Types Of Voice Disorders Research Articles

Acoustic-Aerodynamic Voice Outcome Ratios Identify Changes in Vocal Function Following Vocal Fold Medialization for Unilateral Vocal Fold Paralysis

This study aimed to determine whether ratio-based measures that combine acoustic (output) and aerodynamic (input) parameters detect postoperative change in vocal function following vocal fold medialization for unilateral vocal fold paralysis. Pre- and postoperative acoustic and aerodynamic measures were analyzed retrospectively from 149 patients who underwent vocal fold medialization for unilateral vocal fold paralysis. A 2×2 repeated-measures analysis of variance was conducted for each of four acoustic-aerodynamic ratios-traditional vocal efficiency (VE), sound pressure level to aerodynamic power (SPL/AP), SPL to average airflow (SPL/AFLOW), and SPL to subglottal pressure (SPL/Ps)-to investigate the main effects and interaction of treatment stage and loudness level (comfortable and loud). The patient group showed significant postoperative improvements in self reports of vocal function (voice-related quality of life) and clinical auditory-perceptual judgments of dysphonia (consensus auditory-perceptual evaluation of voice). Main effects for both treatment stage and loudness level were statistically significant for all measures except SPL/Ps. There were interaction effects for VE and SPL/AP, suggesting that magnitude of the treatment effect differs based on loudness. SPL/AFLOW had medium-to-large effect sizes in both loudness conditions. There were postoperative changes in SPL/Ps that were dependent on the magnitude of the reduction in AFLOW; as expected, SPL/Ps increased postoperatively in a subgroup that had large postoperative reductions in AFLOW at the comfortable loudness level. Acoustic-aerodynamic ratios can aid in tracking changes in vocal function following vocal fold medialization. SPL/AFLOW exhibited the largest effect size, which is expected since a reduction in abnormally high AFLOW typically accompanies the increased modulation of glottal air flow associated with successful vocal fold medialization. Future study is needed to model physiological changes in acoustic-aerodynamic voice outcome ratios across different types of voice disorders.

Impact of Voice Therapy on Pediatric Patients With Dysphonia and Vocal Nodules: A Systematic Review

One of the most prevalent pediatric ailments around the world is voice disorders. Around 5-million children suffer from voice disorders, and three out of five of them suffer from vocal nodule-induced persistent dysphonia. Nineteen out of 20 otolaryngologists recommend voice therapies for the treatment of pediatric vocal fold nodules. However, the benefits of these therapies still remain to be assessed systematically. The objective of this study is to systematically review the impact of voice therapy (direct and indirect) on pediatric patients with vocal nodules.In this systematic review of randomized control trials (RCTs), four electronic databases, PubMed, CENTRAL (Cochrane), Science Direct, and Lancet, were explored for the literature survey. The impact of direct and indirect voice therapies on pediatric cases with vocal nodules was reviewed based on the results of the selected articles.Based on stringent inclusion and exclusion criteria, six articles were selected. All these studies examined the effects of direct and indirect voice therapies on two types of voice disorders, that is, dysphonia and vocal nodules. Only one of the six studies reported significant alleviation of the patient condition post-intervention. However, none of the studies discussed the clinical significance of the interventions.Three of the six included studies used both direct and indirect voice therapies and reported substantial differences in the data collected before and after the interventions. However, overall, the studies reported more significant improvements in patient conditions. More studies in this domain are still warranted, especially to help understand and define the meaning of the term “effectiveness” with respect to voice therapies.

