Normalized Noise Energy Research Articles

Effect of Akson Therapy on Acoustic Parameters in Patients with Functional Dysphonia.

Functional dysphonia can impair the language expression ability and adversely affect the career development of some patients. Therefore, an active exploration of effective treatment options is imperative. This study investigated the effect of Akson therapy on acoustic parameters in patients with functional dysphonia. In this retrospective analysis, 79 patients with functional dysphonia who received conventional voice correction training from June 2020 to June 2021 were included in the reference group (RG). Our hospital has implemented Akson therapy since July 2021. Correspondingly, 72 patients with functional dysphonia who underwent Akson therapy from July 2021 to July 2022 were enrolled in the observation group (OG). The acoustic parameters such as fundamental frequency (F0), jitter, shimmer, and normalized noise energy (NNE); the aerodynamic parameters including maximum phonation time (MPT), mean airflow rate (MFR), and Voice Handicap Index-10 (VHI-10) score; and the Grade, Roughness, Breathiness, Asthenia, and Strain scale (GRBAS) score were measured before and after treatment and compared between the two groups. The F0, jitter, shimmer, NNE, MPT, and MFR values as well as the VHI-10 score and the grade (G), roughness (R), and breathiness (B) scores on the GRBAS did not significantly differ between the two groups before treatment (P > 0.05). However, significantly lower F0, jitter, shimmer, NNE, and MFR values and higher MPT levels were found in the OG compared to the RG after treatment (P < 0.001). Furthermore, the VHI-10 score and the G, R, and B scores were significantly lower in the OG than in the RG after treatment (P < 0.001), whereas the asthenia (A) and strain (S) scores remained at 0 before and after treatment. Akson therapy can improve the acoustic parameters of patients with functional dysphonia to a certain extent, indicating its potential application value.

Long-Term Effects of Fat Injection Laryngoplasty in Relation to the Injected Fat Volume in Patients With Unilateral Vocal Fold Paralysis

To evaluate the improvements in vocal function and glottal form before and after autologous fat injection laryngoplasty in relation to the injected total fat volume in patients with unilateral vocal fold paralysis. Clinical study. Seventy-three patients with unilateral vocal fold paralysis received fat injection laryngoplasty and were divided into low-volume injection (<3 mL; average, 2.0 mL) and high-volume injection (≥3 mL; average, 4.3 mL) groups. Voice function before and after fat injection laryngoplasty were examined by aerodynamics evaluations, pitch and intensity measurements, and acoustic analyses. The glottal form before and after fat injection laryngoplasty was determined by measuring the ratio of vocal fold bowing (bowing ratio) and the ratio of lengths between bilateral vocal process (width ratio) at an easy phonation under laryngeal endoscopic examination. The postoperative parameters were evaluated for a median period of four years after fat injection laryngoplasty. The differences between pre- and postoperative parameters were examined separately for each group by the paired t-test. For each variable, a comparison of the effects of surgery was conducted using an analysis of covariance model with the change between the pre- and postoperative values as a dependent variable and the preoperative value as a covariate. In both groups, all parameters of voice function and glottal form after surgery significantly improved in comparison to those before surgery. Maximum phonation time, amplitude perturbation quotient, and normalized noise energy for 0 to 4 kHz in the high-volume group improved more significantly in comparison to those in the low-volume group. As a rough guide for males, injection of more than 3 mL of autologous fat to the vocal muscle layer is recommended for reliable improvement of voice function in patients with unilateral vocal fold paralysis.

