Hyperfunctional Dysphonia Research Articles

A comparative study of stretch-and-flow voice therapy versus Smith accent method in rehabilitation of hyperfunctional dysphonia: a randomized controlled trial

BackgroundThis work aims to compare between stretch-and-flow voice therapy and Smith accent method of voice therapy in treatment of hyperfunctional dysphonia in order to assess the benefit of using this new technique in its management. A randomized controlled trial was conducted at the Unit of Phoniatrics, Otorhinolaryngology Department, in the period from November 2020 to February 2023. A sample of 60 patients with hyperfunctional dysphonia was randomly divided into two groups; each group consisted of 30 patients: “group A” who received stretch-and-flow voice therapy (SnF) and “group B” who received Smith accent (SA) method of voice therapy. Assessment included auditory perceptual assessment (APA) using modified GRBAS scale and Arabic-voice handicap index (Arabic-VHI).ResultsThe study revealed significant improvement in grade of dysphonia, voice quality, and Arabic-VHI post-therapy for both groups. There was a significant improvement regarding voice pitch in SnF group only and in loudness of voice in SA group only.ConclusionSnF can be considered as an alternative approach for treating hyperfunctional dysphonia, offering a shorter duration, and potentially being a simpler alternative for patients who struggle with the more intricate rhythms of the Smith Aaccent voice therapy method.

Classification of functional dysphonia using the tunable Q wavelet transform

Functional dysphonia (FD) refers to an abnormality in voice quality in the absence of an identifiable lesion. In this paper, we propose an approach based on the tunable Q wavelet transform (TQWT) to automatically classify two types of FD (hyperfunctional dysphonia and hypofunctional dysphonia) from a healthy voice using the acoustic voice signal. Using TQWT, voice signals were decomposed into sub-bands and the entropy values extracted from the sub-bands were utilized as features for the studied 3-class classification problem. In addition, the Mel-frequency cepstral coefficient (MFCC) and glottal features were extracted from the acoustic voice signal and the estimated glottal source signal, respectively. A convolutional neural network (CNN) classifier was trained separately for the TQWT, MFCC and glottal features. Experiments were conducted using voice signals of 57 healthy speakers and 113 FD patients (72 with hyperfunctional dysphonia and 41 with hypofunctional dysphonia) taken from the VOICED database. These experiments revealed that the TQWT features yielded an absolute improvement of 5.5% and 4.5% compared to the baseline MFCC features and glottal features, respectively. Furthermore, the highest classification accuracy (67.91%) was obtained using the combination of the TQWT and glottal features, which indicates the complementary nature of these features.

End-to-end deep learning classification of vocal pathology using stacked vowels.

Advances in artificial intelligence (AI) technology have increased the feasibility of classifying voice disorders using voice recordings as a screening tool. This work develops upon previous models that take in single vowel recordings by analyzing multiple vowel recordings simultaneously to enhance prediction of vocal pathology. Voice samples from the Saarbruecken Voice Database, including three sustained vowels (/a/, /i/, /u/) from 687 healthy human participants and 334 dysphonic patients, were used to train 1-dimensional convolutional neural network models for multiclass classification of healthy, hyperfunctional dysphonia, and laryngitis voice recordings. Three models were trained: (1) a baseline model that analyzed individual vowels in isolation, (2) a stacked vowel model that analyzed three vowels (/a/, /i/, /u/) in the neutral pitch simultaneously, and (3) a stacked pitch model that analyzed the /a/ vowel in three pitches (low, neutral, and high) simultaneously. For multiclass classification of healthy, hyperfunctional dysphonia, and laryngitis voice recordings, the stacked vowel model demonstrated higher performance compared with the baseline and stacked pitch models (F1 score 0.81 vs. 0.77 and 0.78, respectively). Specifically, the stacked vowel model achieved higher performance for class-specific classification of hyperfunctional dysphonia voice samples compared with the baseline and stacked pitch models (F1 score 0.56 vs. 0.49 and 0.50, respectively). This study demonstrates the feasibility and potential of analyzing multiple sustained vowel recordings simultaneously to improve AI-driven screening and classification of vocal pathology. The stacked vowel model architecture in particular offers promise to enhance such an approach. AI analysis of multiple vowel recordings can improve classification of voice pathologies compared with models using a single sustained vowel and offer a strategy to enhance AI-driven screening of voice disorders. 3.