Characterization of Primary Muscle Tension Dysphonia Using Acoustic and Aerodynamic Voice Metrics

Objectives/HypothesisThe objectives of this study were to (1) identify optimal clusters of 15 standard acoustic and aerodynamic voice metrics recommended by the American Speech-Language-Hearing Association (ASHA) to improve characterization of patients with primary muscle tension dysphonia (pMTD) and (2) identify combinations of these 15 metrics that could differentiate pMTD from other types of voice disorders. Study DesignRetrospective multiparametric MethodsRandom forest modeling, independent t-tests, logistic regression, and affinity propagation clustering were implemented on a retrospective dataset of 15 acoustic and aerodynamic metrics. ResultsTen percent of patients seen at the New York University (NYU) Voice Center over two years met the study criteria for pMTD (92 out of 983 patients), with 65 patients with pMTD and 701 of non-pMTD patients with complete data across all 15 acoustic and aerodynamic voice metrics. PCA plots and affinity propagation clustering demonstrated substantial overlap between the two groups on these parameters. The highest ranked parameters by level of importance with random forest models—(1) mean airflow during voicing (L/sec), (2) mean SPL during voicing (dB), (3) mean peak air pressure (cmH2O), (4) highest F0 (Hz), and (5) CPP mean vowel (dB)—accounted for only 65% of variance. T-tests showed three of these parameters—(1) CPP mean vowel (dB), (2) highest F0 (Hz), and (3) mean peak air pressure (cmH2O)—were statistically significant; however, the log2-fold change for each parameter was minimal. ConclusionComputational models and multivariate statistical testing on 15 acoustic and aerodynamic voice metrics were unable to adequately characterize pMTD and determine differences between the two groups (pMTD and non-pMTD). Further validation of these metrics is needed with voice elicitation tasks that target physiological challenges to the vocal system from baseline vocal acoustic and aerodynamic ouput. Future work should also place greater focus on validating metrics of physiological correlates (eg, neuromuscular processes, laryngeal-respiratory kinematics) across the vocal subsystems over traditional vocal output measures (eg, acoustics, aerodynamics) for patients with pMTD. Level of EvidenceII

The German Restructured Vocal Fatigue Index and Characteristics of Dysphonic and Vocally Healthy Populations

The Vocal Fatigue Index (VFI), a 19-item psychometric self-report questionnaire, enables individuals with vocal fatigue (VF) to be identified and their complaints to be characterized. The purpose of this study was to improve the German-language version (VFI-G) and to evaluate further vocal fatigue-related characteristics of dysphonic and control populations. The VFI-G was restructured by replacing the three factors that structured the original: (1) tiredness of voice and voice avoidance; (2) physical discomfort; and (3) improvement of symptoms with rest, with two clusters developed on the basis of the results of a factor analysis by Nanjundeswaran etal. (2019). The two new clusters are: (1) tiredness and avoidance plus physical discomfort; and (2) symptom improvement through rest. One hundred one (101) individuals with voice disorders and 100 vocally healthy controls from a previous study that cross-validated the VFI-G participated in this study. In order to assess the validity of our newly adjusted VFI-G, independent samples t test, receiver operating characteristic curve, likelihood ratios and the Youden Index were calculated. The association of the two VF clusters with subject characteristics such as age, sex, type of voice disorder, and level of vocal usage was also analyzed using either a Pearson correlation or a one-way ANOVA for each of the two populations. Significantly higher scores were obtained in voice-disordered subjects in both clusters (all P values < 0.001) than in healthy-voice subjects. The threshold for cluster 1 of the VFI-G was determined as ≥17.5 (74.3% sensitivity and 88.0% specificity). The results of cluster 2 are identical to that of factor 3 of the previous cross-validation study of the VFI-G. Most subject characteristics show no significant association with cluster 1 of the VFI-G, but cluster 2 seems to be moderately associated with age, type of voice disorder and level of vocal usage in the dysphonic population. The restructured VFI-G showed improved validity and can be recommended for use in the assessment of VF. Cluster 2 is also moderately associated with several vocal fatigue-related subject characteristics of the dysphonic population.