Sensation and Repercussion of the Use of Humid Heat in the Treatment of Dysphonia due to Laryngitis in Singers

To verify the efficiency of thermotherapy perceptively and acoustically with hot vapor in the treatment of acute laryngitis. This is a pre and post test quasi-experimental study without a control group, approved by the ethics committee. Its sample counted with 65 singers - 37 females (56.9%) and 28 males (43.1%), mean age 33.7 years (±7.9) years, nonsmokers, with dysphonia due to acute laryngitis. They were submitted to videolaryngostroboscopy and perceptive-acoustic assessment of the voice before and 30 minutes after applying the inhalation of hot vapor. The appropriate statistical tests were used, adopting the significance level lower than 0.05. In the acoustic assessment, there was a statistically significant improvement in jitter and shimmer for vowels A and E, P < 0.001. The F0 assessed separately per sex, as it presented a significant difference, P < 0.001. The women's F0 results before and after the heat were higher than the men's. In the analysis of the acoustic results based on harmonics-to-noise ratio and normalized noise energy, there was significant improvement after the heat. All the mean values increased after the heat. There was a statistically significant decrease in the parameters related to the perceptive-auditory assessment for G (grade of hoarseness), R (roughness), B (breathiness), and S (strain). Of the 47 singers that scored 2 for G, 28 (59.6%) reduced it to 1 after the heat, P < 0.001. All the 45 that scored 2 for R reduced it to 1, P=0.011. Of the 8 who scored 2 for B, 6 (75%) reduced it to 1, P=0.020. All the 28 singers that scored 1 for S reduced it to 0, P < 0.001. Only for A (asthenia), there was no significant improvement, P=0.513. The results of the videolaryngostroboscopy revealed a statistically significant difference in all parameters analyzed, such as hyperemia, edema, muco-undulatory movement, and glottal coaptation. The thermotherapy with using humid heat, provide symptomatic benefits in the treatment of dysphonia caused by laryngitis, demonstrating that the hyperthermoterapy is a potential auxiliary therapeutic resource for the treatment of acute dysphonia due to laryngitis since the intervention with the technique proposed increased the voice quality. It is suggested that this method be used in speech-language clinical practice and that new studies be conducted with stronger designs for its efficacy to be confirmed.

Extreme Vocal Effects Distortion, Growl, Grunt, Rattle, and Creaking as Measured by Electroglottography and Acoustics in 32 Healthy Professional Singers

SummaryVocal effects - also called extreme or extended vocal techniques - with the intention to sound hoarse or rough are widely used as part of many genres and styles of singing, yet scarcely documented in research. Physiological studies detail the involvement of supraglottic structures for the production of vocal effects, yet the acoustic impact of such involvement has not been documented systematically across phonation types. PurposeTo report acoustic measurements and electroglottography-specific measurements for the five rough-sounding vocal effects Distortion, Growl, Grunt, Rattle, and Creaking across phonation types to demonstrate differences between notes with and without vocal effects added. MethodsThirty-two professional singers and singing teachers produced sustained vowels in each of the four vocal modes with alternations of adding and removing the vocal effects. The singers were recorded with a microphone at a constant distance as well as with EGG. ResultsThe vocal effects Distortion, Growl, Grunt, Rattle, and Creaking impact the acoustic spectra in separate and systematic ways across genders and phonation types. Each vocal effect impacted the spectrum in specific and particular frequency regions between 0 and 3.5 KHz as well as in higher partials after 12 kHz with statistical significance. EGG-waveforms were un-impacted by most of the vocal effects produced using supraglottic sound sources, whereas Grunt and Creaking conditions did impact EGG-waveform signals, though not consistently between participants. EGG measures confirmed sustained and unchanged Qx and Fx for most conditions, with statically significant changes in noise measurements Harmonic-to-Noise Ratio, Normalised Noise Energy, Relative Average Perturbation, and Cepstral Peak Prominence, despite Sound Pressure Level differing significantly only for a few specific conditions. Singers scored an average of 5,95 on Voice Handicap Index questionnaires and were all reportedly healthy. ConclusionsVocal effects added to phonation produce specific increases and specific decreases in particular frequency regions in a systematic way and can be produced in a healthy and sustainable manner, as measured by Voice Handicap Index. Vocal effects can be added to different phonation types with differing acoustic output and singers were able to sustain and control involvement of the supraglottic sound source(s) independently of phonation type.