Impact of Face Masks on Acoustic Measures in Patients with Hyperfunctional Voice Disorders and Normal Speakers

Purpose: Wearing face masks during the COVID-19 pandemic has become a very important hygiene measure to block or prevent respiratory droplets and infections. The purpose of this study is to explore the effect of wearing face masks on the acoustical measurement of voice and speech in patients with hyperfunctional voice disorders, and to present guidelines for wearing a mask when evaluating voice and speech.Methods: A total of 20 patients with hyperfunctional voice disorders who diagnosed with vocal nodules, muscle tension dysphonia, and adductor spasmodic dysphonia (14 females, 6 males, age=30.55±8.24) and age-and gender-matched 20 healthy adults (15 females, 5 males, age=27.31±7.52) were enrolled. All participants completed three speech tasks (sustained /a/vowel, CAPEV-3 all voiced sentence, and the ‘Kaeul’ standard passage- 2nd sentence) with their habitual pitch and loudness among the different mask conditions (No mask, surgical, and KF94). Acoustic analysis including perturbation and cepstral & spectral parameters was conducted with MDVP and ADSV.Results: For the healthy speakers, there were significantly lower in jitter (%), shimmer (%), and noise-to-harmonic (NHR) in no mask condition than in mask conditions, while there was no significantly different in perturbation measures (F0, jitter (%), shimmer (%), and NHR for patients. Vocal intensity was significantly reduced in mask-wearing conditions either surgical or KF94 mask with all speech tasks except sustained /a/ vowel phonation for patients. Cepstral peak prominence (CPP) was not significantly different among the different mask conditions in sustained /a/ vowel phonation and 3rd CAPEV sentence (all voiced sentence) in all groups. Both healthy speakers and patients showed significantly lower L/H ratio values in the no mask condition.Conclusions: Overall, in current study, wearing a mask or the type of face mask did not change time-based and cepstral acoustic parameters, while a spectral measure such as L/H ratio was significantly increased in mask-wearing conditions in patients with hyperfunctional voice disorders. These findings suggest that wearing either surgical or KF 94 masks could be a safe and relevant choice for acoustic perturbation and cepstral measures with /a/ vowel in hyperfunctional dysphonia.

A comparative study of the vocal parameters between hypofunctional and hyperfunctional dysphonia using perceptual and cepstral spectral index of dysphonia measures

Background: The main goal of the present study was to obtain the cepstral spectral index of dysphonia (CSID) scores for normophonic, hypo-functional dysphonic and hyper-functional dysphonic Indian population along with correlation of CSID and GRBAS scores for normophonic, hypo-functional dysphonic and hyper-functional dysphonic population using sustained production of vowel and oral passage of Bengali language. Methods: A total of 60 participants between 20-50 years were selected for the study. The participants were divided into three groups viz., 30 normal subjects, 15 subjects with hypofunctional dysphonia and 15 subjects with hyperfunctional dysphonia. The subjects were screened for speech and hearing defects. Recordings of sustained vowels and passage were done and then fed to measure CSID through PRAAT and software developed by C-DAC. Statistical analyses were done for the analyzed data using SPSS. Results: Significant differences (p<0.05) were found in CSID scores across hypofunctional dysphonia group and hyperfunctional dysphonia group when compared to normophonia group. There were no significant differences (p>0.05) between hypofunctional and hyperfunctional dysphonia group in CSID score. A significantly strong correlation of CSID scores with the ‘G’ rating of GRBAS scores (p<0.01) were found for both hypofunctional dysphonia and hyperfunctional dysphonia groups. ROC analysis showed high sensitivity and specificity of CSID scores in two dysphonia groups with respect to normophonia group. Conclusions: The current study revealed significant differences obtained in CSID scores across normophonia, hypofunctional dysphonia and hyperfunctional dysphonia groups suggesting it as assessment tool to determine the presence of dysphonia.

