Maximum Phonation Time Values Research Articles

Changes After Voice Therapy in Acoustic Voice Analysis of Chinese Patients With Voice Disorders

This study aimed to evaluate the effects of voice therapy on patients with voice disorders by comparing the acoustic parameter changes before and after treatment. This is a retrospective study. Forty-five female patients with early-stage vocal nodules or polyps, postoperative patients, and patients with chronic laryngitis were divided into three subgroups. Videostroboscopic, acoustic analysis (fundamental frequency, jitter, shimmer, mean harmonics-to-noise ratio), and maximum phonation time (MPT) were measured before and after treatment. Fifty healthy female volunteers were the control group. After treatment, 24.4% of nodules or polyps had decreased in size, 11.1% of patients with chronic laryngitis and postoperative patients had reduced edema, and the mucosal wave of vocal folds had different degrees of recovery in postoperative patients. All acoustic analysis values and MPT in the patient group were statistically worse than in the control group, except for fundamental frequency before treatment (P > 0.05). After treatment, the acoustic analysis and MPT values were improved. However, the jitter, mean harmonics-to-noise ratio, and MPT values in the patient group were still worse after voice therapy than in the control group (P < 0.05). Most of acoustic analysis values can be useful as a complementary tool in diagnosis and assessment of voice disorders; however, it is not recommended to use a single parameter to assess voice quality. Voice therapy can improve voice quality in patients with voice disorders, but a period longer than 8 weeks is recommended for these patients.

Análise vocal na infância: uma revisão integrativa

Objetivo: realizar uma revisão integrativa de literatura sobre as características de vozes normais e disfônicas e a prevalência de lesões nas pregas vocais em crianças. Métodos: trata-se de uma revisão integrativa da literatura. Foi realizado o levantamento dos artigos científicos por meio das bases de dados Medline, LILACS, IBECS, PubMed e ISI Web of Science. Na busca dos artigos foram utilizados os descritores “Distúrbios da Voz", “Disfonia”, “Rouquidão”, "Qualidade da Voz", "Acústica da Fala", “Voz”, “Fonação”, "Pregas Vocais", “Pediatria”, “Criança”, "Pré-Escolar". Para a análise dos dados, as informações coletadas foram organizadas de maneira concisa em um banco de dados, realizado de forma descritiva, considerando as informações referentes à amostra, objetivos, metodologia e resultados principais, e organizadas por similaridade de conteúdo. Resultados: foram identificados 770 artigos, dos quais 36 estavam diretamente relacionados ao objetivo da revisão e foram analisados. Conclusões: a qualidade vocal das crianças sem alterações vocais é caracterizada por valores de frequência fundamental que decrescem com o aumento da idade e com diferenças em relação ao sexo. O tempo máximo de fonação aumenta com a idade. Em crianças disfônicas a qualidade vocal é soprosa e rugosa, com um grau de alteração de leve a moderado; as medidas acústicas da voz, os valores de tempo máximo de fonação estão alterados; a frequência fundamental é grave. A lesão de prega vocal mais prevalente até seis anos de idade é o cisto, e após esta idade é o nódulo vocal.

Tempos máximos de fonação de idosas com e sem prótese dentária superior

OBJETIVO: caracterizar e comparar o tempo máximo de fonação de idosas usuárias de prótese dentária superior e de idosas com dentição superior natural. MÉTODOS: 31 idosas que foram divididas em: grupo experimental - 19 senhoras que utilizavam prótese dentária superior, média de idade de 71,21 anos; grupo controle - 12 senhoras que não utilizavam prótese dentária, média de idade de 69,83 anos. Analisaram-se os valores dos tempos máximos de fonação das fricativas /s/ e /z/, e das vogais /a/, /i/ e /u/ por meio do teste paramétrico T-Student Pareado. RESULTADOS: as médias das vogais /a/, /i/ e /u/ e das fricativas /s/ e /z/ estiveram dentro do esperado no grupo controle (14,86s; 15,40s; 15,85s; 14,09s e 14,30s, respectivamente) e abaixo no grupo experimental (10,84s; 10,53s; 10,74s; 10,25s e 10,95s, respectivamente). Houve diferença estatística entre as idosas dos dois grupos para o tempo máximo de fonação das vogais, o que não foi encontrado no das fricativas. CONCLUSÃO: o grupo de idosas com dentição natural atingiu o tempo máximo de fonação mínimo de vogais e de fricativas esperado para adultos do sexo feminino e o grupo de idosas com prótese dentária superior completa ficou abaixo do esperado. Ao contrário do esperado, a comparação do tempo máximo de fonação das fricativas entre os grupos não mostrou diferença, mas o tempo máximo de fonação de todas as vogais analisadas foi menor no grupo com prótese. Os resultados mostram a influência do uso de prótese dentária sobre os resultados de tempo máximo de fonação de idosas.