Perceptual, Aerodynamic and Acoustic Evaluation of Vocal Characteristics in Subjects With Obesity

Obesity has tripled since 1975 and affects health across many domains. Increasing body mass index increases the risk to the obese subject of many non-communicable diseases. The study evaluated the perceptive, aerodynamic, and acoustic parameters that characterize the voice of the obese population. Eighty adult subjects (40 participants in each obese and control group) aged 18-50 years were enrolled. The perceptual voice analysis was performed using the Consensus Auditory Perceptual Evaluation of Voice. The aerodynamic and acoustic voice analyses were performed using the MIR Spiro lab instrument and Doctor's Speech software. A digital stopwatch was also used to measure maximum phonation time. Statistical analysis revealed a significant difference (P-value <0.05 and t value >2) between two groups on acoustic parameters, specifically Normalized noise energy and fundamental frequency tremor (F0 tremor). Normalized noise energy and fundamental frequency tremor were greater in the obese group. Moreover, maximum phonation time and expiratory reserve volume were significantly reduced in the obese group. Results of the present study showed poor voice quality and reduced expiratory reserve volume in obese individuals. This could be credited to the adverse effects of accrued adipose on the functioning of the laryngeal and respiratory systems. Increasing body mass index escalates the risk to the obese subjects of many non-communicable diseases.

Assessment of Acoustic Voice Parameters After Anterior Cervical Discectomy and Fusion.

BackgroundAnterior cervical discectomy and fusion (ACDF) is a surgical treatment approach for cervical spine diseases. Alteration in voice quality is a commonly encountered concern after perilaryngeal neck surgeries. Vocal cord paralysis is a known complication of ACDF. In this study, we aimed to investigate the effect of ACDF on acoustic voice parameters and to compare ACDF with posterior cervical discectomy and fusion (PCDF).MethodologyIn this study, we investigated 52 patients admitted to the hospital with symptoms related to cervical spinal cord compression and underwent spine surgery in the Neurosurgery Clinic (26 underwent ACDF and 26 underwent PCDF). For standardization, 25 healthy age and gender-matched volunteers were evaluated as the control group. The voices of the patients were analyzed digitally preoperatively and at first and third months postoperatively. As acoustic parameters, jitter, shimmer, basal frequency, and normalized noise energy were recorded. All patients were examined preoperatively and postoperatively for laryngeal pathology and were asked to fill the Voice Handicap Index-10 (VHI-10).ResultsThe changes in four of the five acoustic parameters from baseline to postoperative first-month assessment in the ACDF group were significant (p < 0.05). These parameters almost approached normal values in the analysis performed at three months. In the PCDF group, no significant differences were seen in the acoustic analysis of the patients in comparison to the preoperative and the first and third-month assessments. The VHI-10 values were not significantly different among the patients who underwent ACDF or PCDF or control patients at any postoperative time point.ConclusionsOur study demonstrated that voice parameters in patients who underwent ACDF worsened significantly after the surgery compared with patients who underwent PCDF; however, these changes recovered within three months postoperatively. The possible causes for these findings include the retraction of the vagus and the recurrent laryngeal nerve, postoperative edema of strap muscles, intubation trauma to the vocal folds, and other laryngeal structures.

Autologous fat granule filling combined with microsuture technique for sulcus vocalis

Objective:To explore and observe voice effect of the resection of the vocal fold sulcus, suture of the vocal fold mucosa, and fat granule packing under the support laryngoscope. Methods:A total of 25 patients with vocal fold sulcus underwent vocal fold sulcus resection under a support laryngoscope. After the vocal fold sulcus was removed, the mucosa on both sides of the vocal fold sulcus was sutured into a pouch. Next the fat granules removed from the abdomen were stuffed into the pouch until the vocal folds were full, and the mucosa was repaired, and then the pouched mucosa was sutured. After the operation, the patients were silent for 2 weeks and followed up at 3, 6, and 12 months postoperatively to observe the state of the vocal fold mucosa and the voice effect of the vocal fold under the stroboscopic laryngoscopy. The main outcome measures were the mucosal movement, fundamental frequency （F0）, fundamental frequency perturbation （Jitter）, amplitude perturbation （Shimmer）, normalized noise energy （NNE）, harmony/noise （H/N） and maximum phonation time （MPT）. Results: Among the 25 patients, 23 patients had good vocal fold closure and smooth mucosa. Under the stroboscopic laryngoscope, the mucosal movement was good and smooth, and the F0, Jitter, Shimmer, NNE, H/N, MPT were significantly improved, and the voice quality was significantly improved. The other 2 patients had fat particles spillover in the vocal fold. The voice function recovered well after the second treatment. Conclusion:Resection of vocal fold sulcus, suture of vocal fold mucosa, and fat granule packing under support laryngoscope are very effective for the treatment of vocal fold sulcus. Indispensably, the operation is done properly, and the patient silence the voice according to the doctor's advice, thus the voice quality will be satisfactory after the operation. .