Prevalence of voice disorders in tertiary care hospital

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Human voice is unique due to laryngeal configuration. However, change in voice is common with age and gender. It can also be altered by vocal abuse and misuse leading to different types of voice disorders. So, the present study aims to study the prevalence of voice disorder in patients visiting the voice clinic ENT-HNS department of Tribhuvan University Teaching Hospital tertiary care center. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a retrospective study carried out among the patients visiting voice clinic in the department of ENT-HNS for a duration of one year. The patients were evaluated for voice disorder by a team of ENT doctors and Speech pathologists using perceptual and instrumental evaluation. The patients who required surgical intervention were excluded. A descriptive study was done among patients with voice disorders requiring voice therapy. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 296 patients, the most common age group was 25-50 years with more females compared to males. Structural cause for voice disorder was most common in all age groups and gender in both professional and non-professional voice users but it was more prevalent in professional voice users.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Voice disorders were more frequent in females than males and also in professional voice users as they tend to use voice more daily. The structural cause for voice disorder is the major cause of voice problems in all age groups. &lt;/p&gt;

A comparative study of the voice-related quality of life among Egyptian elderly with and without voice complaints

BackgroundThis study focuses on the self-perception of the voice in the elderly as assessed by the Voice-Related Quality of Life (V-RQOL) questionnaire. This work aimed to compare differences in the voice-related quality of life outcomes between (1) elderly with and without voice disorders, (2) female and male elderly with voice disorders, and (3) different types of voice disorders, and to explore the correlation between the V-RQOL and perceptual analysis done by the clinician. Forty-three dysphonic and 44 non-dysphonic elderly filled out the Voice-Related Quality of Life (V-RQOL) protocol that analyzes the impact of dysphonia on life quality. Vocal perceptual assessment of each subject with dysphonia was made by three voice therapists, followed by a flexible nasofibrolaryngoscope.ResultsA significant statistical difference was found between the means of total V-RQOL scores and its subdomains for each group (dysphonic and non-dysphonic). No significant differences were found between male and female elderly with dysphonia. The statistical analysis showed a significant correlation with the vocal assessment made by the clinicians and the V-RQOL self-assessment made by the subjects.ConclusionsThis study provides valuable information regarding the risk factors that contribute to vocal quality in the elderly population. Our results revealed that different types of voice disorders are common among the elderly population with significant negative effects on quality of life. It was observed that the poorest score on the V-RQOL was for functional voice disorders, followed by neoplastic lesions, whereas MAPLs had the best score on the V-RQOL.

Medidas cepstrais na avaliação da intensidade do desvio vocal

To analyze whether there is an association between the presence, intensity and type of voice disorder and the cepstral measures in samples of individuals with voice complaints. We used 376 vowel /Ɛ/ samples from individuals of both genders that had voice complaints. An analogue-visual scale was used for the auditory-perceptual analysis of voices regarding the overall grade of dysphonia (G) and the grades of roughness (R), breathiness (B), and strain (S), including a determination of voice quality (rough, breathy or strained). Measures related to cepstral peak prominence smoothed (CPPS) and spectral decline of vocal samples were extracted. There were differences in the CPPS values between the groups with or without voice disorders as well as between the different intensities and types of voice disorder. CPPS values were lower because of the presence and intensity of voice disorders. The CPPS values differentiated the following voices: rough x breathy, rough x strained, and breathy x strained. The spectral decline only differentiated breathy x strained voices. CPPS correlated positively and strongly with G and B; moderately and negatively with R, and negatively and weakly with S. The spectral decline had a moderate positive correlation with S and a weak negative correlation with B. There is association between voice disorder, G, predominant voice quality, and CPPS. In particular, G is strongly correlated with CPPS. Spectral decline is associated only with the parameters B and S.

Prevalence of voice disorders in the Department of Speech- Language Pathology of a tertiary care hospital of Mangaluru: A retrospective study of 11 years

Abstract Background: Voice disorder is now considered a 'public health concern'. Epidemiological studies of yesteryears performed in the West disseminate the importance of prevention and early identification of the change in voice. In India 'Vocology' or study of voice production is slowly emerging with specific attention to vocal health and voice care. Aim of the study: The present study implemented a retrospective observational design to identify prevalence of voice disorders in a tertiary care hospital. Method: The Diagnostic register of Department of Audiology and Speech-Language Pathology of a semi-urban hospital was accessed from January 1st 2007 till January 31st 2018. Patients diagnosed with a voice disorder, in-isolation and/or in conjunction to a medical condition, were tabulated. The data was tallied under the following categories: type of voice disorder; nature of voice disorder; age of onset; gender and perceptual features. Results: Results of the study suggested 21.4% prevalence of voice disorder. In addition the study also noted maximum prevalence of vocal nodule; adult male subjects exhibited a higher rate of vocal fold pathology and increased prevalence of perceptually hoarse voice. Conclusion: The data from the study accounts voice problems to be on higher side with vocal fold hyper-function disorder topping the chart.