Hoarseness in School-Aged Children and Effectiveness of Voice Therapy in International Classification of Functioning Framework

The hoarseness in school-aged children disrupts the educational process because it affects the social progress, communication skills, and self-esteem of children. Besides otorhinolaryngological examination, the first treatment option is voice therapy when hoarseness occurs. The aim of the study was to determine the factors increasing the hoarseness in school-aged children by parental interview and to know preferable voice therapy on school-aged children within the frame of International Classification of Functioning (ICF). Retrospective analysis of data gathered from patient files. A total of 75 children (56 boys and 19 girls) were examined retrospectively. The age range of school-aged children is 7-14 years and average is 10.86 ± 2.51. A detailed history was taken from parents of children involved in this study. Information about vocal habits of children was gathered within the frame of ICF and then the voice therapies of children were started by scheduling appointments by an experienced speech-language pathologist. The differences between before and after voice therapy according to applied voice therapy methods, statistically significant differences were determined between maximum phonation time values and s/z rate. The relationship between voice therapy sessions and s/z rate with middle degree significance was found with physiological voice therapy sessions. According to ICF labels, most of voice complaints are matching with "body functions" and "activity and limitations." The appropriate voice therapy methods for hoarseness in school-aged children must be chosen and applied by speech-language therapists. The detailed history, which is received from family during the examination, within the frame of ICF affects the processes of choosing the voice therapy method and application of them positively. Child's family is very important for a successful management.

Voice Disorders in Teachers: Clinical, Videolaryngoscopical, and Vocal Aspects

Dysphonia is more prevalent in teachers than among the general population. The objective of this study was to analyze clinical, vocal, and videolaryngoscopical aspects in dysphonic teachers. Ninety dysphonic teachers were inquired about their voice, comorbidities, and work conditions. They underwent vocal auditory-perceptual evaluation (maximum phonation time and GRBASI scale), acoustic voice analysis, and videolaryngoscopy. The results were compared with a control group consisting of 90 dysphonic nonteachers, of similar gender and ages, and with professional activities excluding teaching and singing. In both groups, there were 85 women and five men (age range 31-50 years). In the controls, the majority of subjects worked in domestic activities, whereas the majority of teachers worked in primary (42.8%) and secondary school (37.7%). Teachers and controls reported, respectively: vocal abuse (76.7%; 37.8%), weekly hours of work between 21 and 40 years (72.2%; 80%), under 10 years of practice (36%; 23%), absenteeism (23%; 0%), sinonasal (66%; 20%) and gastroesophageal symptoms (44%; 22%), hoarseness (82%; 78%), throat clearing (70%; 62%), and phonatory effort (72%; 52%). In both groups, there were decreased values of maximum phonation time, impairment of the G parameter in the GRBASI scale (82%), decrease of F0 and increase of the rest of acoustic parameters. Nodules and laryngopharyngeal reflux were predominant in teachers; laryngopharyngeal reflux, polyps, and sulcus vocalis predominated in the controls. Vocal symptoms, comorbidities, and absenteeism were predominant among teachers. The vocal analyses were similar in both groups. Nodules and laryngopharyngeal reflux were predominant among teachers, whereas polyps, laryngopharyngeal reflux, and sulcus were predominant among controls.