Clinical Application of Stromal Vascular Fraction Gel in Unilateral Vocal Fold Paralysis

To investigate the therapeutic effect of the stromal vascular fraction gel (SVF gel) in unilateral vocal fold paralysis. A retrospective study was performed on 22 patients who underwent SVF gel autotransplantation for unilateral vocal fold paralysis between June 2017 and December 2018. Fat was removed from the medial thigh under anesthesia and the SVF gel was prepared using standard techniques and injected using a suspension microlaryngoscopy. The SVF gel was transplanted into the vocal fold muscle and the paraglottic space, and subjective and perceptual assessments, aerodynamic and acoustic assessments, and a videostroboscopic assessment were evaluated pre- and postoperatively at 1day, 12 months and 18 months. The GRBAS evaluation results showed that the voice quality of the patients at 12 and 18 months after the operation was significantly improved, and voice analysis showed that in males maximum speech time (MPT) increased and the normalized noise energy decreased 1 day after surgery. The voice quality parameters at 12 months and 18 months after surgery improved significantly compared to preoperatively (P < 0.05), except for the fundamental frequency (F0), at 12 months, which was similar to the values before surgery. In females, the MPT and amplitude (shimmer) at 1 day after the surgery were significantly different from before the surgery, and the MPT, fundamental frequency (jitter), shimmer, and normalized noise energy at 12 months and 18 months after the surgery were significantly improved compared to before the surgery while the F0 was not significant. SVF gel autotransplantation can effectively improve the voice quality in unilateral vocal fold paralysis, and the long-term effect is stable.

Effect of paan masala on voice parameters

Introduction: Ingestion of paan masala (a mixture of areca nut with catechu, slaked lime, and added flavoring agents) is one of the means of smokeless tobacco usage which can also have adverse effect on voice such as dryness in vocal folds which in turn may result in depletion of mucosal layer of the vocal folds. Aim: Aim of the study was to investigate the consequence of paan masala usage on voice parameters and to compare the acoustic parameters amid two groups who were paan users and non paan users respectively. Method: A total of 120 samples (3 trials of phonation of sustained vowel /a/) were obtained from male participants between age ranges of 18 – 40 years. 60 recordings were taken from 20 individuals who indulged in intake of paan masala from past 5-10 years. Another 60 recordings were from 20 individuals who were non paan masala users. The recorded samples were subjected to two types of analysis viz. perceptual evaluation was carried out by 10 qualified speech language pathologists based on standardized voice rating scale and acoustic analysis was done using clinically acceptable software. Results: Results of perceptual analysis indicated increased breathiness which was supported by acoustical NNE. Greater values in jitter, shimmer and Normalized Noise Energy (NNE) in paan users indicates of being at risk of having vocal pathologies. These parameters of voice had a significant difference between paan users and individuals who do not consume paan. Conclusion: The results do indicate that consumption of paan poses an impending threat to voice which is evident in abnormal acoustical findings and it is essential for people to be aware of the consequences of devouring paan for mere pleasure of minutes.

Resection of recurrent third branchial cleft fistulas assisted by flexible pharyngotomy.

