments, including neuropharmacological as well as neurosurgical methods, may be effective in improving limb symptoms, their impact on speech production remains unclear (Baker, Ramig, Johnson, & Freed, 1997; Kompoliti, Wang, Goetz, Leurgans, & Raman, 2000; Larson, Ramig, & Scherer, 1994; Rigrodsky & Morrison, 1970; Solomon et al., 2000; Wang, Kompoliti, Jiang, & Goetz, 2000; Wolfe, Garvin, Bacon, & Waldrop, 1975). In addition, previous speech treatment for individuals with IPD, focusing on articulation and rate, has limited efficacy data and limited evidence of long-term success. Recently, there has been great progress in understanding the function of the basal ganglia; this has shed light on the neural bases of IPD (Albin, 1995; Brooks, 1995; Hayes, Davidson, Keele, & Rafal, 1998; Mink, 1996; Wichmann & DeLong, 1993, 1996). Although many studies have used these findings to understand limb function in individuals with IPD (Rand & Stelmach, 1999; Weiss, Stelmach, Chaiken, & Adler, 1999), their application to voice and speech disorders has been infrequent. At this time, the neural mechanisms underlying speech, voice, and swallowing disorders in IPD are not well understood. Over the past 10 years, our research team has focused on improving speech disorders in individuals with IPD by directing attention to phonation (voice) as a key treatment element. Although disordered voice has been observed in the majority of individuals with IPD (Logemann et al., 1978; Oxtoby, 1982; Streifler & Hofman, 1984), it has until recently been given limited attention in treatment and has been overlooked for its contribution to improving speech intelligibility. Treating voice in individuals with IPD has generated shortand long-term efficacy data for a speech treatment in this population (Ramig, Countryman, O’Brien, Hoehn, & Thompson, 1996; Ramig, Countryman, Thompson, & Horii, 1995; Ramig, Sapir, Countryman, Pawlas, O’Brien, Hoehn, & Thompson, 2001; Ramig, Sapir, Fox, & Countryman, 2001). This treatment— known as the Lee Silverman Voice Treatment (LSVT)—has as its essential concepts (a) exclusive focus on voice (specifically vocal

Abductor laryngeal dystonia: A series treated with botulinum toxin

Abductor laryngeal dystonia (LD) is characterized by a hoarse voice quality which is broken up by breathy or whispered portions. Botulinum toxin injection (Botox) has been a safe and effective treatment for adductor laryngeal dystonia and is currently accepted medical therapy. As an extension of the established treatment program, in 1989 treatment of abductor LD was initiated. Thirty-two patients have been treated by sequential percutaneous electromyogram-guided (EMG) injections of the posterior cricoarytenoid (PCA) muscles. Most patients required treatment of both PCA muscles and improved to an average of 70% of normal voice. Patients who had a preexisting tremor, evidence of dystonia in other muscle groups, vocal tremor, or respiratory dysrhythmia had less improvement. Ten patients also required injection of the cricothyroid muscles and/or type I laryngoplasty.

Acoustic analysis of hoarse voice: A preliminary report

<h2>Summary</h2> Two quantitative parameters of hoarse voice quality (breathiness and strain) were introduced in an attempt to identify more objectively hoarse voice qualities. These two parameters plus jitter were used in the analysis of hoarseness in 39 patients. A significant preliminary finding in this study indicates that high breathiness with high strain suggests the presence of laryngeal carcinoma.

Shaping Behavior in Voice Therapy

This study demonstrates the process of learning and shaping of behavior which occurs during a program of therapy for individuals with hyperfunctional hoarse voice quality. First a therapy program delineating the techniques and criteria to be used was written. The program was presented during 16 individual half-hour sessions over an eight-week period to three clients known to have vocal nodules. The clients' responses were charted at various points from audiotape recordings of each therapy session using a modification of the Boone-Prescott analysis system, to obtain data to demonstrate the learning processes. It was concluded that: (1) the client's behaviors in this vocal rehabilitation program reflected a learning process; (2) facilitating techniques were used to modify or shape behavior through successive approximations to the terminal goal; (3) self-evaluation is an important factor needed to bring about successful changes in behavior; (4) analysis of client's behaviors in relation to the learning process can aid in evaluating the effectiveness of the facilitating techniques; and (5) from such evaluation intraclient and interclient program changes are derived hopefully resulting in a greater success rate and maximum benefits from time spent in therapy.

Voice following radiotherapy.