Auditory perception of lay judges about gender identification of women with Reinke's edema.

To investigate the auditory perception of lay judges of the voice gender identification of women with Reinke's edema and to associate it with its severity and fundamental frequency (F0). This is an observational, analytical and cross-sectional study. A total of 46 lay judges analyzed 48 samples (counting numbers 1 to 10) of 24 women with Reinke's edema - the Reinke's Edema Group (REG) and 24 individuals, men and women, with other types of voice disorders - Control Group (CG). The judges had to classify the voices as being of a man or a woman. Additionally, they needed to indicate their certainty or not about their choice. Results were associated with the severity of the Reinke's edema (Type 1, 2 or 3) and the F0 (extracted from the vowel /Ɛ/). Misidentification of gender was higher in the REG and certainty about the choice was higher in the CG. Type 1 cases caused fewer misidentifications compared to type 2 and 3. The women's voices that were identified as male voices had a lower F0 (141Hz) when compared to voices that were correctly identified (149Hz). Women with Reinke's edema are frequently identified as men. Lower F0 was related with more misidentification and less certainty when assessing the speaker's gender.

Reliability and Validity of the Turkish Version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)

The main purpose of this study was to culturally adapt the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) to Turkish and to evaluate its internal consistency, validity, and reliability. The Turkish version of CAPE-V was developed, and with the use of a prospective case-control design, the voice recordings of 130 participants were collected according to CAPE-V protocol. Auditory-perceptual evaluation was conducted according to CAPE-V and Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale by two ear, nose, and throat specialists and two speech and language therapists. The different types of voice disorders, classified as organic and functional disorders, were compared in terms of their CAPE-V scores. The overall severity parameter had the highest intrarater and inter-reliability values for all the participants. For all four raters, the differences in the six CAPE-V parameters between the study and the control groups were found to be statistically significant. Among the correlations for the comparable parameters of the CAPE-V and the GRBAS scales, the highest correlation was found between the overall severity-grade parameters. There was no difference found between the organic and functional voice disorders in terms of the CAPE-V scores. The Turkish version of CAPE-V has been proven to be a reliable and valid instrument to use in the auditory-perceptual evaluation of voice. For the future application of this study, it would be important to investigate whether cepstral measures correlate with the auditory-perceptual judgments of dysphonia severity collected by a Turkish version of the CAPE-V.

Correlation of VHI-30 to Acoustic Measurements Across Three Common Voice Disorders

Voice disorders that affect the quality of voice also result in varying degrees of psychological and social problems. The research question here is whether the correlations between Voice Handicap Index (VHI)-30 scores and objective acoustic measures differ in patients with different types of voice disorders. The subjects were divided into three groups: muscle tension dysphonia (MTD), benign mid-membranous vocal fold lesions, and unilateral vocal fold paralysis (UVFP). All participants were male. The mean age for the groups were 32.85 ± 8.6 years in the MTD group, 33.24 ± 7.32 years in the benign lesions group, and 34.24 ± 7.51 years in the UVFP group. The participants completed the Persian VHI-30 questionnaire. PRAAT software was used to obtain acoustic analyses. There was a significant correlation between the physical subscale of the VHI-30 and the total score of the VHI-30 and maximum phonation time (MPT) in the MTD group. Also, there was a significant correlation between the total VHI-30 score and the MPT value. There were relatively strong and significant correlations between the physical subscale of the VHI-30 with jitter and shimmer, harmonics-to-noise ratio (HNR) for the group with benign lesions such as nodules and polyps. Also, in this group, there was a significant correlation between the total VHI-30 score and the jitter value. The physical scale had strong and significant correlations between jitter, shimmer, and HNR in the unilateral paralysis group. Findings suggest that although the VHI-30 and the acoustic measurements of voice provide independent information, they are associated to some extent.