BACKGROUNDTreatment of fistulas arising from the third branchial cleft includes endoscopic cauterization or open cervical fistulectomy. Both approaches are associated with recurrence rates of 14%-18%, and possibly greater rates when the fistula has been treated operatively beforehand. Treatment of fistulas arising from the third branchial cleft is associated with an inordinate recurrence rate. Recurrence may be multifactorial and related to incomplete resection of all of the anatomical elements of the fistula.AIMTo present a new approach that involves complete resection of the recurrent fistula by a combined therapeutic approach.METHODSHere, 12 adult patients diagnosed with recurrent third branchial cleft fistulas underwent a combined therapy assisted by flexible fiber-optic pharyngoscopy to identify and resect the entry site of the fistula into the pyriform sinus. The fistulous opening into the pyriform sinus was identified by flexible fiber-optic pharyngoscopy. The application of intubation with a guidewire by pharyngoscopy, in addition to the removal of the partial excision of the thyroid cartilage, allowed complete resection of the opening and all parts of the fistula tract.RESULTSAll of the internal openings of the fistulas in the pharynx were found and easily identified by flexible fiber-optic pharyngoscopy. All of the 12 patients underwent complete resection of the recurrent fistula by the combined therapeutic approach. There were no postoperative complications such as parapharyngeal abscess or wound infection, injury or dysfunction of the recurrent laryngeal or superior laryngeal nerves. The pharyngeal edema had degraded, and the pharyngeal wound healed postoperatively within 1 wk. Laryngeal endoscopy and voice analysis were performed on the 14th d post-operatively. Vocal cord movements did not change. The characters of voice for jitter, shimmer, and normalized noise energy were all within normal limits. In addition, no recurrences were observed during the 13-60 mo follow-up period.CONCLUSIONIt can be concluded that the proposed combined therapy is associated with excellent results, minimal morbidity, and no recurrence.

Liuzijue Qigong: A Voice Training Method For Unilateral Vocal Fold Paralysis Patients.

Objectives:Liuzijue Qigong (LQG), a kind of traditional Chinese health exercise (TCHE), is not only widely used to strengthen physical fitness and maintain psychological well-being in the elderly but has also been utilized to help improve respiratory function. As respiratory support is an important driving force for speech production, it is logical to postulate that the LQG training method with 6 monosyllabic speech sounds, xū, hē, hū, sī, chuī, and xī, can help individuals (1) experience a relaxing and natural state of speech production, (2) eliminate voice symptoms, and (3) improve their overall body function and mood. In the current study, we hypothesized that the LQG method with these 6 sounds can be effective in improving vocal function in subjects with unilateral vocal fold paralysis (UVFP) in comparison with a conventional voice therapy method.Methods:A total of 48 patients with UVFP who met the inclusion criteria were randomly divided into 2 groups. Twenty-four subjects in the experimental group were trained with LQG, and those in the control group received conventional voice training (abdominal breathing and yawn-sign exercises) for a total of 4 sessions, twice a week. Patients in both groups were assessed with acoustic tests, the GRBAS scale, the Voice Handicap Index (VHI-10), and the Hospital Anxiety and Depression Scale (HADS) pre- and posttreatment. Statistical analysis was conducted using nonparametric tests and t tests.Results:There existed significant changes in maximum phonation time (MPT), jitter, shimmer, normalized noise energy (NNE), GRBAS scores, VHI-10 scores, and grade of A in HADS scores pre- and posttreatment in both the experimental group and the control group (P < .004). However, no significant changes were seen posttreatment between the 2 groups (P > .05).Conclusions:LQG could help improve vocal function in UVFP patients as our preliminary data showed no significant differences between LQG and conventional voice therapy methods.

Acoustic Analysis of Soccer Fans in Acute Phonotrauma After the Match

Acute phonotrauma is the result of sound production by shouting or straining one's voice. In this study, we aimed to investigate the acute changes in the vocal folds and voices of soccer fans who voluntarily applied to our clinic after the soccer match where they engaged in acute phonotrauma. There are no other studies in the literature conducted on a similar sample group. This is a case-control study. Videolaryngostroboscopic (VLS) examination, acoustic voice analysis, and Voice Handicap Index (VHI) questionnaire were performed on 29 voluntary soccer fans included to the study before the match and at the first hour after the match. The values obtained were compared statistically with each other and with 29 control groups without voice pathology. The jitter, shimmer, and normalized noise energy values measured after the match increased significantly statistically compared with the pre-match level, but harmonic noise ratio value decreased significantly (P < 0.05). VHI scores increased significantly after the match according to the pre-match scores (P < 0.05). In the VLS examinations, there was no difference in the images before and after the match. It has been concluded that people who are using their voices loudly and intensely by shouting during the match are exposed to sound changes after the match, and if this situation becomes persistent, it may cause permanent voice pathologies. It is thought that VHI and acoustic voice analysis should be done together with VLS for diagnosis and follow-up of voice changes for which the VLS examination alone is not sufficient.

