Voice Nasality Research Articles

Nasalance and perceived voice changes in patients undergoing septoplasty and turbinate hypertrophy reduction

The purpose of this study was to investigate the changes in voice nasality after septoplasty and turbinate hypertrophy reduction and to evaluate the effect of these changes on patients' voice-related quality of life. Sixty patients with nasal obstruction symptoms caused by septal deviation and inferior turbinate hypertrophy who underwent septoplasty and inferior turbinate hypertrophy reduction and 25 healthy controls were included. Active anterior rhinomanometry and acoustic rhinometry were utilized for the evaluation of nasal patency and nasometry was used for quantitative assessment of nasalance. All participants completed validated questionnaires for assessing nasal obstruction symptom severity, psychological status and the impact of voice performance on their quality of life preoperatively and 6months after septoplasty. Patients presented preoperatively statistically significantly lower nasalance scores and higher VHI scores than controls (p < 0.05). Septoplasty and inferior turbinate hypertrophy reduction led to improvement of nasalance for the nasal text and the physical subscale of the VHI scores. Postoperatively, there were no statistically significant differences in nasalance and VHI scores between patients and controls. Significant correlations were found only for the baseline and the postoperative nasalance scores for the nasal text and the total nasal cavity volume (p < 0.05). Postoperatively, patients who presented significant improvement of nasal obstruction symptoms and resolution of stress levels were more likely to positively evaluate the impact of their voice quality on their daily life (OR: 2.32, 95% CI 1.08-5.15, p = 0.041 and OR: 3.06, 95% CI 1.15-7.04, p = 0.038, respectively). Septoplasty and inferior turbinate hypertrophy reduction may increase the nasal resonance, but in the long term, this change appears not to be significant enough. The severity of nasal obstruction symptoms and psychological status mainly affect the patients' perceptual assessment regarding the effect of voice performance on their quality of life.

Speech disorders in Parkinson’s disease - characteristics, assessment and treatment

Introduction. Parkinson?s disease belongs to the group of extrapyramidal neurodegenerative diseases and occurs as a consequence of the loss of dopaminergic neurons in the substantia nigra of the mesencephalon. Persons with Parkinson?s disease may experience a wide range of motor and non-motor symptoms. Material and Methods. A literature search was conducted using electronic databases on the Internet and electronic databases of Serbian libraries. Results. Speech disorders in Parkinson?s disease are classified in the group of hypokinetic dysarthria. Empirical data show that the basic characteristics of dysarthria in people with Parkinson?s disease are changes in voice quality, difficulties in articulating consonants, abnormalities in vowel production, monotonous speech, changes in speech rate, rough and breathy voice, increased voice nasality, reduced intensity of voice, involuntary pauses during speech, and palilalia. Methods used in the assessment of speech disorders include perceptual voice analysis, such as the overall dysphonia Grade, Roughness, Breathiness, Asthenia, Strain and Consensus Auditory Perceptual Evaluation of Voice scales, acoustic voice analysis (e.g., Multi-Dimensional Voice Program), and voice quality self-assessment methods (e.g., Voice Handicap Index and the Dysarthria Impact Profile). In the treatment of dysarthria, various behavioral methods of speech therapy are used, among which the Lee Silverman method is particularly important. Conclusion. Speech disorders in Parkinson?s disease manifest as altered patterns of respiration, phonation, resonance, articulation and prosody. The best results in the treatment are achieved by combination of medical, surgical, and behavioral therapy, through the cooperation of experts of different profiles as well as with family members of the patient.

PALATAL OBTURATOR PROSTHESIS IN A SALIVARY MALIGN TUMOR PATIENT: CASE REPORT

To report a case of rehabilitation with palatal obturator prosthesis post exeresis of mucoepidermoid carcinoma in hard palate in a 48-year-old female patient who came to the university with complaints of liquids and pasty food reflux to nasal cavity, nasality of voice and local sensibility. Clinically, she presented a 2.5 cm in diameter oroantral communication on the right palate. A palatal obturator prosthesis, with metallic structure, without dental implants was performed to re-establish function and aesthetics, obturation of communication, considering himself apt to return to his social activities. The prosthesis in cancer patients re-establishes function, aesthetics, and obturation of the communication, providing adequate phonation, confidence, self-esteem, and better quality of life and survival. To report a case of rehabilitation with palatal obturator prosthesis post exeresis of mucoepidermoid carcinoma in hard palate in a 48-year-old female patient who came to the university with complaints of liquids and pasty food reflux to nasal cavity, nasality of voice and local sensibility. Clinically, she presented a 2.5 cm in diameter oroantral communication on the right palate. A palatal obturator prosthesis, with metallic structure, without dental implants was performed to re-establish function and aesthetics, obturation of communication, considering himself apt to return to his social activities. The prosthesis in cancer patients re-establishes function, aesthetics, and obturation of the communication, providing adequate phonation, confidence, self-esteem, and better quality of life and survival.