Electrophysiological predictors of hyperfunctional dysphonia

Background The relation between the autonomic nervous system (ANS) and muscles of the vocal tract is of particular importance when considering the pathomechanism of a functional voice disorder. Aims The aim of this study was to record electrophysiological indicators from the ANS as well as the tone of the external laryngeal muscle and test whether together they could point to an enhanced risk of primary functional voice disorder. Materials and methods The study material consisted of 81 people, 27 of whom were professional opera singers. None reported any voice complaints. The research comprised ENT and phoniatric examination, superficial electromyography (SEMG), and recording of physiological indicators (pulse rate, skin resistance). Results All subjects had a clear voice with no sign of vocal disability. Endoscopy revealed laryngeal hyperfunction in 26 people. SEMG revealed that the 26 had increased external laryngeal muscle tone during phonation, and this finding correlated with a change in certain electrophysiological indicators HRV, BVP, EDA. Conclusions We conclude that anomalies in electrophysiological parameters in individuals with subclinical symptoms of functional voice disorder may be at risk of developing fully symptomatic hyperfunctional dysphonia in the future. Vocal training, which differentiates singers and non-singers, is known to have an effect on subclinical hyperfunctional dysphonia. Significance By measuring indicators of hyperfunctional dysphonia, it may be possible to take remedial action before symptomatic dysphonia develops.

Hierarchical Multi-Class Classification of Voice Disorders Using Self-Supervised Models and Glottal Features

Previous studies on the automatic classification of voice disorders have mostly investigated the binary classification task, which aims to distinguish pathological voice from healthy voice. Using multi-class classifiers, however, more fine-grained identification of voice disorders can be achieved, which is more helpful for clinical practitioners. Unfortunately, there is little publicly available training data for many voice disorders, which lowers the classification performance on data from unseen speakers. Earlier studies have shown that the usage of glottal source features can reduce data redundancy in detection of laryngeal voice disorders. Another approach to tackle the problems caused by scarcity of training data is to utilize deep learning models, such as wav2vec 2.0 and HuBERT, that have been pre-trained on larger databases. Since the aforementioned approaches have not been thoroughly studied in the multi-class classification of voice disorders, they will be jointly studied in the present work. In addition, we study a hierarchical classifier, which enables task-wise feature optimization and more efficient utilization of data. In this work, the aforementioned three approaches are compared with traditional mel frequency cepstral coefficient (MFCC) features and one-vs-rest and one-vs-one SVM classifiers. The results in a 3-class classification problem between healthy voice and two laryngeal disorders (hyperfunctional dysphonia and vocal fold paresis) indicate that all the studied methods outperform the baselines. The best performance was achieved by using features from wav2vec 2.0 LARGE together with hierarchical classification. The balanced classification accuracy of the system was 62.77% for male speakers, and 55.36% for female speakers, which outperformed the baseline systems by an absolute improvement of 15.76% and 6.95% for male and female speakers, respectively.