Curbing—The Metallic Mode In-between: An empirical study qualifying and categorizing restrained sounds known as Curbing based on audio perception, laryngostroboscopic imaging, acoustics, LTAS, and EGG

This study aims to study the categorization Curbing from the pedagogical method Complete Vocal Technique as a reduced metallic mode compared with the full metallic modes Overdrive and Edge by means of audio perception, laryngostroboscopic imaging, acoustics, long-term average spectrum (LTAS), and electroglottography (EGG). Twenty singers were recorded singing sustained vowels in a restrained character known as Curbing. Two studies were performed: (1) laryngostroboscopic examination using a videonasoendoscopic camera system and the Laryngostrobe program; and (2) simultaneous recording of EGG and acoustic signals using Speech Studio. Images were analyzed based on consensus agreement. Statistical analysis of acoustic, LTAS, and EGG parameters was undertaken using Student paired t tests. The reduced metallic singing mode Curbing has an identifiable laryngeal gesture. Curbing has a more open setting than Overdrive and Edge, with high visibility of the vocal folds, and the false folds giving a rectangular appearance. LTAS showed statistically significant differences between Curbing and the full metallic modes, with less energy across all spectra, yielding a high second and a low third harmonic. Statistically significant differences were identified on Max Qx, Average Qx, Shimmer+, Shimmer-, Shimmer dB, normalized noise energy, cepstral peak prominence, harmonics-to-noise ratio, and mean sound pressure level (P ≤ 0.05). Curbing as a voice production strategy is statistically significantly different from Overdrive and Edge, and can be categorized based on audio perception. This study demonstrates consistently different laryngeal gestures between Curbing and Overdrive and Edge, with high corresponding differences in LTAS, EGG and acoustic measures.

Acoustic Analysis Before and After Voice Therapy for Laryngeal Pathology.

Background Voice problems caused by pathologies in vocal folds are well known. Some types of laryngeal pathologies have certain acoustic characteristics. Objective evaluation helps characterize the voice and voice problems providing supporting evidences, severity of disorders. It helps assess the response to the treatment and measures the outcomes. Objective The objective of the study is to determine the effectiveness of the voice therapy and quantify the results objectively by voice parameters. Method Study includes 61 patients who presented with different types of laryngeal pathologies. Acoustic analyses and voice assessment was done with Dr. Speech ver 4 (Tiger DRS Inc.). Acoustic parameters including fundamental frequency, jitters, shimmers, Harmonic to noise ratio (HNR), Normalized noise energy (NNE) were analyzed before and after voice therapy. Result Bilateral vocal nodules were the most common pathologies comprising 44.26%. All acoustic parameters showed a significant difference after the therapy (p<0.05) except for NNE. Dysphonia due to vocal fold polyp showed no improvement even after voice therapy (p>0.05). Conclusion Acoustic analysis provides an objective, recordable data regarding the voice parameters and its pathologies. Though, few pathology require alternative therapy rather than voice therapy, overall it has a good effect on glottic closure. As the voice therapy can improve the different indices of voice, it can be viewed as imperative part of treatment and to monitor progression.