Changes in nasal resonance following septoplasty in adults: Acoustic and perceptual characteristics

Objectives. Patients undergoing surgery for a deviated nasal septum (septoplasty) often report that their voice sounds different or less hyponasal. However, such a relationship between septoplasty and vocal resonance remains without scientific evidence. The purpose of this work is to investigate whether nasal septal surgery has any effect on nasal resonance, both in terms of objective measurements and patient perception. Methods. The research carried out was a prospective case–control study. We recruited patients who underwent septoplasty (study group) and healthy volunteers (control group). We obtained voice recordings of the nasal consonant /m/ pre- and four weeks postoperatively and twice at similar time intervals in the control group. We investigated objective changes by means of acoustic analysis of the voice recordings and calculated the total amount of acoustic energy in different bandwidths on a wide-band spectrogram. We also utilized a questionnaire to explore patient perception. Results. A total of 34 participants entered the study. ANOVA testing revealed significant changes in average total acoustic energy, phlegm, and throat dryness postoperatively. Regarding patient perception, a considerable number of our patients felt that their voice had changed for the better upon direct questioning. However, statistical analysis of the questionnaire items related to nasality of voice did not show a significant change. Conclusions. In this study it has been demonstrated that surgical correction of septal deviation causes significant spectrographic changes. In particular it causes changes in the average total acoustic energy during the production of a nasal consonant. A considerable number of our patients reported change in their vocal resonance for the better. We recommend that patients be advised that their voice may sound different after surgery, or less hyponasal.

Subjective Assessment of Voice, Nasality, and Swallowing Changes in Patients with OSAS after Anterior Uvulopalatoplasty

Objectives: None provided. Methods: In this prospective clinical study, 41 adult patients (32 males, 9 females) diagnosed for obstructive sleep apnea syndrome (OSAS) and operated at university hospital by anterior uvulopalatoplasty between December 2008 and December 2010 at least 6 months (median 10.0 months) before investigation, formed the study group. A total of 17 nonoperated OSAS patients matched by age, sex, smoking rate, and OSAS severity served as controls. Post service with questionnaires and telephone conversation was accomplished. Patient and control symptoms (hoarseness, nasality of voice, and dysphagia) were assessed using 10-point Likert scale (1-normal). Voice quality was assessed by voice handicap index (VHI), and hypernasality by auditory perceptual Gutzmann hypernasality test. Results: Hoarseness ratings for OSAS patients were similar before and after the surgery, with no significant impact on voice handicap. Moreover, total VHI score significantly dropped after the surgery from 9.2 points to 5.4 points out of maximum 120 ( P &lt; .05). Mild nasality of voice with mean intensity score of 1.4 ± 1.0 points was self-rated by 17.1% of patients, but postoperative rating was significantly lower than that before surgery (2.0 ± 1.9; P &lt; .05). No significant differences were found in dysphagia scores and Gutzmann test before and after the palatal surgery and between treated by surgery and control groups. Conclusions: Anterior uvulopalatoplasty does not result in significant changes in voice, nasality and swallowing when rated by OSAS patients and by clinical assessment.

Juvenile Myasthenia Gravis: Frequent Presentation with Bulbar Symptoms

Juvenile myasthenia gravis usually presents with ocular findings. Rarely, children may present with generalized weakness, sometimes with accompanying bulbar symptoms (dysphagia, facial weakness). However, presentation with isolated bulbar symptoms is extremely unusual. We present four consecutive cases of JMG presenting with predominant bulbar symptoms including voice nasality, dysarthria, and swallowing difficulty (even leading to significant weight loss). Our cases emphasize that primary care physicians should suspect neuromuscular disease such as JMG in children with bulbar symptoms and signs.

The effect of uvulopalatopharyngoplasty on the nasality of voice

We prospectively studied the effect of uvulopalatopharyngoplasty (UPPP) on several speech and vocal parameters in 15 patients. Preoperative, 1-month postoperative, and 6-month postoperative assessments were made. Specific parameters included maximum phonation time, mean speaking fundamental frequency, mean frequency perturbation, intensity, and nasalance. Psychoacoustic analysis included pitch, quality, rate, resonance, and loudness. The primary outcome measure was the nasality of voice. At the 1-month postoperative assessment, one patient exhibited mild hypernasality by psychoacoustic analysis and a mildly elevated measured nasalance. At 6 months, both the psychoacoustic hypernasality and the measure nasalance had normalized. Consequently, no subjects exhibited hypernasality at the final assessment. Although abnormalities by psychoacoustic analysis were exhibited by 3 subjects at the 6-month postoperative assessment, none could be attributed to the surgery, but rather to concurrent illnesses. This study adds further data and support that UPPP done in standard fashion does not result in significant changes in voice either by measured parameters or by clinical assessment. Although this study does not obviate the need for preoperative counseling of patients about the potential effect of UPPP on voice, they can be counseled that the risk of hypernasality after UPPP is low.

Cautery-assisted palatal stiffening operation and nasalance of speech.

Velopharyngeal competence as indicated by nasalance of speech was tested in 18 men before and after a cautery-assisted palatal stiffening operation for snoring. Nasalance was measured preoperatively and postoperatively, with no significant changes noted following surgery. Although there were no objective or subjective changes in nasality of voice, these findings do not rule out all possible changes in velopharyngeal competence, since there were subjective complaints of nasal regurgitation and dysphagia.

The Influence of Nasality of Voice on Sex-Stereotyped Perceptions

Men's and women's voices differ acoustically, and sex-stereotyped attributions are formed based on gender of voice. Recently it has been reported that men's voices are less nasal than women's voices, and that nasality of voice is inversely related to perceptions of persuasiveness. The present study was designed to determine whether nasality of voice affected sex-stereotyped perceptions. Audio tapes were created which contained the voices of 3 men and 3 women each speaking the same sentence at counterbalanced and comparable low, medium, and high levels of nasality as measured by nasalance scores. The voices were rated on 16 randomly presented adjectives by 30 male and 30 female listeners. The adjectives represented positive and negative female and male stereotypes. Ratings did not differ based on gender of listener. Nasality of voice contributed solely and interactively to sex-stereotyped perceptions.