Endoscopic treatment of anterior laryngeal web using keel designed from ePTFE followed by voice therapy: a refined technique

BackgroundTreatment of laryngeal web is challenging due to possibility of recurrence and affected voice quality. Optimal treatment of laryngeal web should emphasize on improving both airway and vocal function. We refined the traditional endoscopic method using a new keel designed from expanded polytetrafluoroethylene (ePTFE) membrane. Our objective is to evaluate the voice outcomes following the endoscopic treatment and voice therapy.ResultsTen subjects presented with anterior laryngeal web. Auditory perceptual assessment, stroboscopic examination and acoustic studies were performed pre- and postoperatively. Endoscopic excision of laryngeal web was performed with cold instruments. An individually designed ePTFE keel was fixed by Nylon thread 2–0 at the anterior commissure and tied subcutaneously in the neck. The keel left for 3–5 weeks followed by voice therapy using abdomino-diaphragmatic breathing exercise and relaxation method. Vocal parameters measured were perceptual voice quality using Grade-Roughness-Breathiness-Asthenia-Strain voice scale (GRBAS), stroboscopic score, fundamental frequency (F0), jitter, shimmer, pitch perturbation question (PPQ), amplitude perturbation question (APQ) and harmonics-to-noise ratio (HNR). Significant decrease in GRBAS (P < 0.001) and significant increase in stroboscopic scores (P < 0.001) were noticed after operation and voice therapy. Also, acoustic voice parameters showed significant improvements. The mean jitter, shimmer, PPQ and APQ showed significant decrease (p = 0.0028, 0.0032, 0.0026, 0.0014, and 0.006 respectively). Overall, 90 % of our subjects have satisfactory voice outcome.ConclusionEndoscopic excision of anterior laryngeal with cold instrument followed by ePTFE keel fixation achieved good long-term voice results. The ePTFE is soft biocompatible material which does not make reaction. The keel should be left in place for sufficient period of time (3–5 weeks). This ensures perfect healing with less or no recurrence. Absence of foreign body reactions in the vocal folds is important for mucosal integrity and good voice outcome. So, the ePTFE could be good alternative for laryngeal keel. Hyperfunctional dysphonia with ventricular hypertrophy may develop in longstanding anterior laryngeal web which needs intensive voice therapy after operation. Our treatment targeted both the organic etiology of dysphonia and the underlying cause of the possible associated functional element of dysphonia.

Provider and Patient Satisfaction with Telemedicine Voice Therapy During the COVID-19 Pandemic

ObjectivesThe COVID-19 pandemic expanded the use of telemedicine, but there is no literature exploring both patient and provider satisfaction specifically in the provision of voice therapy. This study aims to investigate patient and provider satisfaction with virtual voice therapy, its associated factors, and any correlation between the two. MethodsCross-sectional study. Participants included 226 adults who underwent voice therapy delivered via telepractice at the USC Voice Center between April and October 2020. Patients and providers self-reported their level of satisfaction on a visual analog scale (VAS; range 0-100). Patient satisfaction was additionally measured using a previously validated Telemedicine Satisfaction Questionnaire (TSQ; range 1-5), and a binary question about their desire to choose telemedicine over in-person therapy in the future. Three speech-language pathologists rated provider satisfaction for all 226 patients. Patient satisfaction survey was completed by 55 patients. Multivariable linear regression analyses and linear mixed-effects models were used to assess the results. ResultsPatient and provider mean (SD) VAS satisfaction scores were 86.8 (18.6) and 80.6 (19.7), respectively. The mean (SD) TSQ score was 4.4 (0.6). In a multivariable model, patient satisfaction levels were significantly higher for hypofunctional than for hyperfunctional dysphonia diagnoses. Forty-four (73%) patients reported they would prefer telemedicine voice therapy over in-person appointments, which was significantly correlated with internet reliability (P = 0.04). For providers, satisfaction was significantly lower for patients whose diagnosis had changed after initiation of voice therapy (Δ = -16.0 [95% CI: -28.7 to -3.2]) and for encounters with Asian patients compared to White patients (Δ = -11.6 [95% CI: -18.9 to -4.2]). Patient and provider satisfaction scores were weakly correlated (r = 0.19). ConclusionsOur findings suggest that virtual voice therapy is not simply an alternative to in-person service, but rather an effective method useful beyond the current pandemic with proper diagnosis and technical support.