Overdrive and Edge as Refiners of “Belting”?: An Empirical Study Qualifying and Categorizing “Belting” Based on Audio Perception, Laryngostroboscopic Imaging, Acoustics, LTAS, and EGG

We aimed to study the categorizations "Overdrive" and "Edge" from the pedagogical method Complete Vocal Technique as refiners of the often ill-defined concept of "belting" by means of audio perception, laryngostroboscopic imaging, acoustics, long-term average spectrum (LTAS), and electroglottography (EGG). This is a case-control study. Twenty singers were recorded singing sustained vowels in a "belting" quality refined by audio perception as "Overdrive" and "Edge." Two studies were performed: (1) a laryngostroboscopic examination using a videonasoendoscopic camera system (Olympus) and the Laryngostrobe program (Laryngograph); (2) a simultaneous recording of the EGG and acoustic signals using Speech Studio (Laryngograph). The images were analyzed based on consensus agreement. Statistical analysis of the acoustic, LTAS, and EGG parameters was undertaken using the Student paired t test. The two modes of singing determined by audio perception have visibly different laryngeal gestures: Edge has a more constricted setting than that of Overdrive, where the ventricular folds seem to cover more of the vocal folds, the aryepiglottic folds show a sharper edge in Edge, and the cuneiform cartilages are rolled in anteromedially. LTAS analysis shows a statistical difference, particularly after the ninth harmonic, with a coinciding first formant. The combined group showed statistical differences in shimmer, harmonics-to-noise ratio, normalized noise energy, and mean sound pressure level (P ≤ 0.05). "Belting" sounds can be categorized using audio perception into two modes of singing: "Overdrive" and "Edge." This study demonstrates consistent visibly different laryngeal gestures between these modes and with some correspondingly significant differences in LTAS, EGG, and acoustic measures.

Closed reduction for arytenoid dislocation under local anesthesia

Conclusion: Closed reduction under local anesthesia continues to be an effective and well-tolerated method for treating arytenoid dislocation. Bilateral arytenoid dislocation is an uncommon occurrence, and the principles of management are the same as for unilateral dislocation. Objectives: To evaluate the treatment outcomes of closed reduction for arytenoid dislocation under local anesthesia and to conduct an exhaustive review of the literature on bilateral arytenoid dislocation. Methods: Thirty-three patients with arytenoid dislocation were treated with closed reduction under local anesthesia. Arytenoid motion, GRBAS (grade, roughness, breathiness, asthenia, strain), maximum phonation time (MPT), self-assessed Voice Handicap Index (VHI), and acoustic voice analysis were used to evaluate the clinical outcomes. Results: Following closed reduction, 33 patients were divided into a ‘satisfied’ group (n = 26) and a ‘dissatisfied’ group (n = 7). In the ‘satisfied’ group, G, R, B, A, MPT, VHI, jitter%, shimmer%, normalized noise energy (NNE), and noise-to-harmonic ratio (NHR) were significantly improved compared with measurements taken before closed reduction (p < 0.05). The results for F0 and S score were not significantly different. In the ‘dissatisfied’ group, VHI, MPT, F0, and shimmer% were not significantly different 1 month after reduction. However, statistically significant change was observed in jitter% and NHR.

Quantitative analysis of pathological voice and identification with artificial neural network

Objective:To discuss the characteristic of the clinical pathological voice and the feasibility of computer automatic identification of pathological voice.Method:A total of 129 clinical patients with polyp of vocal cord were selected as the pathological voice group, while a total of 125 people with normal voice were selected from the community as the control group. Praat software was used to collect and analyze the related acoustic parameter values of two groups of cases, including Jitter, Shimmer, harmonic to noise ratio (HNR), signal to noise ratio (SNR), and normalized noise energy (NNE). Pathological voice group and control group were used as training set and testing set for neural network testing, and another 140 cases of pathological voice and normal voice data were selected as a validation set. SPSS Modeler was used for artificial neural network reconstruction to calculate the identification rate of pathological voice. Result:This study found according to the calculation of groups with different genders that Jitter, Shimmer and NNE were increased in pathological voice group compared with the normal group (P< 0.05), while HNR and SNR were decreased compared with the normal group (P< 0.05). Recognition rate of artificial neural network model on pathological voice is 75.7%.Conclusion:Objective voice analysis is helpful in the identification of pathological voice. Artificial neural network has higher accuracy in recognition of pathological voice, with good clinical application value.

Could Neuromuscular Electrical Stimulation Really Lead to Changes in Voice of Swallowing Disorder Caused by a Stroke?