Características respiratórias de indivíduos com deformidade dentofacial

Objetivo compreender as características respiratórias em indivíduos com deformidades dentofaciais e verificar se há diferenças comparativamente a indivíduos com equilíbrio dentofacial. Métodos participaram 60 indivíduos (18 a 40 anos), 30 portadores de deformidade dentofacial e 30 de um grupo controle. Foi realizada avaliação do Tempo Maximo de Fonação das emissões /a/, /i/, /u/, /s/, /z/ e contagem de números pelo programa Sound Forge (Sony); avaliação da capacidade vital e coordenação pneumofonoarticulatória, pelo espirômetro PonyFx. Os resultados foram comparados pelo teste “t” de Student. Resultados os indivíduos com deformidade dentofacial apresentaram valores de Tempo Maximo de Fonação inferiores aos indivíduos com equilíbrio dentofacial nas emissões: “s” para aqueles com má oclusão esquelética classe II e homens; “z” para indivíduos com má oclusão classe II; contagem de números para os homens. As medidas extraídas pela espirometria foram semelhantes entre os indivíduos com e sem deformidade dentofacial. Conclusão não houve diferenças em relação à capacidade vital e coordenação pneumofonoarticulatória, mas o grupo com deformidade dentofacial apresentou valores reduzidos de Tempo Maximo de Fonação em emissões que contêm fonemas consonantais.

The effect of patient age on the success of laryngeal reinnervation.

The objective of the study was to investigate the influence of patient age on the efficacy of laryngeal reinnervation with ansa cervicalis in unilateral vocal fold paralysis (UVFP) patients. We retrospectively reviewed 349 consecutive UVFP cases of laryngeal reinnervation with ansa cervicalis to the recurrent laryngeal nerve anastomosis. Preoperative and postoperative videostroboscopy, perceptual evaluation, acoustic analysis, maximum phonation time (MPT) and laryngeal electromyography (EMG) data were collected. Gender, age, preoperative EMG status [preoperative voluntary motor unit recruitment (VMUR)] and denervation duration were analyzed in previous multivariable logistic regression analysis. Stratification analysis was performed on patient age in the present study. All patients were divided into four groups according to their age: Group A included patients with an age less than 30 years; Group B, 30-44 years; Group C, 45-59 years; Group D, ≥60 years. Stratification analysis on patient age showed significant differences between Group A and D, Group B and D, Group C and D (P < 0.05), but no significant difference between Group A and B, Group A and C, Group B and C (P > 0.05), respectively, with regard to parameters including glottal closure, overall grade, shimmer, noise-to-harmonics ratio; but there are no significant differences among the four groups with regard to jitter. However, for MPT and postoperative VMUR, there are significant differences among the four groups expect between Group A and B. In addition, glottal closure, perceptual and acoustic parameters, MPT values and VMUR data, were significantly improved postoperatively in each age group (P < 0.01). The data from this study indicate that patient age is an influential factor of the surgical outcome of laryngeal reinnervation for UVFP patients. Laryngeal reinnervation is less effective when patient age is more than 60 years.

Effect of duration of denervation on outcomes of ansa‐recurrent laryngeal nerve reinnervation

To investigate the efficacy of laryngeal reinnervation with ansa cervicalis among unilateral vocal fold paralysis (UVFP) patients with different denervation durations. We retrospectively reviewed 349 consecutive UVFP cases of delayed ansa cervicalis to the recurrent laryngeal nerve (RLN) anastomosis. Potential influencing factors were analyzed in multivariable logistic regression analysis. Stratification analysis performed was aimed at one of the identified significant variables: denervation duration. Videostroboscopy, perceptual evaluation, acoustic analysis, maximum phonation time (MPT), and laryngeal electromyography (EMG) were performed preoperatively and postoperatively. Gender, age, preoperative EMG status and denervation duration were analyzed in multivariable logistic regression analysis. Stratification analysis was performed on denervation duration, which was divided into three groups according to the interval between RLN injury and reinnervation: group A, 6 to 12 months; group B, 12 to 24 months; and group C, > 24 months. Age, preoperative EMG, and denervation duration were identified as significant variables in multivariable logistic regression analysis. Stratification analysis on denervation duration showed significant differences between group A and C and between group B and C (P < 0.05)-but showed no significant difference between group A and B (P > 0.05) with regard to parameters overall grade, jitter, shimmer, noise-to-harmonics ratio, MPT, and postoperative EMG. In addition, videostroboscopic and laryngeal EMG data, perceptual and acoustic parameters, and MPT values were significantly improved postoperatively in each denervation duration group (P < 0.01). Although delayed laryngeal reinnervation is proved valid for UVFP, surgical outcome is better if the procedure is performed within 2 years after nerve injury than that over 2 years.