Vocal Tract Discomfort Symptoms in Patients With Different Voice Disorders

To analyze the symptoms of vocal tract discomfort in patients with different voice disorders. This study was descriptive, observational, and cross-sectional. A total of 210 subjects with vocal complaints and prior medical assessment were divided into five groups according to diagnosis: no laryngeal lesion, lesion to membranous portion, voice disorder of neurological origin, incomplete glottal closure without organic or neurologic cause, and voice disorder secondary to gastroesophageal reflux. All participants responded to the vocal tract discomfort scale at the time of assessment. Patients had a mean of 4.01±0.70 symptoms, with sore throat being the most commonly reported. Compared with patients in other groups, patients with lesions in the membranous portion of the vocal folds and those with voice disorder due to gastroesophageal reflux showed an increased number of symptoms. Voice disorders of reflux were shown to result in a higher frequency of sore throat and lump in the throat than in those with neurological etiology. The intensity of the lump in the throat was higher in patients with reflux than in patients with neurologic voice disorders. There was a difference between the number, frequency, and intensity of symptoms of vocal tract discomfort based on the type of voice disorder.

The prevalence of voice problems among adults in the United States.

Determine the prevalence of voice problems and types of voice disorders among adults in the United States. Cross-sectional analysis of a national health survey. The 2012 National Health Interview Survey was analyzed, identifying adult cases reporting a voice problem in the preceding 12 months. In addition to demographic data, specific data regarding visits to healthcare professionals for voice problems, diagnoses given, and severity of the voice problem were analyzed. The relationship between voice problems and lost workdays was investigated. An estimated 17.9 ± 0.5 million adults (mean age, 49.1 years; 62.9% ± 1.2% female) reported a voice problem (7.6% ± 0.2%). Overall, 10.0% ± 0.1% saw a healthcare professional for their voice problem, and 40.3% ± 1.8% were given a diagnosis. Females were more likely than males to report a voice problem (9.3% ± 0.3% vs. 5.9% ± 0.3%, P < .001). Overall, 22% and 11% reported their voice problem to be a moderate or a big/very big problem, respectively. Infectious laryngitis was the most common diagnosis mentioned (685,000 ± 86,000 cases, 17.8% ± 2.0%). Gastroesophageal reflux disease was mentioned in 308,000 ± 54,000 cases (8.0% ± 1.4%). The mean number of days affected with the voice problem in the past year was 56.2 ± 2.6 days. Respondents with a voice problem reported 7.4 ± 0.9 lost workdays in the past year versus 3.4 ± 0.1 lost workdays for those without (contrast, +4.0 lost workdays; P < .001). Voice problems affect one in 13 adults annually. A relative minority seek healthcare for their voice problem, even though the self-reported subjective impact of the voice problem is significant.

Evaluación del tratamiento logopédico en la rehabilitación de la disfonía en adultos: seguimiento de los efectos grupales y de las variaciones individuales

This study analyzed group and individual differences in the results of vocal rehabilitation in a group of dysphonic patients with different diagnoses, using a brief multidimensional assessment protocol. The voices of 21 participants with dysphonia and 21 controls were evaluated and compared in a pre- vs. post-speech therapy treatment. Voice performance was assessed before and after treatment by a set of tests that included videolaryngostroboscopy, aerodynamic tasks, and self-rating questionnaires. The speech-therapy treatment group received two sessions of speech therapy a week for 3months. Three follow-up reevaluations of group effects and individual variability were also carried out to assess the latency period after the end of treatment. MANOVA with Pillai's trace test showed a significant group effect of the vocal treatment on all of the variables assessed. A pre- vs. post- treatment T-test of individual changes was also significant in most of the dysphonic participants, despite the wide range of scores (high variance) in the different measures used after the voice therapy program. The results of both group and individual analyses support the effectiveness of vocal rehabilitation with speech therapy in at least some types of voice disorders. However, voice therapy was more effective in participants with certain characteristics and antecedents.