This study investigated the effect of Neuromuscular Electrical Stimulation (NMES) on the loudness, pitch and quality of the voice of the males diagnosed with dysphagia by stroke. NMES was conducted on experimental group of 15 patients for 2 months repeatedly while compensatory strategies for dysphagia were performed on control group of 15 patients. Loudness, pitch (F₀) and quality (Jitter, Shimmer, NNE; Normalized Noise Energy) of the voice was measured by using acoustic-phonetic analysis. For statistical test, difference in voice change after the treatments was compared by using analysis of covariance (ANCOVA). As the result of analysis, NMES and compensatory strategies had significant difference in intensity, jitter and shimmer (p<.05) while they did not in pitch and NNE. After the intervention of NMES, voice loudness of the subjects was enhanced and periodicity of vocal cord vibration (Jitter, Shimmer) was stabilized. The results of this study imply that NMES may have effect on enhancement of voice loudness and stabilization of periodicity of vocal cord vibration.

Physiology and Acoustics of Inspiratory Phonation

Inspiratory phonation (IP) means phonating with inspiratory airflow. Some vocalists remarkably master this technique, to such an extent that it offers new dramatic, aesthetic, and functional possibilities in singing specific contemporary music. The present study aims to a better understanding of the physiological backgrounds of IP. A total of 51 inhaling utterances were compared with 61 exhaling utterances in a professional soprano highly skilled in inhaling singing, by means of high-speed single-line scanning and advanced acoustic analysis. Ranges of intensity and Fo were kept similar. The main differences are: (1) an inversion of the mucosal wave, (2) a smaller closed quotient in IP, (3) a larger opening/closing quotient in IP with the additional difference that in IP, the quotient is larger than 1 (opening slower than closing), whereas it is less than 1 in expiratory mode (opening faster than closing), (4) a larger vocal-fold excursion in IP, (5) higher values of adaptive normalized noise energy in IP, and (6) a steeper slope of harmonic peaks in IP. However, jitter values are similar (within normal range), as well as damping ratios and central formant frequencies. The two voicing modes cannot be differentiated by blind listening. The basic physiological mechanisms are comparable in both voicing modes, although with specific differences. IP is actually to be considered as an "extended vocal technique," a term applied to vocalization in art music, which falls outside of traditional classical singing styles, but with remarkable possibilities in skilled vocalists.

Exploring the feasibility of smart phone microphone for measurement of acoustic voice parameters and voice pathology screening.

The objective of this study is to evaluate the reliability of acoustic voice parameters obtained using smart phone (SP) microphones and investigate the utility of use of SP voice recordings for voice screening. Voice samples of sustained vowel/a/obtained from 118 subjects (34 normal and 84 pathological voices) were recorded simultaneously through two microphones: oral AKG Perception 220 microphone and SP Samsung Galaxy Note3 microphone. Acoustic voice signal data were measured for fundamental frequency, jitter and shimmer, normalized noise energy (NNE), signal to noise ratio and harmonic to noise ratio using Dr. Speech software. Discriminant analysis-based Correct Classification Rate (CCR) and Random Forest Classifier (RFC) based Equal Error Rate (EER) were used to evaluate the feasibility of acoustic voice parameters classifying normal and pathological voice classes. Lithuanian version of Glottal Function Index (LT_GFI) questionnaire was utilized for self-assessment of the severity of voice disorder. The correlations of acoustic voice parameters obtained with two types of microphones were statistically significant and strong (r = 0.73-1.0) for the entire measurements. When classifying into normal/pathological voice classes, the Oral-NNE revealed the CCR of 73.7% and the pair of SP-NNE and SP-shimmer parameters revealed CCR of 79.5%. However, fusion of the results obtained from SP voice recordings and GFI data provided the CCR of 84.60% and RFC revealed the EER of 7.9%, respectively. In conclusion, measurements of acoustic voice parameters using SP microphone were shown to be reliable in clinical settings demonstrating high CCR and low EER when distinguishing normal and pathological voice classes, and validated the suitability of the SP microphone signal for the task of automatic voice analysis and screening.