Perceptual and acoustic parameters of vocal nodules in children

Vocal nodules constitute the major cause of dysphonia during childhood. Auditory-perceptual and acoustic vocal analyses have been used to differentiate vocal nodules from normal voice in children. PurposeTo study the value of auditory-perceptual and acoustic vocal analyses in assessments of children with nodules. DesignDiagnostic test study. Patients and interventionsA comparative study was carried out including 100 children with videolaryngoscopic diagnosis of vocal nodules (nodule group-NG); and 100 children without vocal symptoms and with normal videolaryngoscopic exams (control group-CG). The age range of both groups was between 4 and 11 years. All children underwent auditory-perceptual vocal analyses (GRBASI scale); maximum phonation time and s/z ratio were calculated, and acoustic vocal analysis (MDVP software) were carried out. ResultsThere was no difference in the values of maximum phonation time and s/z ratio between groups. Auditory-perceptual analysis indicated greater compromising of voice parameters for NG, compared to CG: G (79 versus 24), R (53 versus 3), B (67 versus 23) and S (35 versus 1). The values of acoustic parameters jitter, PPQ, shimmer, APQ, NHR and SPI were higher for NG for CG. The parameter f0 did not differ between groups. ConclusionCompromising of auditory-perceptual (G, R, B and S) and acoustic vocal parameters (jitter, PPQ, shimmer, APQ, NHR and SPI) was greater for children with nodules than for those of the control group, which makes them important methods for assessing child dysphonia.

Bridging Gaps Between the Recurrent Laryngeal Nerve and Ansa Cervicalis Using Autologous Nerve Grafts

We investigated the clinical efficacy of free nerve grafts in bridging gaps between the recurrent laryngeal nerve (RLN) and ansa cervicalis in patients with unilateral RLN injury. We retrospectively reviewed the charts of 14 patients who underwent relevant free nerve grafting and assessed the clinical outcomes of this procedure. Between January 2000 and January 2010, 14 patients with unilateral vocal fold paralysis were enrolled in this study. In all patients, the RLN was resected and free nerve grafts were applied to bridge the gap between the distal stump of the RLN and the anterior root of ansa cervicalis during surgery. Videostroboscopy, acoustic analysis, perceptual evaluation, maximum phonation time (MPT), and laryngeal electromyography (EMG) were performed both preoperatively and postoperatively to assess the clinical outcomes. Videostroboscopic findings showed that glottic closure, vocal fold edge, vocal fold position, phase symmetry, and phase regularity were significantly improved postoperatively (P<0.05), and no paradoxical movements of vocal folds were observed. Perceptual evaluation showed that overall grade, roughness, breathiness, asthenia, and strain were also significantly decreased postoperatively (P<0.05). The acoustic parameters jitter (local) and shimmer (local) and the mean noise-to-harmonics ratio were significantly lower than the corresponding preoperative values (P<0.05). The postoperative MPT values were also significantly longer than the preoperative values. Laryngeal EMG revealed significant improvement in voluntary motor unit recruitment during phonation postoperatively (P<0.05). Free nerve grafting is an effective procedure in bridging the gap between the RLN and ansa cervicalis in patients with unilateral RLN injury, as well as a safe procedure without obvious morbidity. A satisfactory vocal outcome can be obtained.