Assessment of auditory processing in childhood dysphonia

IntroductionClinical experience shows that children with functional dysphonia often present disorders that are associated with abnormal auditory and emotional development. These children also struggle with voice therapy, perhaps because of difficulties with auditory control during speech. It has been hypothesized that difficulties in auditory processing in children may be an important factor in the pathogenesis of childhood dysphonia. ObjectiveThe study aimed to assess selected auditory functions in children with hyperfunctional dysphonia. Materials and methodThe study group consisted of 331 children aged from 7 to 12 years suffering from hyperfunctional dysphonia. The control group consisted of 213 children aged 7–12 years. All patients underwent ENT and phoniatric examination. All children underwent two standardized psychoacoustic tests: the Frequency Pattern Test (FPT) and the Duration Pattern Test (DPT). ResultsIn the examined material, 223 children had edematous vocal fold nodules. The largest statistically significant differences were seen in the acoustic parameters describing relative frequency changes. FPT and DPT showed statistically significant differences in children with hyperfunctional dysphonia compared to the control group. At all ages the percentage of correctly identified tone sequences was significantly lower in children with dysphonia. ConclusionChildren with hyperfunctional dysphonia have difficulties in judging the pitch and duration of auditory stimuli. Difficulties in auditory processing appear to be important in the pathomechanism of functional voice disorders. Impaired hearing processes in children with hyperfunctional dysphonia can make it difficult to obtain positive and lasting effects from voice therapy.

Application of High Speed Digital Imaging (HSDI) technique in the diagnosis of dysphonia in patients with laryngopharyngeal reflux disease (LPR).

Introduction Gastroesophageal reflux disease (GERD) may cause extra-esophageal complications, including laryngopharyngeal reflux disease (LPR). It is caused by morphological changes in the laryngeal mucosa due to the regurgitation of gastric contents. Laryngopharyngeal reflux has a wide symptomatology. There is no pathognomonic image of the larynx for LPR. In the diagnosis of LPR, the subjective RSI scale is commonly used, which assesses symptoms in conjunction with the laryngoscopic assessment of the larynx on the RFS scale. The aim of the study was to diagnose the clinical form of dysphonia in patients with laryngopharyngeal reflux (LPR) using the HS camera and HSDI technique. Material and methods The study included a group of 72 patients of both genders, age 20 to 65, who obtained more than 13 points in the RSI scale and more than 7 points in the RFS scale. Results Application of HSDI technique with camera in the high speed (HS) and high resolution (HR) mode allowed precise objective diagnosis of organic and functional disorders of a hyperfunctional dysphonia.

Design and Validation of a New Diagnostic Tool for the Differentiation of Pathological Voices in Parkinsonian Patients.

Pathological speech, in its many forms, is a symptom of numerous serious diseases affecting millions of people worldwide, including more than 10 million Parkinson patients. Here, a powerful method is proposed for detecting pathological speech, using a two-dimensional (2D) convolutional neural network (CNN). Spectrograms are extracted from voice recordings of healthy and Parkinson diagnosed patients, which are fed into the CNN architecture. The voice samples comprise a subset of the benchmark mobile Parkinson Disease (mPower) study. The proposed model achieves 98% accuracy in Parkinson detection (i.e., a two-class problem). Moreover, an average accuracy exceeding 94% is measured in binary tests (i.e., pathological versus healthy) employing six voice pathologies conducted on the Saarbruecken Voice Database. These pathologies are dysphonia, functional dysphonia, hyperfunctional dysphonia, spasmodic dysphonia, vocal fold polyp, and dysody.

Characteristics of swallowing disorders in patients with dysphonia.