Multidirectional Regression (MDR)-Based Features for Automatic Voice Disorder Detection

Objective assessment of voice pathology has a growing interest nowadays. Automatic speech/speaker recognition (ASR) systems are commonly deployed in voice pathology detection. The aim of this work was to develop a novel feature extraction method for ASR that incorporates distributions of voiced and unvoiced parts, and voice onset and offset characteristics in a time-frequency domain to detect voice pathology. The speech samples of 70 dysphonic patients with six different types of voice disorders and 50 normal subjects were analyzed. The Arabic spoken digits (1-10) were taken as an input. The proposed feature extraction method was embedded into the ASR system with Gaussian mixture model (GMM) classifier to detect voice disorder. Accuracy of 97.48% was obtained in text independent (all digits' training) case, and over 99% accuracy was obtained in text dependent (separate digit's training) case. The proposed method outperformed the conventional Mel frequency cepstral coefficient (MFCC) features. The results of this study revealed that incorporating voice onset and offset information leads to efficient automatic voice disordered detection.

Formant analysis in dysphonic patients and automatic Arabic digit speech recognition

Background and objectiveThere has been a growing interest in objective assessment of speech in dysphonic patients for the classification of the type and severity of voice pathologies using automatic speech recognition (ASR). The aim of this work was to study the accuracy of the conventional ASR system (with Mel frequency cepstral coefficients (MFCCs) based front end and hidden Markov model (HMM) based back end) in recognizing the speech characteristics of people with pathological voice.Materials and methodsThe speech samples of 62 dysphonic patients with six different types of voice disorders and 50 normal subjects were analyzed. The Arabic spoken digits were taken as an input. The distribution of the first four formants of the vowel /a/ was extracted to examine deviation of the formants from normal.ResultsThere was 100% recognition accuracy obtained for Arabic digits spoken by normal speakers. However, there was a significant loss of accuracy in the classifications while spoken by voice disordered subjects. Moreover, no significant improvement in ASR performance was achieved after assessing a subset of the individuals with disordered voices who underwent treatment.ConclusionThe results of this study revealed that the current ASR technique is not a reliable tool in recognizing the speech of dysphonic patients.

K�rperbeschwerden bei Patienten mit Dysphonien

In previous studies, patients with benign organic and functional voice disorders were shown to suffer from physical complaints. The present study focuses on a specific nosologic classification of these disorders in the sense of diagnosing a somatoform illness. Eighty patients (50 women, 30 men) aged 44+/-11 years (18-60), suffering from various voice disorders (functional: n=18 women, n=13 men; organic: n=32 women, n=17 men), were examined after informed consent. Physical complaints were assessed using the Giessen Complaint Questionnaire GBB-24. Age and gender matched normal controls were taken from the literature. Data were analyzed using the non parametric two-by-two four-field-test. The individual diagnosis of dysphonic women showed pathologic values in all subscales except limb complaints. The individual diagnosis of men showed pathologic values in the limb complaints subscale (P<0.05). When comparing functional and organic disorders, no significant difference (P>0.05) was found in neither of the gender groups. Depending on gender and type of voice disorder, dysphonic patients suffer from different physical complaints. Both patients with functional and organic disorders are affected. Therefore, it does not seem justified to classify functional voice disorders as somatoform disorders.

The estimation of signal-to-noise ratio in continuous speech for disordered voices

Presented is a method of estimating the signal-to-noise ratio (SNR) of continuous utterances for patients with various types of voice disorders that ranged in severity of dysphonia from mild to severe. The SNR is estimated based on the residual that is left after systematically removing the short- and long-term correlations that exist in the speech signal. Results indicate that the SNR is consistent with human perceptual judgments, particularly those that consistently differentiate close-to-normal versus highly disphonic voices.