Maximum Phonation Time and s/z Ratio in a Large Child Cohort

The purpose of this study was to provide normal values for maximum phonation time (MPT) and the s/z ratio by examining 1660 children aged 4-12 years and without vocal signs or symptoms. The technique was based on the sustained emission of the /a/ vowel and fricatives /s/ and /z/. The average of the MPT in children of the different age groups was as follows: 6.09 seconds for the age group 4-6 years (males, 5.97; female, 6.21 seconds), 7.94 seconds for the age group 7-9 years (males, 8.07; females, 7.79 seconds), and 8.98 for the age group 10-12 years (males, 9.05; females, 8.92 seconds). The overall average for males was 7.78 and females 7.64 seconds. The s/z ratio was near 1.0 in most children but above 1.2 in 133 children and below 0.8 in 133 children. These values of MPT and s/z ratio can be used as normative in further pediatric studies.

Laryngeal dysfunction and oral hygiene: Any relation?

The purpose of this study is to establish a relation between poor oral hygiene and laryngeal dysfunction. 43 adult patients were divided into two groups according to caries activity and oral hygiene. 18 patients with oral hygiene index score (OHI-S) 0-1 were grouped as the control group (good oral hygiene). 25 patients with OHI-S 2-3 were grouped as the study group (poor oral hygiene). Larygostroboscopic examination, aerodynamic measures by defining maximum phonation time (MPT) and s/z ratio and the pitch level measurements were done. Patients with gastroesophageal reflux disease (GERD), laryngopharyngeal reflux (LPR), previously confirmed laryngeal diseases or pathologies, systemic other diseases, or smokers were excluded from this study. The average MPT values of the study group were found to be statistically very significantly lower than those of the control group (p<0.01). In the stroboscopic findings, the proportion of normal closure levels were meaningfully higher in the control group than in the study group (p<0.05). The supraglottic involvement was found statistically meaningfully higher in the study group than in the control group (p<0.05). The proportion of normal closure phase incidences were meaningfully higher in the control group than in the study group (p<0.05). So, our findings of high glottic closure impairment, supraglottic involvement and low MPT scores in the poor oral hygiene group correlate with LPR findings such as muscle tension dysphonia. Poor oral hygiene may aggravate potential LPR in people.

Consequences of Chronic Nasal Obstruction on the Laryngeal Mucosa and Voice Quality of 4- to 12-Year-Old Children

Dysphonia affects 6% to 23% of children, and chronic nasal obstruction may participate in its pathophysiology. To study the effects of chronic nasal obstruction on children's vocal quality. Two study groups were formed: nasal obstruction group (NOG), consisting of 60 children aged 4-12 years with important symptoms of chronic nasal obstruction; and a control group (CG), similar in gender and age range, consisting of healthy students without nasal, vocal, or auditory symptoms. The parents answered a questionnaire containing questions concerning their children's vocal qualities. All the children were submitted to perceptual auditory analysis, acoustic vocal analysis, auditory acuity assessment (transient otoacoustic emissions and/or threshold tone audiometry), and videoendoscopic assessment (flexible laryngoscopy and rigid laryngoscopy). The groups were similar in age and gender. Parents reported a dysphonia rate of 76.6% in NOG and a vocal abuse rate of 68.3%. Eight children from NOG (13.34%) showed mild conductive hypoacusia. Laryngeal lesions were detected in 35 children from NOG (58%): inflammatory processes (n=19), mucosal thickening (n=10), nodules (n=5), and cyst (n=1). In children from the NOG were observed higher scores for the Grade, Roughness, Breathiness, Aesthenia, Strain, Instability (GRBAS) perceptual scale (P<0.05), lower maximum phonation time values, and higher values to the s/z ratio, insufficient nasal resonance. Relevant changes in perceptual auditory and acoustic vocal analyses and in the videolaryngoscopy were detected in children with nasal obstruction. These results showed the importance of the assessment of nasal obstruction in dysphonic children.