This study was undertaken to provide information on the voice of patients following radiotherapy for glottic cancer. Part I presents findings from questionnaires returned by 227 of 235 patients successfully irradiated for glottic cancer from 1960 through 1971. Part II presents preliminary findings on the speaking fundamental frequencies of 22 irradiated patients. Normal to near-normal voice was reported by 83 percent of the 227 patients; however, 80 percent did indicate persisting vocal difficulties such as fatiguing of voice with much usage, inability to sing, reduced loudness, hoarse voice quality and inability to shout. Amount of talking during treatments appeared to affect length of time for voice to recover following treatments in those cases where it took from nine to 26 weeks; also, with increasing years since treatment, patients rated their voices more favorably. Smoking habits following treatments improved significantly with only 27 percent smoking heavily as compared with 65 percent prior to radiation therapy. No correlation was found between smoking (during or after treatments) and vocal ratings or between smoking and length of time for voice to recover. There was no relationship found between reported vocal ratings and stage of the disease. Data on mean speaking fundamental frequency seem to indicate a trend toward lower frequencies in irradiated patients as compared with normals. A trend was also noted in both irradidated and control groups for lower speaking fundamental frequencies in heavy smokers compared with non-smokers or previous smokers. These trends would indicate some vocal cord thickening or edema in irradiated patients and in heavy smokers. It is suggested that the study of irradiated patients' voices before, during and following treatments by means of audio, aerodynamic and acoustic instrumentation would yield additional information of diagnostic value on recovery of laryngeal function. It is also suggested that the voice pathologist could assist in evaluating and guiding patients in vocal usages during and following treatments.

Incidence of hoarseness in school children over a 1 year period

Approximately 1500 school-aged children were screened for hoarseness twice within a 3-month time span. Consensus of three judges was used as the final criterion for regarding a child as having a hoarse voice quality. Results indicated that the general incidence of hoarseness was approximately 13%; however, only between 2.4% and 3.4% of the children were regarded as having a clinically significant problem. Incidence of chronic hoarseness was 5%. A year later, speech samples were obtained from 251 children who were hoarse during the first phase of this study and from an identical number of control children who did not exhibit hoarseness in the first phase. Again, a panel of three judges rated the speech samples for hoarseness. Results indicated that the incidence of hoarseness in the experimental group was considerably and significantly higher than in the control group.

Vocal cord abnormalities in children with velopharyngeal valving problems

AbstractTwenty‐seven subjects with borderline velopharyngeal valving mechanisms diagnosed as having hoarseness with or without vocal cord pathology participated in a follow‐up study. The mean age of the subjects was 13 years, two months, and they were recalled an average of 4.7 years following initial study.The reassessment protocol included an evaluation of speech, velopharyngeal valving, behavioral and health histories, and laryngoscopy. Upon follow‐up, 70 percent of the subjects retained vocal cord abnormalities. The eight subjects who had normal cords continued to demonstrate hoarse voice quality. Only 53 percent of the subjects who retained some atypical condition of the cords showed the same condition upon re‐evaluation. In each case, the condition retained was vocal cord nodules.The subjects who no longer showed vocal cord pathology had an average age of 15 years, eight months, as opposed to an average of 12 years, one month for those children who retained abnormalities. This difference was significant, indicating that age was an important factor in remission.Surgical removal of vocal cord nodules without attention to improving the velopharyngeal valving mechanism proved to be an ineffective approach to management; however, improvement in valving mechanism was usually associated with improvement in the vocal cord condition although it did not always eliminate it.None of the subjects in this study demonstrated an unequivocally adequate velopharyngeal valving mechanism. This was true even in the group of subjects who retained hoarseness but lost vocal cord pathology.The study suggests that careful differential diagnosis is essential in the management of these laryngeal problems which are perhaps the result of laryngeal modification compensatory to poor velopharyngeal valving mechanisms. Investigations of laryngeal anatomy and physiology and study of functional correlates to both hoarseness and vocal cord pathology in these patients, is essential.

Consonant and Vowel Influences upon Judged Voice Quality of Syllables

Generally quality defects of voice are presented as “independent of phonemes,” i.e., the sounds being articulated, and as the result of the unique wave composition of voice defective speakers. The purpose of this study was to investigate a voice quality disorder while varying specific speech sounds. The subjects with hoarse voice quality were selected to speak syllables in which the phonetic elements were controlled. The utterances were recorded and played to trained judges who rated the degree of hoarseness present in the utterance. Statistical analysis (analysis of variance) of the data collected indicated that significant differences in voice quality do exist as some function of the vowel and consonant content of the syllable. Further analysis (t test) reveals that high vowels result in significantly less judged voice quality defectiveness than the low vowels. Front-back vowel comparisons were generally less indicative of real differences. Of the consonants, it is seen that the voiceless, or whispered, plosives, such as t, p, and k, contribute to a judgment of less defectiveness than the other consonants. Generally, the findings are that voiceless consonants are judged less defective than voiced consonants, fricatives increase the judgment of hoarseness, the manner of articulation of consonants is related to perceived voice quality and place of articulation appears to have only slight correlation. In general the results suggest that the degree of perceived voice quality may be related in part to the secondary acoustic characteristics of syllables, such as duration, frequency, and intensity. Such investigations are now in progress.