Coexistence of dysphagia with voice disorders is a topic rarely raised in the literature. Particular attention is paid to the aspect of dysfunction of laryngeal and pharyngeal muscles. The aim of the study was to analyse cases of patients with dysphonia in relation to coexistence of swallowing disorder. The material of the study included 515 patients hospitalised due to dysphonia in 2018. Patients whose interview indicated swallowing difficulties were subjected to additional diagnosis for dysphagia (FEES, extended speech therapy test, SEMG). R esults: 11.8% of people requiring treatment for voice disorders reported coexistence of swallowing difficulties. Dysphagia was diagnosed in 9.3%. The percentage of respondents diagnosed with swallowing disorder differed depending on the type of underlying disease and was the highest in the group with neurological disorders. Analysis of the correlation between the severity of dysphagia (according to the assessed grade, DHI, EAT-10 results) and the severity of VHI showed a weak correlation between VHI and EAT-10 (p = 0.1), statistically significant correlations (p &lt; 0,05) between the value of VHI and RSI in people with diagnosed neurological disease, between the value of VHI and DHI in people with hyperfunctional dysphonia and the value of VHI and BMI and EAT- 10 in people with chronic laryngitis. Moreover, statistically significant correlations were found between the severity of dysphagia and EAT-10 and DHI (p &lt; 0.05). The speech therapy test indicated the co-existing problem of non-normative swallowing pattern. The electromyographic study showed the largest asymmetries in recording the average and maximum amplitude from masseters. C onclusions: Treatment of patients with voice disorders requires interdisciplinary care. A history of dysphagia in these patients should complement the medical history of voice disorders. The characteristics of swallowing disorders vary depending on the cause of the voice disorder and their co-occurrence affects on average 9.3% of patients. Coexistence of muscle tension dysphagia with voice disorder requires separate diagnostic protocol. Logopaedic procedure ought to be a key element in the interdisciplinary care of patients suffering from muscle tension dysphagia.

Mucosal wave measurements in the diagnosis of functional dysphonia.

The aim of the study was to objectify glottal function in different types of FDs. The scope was to use open quotients gained from various mucosal wave imaging techniques for differential diagnosis of FDs. The study included 204 individuals. In the study, each patient underwent otolaryngological and phoniatric examination. LVS, EGG and VSK were conducted, their results were recorded and stored using an EndoSTROB-DX- -Xion GmbH (Berlin) device with DIVAS software. All patients with FDs had abnormalities in LVS. A statistical analysis showed differences in LVS characteristics according to the type of FD. The mean value of OQVSK was 0.521 in the control group and 0.565 in the study group (P &lt; 0.05). Significant differences were found between patients with hypofunctional - 0.584 and hyperfunctional dysphonia - 0.55. The QOQEGG mean value in patients with FDs was 0.581 and in the control group 0.549 (P &lt; 0.01). There were statistically significant differences between groups of patients with hyper- and hypofunctional dysphonias. Medians amounted to 0.574 and 0.604, respectively. Authors observed different relations of OQ with the type of FD. They decided to introduce a new parameter, illustrating the proportion of QOQEGG/OQVSK. Videostrobokymographic and electroglottographic open quotients differentiate euphony from dysphony. The value of OQVSK and QOQEGG and their proportion varies depending on different types of functional dysphonias. The OQVSK and QOQEGG should be included in the diagnostic algorithm of voice.

Verbal communication disorders in psychogenic dysphonia.

Psychogenic dysphonia is defined as disturbances in voice and speech quality with emotional background with lack of organic changes in the larynx. Mental condition has significant impact on the process of producing voice, functioning of respiratoryphonatory- articulation mechanism and speech prosody. The aim of the study was visual, acoustic, perceptual assessment as well as self-assessment of voice and speech quality using subjective and objective methods in patients with psychogenic dysphonia. The study included 50 patients with psychogenic dysphonia diagnosed in the Department of Clinical Fonoaudiology and Logopedics, Medical University of Białystok and treated at the Foniatric Outpatient Clinic, University Hospital in Białystok in 2017-2018. The control group consisted of 30 subjects with euphonic voice. All patients underwent subjective and objective assessment of voice and speech quality. The GRBAS scale, breathing pathway assessment, respiratory-phonatory-articulation analysis, voice and speech intensity evaluation have been performed. Speech prosody has also been examined. Patient selfassessment of voice has been conducted using Voice Handicap Index (VHI). Objective evaluation of larynx included vibrations of vocal folds visualization using High Speed Digital Imaging (HSDI). Acoustic analysis of voice quality has been performed using DiagNova Technologies. The maximum phonation time (MPT) has been determined. Hyperfunctional dysphonia is the most common clinical form of psychogenic dysphonia. Abnormal breathing pathway influence the reduction of MPT and disturbance of respiratory-phonatory-articulation coordination in patients with psychogenic dysphonia. In psychogenic dysphonia intonation and speech rate disorders are observed. Results of voice self-assessment in the majority of examined patients indicates a mild voice disability.