Effect of Geographical and Ethnic Variation on Dysphonia Severity Index: A Study of Indian Population

Dysphonia Severity Index (DSI) is a widely used multiparametric approach to objectively quantify the voice quality. Few research groups have investigated the test-retest, interobserver variability, and influence of age and gender. They have also verified the application of DSI in various voice rehabilitation conditions. However, all these studies have been conducted on European population. There is a possibility of variation in the basic parameters of DSI across geographical and ethnic groups. Hence, the present study evaluated DSI in Indian population. One hundred twenty voluntary participants (60 males, 60 females) who had G(0) on the Grade, Roughness, Breathiness, Aesthenia, Strain (GRBAS) scale participated in the study (age range of 18-25 years, M=21.8, standard deviation=2.7). Maximum phonation time (MPT), frequency intensity, and jitter measurements were made using CSL 4500 (Kay Elemetrics, Pine Brook, NJ). Results showed noticeable difference between Indian and European population on MPT, Highest frequency (F(0)-High), and DSI values. Significant gender difference was also observed on MPT and F(0)-High. Test-retest reliability showed >95% for all the parameters. The MPT decrement lead to a reduction in the overall DSI value in both the genders. These results of the study caution voice professionals to reinvestigate and establish their own norms for their geographical and ethnic groups.

Improvement in phonation after reconstruction of the recurrent laryngeal nerve in patients with thyroid cancer invading the nerve

We report vocal improvement after reconstruction of the recurrent laryngeal nerve (RLN) in patients with nerve resection, although vocal cord movement was not restored. These methods are not widely recognized. Direct anastomosis, free nerve grafting, or anastomosis to the ansa cervicalis or the vagus nerves with the RLN were performed in 7, 14, 65, and 2 patients with thyroid cancer invading the RLN, respectively. A total of 51 patients had vocal cord paralysis (VCP) pre-operatively. Maximum phonation time (MPT) and vital capacity (VC) were measured before and 1 year after reconstruction. A total of 34 normal subjects and 27 patients with VCP served as controls. Patients with VCP had significantly shorter MPT values than normal subjects. At 1 year after operation, patients with reconstruction had values of MPT similar to those of normal subjects. Men had significantly longer MPT values than women, but the phonation efficiency index (PEI), defined as the MPT/VC ratio, did not differ by sex. The PEI was significantly less in VCP patients than in normal subjects. Patients with reconstruction achieved PEI values similar to those in normal subjects. Phonation efficiency index values at 1 year after operation was significantly greater than pre-operative PEI and was not affected by the presence or absence of VCP pre-operatively, age, reconstruction method, thickness of suture thread, or use of magnification during the operation. In patients with thyroid cancer requiring RLN resection, RLN reconstruction achieved recovery in phonatory function.

Subjective and Objective Evaluation of Voice Quality in Patients With Asthma

To evaluate the voice quality in patients with mild-to-moderate asthma by subjective and objective methods. Comparative, controlled, cross-sectional study. Patients with mild-to-moderate asthma (n=40) and age- and sex-matched healthy controls (n=40) were included. Acoustic analyses were performed by the Multi-Dimensional Voice Program (MDVP; Kay Elemetrics Corporation, Lincoln Park, NJ) and the movements of the vocal cords were examined by videolaryngostroboscopy (VLS). In addition, the duration of illness, maximum phonation time, "s/z" values, and vital capacity were evaluated. Voice Handicap Index (VHI) and GRB scales were used for subjective evaluations. Maximum phonation time values were significantly shorter both in male and female asthma patients compared with controls (P<0.0001). Also, average shimmer values in MDVP were higher for both sexes in the patient group compared with controls (P=0.002 and P=0.04, respectively). There was a significant difference between female patients and sex-matched controls with regard to mean noise-to-harmonic ratio values (P=0.006). Female patients with asthma had higher average jitter values compared with sex-matched controls (P<0.0001). A significant difference was noted between asthma and control groups with regard to GRB scale (P<0.0001, P<0.001, and P<0.0001, respectively). The VHI score was above the normal limit in 16 (40%), and VLS findings were abnormal in 39 (97.5%) asthmatics. In asthmatic patients, maximum phonation time, frequency, and amplitude perturbation parameters were impaired, but the vital capacity and the duration of illness did not correlate with these findings.