Analysis of voice quality parameters in patients with vestibular voice.

Vestibular voice includes participation of larynx structures which are absent in physiological process. Vestibular phonation may be desired when vocal folds are damaged as in paralytic dysphonia, or undesired in marginal hyperfunction. Vestibular voice may result from psychogenic dysphonia - phononeurosis. The aim of the study is perceptive evaluation of vestibular voice, objective larynx visualization, acoustic and aerodynamic examination. The study included 40 patients: 20 with vestibular voice, 20 with euphonic voice. Voice quality has been evaluated using perceptual GRBAS scale. Endoscopic and stroboscopic larynx examination used Endo-STROB-EL-Xion GmbH with visual tract. High-Speed Digital Imaging (HSDI) and High Speed (HS) camera registered true vocal folds vibrations. Acoustic evaluation of voice with DiagnoScope Specjalista, DiagNova Technologies included analysis of F0, Jitter, Shimmer, NHR, nonharmonic components. MPT has been analyzed. In examined group, hoarseness (95%), roughness (75%) and voice strain (55%) have been recorded. Endoscopy revealed edema of vestibular folds with dilation of vessels covering glottis. Stroboscopy and HSDI confirmed coexistence of hyperfunctional (95%) or paralytic (5%) dysphonia. Acoustic assessment revealed increase in Jitter, Shimmer, NHR and decrease in F0 and MPT. The vestibular voice is observed most frequently in women with hyperfunctional dysphonia (phononeuroses) or in paralytic dysphonia. Visualization techniques confirm the coexistence of vestibular folds hypertrophy and edema with vibration disorders. In the perceptual assessment, vestibular voice was hoarse, rough and strained. Acoustic examination showed increase of Jitter, Shimmer, NHR, presence of nonharmonic components and decrease of F0 and MPT.

Correlating Undiagnosed Hearing Impairment with Hyperfunctional Dysphonia

This study initially investigated the co-occurrence of hearing impairment that had not been previously diagnosed in a group of patients with hyperfunctional dysphonia. Subsequently, it explored whether any correlations exist between quantitative dysphonia severity assessment parameters and distinctive acoustic features of hearing impairment. The age-stratified participants were 36 patients presenting with hyperfunctional dysphonia to the voice clinic. For each subject, the following measurements were collected: grade of dysphonia severity rating by the clinician, a Voice Handicap Index (VHI) Patient Questionnaire, and an acoustic analysis of a standardized voice sample. Subsequently, the participants were referred to the audiology clinic for pure tone audiometry testing. The co-occurrence of hyperfunctional dysphonia and coincidentally discovered hearing impairment showed a percentage of 33% in the study subjects. There were no significant differences in the acoustic profiles of patients with and without hearing impairment. Mean frequency and jitter % were positively correlated in all investigated cohorts, except in subjects with simultaneous occurrence of hearing impairment and dysphonia. Mean intensity and shimmer % were not correlated in any of the groups investigated. The physiological mechanism for regulating pitch perturbation is altered in individuals with hearing impairment compared to normal hearing subjects. Pitch and amplitude perturbation have different regulatory mechanisms.

Variation on Vocal Economy After Different Semioccluded Vocal Tract Exercises in Subjects With Normal Voice and Dysphonia

The present study aimed at observing the possible differential effects of eight semioccluded vocal tract exercises (SOVTE) on vocal economy measured by the Quasi Output Cost Ratio (QOCR). Thirty-six participants were included in this study. They were divided into two groups: an experimental group of subjects diagnosed with mild hyperfunctional dysphonia (n = 17) and a control group of vocally healthy subjects (n = 19). Participants were required to randomly select and produce a series of three SOVTE from a list of eight exercises. The electroglottographic based measure QOCR was used to calculate the vocal economy before and after each voice exercise. Significant differences were found when comparing pre and poststages regardless of the vocal condition (normal voice or dysphonia) or the specific SOVTE used. Moreover, when individually comparing the effect of each SOVTE, only tube in water (10 cm) showed significant differences between pre and postconditions (QOCR values were higher after exercises). In general, semioccluded vocal tract exercises tend to increase vocal economy regardless the vocal condition (normal voice or dysphonia) or the specific SOVTE used. Phonation into a tube submerged deep into water promoted the highest increase in vocal economy. An increased acoustic output, nonproportional increase in vocal folds adduction and an effortless voice production would cause this increase in vocal economy after water resistance therapy.

The influence of kinesiotaping on the loosening of the laryngeal muscles in hyperfunctional dysphones.

Hyperfunctional dysfunction is one of the most common functional dysphonia, cha-racterized by voice insufficiency with excessive tightening of the muscles inside and outside the larynx during phonation. To make the treatment process more effective, new ways of rehabilitation are constantly being sought and developed. The aim of this work is to evaluate the effectiveness of laryngotaping - an innovative method of taping around the larynx and neck muscles. 10 patients with diagnosed hyperfunctional dysphonia participated in the study. Using the kinesiotaping principles, for 7 days, the suprahyoid and infrahyoid muscles, ster-nocleidomastoid muscles as well as the thyroid cartilage were taped. Before and after the therapy, the patients completed the VHI voice self-evaluation questionnaire. The evaluation of the larynx according to the L. Mathienson scale was also assessed palpation. Analyzing the results of the VHI questionnaire and evaluation of palpation evaluation of the larynx before and after the therapy, statistically significant differences were observed. The results on average decreased by half, which is the desired effect of therapy. The results confirm the positive impact of kinesiotaping around the larynx. However, more research is needed on a larger group of patients to fully evaluate the therapeutic effect. 1. Laryngotaping is an effective way to normalize muscle tone, and thus to improve the quality of the voice. 2. The presented studies require continuation, however, positive reception of the introduced therapy by patients encourages further research on a larger group of patients.

Electroglottography in the diagnosis of functional dysphonia

IntroductionElectroglottography (EGG) is the most commonly used method of indirect visual examination of vocal fold vibration.AimThe study was conducted with an aim of assessing EGG quasi open quotient (QOQEGG) in different functional dysphonias to develop a differential diagnosis. The second aim was to check the influence of articulation on QOQEGG values.Material and methodsThere were 20 people without voice problems, 20 patients with hypofunctional dysphonia and 20 patients with hyperfunctional dysphonia included in the study. Electroglottography was recorded during comfortable sustained phonation of [a], [e], [i], [o], [u].ResultsThere were no statistically significant differences in QOQEGG observed during phonation of different vowels in the control group and patients with hyperfunctional dysphonia. In patients with hypofunctional dysphonia, significantly higher values of QOQEGG were observed during [a] and [e]. Both in the control and in studied groups vowel [i] was vocalized significantly quieter.ConclusionsTo conclude, EGG can be useful in differential diagnosis of functional dysphonia. QOQEGG is a parameter differentiating hypofunctional dysphonia from hyperfunctional dysphonia. Dissimilarities in articulation of different vowels in patients with various types of dysphonia influence values of QOQEGG. EGG study protocol in cases of functional dysphonia should include a comparison of [a], [e], [i] vowels.